This article is based on the 3-hour Traumatic Brain Injury course, written by Margaret-Ann Carno, PhD, MBA, MJ, CPNP, FAAN.
A concussion on the soccer field. A hit in the boxing ring. The blast of an improvised explosive device.
These are just a few situations that may result in a traumatic brain injury, or TBI. According to data from the Centers for Disease Control, between 3.2 million and 5.3 million Americans are living with a TBI-related disability that interferes with their daily life.
Because of the serious, long-lasting, and often life-changing nature of TBIs, nurses and rehabilitation professionals are uniquely positioned to provide the kind of unique care that TBI patients need.
What is a TBI?
Broadly speaking, a TBI is an alteration in brain function caused by an external force. That force may be categorized in several ways:
- Blunt trauma: An external force directly impacts the head, causing injury to the internal structures of the skull or brain tissue.
- Blast trauma: The shock wave of an explosive device can direct objects into the cranium and even affect the lung or ear canals.
- Penetrating trauma: An object penetrates the brain tissue and typically must be removed. Patients with penetrating injuries are more likely to experience infections, cerebrospinal fluid leaks, aneurysms in distal blood vessels, or epilepsy.
Because different kinds of injuries impact different parts of the brain, understanding the cause of a TBI will help nurses and rehabilitation professionals provide the specific care their patients need.
Related CE Course: Traumatic Brain Injury, 3rd Edition
Signs and symptoms of traumatic brain injuries
In the first stage of patient care, careful monitoring is critical. Depending on how they received their injury, the patient may not remember details of the incident, so it is important for caregivers to keep a close eye.
Initial physical symptoms may include: brief or extensive loss of consciousness, seizures, pupil changes, clear fluids draining from the nose or ears (otorrhea or rhinorrhea), fatigue, dizziness, nausea, blurred vision, or tinnitus.
Cognitive and emotional processes may also be affected. Patient symptoms may include:
- Difficulty concentrating,
- Increased slowness in processing information
- Agitation, sadness, or uncontrollable anger
- Disrupted sleep patterns
Stages of care
Once the patient is stable and the TBI’s severity is determined, the next stage of care requires managing intracranial pressure (ICP), watching for intracranial bleeding, maintaining cerebral oxygenation, and preventing secondary brain injury.
Later stages of inpatient care may focus on positioning, behavioral management, early mobility, fever, blood pressure, and ICP management. When necessary, pharmacological treatments may also be a focus.
Related CE Course: Traumatic Brain Injury: Occupational Therapy Interventions
Returning to normalcy
As patients heal, the focus of care moves to rehabilitation. Starting with range-of-motion exercises, therapists and rehabilitation professionals may employ positioning to prevent pressure injuries, promote deep breathing and ventilation, and begin training family members or caregivers.
Ideally, the critical care stage would involve the introduction of cognitive retraining, speech and language therapy, and behavior management therapies, but it’s during the acute rehabilitation stage where they become the main focus.
The best possible outcome
Sadly, TBIs often have lifelong consequences. Potential complications vary widely and can include seizures, chronic headaches, pain, depression, stroke, and Parkinson’s disease. Other long-term complications — like Alzheimer’s disease, mood and behavior disorders, and post-traumatic dementia — are also possible.
It’s important to remember, however, that the goal isn’t to improve the patient’s abilities beyond pre-injury levels. Instead, it’s to return them to their environment in the best possible physical condition with the most desirable neurologic outcome: maximal independence.