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Traumatic Brain Injury

Terms in this set (45)

-Head Midline and Elevated 15 to 30 degrees - this promotes venous return and decreases intracranial pressure by 10%
-Decrease activities that increase ICP - valsalva maneuver will increase ICP (make sure patients are not straining on stool, take stool softeners, do not receive enemas, are not moving themselves around in bed)
- when turning patient in bed have them exhale (it helps to decrease intrathoracic pressure → this decreases intracranial pressure
- avoid coughing and sneezing
-Administer analgesics and short acting sedatives - these help to decrease agitation
- multi-trauma patients will have pain (give analgesics)
- agitationand pain will increase metabolic rate → which will increase ICP
- sedatives will mask level of consciousness (so titer down)
-Close monitoring of fluids - administer IV fluids
- monitor urine output, specific gravity, electrolytes, hemorrhanging , MAP, and serum osmolality (should be 310-320milli osmoles to maintain kidney function)
-DO NOT administer IV fluids rapidly (can cause fluid volume overload)
-Osmosis and Diuresis - osmosis drug = mannitol (Osmitrol) - used to decrease cerebral edema, therefore decreasing ICP)
-it is extremely hypertonic (it will pull fluid out of the brain cells and put it into the intravascular space [blood])
-monitor for fluid volume overload (jugular vein distension, BP increase, urine output, osmolality)
-Mild to Moderate Hyperventilation - patient is on ventilator (set to a high respiratory rate)
-want to keep the PaCO2 at 35mmHg (this will cause vasoconstriction)
-if PaCO2 is <35mmHg not enough blood is delivered to pain, this will decrease respiratory rate and cerebral perfusion
-Controlled hypothermia - used to decrease cerebral metabolism
-this is done for a person at normal body temperature (goal is to get core body temp. 34-35degrees C)
-done slowly so no shivering occurs
-rewarm the body over 24-48hrs.
-Surgical intervention: hematoma removal - surgically corrected in OR
-Continuous monitoring
-Seizure pre cautions and use of anticonvulsants - posttraumatic seizures will cause secondary brain injury
-give patient an anticonvulsant (Dilantin) prophylactically for the first 7days post injury
-if after 7days no seizures have occurred you can take them off the med
-if the patient has a known seizure disorder make sure you administer the correct anticonvulsant
-Barbituate induced coma - suppresses cerebral metabolism (therefore decreasing ICP)
-patient must be on a ventilator
-drug = pentobarbital (give for 48hrs then wean off)
-Decompressive Craniectomy - a piece of the skull is removed to release the pressure in the brain
-skull piece is kept in stomach
-dura sheath is used to cover exposed brain and the patient must wear a helmet for 3-6months until skull bone is reattached
-monitor patient for signs and symptoms of meningitis, and cerebral spinal fluid leak