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Cuidado de enfermería en el Trauma Craneo Encefálico

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Encontrará los principales tipos de trauma encefalo-craneal, diagnóstico, tratamiento, monitoreo y cuidados de enfermería

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Cuidado de enfermería en el Trauma Craneo Encefálico

  1. 1. CUIDADO PARA EL PACIENTE CON TRAUMA CRANEOENCEFALICO (TCE) JORGE ELIECER RODRIGUEZ MARIN Aspirante a Especialización en Enfermería en Cuidado Crítico del Adulto ESPECIALIZACION DE ENFERMERIA EN CUIDADO CRITICO DEL ADULTO
  2. 2. ANATOMIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  3. 3. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO 80% 10% 10% PIC
  4. 4. DRENAJE VENOSO Critical Care Neurology and Neurosurgery p 380 ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  5. 5. El SNC, al que corresponde el 2% del peso corporal total (peso del cerebro: 1.300 a 1.500g) El consumo de oxígeno cerebral es de 3,5 ml por 100 g/min. El flujo sanguíneo cerebral (FSC) se mantiene a un valor constante de 70 a 90 ml/100 g/min. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Bárcena orbe y cols . Revisión de TEC. Neurocirugía 500 2006; 17: 495-518
  6. 6. EPIDEMIOLOGIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Cuidado intensivo y trauma. Carlos A, Ordóñez D., Ricardo Ferrada, Ricardo Buitrago B. -- 2a. ed. Sección III Cap 39, Pag 501- 530
  7. 7. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Alted lópez e et al. Actualizaciones en el manejo del traumatismo craneoencefálico grave. med intensiva. 2009;33(1):16-30 FISIOPATOLOGIA
  8. 8. LESION PRIMARIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Efectos inmediatos de disipación de la energía Autolimitada y teórica mente irreversible Dependiente del mecanismo (ACELERACION Y DESACELARACION)
  9. 9. LESION SECUNDARIA Ocurre minutos a días después del impacto Resultado de procesos como isquemia, reperfusión, hipoxia, edema, hemorragia, HIC Agrava el daño primario e impide la recuperación de las zonas lesionadas ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  10. 10. FISIOPATOLOGIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Neurocritical Care : A Guide to Practical Management Capitulo 1: p 4
  11. 11. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Bárcena orbe y cols . Revisión de TEC. Neurocirugía 500 2006; 17: 495-518 Alted lópez e et al. Actualizaciones en el manejo del traumatismo craneoencefálico grave. med intensiva. 2009;33(1):16-30
  12. 12. Cuidado intensivo y trauma. Carlos A, Ordóñez D., Ricardo Ferrada, Ricardo Buitrago B. -- 2a. ed. Sección III Cap 39, Pag 501- 530
  13. 13. FACTORES PREDISPONENTES DE LESION SECUNDARIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Neurocritical Care : A Guide to Practical Management Capitulo 1: p 4
  14. 14. EDEMA CEREBRAL Edema vasogénico Ruptura barrera hematoencefálica Edema citotóxico Secundario a proceso inflamatorio Edema hidrostático PA o Congestión venosa Edema osmótico Metabolismo dextrosa ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Cuidado intensivo y trauma. Carlos A, Ordóñez D., Ricardo Ferrada, Ricardo Buitrago B. -- 2a. ed. Sección III Cap 39, Pag 501- 530 Neurocritical Care : A Guide to Practical Management Capitulo 1: p 4
  15. 15. TIPO DE LESION Lesión focal - Fracturas - Hematomas traumáticos - Daño localizado secundario a masa expansiva Lesión difusa - Conmoción cerebral - Lesión axonal difusa - Isquemia global - Edema difuso - Lesión vascular difusa ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  16. 16. HEMATOMA EPIDURAL
  17. 17. HEMATOMA SUBDURAL
  18. 18. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  19. 19. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  20. 20. LESION AXONAL DIFUSA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  21. 21. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO LESION VASCULAR DIFUSA
  22. 22. HERIDA PENETRANTE
  23. 23. DIAGNOSTICOS DE ENFERMERIA Disminución de la perfusión tisular cerebral R/C - Aumento del volumen sanguíneo intracraneal - Pérdida de la autorregulación - Disminución en el aporte de oxígeno - Aumento de la demanda de oxígeno tisular ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  24. 24. Disminución de la capacidad adaptativa intracraneana R/C lesiones cerebrales Disminución de la capacidad adaptativa intracraneana R/C - Hipotensión sistémica - Hipertensión endocraneana E/P aumento desproporcionado de la PIC ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  25. 25. Riesgo de aspiración R/C deterioro del nivel de conciencia Riesgo de nivel de glicemia inestable R/C estrés Riesgo de escaras R/C - Inmovilidad - Disminución en la perfusión tisular E/P estado de shock, disminución glasgow ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  26. 26. Deterioro de la deglución R/C traumatismo craneal R/C incapacidad para ingerir alimentos Desequilibrio nutricional: ingesta inferior a las necesidades R/C incapacidad para ingerir los alimentos E/P pérdida de peso ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  27. 27. Síndrome postraumático R/C - Desastres - Accidentes graves E/P pensamientos inquietantes, ataques de pánico. Trastornos del patrón del sueño R/C - Iluminación - Ruido - Sujeción E/P quejas verbales de no sentirse bien. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  28. 28. Deterioro de la ambulación R/C - Deterioro del estado físico, - Deterioro sensorio perceptivo  Afrontamiento familiar incapacitante R/C - Sentimientos de culpa, ansiedad, desesperación - Relaciones familiares ambivalentes - Afrontamiento individual discrepante ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  29. 29. ACTIVIDADES DE ENFERMERIA ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  30. 30. Da-v O2= Ca-Cv (5-7ml/100gr) CaO2= (1.36 x Hb x Sat O2) + (0,003 x PaO2) 15-17 CvO2=(1.36 x Hb x Sajv O2) + (0,003 x SvjO2) 13-15 Rext= Ca-Cv/Ca (30-45%) Hb (10-12) Hcto (30-35) SvjO2 = 55 – 75 PaCO2= 30 -35 ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  31. 31. Hb- Hcto 30-35 SvjO2 = 50 – 75 PaCO2= 30 -35 Glicemia 60-150 Temperatura 35-37 ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  32. 32. INDICE DE LACTATO/OXIGENO Valor normal de 0.03 Valores mayores a 0.08 indica estado de isquemia o infarto cerebral
  33. 33. MONITOREO DE LA PRESIÓN INTRACRANEAL ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Neurocritical Care : A Guide to Practical Management Capitulo 1: p 4
  34. 34. 25ml Catéter intraventricular 1 Catéter subaracnoideo 5 Fibra óptica intraparenquimatosa 2 Tornillo subaracnoideo 3 Transductor epidural 4 ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  35. 35. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  36. 36. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  37. 37. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Alted lópez e et al. Actualizaciones en el manejo del traumatismo craneoencefálico grave. med intensiva. 2009;33(1):16-30 Neurocritical Care : A Guide to Practical Management Capitulo 1-3: p 4-33
  38. 38. ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO Alted lópez e et al. Actualizaciones en el manejo del traumatismo craneoencefálico grave. med intensiva. 2009;33(1):16-30
  39. 39. MONITOREO RESPUESTA PUPILAR  Miosis no reactiva Compromiso de los axones simpáticos originados en el hipotálamo  Anisocoria Preludia la herniación transtentorial con ulterior compresión mesencefálica  Midriasis Las lesiones pontomesencefálicas dorsales ESPECIALIZACIONDEENFERMERIAENCUIDADO CRITICODELADULTO
  40. 40. REFLEJO OCULOCEFALICO
  41. 41. REFLEJO OCULOVESTIBULAR
  42. 42. Pulsatility Index (PI) FVsys − FVdias/FVmean (normal value: 0.6–1.1) DOOPLER TRANSCRANEAL
  43. 43. Apoyo al paciente y familiar multidisciplinar Rehabilitación enfocada en la neuroplasticidad

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