Brain injuries are common in Australia, with over 700,000 people having sustained a brain injury which restricts their normal daily activities to some extent. Even more concerning, is three quarters of these people are under sixty five years of age, and two thirds of them acquired their brain injury before twenty five years of age (Brain Injury Australia 2016). Sadly, there is a need for dates like Brain Injury Awareness Week, to raise awareness of the overrepresentation of the condition in our society.
Acquired Brain Injury?
An acquired brain injury (ABI) is any type of brain injury that has occurred following birth and can be a result of damage to the brain following infection, disease, trauma and lack of oxygen (Better Health Channel & Brainlink 2014).
Every person with an ABI is different. Varying long-term effects can include delays in processing information, planning and solving problems, fatigue, changes in behavior and personality, changes with their thinking and learning as well as physical and sensory changes (Better Health Channel & Brainlink 2014).
Traumatic Brain Injury
A traumatic brain injury (TBI) occurs following an impact to the head which then causes disruption to the brain tissue (Mauk 2012). These head injuries can be classed as either non-penetrating injuries (closed head injuries) or penetrating, which means that something has impacted the head and pierced through the scalp, skull or brain (Mauk 2012).
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 (BIA 2016).
Common signs and symptoms of a TBI immediately following the injury can include loss of consciousness which can last from minutes to days, and post-traumatic amnaesia, which also varies in it’s length of duration for each individual (Mauk 2012). Other symptoms include nausea and vomiting, seizures, confusion and headaches (Mauk 2012).
Consequences of a TBI
There are many consequences following a TBI for not only the patient, but also for their family and friends. Relationships, social networks and the person’s lifestyle can be affected and ultimately changed forever. Whenever an ABI occurs, it involves both the patient and their family coping with potential loss of function of the individual, and can cause distress. Consequently the patient and their family may experience difficulties as they navigate these changes and grieve for their losses.
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
- Cognitive deficits
- 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
- Post-concussive syndrome
- 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 & Brainlink 2014). Generally there are five areas in which people with an ABI may experience long-term changes:
- Medical difficulties
- Changes in physical and sensory abilities
- Changes in cognition
- Psychological and behavioral changes
- Communication difficulties
Nursing Care of the Patient with a TBI
The prevalence of TBIs is higher among young adults between fifteen and thirty four years of age than other age group (Australian Institute of Health and Welfare 2007). It is also important to mention here that life expectancy of someone with a TBI who continues to be mobile is only shortened by four to five years, but for those who have limited mobility, it is shortened by ten to thirty five years depending on what age the TBI occurred in the individual (Greenwood et al. 2013). Because this younger age group is over-represented for TBIs, this makes the process of rehabilitation crucial for these patients in order to minimise disability and reduce the demand of increased care in the future (Greenwood et al. 2013).
Nursing care of the patient with a TBI involves providing the individual with a safe environment and managing any cognitive deficits and physical needs of the patient (Greenwood et al. 2013). Each patient will display different symptoms of the TBI, therefore nursing interventions and considerations are individualised to each patient.
Often these interventions will include strategies for:
- Physical impairments
- Behavior management
- Communication management
- Emotional support
- Environmental management (safety of their environment and home preparation)
- Family support
- Health education
- Memory training
- Socialisation enhancement
- Speech therapy; and
- Any unilateral neglect management.
As you can see, the patient with a TBI may have very complex needs, and therefore it is extremely important that there is a multidisciplinary approach to treatment.
Family members also need to be involved in their loved one’s treatment. They will need to support the patient in this process and may also need to support themselves during their loved one’s recovery. Nurses need to ensure family members have information on ABIs and their effects, understand that recovery is a slow process, and that difficulties may arise during this process (Better Health Channel & Brainlink 2014).
(For further reading see Rehabilitative Care of a Patient Following Polytrauma / Multi-Trauma)
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- Australian Institute of Health and Welfare 2007, Disability in Australia: Acquired Brain Injury, AIHW, Canberra, ACT, Australia, viewed 23 August 2016 http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=6442453666%20
- Better Health Channel & Brainlink 2014, Acquired Brain Injury, State Government of Victoria, Australia, viewed 23 August 2016 https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/acquired-brain-injury
- Brain Injury Australia 2016, About Acquired Brain Injury, BIA, Putney, NSW, Australia, viewed 23 August 2016 http://www.braininjuryaustralia.org.au
- Greenwood, RJ, Barnes, MP, McMillan, TM & Ward, CD (eds) 2013, Handbook of Neurological Rehabilitation, 2nd edn, Psychology Press, New York, NY.
- Mauk, KL 2012, Rehabilitation Nursing: A Contemporary Approach to Practice, Jones & Bartlett Learning, Burlington, MA.
Sally is a Rehabilitation Clinical Nurse Specialist and Nurse Educator teaching the Diploma of Nursing. She is passionate about education in nursing so we can become the best nurses possible. Sally has experience in many nursing sectors including rehabilitation, medical, orthopaedic, neurosurgical, day surgery, oncology, emergency, aged care and general surgery. Sally's Blog.