TBI

Definition of TBI

Brain damage from an external mechanical force (not congenital or degenerative).

Priority Concepts

Perfusion and Cognition.

Interrelated Concepts

Mobility and Sensory Perception.

Mild TBI (Concussion)

Brief LOC or confusion; memory, communication, concentration, and behavioral changes.

Moderate TBI

LOC < 6 hours; problems with learning, problem-solving, sensory changes, post-traumatic amnesia, headache.

Severe TBI

LOC > 6 hours; unequal pupils, slurred speech, agitation, vomiting, seizures, diffuse axonal injury.

Causes of TBI

Falls, MVCs, assaults, self-harm, alcohol or drug use.

Health Promotion / Prevention

Use helmets, seatbelts, fall prevention, avoid substance use and high-risk activities.

When to Seek Medical Attention

Worsening headache, slurred speech, weakness, vomiting, seizures, LOC, symptoms >10–14 days, multiple concussions.

Chronic Traumatic Encephalopathy (CTE)

Repeated mild TBIs; memory loss, confusion, aggression, depression, suicidality, parkinsonism, dementia; diagnosed after death.

Initial Assessment Priorities

Airway, breathing, circulation, spinal precautions, LOC, pupil response, motor response.

First Sign of Increased ICP

Change or decline in level of consciousness.

Glasgow Coma Scale (GCS)

15 = best; 8 or less = comatose; 3 = unresponsive.

Manifestations of Increased ICP

Papilledema, blurred/double vision, headache, unequal or fixed pupils, vomiting, abnormal posturing.

Late Sign of Increased ICP

Abnormal posturing (decorticate or decerebrate).

ICP Monitoring Contraindications

Anticoagulant therapy, bleeding disorders, scalp infection, or brain abscess.

Goal ICP / CPP

Maintain CPP ≥ 50 mmHg (preferably 70+), keep ICP normal.

Hyperosmotic Therapy

Mannitol to decrease ICP; monitor electrolytes and urine output.

Loop Diuretic (Lasix)

Enhances mannitol effect, decreases sodium uptake and CSF production.

Corticosteroids

Reduce cerebral edema and inflammation.

Calcium Channel Blocker (Nimodipine)

Helps control mean arterial pressure (MAP).

Positioning for TBI

Head of bed 30°, head midline to promote venous drainage.

Nursing Care for Cerebral Edema

Monitor ABGs, electrolytes, I&Os; prevent hypoxia, hypotension, infection, and aspiration.

Postoperative TBI Care

Frequent neuro & VS checks, cardiac monitoring, ROM, anti-embolic stockings, drain care, HOB 30°.

Prevent Injury Strategies

Adequate lighting, maintain sleep-wake cycle, avoid restraints (use mittens), monitor dressings for constriction.

Care for Concussion/Contusion

Report LOC changes, severe headache, vomiting, hypotension, or hypoxia immediately.

Epidural Hematoma

Bleeding outside the dura mater; rapid onset and emergency.

Subdural Hematoma

Bleeding under the dura; slower onset, usually venous.

Intracerebral Hemorrhage

Bleeding within brain tissue, often with contusions or lacerations.

Nursing Priorities

Maintain cerebral perfusion, prevent secondary brain injury, support cognition, mobility, sensory function.

Care Coordination / Rehab

Mild TBI = home rest; moderate–severe = long-term rehab, collaborative care.

Expected Outcomes

Maintains cerebral perfusion, adapts to mobility/sensory changes, minimal cognitive impairment.

Exam Question 1

Nonreactive, dilated pupils → Brain stem herniation (poor prognosis).

Exam Question 2

Agitation/confusion → Early sign of increased ICP, requires immediate nursing action.

Safe Discharge Education (Mild TBI)

Rest the brain, avoid physical/mental activity, avoid screens, no NSAIDs, stay hydrated, eat protein & omega-3s.