Traumatic brain injuries (TBIs) are commonly encountered by those on the front lines of care and can be brought about by all sorts of eventualities, from trips and falls at home to automotive collisions on the roads.
Because of this, nurses need to be prepared to confront an array of TBIs, from the jarring impact of concussions to the subtler signs of diffuse axonal injuries.
The challenges are as varied as the conditions, so here are some of the main examples to know about, and the treatment options to consider in each scenario.
Let’s get to it!
Contents
The Basics of Concussions
Concussions are the chameleons of brain injuries, as they can often sidestep detection with their range of symptoms that start at the subtle and peak at the severe end of the spectrum. Here’s what nurses can do to identify and manage them:
- Quick Recognition: Identify common signs such as confusion, dizziness, and headaches.
- Patient Education: Explain the importance of rest and gradual return to activities.
- Monitoring Progress: Watch for delayed or prolonged symptoms that could indicate complications.
Children are especially likely to suffer a concussion due to the active lifestyles they lead, with 6.8% of under-17s experiencing associated symptoms. Timeliness in response can dramatically shape recovery trajectories for those affected, and for youngsters with developing brains, it’s doubly necessary for nurses to take care in pinpointing this problem.
The Reality of Contusions
Contusions are commonly associated with brain injuries from truck accidents, and the deep bruising that is brought about by sudden impacts to the head can be an outward sign of additional damage beneath the surface.
Here’s how nurses can take stock of the extent and impact of these lesions:
- Initial Assessment: Gauge the size and location using imaging tech.
- Symptom Tracking: Monitor for changes in motor skills, consciousness, or behavioral changes.
- Intervention Readiness: Prepare for potential swelling treatment or surgical intervention if necessary.
The good news is that just 3% of TBIs result in death, and this is largely down to the prompt attention and intervention of nurses and other healthcare practitioners.
The Dilemma of Diffuse Axonal Injuries
Diffuse axonal injuries (DAI) are a little different to TBIs like contusions that have unambiguous symptoms visible to the naked eye. In fact, standard scans may not be able to identify DAIs, so nurses have to really hone their deductive skills and understanding to sniff them out:
- Keen Assessment: Monitor for subtle neurological changes that may signal DAI.
- Continuous Monitoring: Track patient consciousness levels and report any deterioration.
- Collaborative Care: Work closely with interdisciplinary teams for comprehensive management.
The main problem with DAIs is that, for the time being, they’re an under-studied and little-understood form of TBI – although one report pegs the fatality rate at around 30%.
And again, with variable severity even within this category of injury, close attention is a nurse’s best friend.
The Extremes of Penetrating Brain Injuries
Penetrating brain injuries are understandably the most dangerous and deadly of the bunch, and again are more common in auto accidents where the forces involved are potentially colossal – and can also be caused by firearms. Providing targeted care in this context involves:
- Emergency Response: Swift action to stabilize vital signs and prevent further injury.
- Infection Control: Rigorous monitoring for signs of infection due to open wounds. This is relevant to hospital safety and patient care, just as much as it is to individual working relationships.
- Rehabilitation Collaboration: Facilitation with physical, occupational, and speech therapists for long-term recovery.
The stats on this are stark – with roughly three-quarters of patients with penetrating TBIs dying en route to the hospital, while just half of those who do make it survive once treatment begins in the emergency room.
Experience and collaboration are fundamental to tackling this monumental challenge.
Final Thoughts
Mild concussions and major penetrating brain injuries may sit on very different sides of the table in terms of severity, but nurses responsible for providing care need to be just as diligent when dealing with each.
This is because the fragility of the brain can throw up all sorts of oddities, and patients deserve the best chance of recovering comprehensively.
