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
