NSB236 Integrated Nursing Practice 3: Traumatic Brain Injury Essay

This essay provides a detailed analysis of Traumatic Brain Injury (TBI), focusing on the case of Mr. James Parsons, who sustained a head injury. It begins by defining TBI and outlining its causes, then discusses two key signs and symptoms: unconsciousness and pupil dilation, linking them to the underlying pathophysiology. The essay then reviews Mr. Parsons' assessment data, including increased respiratory and heart rates, and elevated blood glucose levels, explaining the physiological basis for these findings. A priority area for nursing intervention is identified as brain hemorrhage, with the essay then detailing three critical nursing interventions: medication (diuretics, anti-seizure drugs, coma-inducing drugs, and painkillers), surgical operations (removal of clotted blood, repair of skull fractures), and rehabilitation (physiatrist, occupational therapist, speech pathologist). Each intervention is thoroughly evaluated, emphasizing the importance of a multi-faceted approach to managing TBI and promoting patient recovery. Finally, the essay concludes by summarizing the key findings, reiterating the importance of prompt and appropriate interventions in mitigating the effects of TBI.

Running head: TRAUMATIC BRAIN INJURY 1
Traumatic Brain Injury
Student’s Name
Institutional Affiliation

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Introduction
Traumatic Brain Injury (TBI) results from a rapid, violent jolt on an individual’s head
leading to the damage of brain cells (Thurman, 2016). The brain suffers bruises due to the
collusion between the inner and outer layers of the skull. The causes of the injury include
physical aggression, road accidents, sports injuries, and falls. In the case study, Mr. James
Parsons is involved in a fight where the opponent punches him on the face. The physical
aggression makes Parsons lose consciousness, fall thereby hitting the back of his head on the
pavements. This essay will discuss two signs and symptoms of TBI. Additionally, the paper will
identify one priority area and discuss three nursing interventions towards the condition. The
write-up will then review the assessment results and evaluate the suitability of the responses.
Proper interventional strategies assist in managing TBI.
Signs and Symptoms of TBI
Unconsciousness is a significant symptom of severe TBI in patients. The medical
imaging results paint a picture of a patient that is unaware of the activities within his
surroundings. Unconsciousness occurs due to the damage of brain cells which leads to the
disruption in the synthesis of ATP (Marshall et al., 2015). The destruction of brain tissues
impairs the regulation of metabolism and CBF. The interruption in energy production leads to
the onset of anaerobic respiration which produces insufficient energy to serve the cells of the
body. Parsons has a history of diabetes which leads to excessive levels of blood sugar which
reduces the amount of glucose available for energy production.
The dilation of pupils of an individual's eyes is another symptom of TBI. The assessment
data indicates that the patient's pupils are equal and reactive to light and accommodating. The
imaging also shows the evidence of raccoon eyes. The pupil dilation suggests that the patient

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suffered severe cranium injury (Epstein, Mitra, Cameron, Fitzgerald, & Rosenfeld, 2015).
Additionally, the intracranial pressure due to hitting his head on the pavement is responsible for
the reactive and accommodating pupils. A significant number of TBI patients experience dilation
of both or either of the eye's pupils. Therefore, the symptom is useful in gauging the severity of
the condition.
Assessment Data
The data indicates that the patient’s respiration (RR) and heart rates (HR) have both
increased after the accident. TBI causes an imbalance in the brain’s oxygen consumption and
delivery. The mismatch in the cerebral oxygen intake and usage is due to hemodynamic and
vascular mechanisms leading to hypoxia. Therefore, the body responds by increasing the RR and
HR to correct the deficiency in the levels of brain oxygen. The blood glucose is 12.4 mmol/Lit
which is higher than the normal range of 4 to 5.3 mmol/Lit (Siu, 2015). Brain injury interferes
with the hypothalamus which instructs the pancreas to produce insulin for glucose metabolism.
Therefore, the inability of the brain to trigger the conversion of blood sugar into energy leads to
high glucose levels. The patient’s data also indicate an increase in the amounts of Ca2+ in the
arterial blood. The increase is due to oxidative stress and excitotoxicity due to TBI (Hall, Singh,
& Cebak, 2018).
Priority Area
The priority area that requires urgent and relevant nursing intervention is the brain
hemorrhage. Appropriate medications, surgical operations, and rehabilitation can assist in
correcting the TBI and induce healing.
Nursing Interventions

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Proper medications are the primary remedy for reducing the bleeding that Mr. James
experienced due to the TBI. The intense pressure on the brain after falling on the pavement
caused bleeding in his brain. The nurse attending to Parsons should administer diuretics to
decrease the pressure in the patient's brain (Eli, Joyce, & Hawryluk, 2018). Diuretics also lower
the level of tissue fluids and enhance the increase in the amounts of urine output.
Hemorrhage also leads to seizers after a week from the injury. The caregivers should
prescribe anti-seizers drugs to avoid further brain damage (Sundararajan, Milne, Edwards,
Chapman, & Shakib, 2015). The blood transports oxygen to the brain cells to aid in the synthesis
of energy. Therefore, brain bleeding interferes with the oxygen supply to the brain. The
caregivers should administer coma-inducing drugs to the patients; since a comatose brain
requires little amounts of oxygen to operate. Apart from the diuretics, anti-seizer, and coma-
inducing drugs, painkiller are also useful in managing brain injury. The pain relievers lower the
pain due to intracranial pressure and bleeding. Therefore, appropriate drugs help to manage
hemorrhage due to TBI.
Surgical operations are also useful in the management of the effects of the brain hemorrhage.
Operative procedures are helpful in the removal of clotted blood after bleeding (Mendelow et al.,
2015). External or internal brain bleeding leads to the development of hematoma that increases
pressure on the brain cells. The clotted blood causes damage to brain tissues if the caregivers do
not get rid of it. Therefore, the surgical procedures remove the clotted blood. TBI damages the
skull leading to bleeding in the brain. An operation can remove the damaged section of the head
and also repair the fractures.
Operative procedures can also stop the bleeding after brain injury. Mr. James suffered a head
injury that caused bleeding of the skull. Efficient surgical procedures repair the cranium and end

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the hemorrhage (Kolias et al., 2016). Surgeons can also construct an opening in the head to
reduce the pressure in the brain. The caregivers can use the opening to drain the accumulated
fluid after bleeding. Furthermore, the opening creates room for the inflammation of the injured
section. Healthcare professionals should operate after the accident to minimize the effects of
bleeding and pressure in the brain. Therefore, surgery is an alternative for medication in
managing brain hemorrhage.
The effects of TBI limit the ability of the patient to talk or to move from one place to the
other. The hemorrhage dehydrates the brain; thus interfering with the production of ATP.
Therefore, the patient finds difficulties in conducting daily activities. Therefore, rehabilitation
specialists have a role to play in the recovery of Mr. James. The first rehabilitation officer is the
physiatrist who monitors the entire process of rehabilitation. The specialist prescribes related
drugs such as diuretics to manage brain bleeding (Tate et al., 2014). Occupational therapist
assists patients to resume daily chores. Therefore, the specialist has the task of helping Parsons to
continue his duties.
Hemorrhage also interferes with the segment of the brain that coordinates speech in
healthy individuals. Therefore, a language and speech pathologist should assist the patient to
regain his communication skills (Braaf et al., 2018). A nurse specializing in TBI should educate
the patient’s family about the complication and the process of recovery. The patient also needs
the services of a neuropsychologist to assess the cognitive functions. The specialist assists the
patient to control the behavioral changes. The rehabilitation nurse plans the discharging process
after adequate medical attention to the patient. Therefore, rehabilitation is a back-up for
medication and surgery.

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Evaluation of the Nursing Interventions
The first intervention is the administration of medications such as diuretics, anti-seizer,
and coma-inducing drugs. The intake of the diuretic according to the doctor's prescription
reduces the pressure due to TBI thereby reducing the extent of hemorrhage (Udy et al., 2017).
Anti-seizer drugs minimize brain damage; thus decreasing bleeding. The coma-inducing
medicines place the brain at rest and reduce the oxygen requirements.
The second line of intervention is through surgical operations. Surgery removes blood
that clots after hemorrhage (Carney et al., 2017). The hematomas exert further pressure on the
brain cells; hence the surgeons should remove it to reduce pain. Operative procedures also
prevent hemorrhage directly thereby reducing hypoxia. Surgery also helps to repair cranium
fractures; therefore decreasing external bleeding.
The third intervention is through rehabilitation sessions which help in the recovery of the
affected individuals. The physiatrist ensures that the patient intakes the correct drugs such as
diuretics to manage to bleed (Pretz et al., 2016). Rehabilitation processes are efficient as they
help the patient to resume daily chores.
Conclusion
The caregivers diagnose Parsons with TBI which resulted from the fight that made him
hit the back of his head on the pavement. The signs and symptoms of the complication include
unconsciousness and dilation of the eyes' pupils. Unconsciousness makes an individual unaware
of the activities in the surrounding environment. The dilation of the pupils indicates that the
patient suffered a severe brain injury. The assessment data indicates an elevation in the patient's
blood glucose levels and the RR. The brain controls the levels of blood sugar level and the
respiratory rates; hence an injury distorts its functions. The priority area for nursing interventions

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is the brain hemorrhage due to the TBI. The nursing interventions include medications, surgery,
and rehabilitation. An efficient application of the remedies minimizes the bleeding and ensures
recovery from the complication.

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