Neurotrauma

Dr Nadine Abelson-Mitchell is Senior Lecturer in the School of Nursing and Community Studies at the University of Plymouth. She is the partnership link for the neuroscience programme and is Appointed Honorary Nurse Consultant to Rowans Rehabilitation Unit, Plymouth teaching PCT.

Preface xi

Dedication xii

Acknowledgements xiii

Contributor Details xiv

Abbreviations xviii

List of Tables and Figures xx

Section 1 Foundations for Practice 1

Introduction 1

1 The Patient’s Journey 3
Nadine Abelson-Mitchell

Introduction 3

Care pathways: policies and guidelines 4

Integrated care pathways 4

2 Philosophy 6
Nadine Abelson-Mitchell

Introduction 6

Conclusion 9

3 The Needs Approach Model 11
Nadine Abelson-Mitchell

Introduction 11

What is a need? 11

Structure of the Needs Approach Model 11

Use of the model 12

Assessing the patient’s needs 12

Planning 13

Goal setting 14

Implementation 14

Evaluation 14

Risk 14

The miraculous recovery 23

Nursing diagnosis 26

Conclusion 28

4 The Patient Matters 31
Nadine Abelson-Mitchell, an anonymous carer and Sue Mottram

The patient 31

Family and carers 31

Conclusion 37

5 Multidisciplinary Management 38
Nadine Abelson-Mitchell and Katie Searle

Introduction 38

Staffing 39

Speech and language therapy services 40

6 Physiotherapy 43
Jude Fewings

Introduction 43

Respiratory care 43

Positioning 43

Musculoskeletal integrity and neuromuscular status 44

Summary 44

Rehabilitation and motor control theories 45

Posture and seating 45

Conclusion 46

7 Neuropsychology 47
Michelle Smith

Introduction 47

What is clinical neuropsychology? 47

Who is a clinical neuropsychologist? 47

What is the role of the clinical neuropsychologist in the management of TBI? 47

Neuropsychological functions 47

The patient’s neuropsychological journey 49

Additional factors influencing neuropsychological functioning 50

Other issues and considerations 51

8 Social Considerations 52
Judi Thomson and Anthony Gilbert

The role of the social worker 52

Social issues 54

Conclusion 56

9 Occupational Therapy 57
Danielle Williams

Section 2 Pre-requisite Knowledge 61

Introduction 61

10 Epidemiology 63
Nadine Abelson-Mitchell

Introduction 63

Severity of injury 63

Hospital attendance 64

Incidence 64

Prevalence of head injury 64

Age distribution 65

Gender distribution 65

Race and ethnicity 65

Mechanism of injury 65

Seasonal variation 66

Predisposition 66

Use of alcohol 66

Head injury mortality 66

Conclusion 66

11 Prevention of Head Injuries 68
Nadine Abelson-Mitchell

Introduction 68

Recommendations 68

Road traffic accidents (RTAs) 69

Action regarding the use of prescription, over the counter and illicit drugs 70

Prevention of sports injuries 71

Care of older people 71

Interpersonal violence 71

Conclusion 72

12 Applied Anatomy and Physiology 74
Nadine Abelson-Mitchell

Introduction 74

The nervous system 74

The scalp 74

The skull 75

Structure of the brain 84

Additional concepts related to neurophysiology 102

Acid-base balance 102

Summary 105

Conclusion 106

13 Investigations 108
Nadine Abelson-Mitchell

14 Pharmacology for Neurotrauma Patients 126
Nadine Abelson-Mitchell and Penny Franklin

Introduction 126

Anaesthetic agents 127

Analgesics 127

Diuretics 127

Anti-epileptic drugs 127

Anticoagulants 127

Antiemetics 127

Laxatives 127

Conclusion 127

15 Applied Microbiology 129
Nadine Abelson-Mitchell

Introduction 129

Meningitis 129

Encephalitis 130

Brain abscess 131

Conclusion 133

Section 3 Features of Neurotrauma 135

Introduction 135

16 Classification of Traumatic Brain Injury 137
Zuhair Noori and Nadine Abelson-Mitchell

Introduction 137

Primary and secondary brain injury 137

Open and closed head injury 139

Conclusion 140

17 Raised Intracranial Pressure 141
Nadine Abelson-Mitchell

Introduction 141

Definition 141

Cause of increased intracranial pressure 141

Diagnosis 141

Investigations 142

Treatment 142

Management of the patient 142

Conclusion 143

18 Assessment of the Patient with Neurotrauma 144
Nadine Abelson-Mitchell

Introduction 144

General principles 144

Neurological observations 146

Vital signs 151

Recording the observations 152

Undertaking a comprehensive CNS examination 152

Recording the assessment 160

Conclusion 160

Section 4 Management of Neurotrauma 161

Introduction 161

19 Management of Neurotrauma at the Scene 163
Henry Guly

Introduction 163

Severe and moderate head injury 163

Airway with cervical spine protection 164

Breathing 164

Circulation 164

Disability 165

Exposure and environment 165

Minor head injury 166

20 Management of Neurotrauma on Transfer 168
Henry Guly

Introduction 168

Airway with cervical spine protection 168

Breathing 169

Circulation 169

Disability 169

Exposure 169

Other 169

Who should accompany the patient? 169

21 Management of Neurotrauma in the Emergency Department 171
Henry Guly

Introduction 171

Preparing for the arrival of a seriously injured patient 171

Severe and moderate head injury 171

Minor head injury 176

Admission 178

Discharge from the ED 178

Management of patients who are admitted for observation 178

Social aspects 179

22 Hospital Management of Neurotrauma 182
Kevin Tsang and Peter Whitfield

Introduction 182

Initial assessment of trauma patients 182

Management in the neuroscience unit 184

Intensive care management 185

Further management and prognosis 191

23 Nursing the Patient with Neurotrauma 194
Nadine Abelson-Mitchell

Introduction 194

Advocate 194

Essential nursing skills 195

Therapeutic practice 195

Co-ordination 196

Clinical governance 196

Advice/counselling 196

Political awareness 196

Education 196

Research 196

Ethical considerations 196

Rehabilitation nursing 196

Activities 234

24 Prognosis and Patient Outcome 235
Zuhair Noori and Nadine Abelson-Mitchell

Introduction 235

Factors predicting prognosis after head injury 236

Outcome measures 236

Return to work 237

Quality of everyday life 237

Conclusion 237

25 Dying and Death 238
Zuhair Noori and Nadine Abelson-Mitchell

Introduction 238

The family 239

Brain death 239

Conclusion 241

Activities 241

Section 5 Neurorehabilitation 243

Introduction 243

26 Sequelae of Neurotrauma 245
Nadine Abelson-Mitchell

Introduction 245

Additional information about some sequelae 247

Conclusion 249

27 Neurorehabilitation 250
Zuhair Noori and Nadine Abelson-Mitchell

Introduction 250

Definition of rehabilitation 251

Levels of rehabilitation 251

Settings for rehabilitation 252

Rehabilitation costs 252

Staffing for rehabilitation 252

Standards of rehabilitation practice 254

Rehabilitation criteria 254

The rehabilitation process 255

Goals of rehabilitation 256

Concepts underpinning rehabilitation 256

Planning the rehabilitation programme content 256

Scheduling the programme 257

Community-based rehabilitation (CBR) 257

Conclusion 260

28 Early Stimulation Programmes 263
Nadine Abelson-Mitchell

Introduction 263

Definition of early stimulation programme 263

Background 263

Objectives of introducing an early stimulation programme (ESP) 263

Setting up the ESP 264

Content of the ESP 264

Specific techniques 265

How to encourage the involvement of family or friends 265

29 Discharge Planning 266
Nadine Abelson-Mitchell

Introduction 266

What is discharge planning? 266

Benefits of discharge planning 266

Discharge planning process 266

Criteria for discharge planning 267

Selecting the discharge destination 267

The day of discharge 267

Conclusion 267

30 Living in the Community 270
Nadine Abelson-Mitchell

Introduction 270

Integrating into the community 270

31 Legal Matters 271
Andrew Warlow and Simon Parford

Introduction 271

Compensation claims arising out of head injuries 271

Brain injury and medical negligence 273

Head injuries 273

The cost of brain injury 276

32 Meeting Tomorrow’s Challenges 277
Nadine Abelson-Mitchell

Conclusion 277

Section 6 Appendices 279

Appendix 1 Pre-Admission Assessment 281

Instructions 281

Pre-admission assessment 282

Family information 282

Previous health history 283

Current health status 283

Health needs 286

Appendix 2 Discharge Report 293

Instructions 293

Section A 293

Section B 294

Section C 294

Section D 294

Activity Answers 299

Additional Resources 309

Glossary 315

References 317

Index 333

Colour plate section can be found between pages 106 and 107