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Acute HospitalizationAcute Hospitalization

njurynjuryIIrainrainBBnderstandingnderstandingUU

UNDERSTANDING

BRAIN INJURY

UNDERSTANDING

BRAIN INJURY

Acute Hospitalization

An Educational Guidefor Family & Friends

ACKNOWLEDGMENTS

The third edition of this booklet was made possible with the help and dedication of the following health care professionals:

Medical Illustrator

Chief Editor

Contributing Editors

This first edition of this booklet was made possible with the help and dedication of the following health care professionals:

Authors

Senior Editor

Contributing Editors

Medical Illustrator

TABLE OF CONTENTS

23 ASSESSMENT AND TREATMENT

28 INTENSIVE CARE

34 ACUTE HOSPITALIZATION

39 SYMPTOMS AFTER BRAIN INJURY

41 FAMILY ADJUSTMENT

45 ISOLATION

46 EXPECTATIONS

47 HOW TO HELP

49 MANAGING STRESS

51 MEMBERS OF THE TEAM

53 QUESTIONS & ANSWERS

55 GLOSSARY

60 APPENDIX OF MEDICAL ILLUSTRATIONS

61 SUGGESTED READINGS

62 NOTES

1 INTRODUCTION

2 THE HEAD AND BRAIN

10 BRAIN INJURIES

Understanding Brain Injury, Neurologic Rehabilitation

1

INTRODUCTION

2

THE HEAD AND BRAIN

Structures and Functions

This section will cover the structures and functions of the following areas:

The Skull

ILLUSTRATION 1.1

CORONAL VIEW OF THE HEAD

PIA MATER

DURA MATER

SUBDURAL SPACE

EPIDURAL SPACE

SKULL

CEREBELLUMBRAIN STEM

SPINAL CORDVERTEBRAE

CORTEX

LATERAL VENTRICLE

3

IILLLUSSTTRRAATTIIOONN 1.2

INSET VIEW OF THE HEAD WITH BRAIN

DURA MATERSUBDURAL

SPACE

SUBARACHNOID SPACE

ARACHNOID MEMBRANE

PIA MATER

EPIDURAL SPACE

SKULL SKIN

CORTEX

Frontal Lobes

4

LATERAL VIEW OF THE HEAD WITH FULL BRAIN

DURA MATER

SKULL

CORTEXPARIETAL LOBE

PFRONTAL LOBE

OCCIPITAL LOBE

TALE

CEREBELLUM

OCCIPITLOBE

UM

O

CEREBELLLU

TEMPORAL LOBE

BRAIN STEM

VERTEBRAE

SPINAL CORD

ILLUSTRATION 1.3

Damage to the Frontal Lobes

Parietal Lobes

5

Damage to the Parietal Lobes

Temporal Lobes

6

Damage to the Temporal Lobes

Occipital Lobes

Damage to the Occipital Lobes

7

The Cerebellum

The Brain Stem and Cranial Nerves

8

BRAIN STEM AND CRANIAL NERVES

ILLUSTRATION 1.4

BRAIN STEM AND CRANIAL NERVES

ILLUSTRATION 1 4CRANIAL NERVES(DENOTED IN YELLOW)

BRAIN STEM

9

THE 12 CRANIAL NERVES

ILLUSTRATION 1.5

I. OLFACTORY II. OPTIC

III. OCULOMOTOR IV. TROCHLEAR

V. TRIGEMINAL

VIII. VESTIBULOCOCHLEARVII. FACIAL

VI. ABDUCENS

IX. GLOSSOPHARYNGEAL

XI. SPINAL ACCESSORY

X. VAGUS

XII. HYPOGLOSSAL

Cranial nerve Sensory and motor func onI Olfactory SmellII Op c SightIII Oculomotor Moves eye upward, downward and inward; raises eyelids; controls pupils IV Trochlear Moves eye downward and inward (towards nose)V Trigeminal Sensa on in eyes, teeth and face, lower jaw; jaw movement; chewing VI Abducens Turns eye outward (away from nose)VII Facial Taste ( p and middle of tongue), facial expression, tear and saliva produc onVIII Ves bulocochlear Hearing and balanceIX Glossopharyngeal Taste (back of tongue), touch, temperature sensa on from tongue and

throat; tongue and throat movement, swallowing, gag re exX Vagus Swallowing, breathing, heart rate, stomach acid produc onXI Spinal accessory Moves head, neck and shoulders, larynx and throat (swallowing)XII Hypoglossal Moves tongue

This section will discuss:

10

BRAIN INJURIES

Concussions

Skull Fractures

Penetrating Head Wound

11

PENETRATING HEAD WOUND

ILLUSTRATION 2.1

BONE FRAGMENTS

DAMAGE TO BRAIN TISSUE

DURA LAYER

SKULL

PENETRATING OBJECT

Arterial Dissections

12

ILLUSTRATION 2.2

DIFFUSE AXONAL INJURY

DAMAGED AXON

MYELIN SHEATH

13

ILLUSTRATION 2.3

CEREBRAL INFARCTION/STROKE

FATTY PLAQUE

MIDDLE CEREBRAL ARTERY

BLOOD CLOT

DEAD BRAIN TISSUE

MIDDLE CEREBRAL ARTERY

14

ANOXIA / HYPOXIAANOXIA / HYPOXIA

ILLUSTRATION 2.4

BLOOD SUPPLY TO BRAIN

HIPPOCAMPUS

BASAL GANGLIA

DAMAGE DUE TO LACK OF

OXYGEN

Increased Intracranial Pressure

15

Hydrocephalus

Contusions

16

CONTUSIONCONTUSION

ILLUSTRATION 2.5

Hemorrhages & Hematomas

Epidural Hematoma

17

EPIDURAL HEMATOMA

ILLUSTRATION 2.6

EPIDURAL HEMATOMA

DURA LAYER

SKULL

BLOOD IN EPIDURAL

SPACE

SUBARACHNOID SPACE

Intraparenchymal Hematoma

Subdural Hematoma

Acute:

Subacute:

Chronic:

18

INTRACEREBRAL HEMATOMA

ILLUSTRATION 2.7

DURA LAYER

SKULL

SUBARACHNOID LAYER

BLOOD WITHIN THE BRAIN TISSUE

S H

ILLUSTRATION 2.8

S HSUBDURAL HEMATOMA

DURA LAYER

SKULL

ARACHNOID LAYER

BLOOD IN THE SUBDURAL SPACE

Subarachnoid Hemorrhage

19

SUBARACHNOID HEMORRHAGE

ILLUSTRATION 2.9

SKULL

BLOOD IN THE SUBARACHNOID

SPACE

DURA LAYER

Intraventricular Hemorrhage

20

INTRAVENTRICULAR HEMORRHAGE

ILLUSTRATION 2.10

INTRAVENTRICULAR HEMORRHAGE

PROFILE OFNORMAL VENTRICLES

BLOODIN LEFT VENTRICLE

BLOODIN LEFT VENTRICLE

Aneurysm

21

ILLLUSTRATION 2.11

PRESSURE ON SURROUNDING TISSUE

ANEURYSM

ARTERY

AANEURYSM

Seizures

Coma

22

23

ASSESSMENT AND TREATMENT

Early Assessment

This section will discuss:

Diagnostic Tests

X-ray / Evaluation of the Cervical Spine

CT Scan

MRI

24

Catheter Angiography / CTA / MRA

EEG / QEEG

PET / SPECT Scan

Other Tests

25

Glasgow Coma Scale

Eye opening

Best verbal response

Best motor response

26

Early Treatment

27

injuries.

Intravenous Line

Arterial Line

28

INTENSIVE CARE

IIIIIIIIIIII AAVVEENNOUUUSSSAAAAAAAAAANNNNTTTRRRRRRRRRRRAAAAAA LINNEE

IILLLLLLLLUUUUSSSTTRRAATTIIOOONNN 4.1

FLUID BAG

Monitoring Equipment

Foley Catheter

29

IILLLUSTRAATTIIOO

CARDDIIOVASCULLAAR MONITOR, FOOLLLLEYYY CCCATHHEETTEERR, AND CCHEST TUBE

CARDIOVASCULAR MONITOR

FOLEY CATHETER

ELECTRODES

OONNN 444.222

URINE DRAINAGE

BAG

RINEINAGEAG CHEST

DRAINAGE SYSTEM

CHEST TUBE

Chest Drainage System

Nasogastric Tube

Cooling (Hypothermia) Therapies

30

NNAASSOOGGAASTRIICC TTUBE

IIILLLLLLUUUSSSTTTRRRAAATTTIIIOOONNN 4444.3333

TO STOMACH

LUNGS STOMACH

ESOPHAGUS

31

Endotracheal and Tracheal Tubes

Ventilator (Respirator)

TRACCHHEOSTOMY TUBE

ILLUSTRATION 4.5

TO VENTILATOR LUNGS STOMACH

ESOPHAGUS

ENDOTRACHEAL TUBE

ILLUSTRATION 4.4

TO VENTILATOR

LUNGS STOMACH

ESOPHAGUS

Suction Catheter

ICP Monitor

/ Ventriculostomy

32

VVEEN RICULOSTOOMMYYNTTTTTTTTTRRRRRRRR

IILLLLLUUSSSTTTTRRRRAAATTION 4.66

PRESSURE MONITOR

BRAINVENTRICLES

CSF DRAINAGE

33

ILLUSTRATTTIOIONN 44..777

EPIDURAL

SUBDURAL

SUBARACHNOID

INTRAPARENCHYMAL

INTRACRANIAL PRESSURE MONITORING LOCATIONS

INTRAVENTRICULAR

This section will discuss the acute rehabilitation phase of care, including:

Cognitive Functioning Elimination Patterns

Fluid Balance

34

ACUTE HOSPITALIZATION

35

Rancho Los Amigos Scale of Cognitive Functioning

Level 1

Level 2

Level 3

Level 4

Level 5

Level 6

Level 7

Level 8

Physical Care

Airway Management

36

37

M a i n t a i n i n g Nutrition and Fluid Balance

Promoting Normal Elimination Patterns

GASTROSTOMY TUBE

IILLUUSSTTTRRAAATTTIIOOONN 55.1

GASTROSTOMY TUBE

LUNGS STOMACH

ESOPHAGUS

Preventing Eye Irritations

Skin Care

38

39

SYMPTOMS AFTER BRAIN INJURY

Brain injury results in three main types of impairments. This section will discuss:

Physical Problems

Cognitive Impairments

Behavioral Disorders

40

41

FAMILY ADJUSTMENT

suffered a brain injury.

Feelings of Panic

Denial

42

43

Anger

Fatigue

Guilt

44

45

ISOLATION

46

EXPECTATIONS

47

HOW TO HELP

The following guidelines will help during the acute rehabilitation phase:

Avoid overstimulation.

Use the familiar.

Be consistent.

Stay calm.

Give step-by-step directions.

Do not remind the patient of past abilities.

Do not talk down to the patient.

Avoid arguments and stressful situations.

Allow response time.

Maintain a sense of humor.

Remember to praise.

48

49

MANAGING STRESS

This section offers simple tips on dealing with stress.

Some tips for managing and preventing stress are listed below:

Eat properly.

Try to get enough rest.

Avoid excessive use of alcohol and sedative medications.

Express feelings.

Seek out professional help.

Be kind to yourself.

Let others help.

Ask questions.

50

51

MEMBERS OF THE TEAM

The following list includes many

treatment team members and briefly describes their responsibilities.

Anesthesiologist:

Attending Physician:

Clinical Psychologist:

Consulting Physician:

Intern:

Internist:

Neurologist:

Neuropsychologist:

Neurosurgeon:

Nurse:

Nutritionist:

Occupational Therapist (OT):

Physical Therapist (PT):

Speech Language Pathologist (SLP):

Psychiatrist:

Psychologist:

Physiatrist:

Resident:

Respiratory Therapist (RT):

Social Worker (SW):

Unit Secretary/Clerk:

52

53

QUESTIONS & ANSWERS

HOW LONG DOES IT TAKE FOR PATIENTS TO COME OUT OF A COMA?

HOW DO PATIENTS ACT AS THEY COME OUT OF A COMA?

WHAT DOES IT MEAN WHEN THE PATIENT MOVES WHILE IN A COMA?

IS THERE ANYTHING I CAN DO TO BRING THE PATIENT OUT OF A COMA?

WHAT CAN I TELL MY CHILDREN ABOUT A COMA AND BRAIN INJURY?

54

55

GLOSSARY

ANOSMIA

ANOXIA

CATHETER

CEREBROSPINAL FLUID

CLOSED HEAD INJURY

COGNITION

COMA

SCAN

DECUBITUS ULCER

DEFICIT

DIPLOPIA

ELECTROENCEPHALOGRAM

ELECTROCARDIOGRAM

EYE TAPE

FEEDING TUBE

HALO

ORTHOSIS

PERSISTENT VEGETATIVE STATE

PLATEAU

RESPIRATOR

56

57

SCANNING

SEIZURE

SENSORY INTEGRATION

SENSORY STIMULATION

VENTILATOR

Classes of Medications

ANTIBIOTICS

ANTICOAGULANTS

ANTICONVULSANTS

ANTIDEPRESSANTS

ANTIPSYCHOTICS

BLOOD PRESSURE MEDICATIONS

DIURETICS

LAXATIVES

MUSCLE RELAXANTS

SEDATING AGENTS

Specific Medications

58

59

MANNITOL

The Head and BrainIllustration Title Page

Brain InjuriesIllustration Title Page

Intensive CareIllustration Title Page

Acute HospitalizationIllustration Title Page

60

APPENDIX OF MEDICALILLUSTRATIONS

61

SUGGESTED READINGS

An Introduction to Head Injuries

Physical Medicine and Rehabilitation: State of the Art Reviews

Austin American Statesman

Journal of Neurosurgical Nursing

Physical Medicine and Rehabilitation: State of the Art

Reviews

Reference Tools

FINR Brain Atlas

Handbook of Neurosurgery: Trauma, Infection, Seizures, Vascular, Critical Care, Hydrocephalus,

Differential Diagnosis, 4th Edition, Vol. 2.

HDI Coping Series on Head Injury

Treatments

Principles of Neurorehabilitation

Catalogue of Educational Materials

Neuroanatomy and Neuropathology, a Clinical Guide for the Neuropsychologist, 2nd

Edition

62

NOTES

NOTES

63

64

NOTES

NOTES

65

Neurologic RehabilitationUnderstanding Brain Injury

Neur

ADDITIONALEDUCATIONAL MATERIALS

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