CRANIOCEREBRAL TRAUMA (ACUTE REHABILITATIVE PHASE)
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.
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.
Cerebrovascular accident (CVA)/stroke
Psychosocial aspects of care
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.
Weakness, fatigue, clumsiness, loss of balance
Altered consciousness, lethargy
Unsteady gait (ataxia); balance problems
Orthopedic injuries (trauma)
Loss of muscle tone, muscle spasticity
Normal or altered BP (hypotension or hypertension)
Changes in heart rate (bradycardia, tachycardia alternating with bradycardia, other
Behavior or personality changes (subtle to dramatic)
Anxiety, irritability, delirium, agitation, confusion, depression, impulsivity
Bowel/bladder incontinence or dysfunction
Nausea/vomiting, changes in appetite
Vomiting (may be projectile)
Swallowing problems (coughing, drooling, dysphagia)