In Australia, over 700,000 people have sustained a brain injury that restricts their normal daily activities to some extent (BIA 2020).
Among those with brain injuries, three-quarters are under 65, and two-thirds acquired their brain injury before the age of 25 (BIA 2020).
What is an Acquired Brain Injury?
The umbrella term acquired brain injury (ABI) refers to any type of brain injury that has occurred following birth (QLD DoH 2020). It may be the result of:
Infection or disease;
Near drowning or another episode of reduced oxygen supply; or
Alcohol or drug abuse.
(QLD DoH 2020)
Every person with an ABI is different. Long-term effects may range from mild to severe, depending on the patient (Better Health Channel 2014).
What is a Traumatic Brain Injury?
A traumatic brain injury (TBI) is a type of ABI that occurs following an impact to the head, causing damage to the brain tissue (Better Health Channel 2014).
These head injuries can be classified as either:
Non-penetrating injuries (closed head injuries), where the brain tissue and blood vessels are damaged by rapid forward and backward movement and shaking of the brain inside the skull; or
Penetrating injuries, where an objected has impacted the head and pierced through the skull.
(Stanford Health Care 2019)
As a result of the head being forced to move rapidly, the brain can tear, stretch, or become bruised or swollen. Force can also cause oxygen starvation and bleeding to the brain (Synapse 2019).
Common signs and symptoms of a TBI immediately following the injury include loss of consciousness, which can last from minutes to days, and post-traumatic amnesia, which also varies in length (Mayo Clinic 2019; Headway 2019).
Other symptoms include nausea and vomiting, seizures, confusion and headaches (Mayo Clinic 2019).
Consequences of a TBI
There are many consequences following a TBI not only for the patient, but also for their family and friends. Relationships, social networks and the person’s lifestyle may be affected and ultimately changed forever. The patient and their family may experience difficulties as they navigate these changes and grieve for their losses (Better Health Channel 2014).
Common Problems Associated with TBIs Include:
Agitation, anxiety, depression and post-traumatic stress disorder;
Behavioral and psychological impairments;
Problems with autonomic system regulation resulting in hypertension, hypotension, tachycardia and temperature regulation abnormalities;
Cardiovascular system problems including arrhythmias and deep vein thrombosis;
Endocrine system abnormalities including sodium regulation problems, sleep disturbances and decreased immune response;
Gastrointestinal system problems including bowel dysfunction, decreased gut motility, and nausea and vomiting;
Genitourinary system problems including incontinence and neurogenic bladder;
Neurological system dysfunction such as seizures, sensory deficits, neglect and lack of spatial awareness;
Neuromuscular system problems including rigidity, contractures, tremors and spasticity;
Respiratory complications including airway management difficulties; and
Skin integrity problems from lack of mobility and moisture.
Recovery Following a TBI
Recovery depends on the extent and location of the brain damage, the age and general health of the person, and what treatment they have had directly following the injury and during their rehabilitation (Better Health Channel 2014).
A person with an ABI may experience long-term changes including:
Changes in physical and sensory abilities;
Changes in cognition;
Psychological and behavioral changes; and
(QLD DoH 2020)
Nursing Care of a Patient with a TBI
The life expectancy of someone with a TBI is generally shorter compared to the general population. Those who have retained independent mobility tend to live longer (Physiopedia 2019).
Nursing care of the patient with a TBI involves providing the individual with a safe environment and managing any cognitive deficits and physical needs (Greenwood et al. 2003). Each patient will display different symptoms of the TBI, therefore, nursing interventions and considerations should be individualised to each patient.
Often, these interventions will include strategies for:
Managing physical impairments;
Environmental management (safety of their environment and home preparation);
Speech therapy; and
Any unilateral neglect management.
As you can see, the patient with a TBI may have very complex needs. Therefore, it is extremely important to adopt an interprofessional approach to treatment.
Family members also need to be involved in their loved one’s treatment. They will need to support the patient during this process and may also need to support themselves during their loved one’s recovery. Nurses need to ensure that family members:
Are adequately informed about TBIs and their effects;
Respect that recovery may be slow; and
Understand that difficulties may arise during the recovery process.