How to respond to a classmates nursing discussion on traumatic brain injury (TBI)

Brain injuries can be categorized in multiple ways, such as mild, moderate, and severe. Injuries can be as minimal as a headache and as severe as a life long vegetative state. It is important as healthcare providers to understand the signs and symptoms of each injury.

First, mild traumatic brain injury (TBI) can be categorized as an injury that causes momentary or less than 30 minutes of loss of consciousness (McCance & Huether, 2019). In mild TBI’s we can determine that the Glasgow Coma Scale (GCS) will be between 13 to 15 (McCance & Huether, 2019). The Glasgow Coma Scale is a widely used instrument used to identify a patient’s level-of-consciousness (Chou et al., 2017). The GCS consists of 3 items: eye (scored 1 to 4), verbal (scored 1 to 5), and motor (scored 1 to 6); scores are summed to obtain the total GCS score, ranging from 3 to 15; lower scores indicating lower levels of consciousness (Chou et al., 2017). Symptoms include amnesia lasting for less than 24 hours, headaches, nausea, vomiting, confusion, disorientation, attention deficit, dizziness, and inability to concentrate for days after the injury (McCance & Huether, 2019).

Next, moderate TBI’s can be categorized as a loss of consciousness lasting longer than 30 minutes, amnesia lasting longer than 24 hours, and a GCS between 8 and 13 (McCance & Huether, 2019). Symptoms that may be present are confusion, amnesia, deficits in attention, vigilance, memory, data processing, vision, perception, and language (McCance & Huether, 2019). These are symptoms that can last a lifetime after the injury has healed.

Finally, severe TBI’s are categorized as having a GCS less than 8 and loss of consciousness lasting more than 24 hours (McCance & Huether, 2019). Symptoms that may be present are decreased pupillary reactions, posturing such as decorticate and decerebrate, intercranial pressures increasing over a 4-to-6-day period, and immediate autonomic dysreflexia (McCance & Huether, 2019). Per McCance and Huether (2019), “Autonomic dysreflexia is a sudden, life-threatening massive reflex systemic discharge associated with spinal cord injuries at the level of T6 or above”. Symptoms of autonomic dysreflexia consist of paroxysmal hypertension, a pounding headache, blurred vision, sweating above the level of lesion, flushed skin above the level of lesion, nasal congestion, nausea, piloerection, and bradycardia (McCance & Huether, 2019). Due to the severity of an injury like this there will be lifelong complications with a patients coordination, communication, and ability to learn (McCance & Huether, 2019). These injuries also come with a 14% chance of remaining in a lifelong vegetative state (McCance & Huether, 2019).

SOLUTION TO THE DISCUSSION POST

Discussion 4 Response (805) (Lauren Henn)

Hi Lauren Henn, traumatic brain injury ultimately exists in three forms: mild and moderate, as stated in your post. It is vital to note that the signs and symptoms of mild and moderate traumatic brain injury are almost the same. A difference exists between the persistence of symptom relation with time. I agree that your post depicts the time frame of each persistent symptom between the three levels of traumatic brain injury. Mild TBI is characterized by a traumatic force that completely disrupts brain function. Signs experienced range from dizziness, confusion, headache, and slurred speech not prolonging more than 30 minutes. Your post explicitly indicates the significance of using the Glasgow coma scale to relate mild, moderate, and severe TBI. The Glasgow coma scale of mild traumatic injury ranges from 13 to 15 (Capizzi t al., 2020).

Moderate traumatic brain injury entails when the symptoms seen in mild traumatic brain injury prolong for more than 3 minutes.   The Glasgow coma scale ranges from 8 to 12. Symptoms associated with moderate TBI include confusion, disorientation, slurred vision, and memory loss. Additionally, symptoms from Moderate TBI require immediate intervention such as computed tomography. However, moderate TBI affects cognitive, physical, and sensory functions.

Finally, severe traumatic brain injury occurs when the traumatic force extensively affects the brain’s normal function, contributing to lifelong complications, as depicted by the post. Since the central nervous system is intertwined with spinal cord function, symptoms of autonomic dysreflexia may occur. Its symptoms range from physical, cognitive, and sensory symptoms requiring urgent medical interventions. Severe TBI ends up in a state of coma, with a Glasgow coma scale of less than 8 (Najem et al., 2018). Physical symptoms of severe TBI include; complete loss of consciousness, convulsions or seizures, persistent headache or headache that worsens,  dilation o both or one pupil,  sudden swelling or bruises behind the ears or around the eyes, and loss of coordination and balance. Sensory symptoms include blurred vision, double vision, and sensitivity to light or sound. Cognitive symptoms include coma and profound confusion.

References

Capizzi, A., Woo, J., & Verduzco-Gutierrez, M. (2020). Traumatic brain injury: an overview of epidemiology, pathophysiology, and medical management. Medical Clinics, 104(2), 213 238.

Najem, D., Rennie, K., Ribecco-Lutkiewicz, M., Ly, D., Haukenfrers, J., Liu, Q., & Bani-Yaghoub, M. (2018). Traumatic brain injury: classification, models, and markers. Biochemistry and cell biology, 96(4), 391-406.

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