Reference no: EM133444469

Traumatic Brain Injury with Increased Intracranial Pressure OBJECTIVES

• Explain the physiologic mechanisms  that maintain normal intracranial pressure.
• Describe the common etiologies, clinical manifestations, and interprofessional care of the patient with increased intracranial pressure.
• Describe the interprofessional and nursing management of the patient with increased intracranial pressure.
• Differentiate types of head injury by mechanism of injury and clinical manifestations.

Patient Profile

D.G., a 19-year-old male, was brought to the emergency department following a motor vehicle accident in which he was the driver. He is transferred to the Neuro-Trauma Intensive Care Unit with a diagnosis of traumatic brain injury.

Subjective Data

• Multiple family members and friends in the waiting room
• D.G.'s girlfriend died on scene
• Hospital chaplain present

Objective Data

Physical Examination

• Glasgow coma scale 4
• Neurologic Assessment:
  • Pupils 4 mm and sluggish
  • Decerebrate posturing
  • Periorbital ecchymosis
• Clear drainage from nares is positive for glucose

Diagnostic Studies

• Computed tomography (CT) scan: Subdural hematoma compressing the ipsilateral ventricle and causing a midline shift

Interprofessional Care

• Admission orders include:
  • Multiple line placements: Arterial monitoring, central venous pressure line, ventriculostomy, and jugular bulb oximetry
  • Keep cerebral perfusion pressure (CPP) > 70 mm Hg
  • Begin standing orders for proprofol, midazolam, ranitidine, and phenytoin
  • Continuous cardiac monitoring
  • Urinary catheter with strict I&O measurements
  • Neuro checks every hour
  • Monitor lab values (arterial blood gases, complete blood count, electrolytes)

Discussion Questions

1. Describe the functions of the 12 cranial nerves.
2. Describe the significance of the Glasgow Coma Scale.
3. What significant subjective and objective data related to the nervous system would you obtain?
4. Describe the purpose, significance of results, and nursing responsibilities related to diagnostic studies that may be related to D.G.?
5. Based on the assessment data, what are the nursing priorities for D.G.?
6. Indicate the expected outcome associated with each of the medications D.G. is ordered.
7. Describe the purpose and care of D.G.'s ventriculostomy.
8. The resident on call writes an order to insert a nasogastric (NG) tube. Would you implement this order or question it? Why?
9. Describe independent nursing interventions to assist in controlling D.G.'s increased intracranial pressure.