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CRANIOCEREBRAL TRAUMA (ACUTE REHABILITATIVE PHASE) Craniocerebral trauma, also called head or brain injury (open or closed), includes skull fractures, brain concussion, cerebral contusion/laceration, and hemorrhage (subarachnoid, subdural, epidural, intracerebral, brainstem). Primary injury occurs from a direct or indirect blow to the head, causing acceleration/deceleration of the brain. Secondary brain injury results from diffuse intracerebral axonal injury, intracranial hypertension, hypoxemia, hypercapnia, or systemic hypotension. Cerebral concussion is the most common form of head injury. Consequences of brain injury range from no apparent neurological disturbance to a persistent vegetative state or death. Therefore, every head injury must be considered potentially dangerous. CARE SETTING This plan of care focuses on acute care and acute inpatient rehabilitation. Brain injury care for those experiencing moderate to severe trauma progresses along a continuum of care, beginning with acute inpatient hospital care and inpatient rehabilitation to subacute and outpatient rehabilitation, as well as home- and community-based services. RELATED CONCERNS Cerebrovascular accident (CVA)/stroke Psychosocial aspects of care Seizure disorders/epilepsy Surgical intervention Thrombophlebitis: deep vein thrombosis Total nutritional support: parenteral/enteral feeding Upper gastrointestinal/esophageal bleeding Patient Assessment Database Data depend on type, location, and severity of injury and may be complicated by additional injury to other vital organs. ACTIVITY/REST May report: Weakness, fatigue, clumsiness, loss of balance May exhibit: Altered consciousness, lethargy Hemiparesis, quadriparesis Unsteady gait (ataxia); balance problems Orthopedic injuries (trauma) Loss of muscle tone, muscle spasticity CIRCULATION May exhibit: Normal or altered BP (hypotension or hypertension) Changes in heart rate (bradycardia, tachycardia alternating with bradycardia, other dysrhythmias) EGO INTEGRITY May report: Behavior or personality changes (subtle to dramatic) May exhibit: Anxiety, irritability, delirium, agitation, confusion, depression, impulsivity ELIMINATION May exhibit: Bowel/bladder incontinence or dysfunction FOOD/FLUID May report: Nausea/vomiting, changes in appetite May exhibit: Vomiting (may be projectile) Swallowing problems (coughing, drooling, dysphagia) NEUROSENSORY
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May report: Loss of consciousness, variable levels of awareness, amnesia surrounding trauma events Vertigo, syncope, tinnitus, hearing loss Tingling, numbness in extremity Visual changes, e.g., decreased acuity, diplopia, photophobia, loss of part of visual field Loss of/changes in senses of taste or smell May exhibit: Alteration in consciousness from lethargy to coma Mental status changes (orientation, alertness/responsiveness, attention, concentration, problem solving, emotional affect/behavior, memory) Pupillary changes (response to light, symmetry), deviation of eyes, inability to follow Loss of senses, e.g., taste, smell, hearing
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This note was uploaded on 02/01/2011 for the course PNR 182 taught by Professor Toole during the Spring '10 term at Orangeburg-Calhoun Technical College.

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