MANAGEMENT OF
NEUROLOGIC DISORDERS
What is Traumatic Brain Injury?
Closed – head collides with another object but there
is no opening through the skull and dura
Open – object penetrates the skull, enters the brain
and damages the soft brain tissue in its path.
Exposes the brain
STATISTICS
Annual number of people who experience a
traumatic brain injury:
• 1. 4 million annually in the United States
 Deaths: 50,000
 Hospitalization: 235,000
Among children ages 0 to 14 years
 Deaths: 26, 850
 Hospitalizations: 37,000
Number of Americans living with a traumatic brain
injury: Approximately 5.3 million
LEADING CAUSES OF TBI :
CLASSIFICATION OF TBI:
MILD
• loss of consciousness
and/or confusion and
disorientation is
shorter than 30
minutes
• The person looks
normal and often
moves normal in spite
of not feeling or
thinking normal.
SEVERE
• loss of consciousness for
more than 30 minutes
and memory loss after
the injury or penetrating
skull injury longer than
24 hours
• Results in permanent
neurobiological damage
that can produce lifelong
deficits to varying
degrees.
CONCUSSION vs CONTUSION
CONCUSSION
• Temporary loss of
neurologic function
with no apparent
structural damage
lasting for a few
seconds to few minutes
• Jarring of the brain that
caused it to stop
functioning
momentarily
CONTUSION
• More severe injury in
which the brain is
bruised, with possible
surface hemorrhage
• Unconscious for more
than a few seconds or
minutes
• Picture is somewhat
similar to that of shock
MANAGEMENT of TBI
MAINTAINING THE AIRWAY
• Keep unconscious patient in a position that facilitates
drainage of oral secretion
• Establish effective suctioning procedures
• Guard against aspiration and respiratory insufficiency
• Monitor for pulmonary complications
MAINTAIN HYDRATION & ADEQUATE NUTRITION
• Fluid 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 INTEGRITY
• The patient is turned and positioned in bed
• A compression device wrapped around the
legs that prevents blood clots. Daily
injections are also given to prevent blood
clots.
SEIZURE PRECAUTION
• Dilantin is the usual medication administered
through the IV to prevent seizures. A tetanus
shot also may be given.
RECOVERY
• Duration 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.
S
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A
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C
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CAUSES OF SCI
STAGES
• Stage of spinal shock
• sensation 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 recovery
• after 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 failure
• after a period of days the recovered reflexes again start to
give way due to complete degeneration of nerve cells.
SYMPTOMS
The location of the The severity of the
injury.
injury
• In general, injuries • Spinal cord injuries
are classified as
that are higher in
partial or complete,
your spinal cord
depending on how
produce more
much of the cord
paralysis.
width is damaged.
COMPLICATIONS
Thrombophlebitis
• Measures such as ROM exercises, thigh-high elastic
compression stockings, adequate hydration and
anticoagulation medications (heparin and warfarin ) as
prescribed are given
Orthostatic Hypotension
• Activity should be planned in advance and adequate
time given for a slow progression of position changes
Autonomic Dysreflexia
• Stimuli that may trigger this: distended bladder ( most
common ); distention or contraction of visceral organs,
especially the bowel; or stimulation to the skin
NURSING BEDS
• Clinitron Bed
• Tilt Bed
STRYKER FRAME
ROTAREST BED