Traumatic brain injury is characterized by damage to the bones of the skull or the meninges, brain tissues, blood vessels. By the nature of the origin, injuries can be closed and open, penetrating and non-penetrating, as well as concussion or brain injury. There are the following clinical forms of traumatic brain injuries: concussion, brain contusion, brain compression. Concussion of the brain is the most common clinical form and accounts for 70% of other types of injuries. Mild brain contusion is rarely detected and this type of injury accounts for 10-15% of victims, moderate severity is diagnosed only in 8-10% of victims, severe contusion is less common and only in 5-7% of victims. The clinical picture of a traumatic brain injury depends on the nature and severity of the disease. The anatomical and pathological picture of isolated brain lesions is based on primary traumatic dystrophy and tissue necrosis, as well as circulatory disorders and the organization of a tissue defect.
The main symptoms are headache, dizziness, nausea, vomiting, loss of consciousness, memory impairment. Concussions of the brain are characterized by a complex of interrelated compensatory and adaptive processes occurring at the ultrastructural level in the synaptic apparatus, neurons and cells. Brain contusion and intracerebral hematoma are accompanied by focal symptoms. The diagnosis of traumatic brain injury includes the collection of anamnesis, neurological examination, X-ray of the skull, CT or MRI of the brain to diagnose the injury and its timely treatment. Brain injury is an injury characterized by the presence of macroscopically visible foci of destruction and hemorrhages in the substance of the brain and its membranes, in most cases accompanied by damage to the bones of the arch, the base of the skull. Direct damage to hypothalamic-pituitary structures, the trunk and their neurotransmitter systems in traumatic brain injury determines the specificity of the stress response. Violation of neurotransmitter metabolism is the most important feature of the pathogenesis of TBI. Cerebral circulation is very sensitive to mechanical influences. The main changes that develop in the vascular system are expressed by spasm or vasodilation, as well as increased permeability of the vascular wall. Another pathogenetic mechanism of the consequences of TBI is directly related to the vascular factor, which is a violation of hydrodynamics. Changes in the production of cerebrospinal fluid and its resorption as a result of traumatic brain injury are associated with damage to the endothelium of the ventricular vascular plexuses, secondary disorders of the cerebral microcirculatory bed, meningeal fibrosis, in some cases - liquorrhea. These disorders lead to the development of hypertension of the cerebrospinal fluid, less often – hypotension.In craniocerebral trauma, hypoxic and dysmetabolic disorders play a significant role in the pathogenesis of morphological disorders along with direct damage to nerve elements. Traumatic brain injury, especially severe, causes respiratory and circulatory disorders, which aggravate the existing disorders of cerebral circulation and generally lead to more pronounced cerebral hypoxia of the brain.
It should be noted that currently there are three main periods of the course of craniocerebral disease: acute, intermediate, distant.
The acute period is the period from the moment of harmful effects of mechanical energy on the brain with a sudden violation of its integrative–regulatory and local functions to stabilization at one or another level of impaired brain functions and general body functions, or in the case of death of the victim. In the acute period, metabolic processes intensify, and then there is a shortage of energy with its secondary changes in the nervous tissue. Clinically, the acute period of traumatic brain injury is characterized by symptoms of brain decay and loss of its functions. Disorders of consciousness are characterized by the type of oppression and shutdown with a quantitative decrease in mental activity. Among the focal neurological signs, symptoms of loss of brain function prevail, the structure and severity of which are determined by the localization and type of traumatic substrate.
The intermediate period is the moment from the stabilization of the general organizational, cerebral and focal functions disrupted by trauma to their full or partial recovery or permanent compensation. Clinically, the intermediate period is characterized by the restoration of consciousness, but there may be syndromes of its resolution. It should be noted that after a prolonged coma, vegetative status and akinetic mutism are possible. The symptoms of focal prolapse disappear completely or partially. Usually, cranial nerve paresis is more stable. A variety of psychovegetative symptoms begin to manifest. In the interim period, homeostasis is restored either in a stable mode, or in a mode of stress and subsequent depletion of the activity of adaptive systems, followed by the formation of long-term progressive consequences. Restoration of humoral immunity while preserving cellular defects.
The long–term period is the path of clinical recovery or the maximum achievable rehabilitation of impaired functions or the occurrence or progression of new pathological conditions caused by traumatic brain injury. The duration of the long-term period: with clinical recovery - up to 2 years, with a progressive course - is not limited. Clinical symptoms become persistent, combining signs of loss, irritation and disunity. New neurological symptoms may develop. Immunologically, autoantibodies to neurons and glial cells are detected in 50-60% of cases in the long-term period. With this in mind, there are two forms of post-traumatic development: immuno-dependent and immuno-independent.
This type of injury can occur in both a child and an adult, as it is a consequence of trauma of different nature and origin. Traumatic brain injury can occur for many reasons, which can affect the course of the disease and further complications during treatment. The patient may experience dislocation of tissues and rupture of protective membranes around the brain, as well as a skull fracture or bleeding from damaged vessels into or around the brain. The damage may be due to increased intracranial pressure or bacterial infection.
Violations of vital functions are characterized by a disorder of the main functions of external respiration and gas exchange, systemic and regional blood circulation. In the acute period of traumatic brain injuries, among the causes of acute respiratory failure, lung ventilation disorders associated with impaired airway patency caused by the accumulation of secretions and vomit in the nasopharyngeal cavity with their subsequent aspiration into the trachea and bronchi, tongue entrapment in comatose patients prevail. Purulent-inflammatory complications are divided into intracranial (meningitis, encephalitis and brain abscess) and extracranial (pneumonia). Hemorrhagic — intracranial hematomas, brain infarctions.
Nursing care is a scientific method of organizing and performing systematic patient care, which focuses on meeting the needs of the patient and maintaining his health.
Traumatism is a set of injuries of various nature, received under any circumstances, which entail insurmountable consequences and complications of the disease.
The nursing process is a scientific method of providing and organizing nursing care, drawing up a care plan and caring for the patient himself.
It is worth noting the important role of the nurse in preparing the patient for surgery and care in the postoperative period. Conservative treatment plays a major role, in which the nurse is of paramount importance. She ensures that the patient follows bed rest from 14 days to several weeks, and she must also monitor the administration of drugs strictly according to the doctor's prescription. An important role is played by the conduct of dehydration therapy, which lies in the obligations of the nursing staff. This type of therapy includes the introduction of hypertensive solutions and diuretics, while the patient's diuresis is monitored. Preparing the patient for a lumbar puncture, the nurse conducts an individual conversation to relieve psychoemotional tension, and also an important task for preparing the patient for this manipulation is the setting of a cleansing enema. The nurse constantly monitors the patient's condition and monitors the monitor indicators, and if the patient's condition changes and worsens, she immediately informs the doctor.
It is necessary to note the importance of the prevention of traumatic brain injuries, the knowledge of which helps to prevent accidents, and also leads to a decrease in the statistics of this type of injury and reduces the number of patients with this problem. There is no specific prevention for traumatic brain injuries, but to reduce the risk of injury and reduce the likelihood of consequences, it is recommended:
• follow the rules of the road;
• observe safety precautions at work and during a trip on a vehicle;
• after receiving an injury, you need to consult a doctor.
