By Dr. Ravindra Patil
NCP means nursing care plan.
Any severe blow to the brain, skull or the scalp is considered a head injury. It ranges from a minor bump to a fractured skull.Along with the neurosurgeons and critical care specialists, nurses have a major role in managing head injury and traumatic brain injury. Nurses have a nursing care plan for managing every type of patients, and similarly they have a nursing care plan or NCP for managing head injury patients.
Nurses have their own head injury nursing diagnosis. While surgeons operate and physicians decide the medicines, a proper nursing care plan of head injury helps administer medicines and take due patient care. Remember, a critically ill head injury patient needs constant care from his or her head to his or her toes. For a nurse, the head injury is a just one part.
In head injury nursing management, most important is general nursing care which includes eye care, hair care, nail care, intubation and ventilator care, urinary catheter care, intravenous lines care, central line care, feeding and feeding tube care and so on. Over and above all this the nurse will care for the head injury with her nursing care plan for head injury.
If a patient is unable to move or is unconscious, he/she has to be turned over every two hours to prevent pressure sores. Such patients are on diapers and the diapers need to be changed and the area sponged and cleaned. The patient’s body must be sponged at least once or twice a day. Head injury nursing management also includes urinary catheter care.o.
Because of various reasons, the pressure of the cerebrospinal fluid [CSF] may increase in head injury patients. The patient will have an optimal cerebral tissue perfusion only with a normal ICP. To maintain normal ICP, in every nursing care plan for head injury, the nurse will monitor the patient’s neurological status by checking the pupils, Level of Consciousness [LOC] and Glasgow Coma Scale [GCS] scores continuously.
Remember, it is the nursing staff who is with the patient 24×7. Only the nurses can observe such changes and report them to the physician, who in turn can take appropriate action.
Any changes in vital signs may be a sign of increased pressure in the brain. An increased ICP causes slowing heart rate, a widening pulse pressure, and irregular respiration.
Every nursing care plan on head injury will check for fluid leakage from the ears and nose. Leakage of a clear liquid from the nose (rhinorrhoea) and ears (otorrhea) might be the cerebrospinal fluid leaking after head injury caused by fractures. Because there is no accumulation of fluid in the brain, there might be no signs of raised ICP.
In a typical ICU patient’s file will be written:
“Keep PO2 between 80 and 100 mmHg and PCO2 between 35 and 38 mmHg.”
These are levels of blood oxygen and carbon-dioxide which are to be maintained by the oxygen administered through nasal prongs, mask, or a tube inside the trachea, a process called “Intubation”. When a patient is intubated, a machine called the “ventilator” controls the patient’s breathing.
In every NCP of head injury, the goal is to prevent prolonged states of hypoxemia (decreased blood level of oxygen) and hypercarbia (increased amount of carbon dioxide).
A competent ICU nurse’s nursing management of head injury will avoid any activities and symptoms that increase ICP. They are:
In a good nursing care plan of head injury, although it is essential, it is good to limit suctioning and do hyperoxygenation before suctioning to help keep ICP at bay.
Head injury nursing management may have equipment to measure ICP continuously. An ICP that is greater than 15 mmHg should be reported right away.
A nurse must administer medication as ordered to decrease ICP. Medicines used to reduce ICP are:
Thus, all the above types of medicines are a vital necessity in a nursing care plan for head injury.
Seizures are caused by many reasons, some of which are:
Every nurse trained in a nursing care plan on head injury must know how to look the above. A good nurse must have her own head injury nursing diagnosis. The above characteristics of seizures must be noted by nurses and recorded:
The worst that can happen during head injury nursing management is patient’s self-injury. To prevent injuries, do this:
Every nursing care plan of head injury must assist the patient during the seizure by:
These measures protect the patient’s airway during and after the seizure.
Anticonvulsants medicines must be given as ordered. Phenytoin is given as an anti-seizure medicine. But it requires close monitoring or toxicity may occur.
ICU nursing care plan for head injury includes very close constant monitoring of the patient’s consciousness. The nurse must check for:
Memory might be affected. Hence requires frequent repetition of the same information. Informing the patient about their situation might reduce anxiety levels and bring their cognitive status back to baseline.
Only in the NCP for unconscious patient will communication with the patient be not be possible. Otherwise in every nursing care plan for head injury, the nurse must talk to the patient often and explain things in short and simple sentences before and throughout the process. Also;
No patient knows about his head injury. Hence head injury patients are very, very confused. It is a sudden event. Hence the nursing care plan on head injury must factor this in.
Brain injury might affect short-term memory and cause behaviour and mood changes. Ability to focus and learn new information might be difficult and take more time. Most patients and families have no prior experience with head trauma injuries. In most cases, head injuries arise from very sudden and unexpected events.
Whatever good care is taken, it must be communicated to the patients and family members daily. Family members and caregivers are a vital part of the healthcare team.
Head injury nursing management will prepare the patient and family for the need for physical therapy, occupational therapy, speech therapy and home nursing care. This does not raise expectations greatly and helps the family adjust themselves to the new situation.
All in all, along with the surgeon, only a good head injury nursing care plan implemented by committed nurses will make the head injury patient better.
And at Samarth Neuro and Superspeciality Hospital, run by neurosurgeon Dr. Ravindra Patil, this combination of a competent neurosurgeon and the best nursing care is accessible around-the-clock.
In the above essay, nurses are mentioned as women only for the sake of convenience. Male nurses are also equally dedicated and capable.
Samarth Neuro and Superspeciality Hospital has 100+ beds & specializes in emergency surgery for neurological issues/disorders & diagnostics.
Samarth Neuro and Superspeciality Hospital
