MANAGEMENT OF NEUROLOGIC DISORDERS

What is Traumatic Brain Injury?Closed – head collides with another object but there is no opening through the skull and duraOpen – object penetrates the skull, enters the brain and damages the soft brain tissue in its path. Exposes the brain

STATISTICSAnnual number of people who experience a traumatic brain injury: 1. 4 million annually in the United StatesDeaths: 50,000Hospitalization: 235,000Among children ages 0 to 14 yearsDeaths: 26, 850Hospitalizations: 37,000Number of Americans living with a traumatic brain injury: Approximately 5.3 million

Deaths: 50,000

Hospitalization: 235,000

Deaths: 26, 850

Hospitalizations: 37,000

LEADING CAUSES OF TBI :

CLASSIFICATION OF TBI:MILDloss of consciousness and/or confusion and disorientation is shorter than 30 minutesThe person looks normal and often moves normal in spite of not feeling or thinking normal.SEVEREloss of consciousness for more than 30 minutes and memory loss after the injury or penetrating skull injury longer than 24 hoursResults in permanent neurobiological damage that can produce lifelong deficits to varying degrees.

CONCUSSION vs CONTUSIONCONCUSSIONTemporary loss of neurologic function with no apparent structural damage lasting for a few seconds to few minutesJarring of the brain that caused it to stop functioning momentarilyCONTUSIONMore severe injury in which the brain is bruised, with possible surface hemorrhageUnconscious for more than a few seconds or minutesPicture is somewhat similar to that of shock

MANAGEMENT of TBI

MAINTAINING THE AIRWAYKeep unconscious patient in a position that facilitates drainage of oral secretionEstablish effective suctioning proceduresGuard against aspiration and respiratory insufficiencyMonitor for pulmonary complicationsMAINTAIN HYDRATION &ADEQUATE NUTRITIONFluid is administered through the IV for nutrition and liquid. A urinary catheter is put in the bladder for urine collection. It is important to maintain the unconscious patient's blood pressure through IV fluid and medication.

MAINTAINING SKIN INTEGRITYThe patient is turned and positioned in bedAcompression device wrapped around the legs that prevents blood clots. Daily injections are also given to prevent blood clots.SEIZURE PRECAUTIONDilantin is the usual medication administered through the IV to prevent seizures. A tetanus shot also may be given.

RECOVERYDuration of Coma. The shorter the coma, the better the prognosis. Post-traumatic amnesia. The shorter the amnesia, the better the prognosis. Age. Patients over 60 or under age 2 have the worst prognosis, even if they suffer the same injury as someone not in those age groups.

What is it?Spinal cord injuries cause myelopathy or damage to white matter or myelinated fiber tracts that carry signals to and from the brain. It also damages gray matter in the central part of the spine, causing segmental losses of interneurons and motorneurons.SPINALCORD

CAUSES OF SCI

STAGESStage of spinal shocksensation and motor power localized below the vertical height of the lesion are lost. This stage lasts for 2 to 3 weeks in humans, and hours to days in other animals due to a lesser degree of encephalitis.Stage of recoveryafter a period typically ranging from 2 to 3 weeks of injury, the nerves partially recover, and the return of segmental reflexes produce paraplegia-in-flexion.C. Stage of reflex failureafter a period of days the recovered reflexes again start to give way due to complete degeneration of nerve cells.

SYMPTOMSThe location of the injuryIn general, injuries that are higher in your spinal cord produce more paralysis. The severity of the injury.Spinal cord injuries are classified as partial or complete, depending on how much of the cord width is damaged.

COMPLICATIONSThrombophlebitisMeasures such as ROM exercises, thigh-high elastic compression stockings, adequate hydration and anticoagulation medications (heparin and warfarin ) as prescribed are givenOrthostatic HypotensionActivity should be planned in advance and adequate time given for a slow progression of position changesAutonomic DysreflexiaStimuli that may trigger this: distended bladder ( most common ); distention or contraction of visceral organs, especially the bowel; or stimulation to the skin

NURSING BEDSClinitron BedTilt Bed

STRYKER FRAME

ROTAREST BED