Sister lookout for patients with craniocerebral injuries. With chills to the brain

18. Nursing process in case of closed craniocerebral trauma: strius to the brain. Relevant problems of the patient, fallow and independent nursing involvement.

Brain strius- the most common form of the brain earning is, of course, easy for the course and result; at the same time, there is a lot of functional support without the need to talk to the brain.

Symptoms. Recurrent symptoms: short-term (from decilkoh seconds to 15-20 min) loss of evidence, retro- or anterograde amnesia, nudota, disposable bloating. Patient's types of scarg: headache, zapamorochennya, noise in the vuhah, bil when rus real apples, Pitlivist. Ailments blidiy, dikhannya often, overt, sposter tachycardia; temperature і АТ value without change. The cysts of the skull are not lumpy. The grip of the spinal cord in the norm. functional rozladi The central nervous system is saved for 10-12 days. Some patients are susceptible to post-concussion syndrome - sleeplessness, spoilage, light stupidity, malaise, pity.

lykuvannya conservatively with the obligatory hospitalization in neurosurgical and traumatological education. Those who are guilty are subject to suvorogo post-regime for 10-14 days; I will take care of my physical and mental calmness. Dehydration therapy is carried out: internal (i / v) introduction of glucose, ascorbic acid, supplemental dimedrol, vitamins of group B; vseredin priznachayut tablets of analgesics.

With a blow to the brain

19. Nursing process in case of closed craniocerebral trauma: clogged brain problems of the patient, fallow and independent nursing involvement.

Fuck your brain- the price of brain speech from the insignificant (other bloodshed in the suffering of the disease and the embryo) to the important (the development of the brain tissue). Fractures of the cranial cysts, the presence of blood in the spinal cord, the diagnosis is confirmed. V cool paintings In addition to the symptoms of zagalomoskovy, they can clearly stand in the signs of symptoms, which are characteristic of the urazhenoi dilyanka in the brain. Vidіlyayut 3 steps to clog the brain: easy, average, important.

symptoms. With an easy step The testimony is determined by the decile of dozens of quills until the decile (1-3 years). Symptoms: amnesia, nudity, bloating. Patient turbine head bil, zamorochennya. There are middling symptoms: collapse of collapse and sensitivity on the side of the body, against a blow to the brain; rozladi movi, zoru; the paresis of the minutiae of the face and of the voices of the mov; easy anisocoria; nistagm. The grip of the spinal cord is often deformable. morphological changes subarachnoid hemorrhage manifests itself, as supervoduzhuyutsya spasm of the sudin. To this, when the symptoms of a convulsive spasm are eliminated, the symptoms of a clogged brain with an easy step regress for 2-3 days.

At the middle step The testimony is to be found in dozens of decils to dobi. The patients have amnesia, they are susceptible to psychotic deterioration, restlessness, bagatoraz blues. Pulse rate fluctuates (brady-abo tachycardia), arterial grip and temperature rise (subfebrile), part of the response without disturbed rhythm. Variations in cognitive symptoms: impaired pupillary reaction, okorukhovy dislocations, nistagmus, paresis of symptoms, sensitivity disorder. Progressively stretching 3-5 times. middling symptoms smoothen. rіzke pіdvischennya internal cranial vise wiklikє distribution of functions of the central nervous system.

Kick a heavy step characterized by certificates of certificates from decilcoh years to decilcochtis. Vibrations and trivially occurring in the symptoms of cerebrovascular accidents: hyperthermia (up to 39-40 ° C), disruption to the rhythm of the dichotomy, brady, or tachycardia, arterial hypertension... Dominate neurological symptoms: deterioration of the diameter and reaction of the light, okorukhovy problems, the reduction of corneal reflexes and contamination of the brain. The grip of the spinal cord is rapidly shifted. The zalny camp will be overwhelmed with an important stretch of bagatoo dib and often end in death.

In case of positive dynamics of brainwash and middling, the symptoms become more common, and rudimentary and mental deterioration is overwhelmed by all life.

lykuvannya brain damage is carried out in the minds of health care facilities, mainly focused on combating a hostile mental deficiency - renewal of safety dikhalnyh nobles(Introducing an air duct, intubation, piece ventilation of legends, inglyatsiya sisnyu). To fight against the movement of the internal cranial vise intravenously, glucose, sechovina, manitol, lasix, novokain are injected. For lowering the temperature of the i / m, amidopyrine and analgin are prescribed 3-4 times per dose. In case of an important form of brain clogging, a combination of lithic sums (diphenhydramine, pipolphene, aminazine, tizercin, pentamin) is administered. Transfusion therapy is carried out up to 3-4 liters for a supplement. For the improvement of the brain supply, acid is injected intravenously with 20% sodium hydroxybutyrate (GHB), 40-80 ml per dose.

Traumatic brain injury (TBI), type, classification.
Klinika TBI (closed TBI and closed TBI)
Deposition and inheritance of TBI.
Unavoidable assistance and transportation of ailments from TBI.
injury spinal cord(Klinika, unavailable assistance, transportation of ailments).
The principle of antishock therapy for TBI and spinal cord injury (SM).
Particulars to look after the ailments from TBI and SM injuries.

TBI - the most widening of the type of injuries and become close to 40% of all injuries.

Classification of TBI

Zakrita- ZChMT - trauma, when there is no loss of soft tissues of the head, or of up to aponeurosis, as well as fractures of the crypt of the skull without the ears of the soft tissues.
vidkrit- OChMT - including the reduction of soft tissues of the head and aponeurosis, as well as a fracture of the base of the skull. A) Penetrating - for the pockets of the dura mater. B) non-penetrating - without її ushkodzhen.

At the CLI clinic they see: Strus, Zabiy, Zdavlenya.

Brain strius - the whole TBI is easy, when there is a mild gross lesion of the NA, and there is a reflexive impairment of the blood circulation, liquorodynamics and neurodynamics. Clients are encouraged to experience: a short-hour loss of testimony on a block of chilin, because of a headball, blotting, memory loss in a retrograde amnesia (on the side, when overdue injuries), vegetative disorders When looking around, you can see the same: nistagmus, ailment with Russian apples.

Fuck your brain - important trauma. Hit vinikayut at CCMT і OCMT, can supravodzhuvatisya blood in the cerebral cavity or subarachnoid. When hitting at the moment of impact, it is more often that the frontal pole and early part... There are three stages of clogging up the brain.

Hammer an easy step - deafening of svidomostі at viglyadі stunned or sopor up to 2 years. In addition to hypoglycemic syndrome (headache, bloating) and vegetative symptoms, there are gross and middling symptoms - mild paresis, slight impairment of sensitivity. Symptoms regress after 2-3 months.
Hammer the middle step - loss of property up to 4-6 years. Zagalomoskovy syndrome of bends is stronger, more gross vignischevia: hemiparesis, hemianesthesia, aphasia, amblyopathy, hypoacusia. Fractures of the crypt of the skull are not often spared.
Kick a heavy step - loss of quality from decilcoh years to decilcoh dates. It can be psychomotor zbudzhennya. Violation of the rhythm of the dichanya and the heart's activity. Floating apples, lower reaction of zinits to light, gross paresis, inodi sudom. Hammering a heavy step, as a rule, is supervised by a fracture of the crypt and the base of the skull, massive subarachnoid hemorrhages. Regression of symptoms in general, characteristic of gross surplus manifestations - rukov and mental.

squeezing the brain - the cause of this can be hematomas (epidural, subdural, intracerebral), depressed fractures of the cranial cysts. Characteristic is the appearance of light progress (period of obvious well-being) due to injuries. Falsely due to the severity of injuries, we can be trivial, we erase every day, in the middle of the day become 12-36 years old. After a whole hour, a headache, bloating is unsuccessful, there is a meningial syndrome, progression of the disease, bradycardia, sudomi, hemiparesis on the protylezhny bots, anizocoria (extended winter on bots).

TBI. Including fracture of the crypt of the skull and base of the skull. In case of a fracture of the crypt of the skull, the ears of the cysts should be formed by the hard cerebral membrane and the speech to the brain.

Fracture of the base of the skull - in the class of symptoms of a struma or clogged, bleeding from the nose and vuh, the symptom of "eyepieces" - through the penetration of blood into the area near the eyes to the cell, lykvorrhea - vitiations from the nose and vuh. Characteristic is the censorship of the CHMN: green, front, front-door-ultkovy at the viglyadi amblyopia, hypoacusia, asymmetry of the individual. The sickness is grave, may be accelerated: meningitis, meningoencephalitis, abscess to the brain.

Dodatkovi obsozhennya in TBI.

X-ray of the skull
Insight into the bottom
CT and MRI
EXO-EG

Warehouse and legacy of TBI:

early (Up to 3 months) - meningitis, meningoencephalitis, brain abscess, osteomyelitis.

Pizni. 1) Post-traumatic epilepsy- the nature of the attacks lies in the localization of the fire, and in its basis the establishment of a tissue scar. 2) post-traumatic pains- to be molded in the bloodstream. Vyavlyayetsya by judges, progressive destructions of the psyche, paresis of m'yaz_v k_nts_vok. 3) Hypertensive-hydrocephalic syndrome- to be molded on aphids and transmitted by a state road in shells. To appear with dull headaches, you can do it with nagging and turning of the head, tediousness and blues. 4) cerebrasthenic syndrome. Appear with stomachache, sleep disturbances, headaches, vegetative disturbances.

nadannya inconvenient help

Viklikati lykarya, I will help the shvidka.
Take care of the victim's vitiagti.
Sounds like a squeeze.
Put your head down to the softness. Cold on the head.
Control of AT, pulse, dikhannya.
With blues, turn your head to the bik.
Cross the zapadannya language, clean the mouth empty out of the sludge.
In case of bleeding from the nose and vuh - a toilet of the nose, vuh, tamponade with sterile servetka.
at in the early days Apply an aseptic bandage.
In case of damaged dikhannya - SHVL.

Transport the ailments on the wearers, pushing their heads down to the meat, fixing them from the sides with rollers.

Hospitalization of ailments in neurosurgical treatment, with an important TBI in resuscitation. Drug treatment inclusive - dehydrogenation coughs (furasemide, manitol), which reduce cerebral blood circulation (cavinton, vinpocetin), nootropics (nootropil, piracetam), analgesics, normalization of hemodynamics (polyglucose) With TBI from the first day - antibiotics. not more than 12 years ago, after injuries, a counterpart was introduced.

Spinal cord injury.

Yak, as a rule, to feast on the injury of the ridge. The spinal cord is suffering from fractures of the ridges (compression, splinter). Morphologically, it manifests itself as a swelling of roots, sheaths, speech in the brain, vignettes of blood and necrosis. The forms of SM injuries are also like GM: scab, slaughter, pressurization. hematomyєliya - bleeding into the thread of the CM. Hematocharis - hemorrhaging in the shell of the CM.

Spinal cord strius — easy form, Manifest parasthesia, hypesthesia, slight weakness in the legs, pelvic dislocations (overlap, constipation), pain in the trauma. There are short hours of damage, the functions are updated in 2-3 times.

Hammer the spinal cord - beckon to walk with the fracture of the arch of the ridge and change to the spinal canal. It is clinically manifested by korintsevym pains (shooting, drooping), impaired sensitivity from the level of striking, blistering paresis and plegia, pelvic dislocations.

Type of debris sechovipuskannya lie in the form of injuries: Poshkodzhennya cross-kryzhova viddilu yes, a reference to the non-scrutiny of the sprinkler (vidіlennya її on the splinters), for the sake of the sight of the sphinkter in the world. Poshkodzhennya vishche explanatory-krestovoe rivnya Yes, you will be able to catch up with it, and then you will be periodically unattractive.

Spinal cord injury - vinikє in case of replacement of til ridges, in case of confirmed hematomas. The clinitsi are susceptible to: pain, paresthesia, malaria paresis of myaziv, damaged trophies, - below the level of the ear. In the first year after injuries through spinal shock, the severity of the injury is important.

spinal shock- the reason for the reflex action of the SM, manifested by the syndrome of repeated interruptions - ceregia, anesthesia, pelvic and trophic disruptions. Trivay up to 2-3 dB. Ailments from the injury of the SM are due to the term hospitalization in neurosurgery or the reanimation of medical treatment by the machine of the joint venture.

Unavailable assistance

Viklikati likarya, SP.
The victim should be laid down on the shield, fixing it in place. The position of the person is strictly horizontal.
in case of injury shyny viddilu the ridge - transport on the back, shyu fiksuvati cotton-gauze comir Shants. For the prevention of bedsores in the area, rollers on top of the bed, scapula, kryzhi, five.
in case of injury breastfeeding- on the belly - turn your head to the bik, kintzivki fiksuvati.
Vimіryati arterial grip, pulse, frequency of movement.
In case of early breakdown, an aseptic dressing is applied.

Principles of anti-shock therapy for TBI and RM injury:

Znebolyuchі zasobi: Analgin 4 ml in / in at once from relanium 1-2 ml, in important drops - narcotic analgesics.
Prednizolone 60-90 ml.
40% roschin glucose 10-20 ml i.v.
For normalization of heart activity-strophanthin, korglikon.

In the case of a person's mortgage, to carry out the following: X-ray, CT, EXO-EG, MRI, to see if there is a need for an operative treatment. s medications stasis: antibiotics, vitamins B, nootropics, boistimulators, anticholinesterases, exercise therapy, massage, physiotherapy.

Peculiarities of looking for ailments from TBI and SM injuries:

Dotrimuvatisya sanitary-hygienic regime.
All gіgієnіchnі come in to carry out the bed.
Prophylaxis of congestive pneumonia: changes in the condition of the skin for 2-3 years; vibrating massage of the back, breasts; carry out dichny gymnastics; put cans, mustard (for the signs of the liquor).
Prevention of contractures - the arrangement of paralized patterns.
Control over the functions of the pelvic organs. Naybіlsh nebіlsh

Nursing involvement in the event of a catheterization: reflex provocations, with the help of prevention of urosepsis, to carry out catheterization sectional mikhura 2 times a day, when you can visibly wash it out with furatsilina. With non-trivial slaughter, you can develop ignition process To that, the sečovy mіkhur is also washed out by inserting a permanent catheter.

At the 1st stage of the nursing process, the nurse took an anamnesis, took care of the injuries, as well as the patient at the svidomosty. As soon as it’s wrong for an unaware country, it’s possible to recognize the trauma as witnesses to the trauma. In case of taking an anamnesis in the near-term indication of the injury, there may be dates of the individual who delivered the sick person to the hospital.

When looking around the head and revealing the nurse can reveal the appearance of sadness, wounds, defects in the cyst, hematomas, vitiations spinal cord(Likvoru) from the nose, vuh. The shape of an individual can be a bit of a lower slit, breaking a slit, and also the loss of teeth. When the patient is obstinate, there is evidence of witness, winter and horny reflexes, the nature of the behavior, pulse, arterial grip. Palpation of cysts of the crypt of the skull, individuals are carried out even more carefully. Pressing, zapadannya, krepіtatsіya, abnormal rupture to indicate a fracture.

Tse allow you to formulate a nursing diagnosis (2nd stage of the nursing process).

Physiological problems of the patient:

· Head b_l;
· Loss of svidomostі;
· Amnesia;
· Rozlad reflexiv (zinichnyh, rogivkovyh);
· Rozlad hearing;
· Rozlad zoru;
· Rozlad movi;
· Loose bite;
· Deformation of the heads;
· Crepіtatsіya;
· Paresis, parallel;
· Zmіna frequency and pulse (bradycardia abo tachycardia);
· Zm_na value of AT;
· Rozlad dikhannya.

Psychological problems of the patient:

· Dratіvlivіst abo depression;
· Deficiency of spilkuvannya;
· Lack of knowledge about trauma inheritance;
· Fear of death.

At the 3rd stage of the nursing process, a meta and a plan for nursing are put together.

4th stage of the nursing process of assignment to the plan of the sister's plan to look at the urahuvannya m_stsya znakhozhennya paciєnta. So, at the center of the pod, the nurse is planning to dolikarskoy additional helpі zdіjsnyu її, according to the algorithms for dіy. The neurosurgical treatment of LPZ has gotten patients up to special methods of pre-treatment:
1) Spinal puncture.
2) Craniography.
3) Computer tomography.
4) EEG.
5) Ultrasound echoencephalography.

All patients with TBI are guilty of being examined by a neurologist and an oculist. Patients with slit-facial trauma are hospitalized in the form of slit-facial surgery. Warehouse nurse plan for preoperative training, for the operative look at the patients who require promptly, The first visit is planned for nursing.

The nurse assesses the result of her work (the 5th stage of the nursing process).

Injury of soft fabrics the result is severe bleeding due to good blood flow. With a lot of ears: shkіra, aponeurosis, mucous and okistia. Can be scalped wounds.

Priority problems of the patient: bleeding, especially when growing and rubbing wounds; zyannya; b_l.

Algorithm for getting some extra help:

· Zupiniti is bleeding.
· Apply an aseptic bandage.
· Zneboliti for great wounds.
· Transport to health care facilities (position - lying on the back with the head raised by 10 °).

Transport immobilization of the head. At the health care facility, a nurse will take care of the PHO with weld overlays and prophylaxis.

extradural injury- there is a big trauma, as it will cause the cranial cyst to be posed. Often supravodzhutsya concussion brain, hemorrhages. The price of injury is not penetrating, so as not to break the integrity of the dura mater - the cordon of the empty skull.

Intradural injury- the wound penetrates into the empty space of the skull, so the integrity of the dura mater will be destroyed. At the connection with the great ruinous speeches of the brain and the life of the important centers dovzhastogo brain wounds are often fatal. The severity of the injury is explained by the movement of the intracranial vise and the damage of the nuclei of the cranial nerves.

Nursing diagnosis is put on the display and the situation. Nurse vyavlya mіscevі pozhkozhennya, zagalnomoskovі and middling symptoms and formula of the problem of the patient.

Priority problems of the patient at the school of education ryasna bleeding; vitality of liquor and rudimentary speech to the brain (detritus); the appearance of cultural openings.

Priority problems of the patient, enveloping with an internal cranial grip: loss of evidence; psychomotor zbujennya; bradycardia; blues; the rigidity of the link and the link of the link; mimovіlіnі sečovіlnі and defecation.

If you come to terms with the problems, the change in the cranial nerves: the asymmetry of the individual; ruinous movi; hearing; relish; scent; okorukhovyh functions; paresis; parallel. The prognosis of life is based on the laxity of the symptoms of the brain, and the prognosis of the disability is based on the symptoms of the disease.

potential problems pacinta tied with penetration of infection into the emptying of the skull and the brain: risk of diagnosis of meningitis, abscess.

Algorithm for dolikarskoy additional help:

· Timchasova zupinka bleeding.
· The sound of the patient in the grip of the commander.
· Apply an aseptic bandage (for vibuhanna cerebral speech - with a "donut"),
Assessment of the victim's camp:
· Yakshcho vіn at svidomostі: put on a stretcher on the back, put on the head with a cotton-gauze circle or a pillow (lift the head by 10 °);
· Even without evidence: reconsider the passage of the upper dichally nobles, if necessary; layering in the style of life.
· Apply cold to the point of injury.
· Conduct sickness and simple problems, come in with great wounds.
· Transport to health care facilities.
Pid hour of transport:
· Bezpechuvati passages of the upper dichal nobles;
· Restruvati stan of the patient (pulse, AT, CHDD) skin 10 min.

Nursing help for fractures of the cranial cysts.

Fractures of the cranial cysts are subdivided into fractures of the crypt and the base.

Break the crypt of the skull- there are direct injuries, the stench can be closed and visible (in the presence of injuries). Problems of a patient with severe fractures: loss of svidomosty; local soreness; hematoma; deformation. Problems of the patient with acute fractures: defect of the shkiri; zyannya; bleeding; depression or looseness of the brush.

Break the base of the skull - there are indirect injuries: hitting the head with water on the bottom, landing on your feet when falling from the sky. Cranial trauma is not important because of the damage to the integrity of the dura mater, and infection can penetrate into the empty space of the skull from the nose, sinuses, Hearing passages. Priority problems of the patient: making a link with a family from home, because it is clear; sants appeared in 1-2 days with injuries. The mice of the end of the spinal cord and the formation of the sinuses lie in the localization of the fracture. Signs of a fracture of the base of the skull by localization (Div. Dodatok 9)

Potential problems of the patient: risk of infarction of the brain and its shell, loss of pre-medication and invalidization, death through asphyxia.

Particularities of the necessary assistance in case of fractures of the base of the skull: a slight tamponade of the outer ear canal or of the anterior nasal passages in the presence of the localization of the skull.

Sister dopoga in case of severe skull injuries

Zakriti vidi TBI - tse strus to the brain, the reason is a blow or a fall, scho wiklikayut blood points into the brainwave; hammering the brain, the reason is a blow of the brain tissue about the cranium, when the brain tissue is rattling (cutting, cutting, bleeding); Pressing the brain is drawn behind the rakhunok of the intracranial hemorrhage, the brain is filled with fragments of the cyst.

Diagnostics of the ears of the brain is twisted for an hour for patients. When the TBI is closed, the patient's problems are formulated by the nurse at the stage of the cerebral osteoarthritis and symptoms.

Library Neurology Watching for ailments in the brain

Watching for ailments in the brain

For a human, written from a license, writing a brain to a brain, it is necessary to respectfully sponsor for a stretch of one or two days, so that you can slow down. If you happen to catch a glimpse of such ailments, take care of such prompts:

1. In the first place, once you have woken up the patient and set the next meal:

Yak call you?
Do you know children?
Who am I like that?

If it’s not a mistake, or if I can’t tell you, you should inaccurately click on the license.

2. At the same time, take a look at the words of the doctor for the first 48 years, call the stench to turn on the next step:

Do not be too lazy to get busy і step by step go to the most extravagant way of living.
Avoid getting too strong a headache. Do not take aspirin, as it may be possible to manage internal bleeding, as a result of injuries. Try it head b_l, Lying with a raised head.
Eat lightly, especially when you are bored and bloated (blotching is not easy, it’s a little guilty to stick through a few days).

3. Wikite the drug or take the patient to the drug at once, if you remember:

posilennya zapokoєnnya abo zmіni osostosti;
to admit it;
hazy evidence;
sudomi;
a strong headache, which is not familiar with Tylenol;
strong or without interruption of vomiting;
lack of clarity;
abnormal eyes;
stumble on the move.

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Entry

1. Theoretical part

1.2 Classifications of head injuries

1.5 Crack the brain

1.6 Disease of the brain

1.7 Fractures of the base of the skull Fractures of the base of the skull

2.1 nursing process

2.2 the sisterly dogglyad

visnovok

List of Victory Literature

supplement

brain trauma sisterly

Entry

When I was building, I’ll not clutter up our brain very much. Aje vin abductions on the basis of the program. Yogo omivaє is a special place, as it will not only give the brain a dodatkova harchuvannya, but serve as a kind of shock absorber. Mozok in the grout with balls of shells. I’m sorry, I’m just hoping to get lost in the skull. Protest, head injuries often end up with serious brain problems for people.

Craniocerebral trauma is one of the most significant in the protection of health. Tse pondered:

1) the widening of the mass population (in the middle in the light of 2-4 per 1000 population in the Rik) with the greatest susceptibility to children, especially the young and young middle age;

2) high lethality and invalidization of the patient, the heavy inheritance from the old, or the hourly second proclamation, superbly economically cumbersome for the family, the suspension of the whole power;

3) critical anthropogenic and technogenic craniocerebral trauma.

In light craniocerebral trauma, as the cause of death of the population is borrowed from the third place, deprived of heart-and-brain and oncological diseases. However, the middle of children, especially the young and young middle age, have left their "competitors" far behind, surpassing the mortality rate in cases of heart disease by 10, and to cancer - by 20 times. With a large increase in 50%, the cause of death is caused by traumatism, the brain is damaged. Craniocerebral trauma is one of the main reasons for the disability of the population. In Russia, such an injury is the cause of death to go to another place, entering into the whole leadership deprived of the heart-and-heart disease. Shorіchno craniocerebral trauma otrimuyut close to 600 yew. Cholovik, 50 yew. For them to go, and more than 50 yew. Stayu invalids. The frequency of craniocerebral injuries in choloviks is twofold higher than in females because of the sparing of the number of fallows in all groups. The most common reasons are car trauma and side injuries. A craniocerebral trauma occurs more often, less often, and close to 90% of all traumatic lesions of the brain. In the midst of head injuries, the strus brain is lost persevere.

The head of the primary prevention of traumatism in the brain and craniocerebral zokrem lies in the posture of medicine and is clearly linked to the social structure and development of the suspension. Treatment of sufferers with traumatic brain injury, second prevention of patients with traumatic diseases and rapid progress to the competence of health protection and the first for all clinicians-neurosurgeons, neurologists, rheumatologists, psychiatrists Їх proper training for craniocerebral trauma to complete a folding and far from being a problem.

In the operative treatment of cerebral ears and their inheritances, they have become widely used in minimally invasive techniques, reconstructive involvement, microneurosurgery, new technology and new medical technologies. We rejected the approval and knowledge of the concept of early and diffuse diseases, primary and secondary lesions of the brain, phasic interruption of advanced forms of craniocerebral trauma. At the pidsumku I learned the sutta of the tactics of dealing with victims of traumatic brain injury. Apparently, they are guilty of changing and technology to look after the victims. The very cim and the relevance of this robot begins.

metadoslіdzhennya:

Organization of nursing process in traumatic brain injury.

zavdannyadoslіdzhennya:

1. Conduct a review of the literature on topics of advancement.

2. Investigation of the history of ailments of patients of traumatological diagnosis.

3. To conduct an analysis of statistical data on traumatism of the State Healthcare Institution "Duldurginskaya Central District Hospital".

4. Vivchit especially to look for ailments with craniocerebral injuries on the butt of a nursing look after patients of traumatology.

ob'єktdoslіdzhennya:

Nursing process and method of organizing and visiting nursing eyes for patients with craniocerebral trauma. The pre-treatment was carried out on the basis of the DNZ "Duldurginskaya Central District Likarna".

hypothesis:

Timely and correct nursing process in case of craniocerebral trauma to allow the polypsy of the disease, rehabilitation and change in the reduction of ailments.

methods:

1. Inspection of the scientific literature.

2. Fighting for an hour before the diploma practice for ailments with craniocerebral trauma.

3. Statistical data on the State Healthcare Institution "Duldurginskaya TsRL".

4. Analysis of scientific literature and previous materials.

1. Theoretical part

1.1 General views on craniocerebral trauma

Craniocerebral trauma (TBI) is a mechanical degradation of the skull, brain and shell. When the brain is damaged, cerebral blood circulation, cerebrospinal fluid circulation, penetration of the hematoencephalic bar are diagnosed. The brain grows up, like at once with the other pathological reactions, the formation of the internal cranial vise is accumulated. Zsuv і pressure of the brain can be produced before the wedging of the cerebral stovbur into the opening of the cerebellar tentorium, or in the great potilichny opening. Tse, in its own turn, wicked away the destruction of blood circulation, metabolism and functional activity of the brain. An unfriendly factor of damage to the brain є hypoxia due to damage to the brain or to a decrease in systemic arterial vise... To develop a craniocerebral trauma, when they are out of the way, wash the brain and its shell for information, and when it comes to the brain, which often leads to development infectious diseases from the side of the cerebral membranes (meningit) and the brain (abscess, encephalitis). Prior to close injuries, all types of craniocerebral ears are known, with which the integrity of the scalp cover of the head will not be damaged, and the wounds of soft tissues, which do not supervise the aponeurosis.

For craniocerebral injuries, it is characteristic that the soft covers of the head and cranial cysts are instantly lost. It’s because of the damage to the integrity of the dura mater, which I call it penetrating, in which the infarction of the brain is not safe is especially large. Scallop of the skull can be found in the eyes of thrusts, frequent and depressed fractures, fractures of the cysts of the base of the skull.

Signs of a fracture of the base of the skull sinus near the eyes near the eyepieces, bleeding and vitality from the nose and nose.

clinical symptoms traumatic ear to develop from zagalomozkovyh symptoms and muscular disorders, which are summarized by the size of the singing dishes to the brain. Give the first help to the Polyaga, the first for everything, in the increased consumption of blood, spinal spinal cord, or bluish masses in the dizzy way.

Diagnosis of craniocerebral trauma should be based on anamnesis key signs ear to the brain and all curves. To clarify the diagnosis, use the instrumental methods of diagnosis.

All sufferers of traumatic brain injury X-ray signs skull (craniography), slither in 2 projections - bichny and straight. The stench permits the appearance (or viklyuchi) of the tremors and fractures of the bones of the crypt of the skull.

The identification of fractures in the cysts of the base of the skull is not readily visible for recognizing special styling, however, the manifestation of bleeding, or especially liquor from the nose, or else it is allowed to start in a classy way. Echoencephalography allows the compression of the brain to occur as a result of internal cranial hematoma, hygromy, or in the presence of brain growth.

The most informative method for diagnosing craniocerebral trauma is a computer X-ray tomography, which gives an indication of the breakdown of anatomical and topographic spines in the skull. For the change in tissue production, it is necessary to establish growth, the nature of the stages of brain damage, the basis of the cerebral cysts and internal hematomas and hygromies, subarachnoid and internal diseases of the brain, such as blood cells For the development of enveloped hematomas, cerebral angiography is stagnant, as in case of revealed changes in magistral vessels, which is especially characteristic of cych hematomas of the non-vascular zone on the angiogram, allowing the development of a lack of locks

The general nature of the visit to the brain is severe and the type of craniocerebral trauma, various factors in the brain and internal cranial hypertension, impaired cerebral blood circulation, cerebrospinal fluid circulation, brain metabolism and such vegetative functions.

1.2 Classification of head injuries

vidkritiushkojennya.(Div. Appendix 8)

In case of craniocerebral trauma, fractures of the crypts of the crypt, or the base of the skull with injuries to the lingering tissues, bleeding, the end of the nose from the nose or air, as well as the development of the aponeurosis of the head with wounds

When the dura mater is intact, it can be infiltrated with craniocerebral trauma, and when it is not penetrated, it can be penetrated. Just be-like postcranial postcranial injury, craniocerebral trauma is isolated.

Zakriti poshkojennya.

When a craniocerebral trauma is closed, the aponeurosis is not shkodzheniya, if the shkira can be shkodzhena.

Strus in the brain is a trauma, when there are no strong damages in the brain. All the symptoms that occur in a struma should be known in an hour (stretching out a few days). Stike of preserving symptoms є I am familiar with more serious brain damage. The main criteria for the severity of the brain are triviality (from decile seconds to years) and the amount of glybin in the loss of evidence and amnesia. Chi not specific symptoms- tediousness, blues, blistering curls, broken heart.

Brain pressure (hematoma, alien til, Povitryam, occasional blow).

Fuck your brain

Diffusion axonal ear.

Subarachnoid hemorrhage.

day

One hour you can prevent the development of other types of craniocerebral injuries: slaughter and hematoma, slaughter and subarachnoid hemorrhage, diffuse axonal auricular and heal, cerebral hemorrhage, subarachnoid hemorrhage

According to the severity of craniocerebral trauma, there are:

Mild TBI - strus and hammer in the brain of the lung step

Medium severity - hammer the brain of the middle step

Important - hammer the brain of an important step that pressurizes the brain in the state of the art.

Sister dopoga in case of severe head injuries.

The reason for the head injury is a direct blow, in the fire-wound.

Classification of injury:

Glibina poshkojennya:

· Injury of soft tissues of the head;

· Extradural injury;

· Intradural injury.

Localization of the ear:

· Tim'yana region;

· Potilichna area;

· Lobova region;

· Skronev region.

Hid wound canal:

· Slipe injured;

· Naskr_zne wounded;

· Dotically injured.

1.3 Closed craniocerebral trauma

the main key forms craniocerebral trauma є strius to the brain, poor brain (easy, middle that important step), brain compression , fractures of the crypts of the crypt or the base of the skull.

1.4 Brain strius

The strius of the brain is functionally a werewolf of the brain's ear with a short-time second svidomost. The strius of the brain is prone to manifest itself in the second degree of triviality (from a few seconds to a few chilins).

Headache, nudota, some blues, ailments may not be remembered, but the trauma was overwhelmed, and the very moment (retrograde amnesia), forcibly made people feel sick. The loss of memory є with an important acquaintance, for what it is possible to judge the severity of the ear for the brain: if the memory of a person is the moment of trauma, if it’s not, then there’s a great shambles an hour before the trauma came from his memory. More memory failure, more serious injury!

Life is important functions are not damaged, in the cognitive neurological symptomatology of the day.

Children with ailments need to have a weakness, headache, instability court system, Increased efficiency, reduction of prasezdatnost. In the first year, the brain was struck by the patient's enlargement or the sound of the brain - a craniocerebral trauma of any degree of severity could lead to the destruction of the nerve paths, which led to the robot's eyes. With light chills, the brain of the brain responds to light, ale, and with an important reaction, every day is called. At the same time, the expansion of only one of the brain and the visibility of the reaction of the other is a terrible symptom, and you can talk about an important clogged brain.

Hospitalization of obov'yazkov, some of the symptoms of stricture and more important brain injuries (for example, a brain injury or internal cranial hemorrhage) may be identical. Only a likar can be significant, as the injury itself is borne out. Obov'yazkovo can be known roentgenologic obsozhennya (sign of the cranial cysts) with the sign of a fracture of the cranial cysts.

In case of striae of the brain, conduct a conservative treatment: prescribe non-narcotic analgesics for pain, antibacterial drugs in the presence of wounds of soft tissues, sedation and sleepiness, a rest regime for 7-10 dB.

We are sick of the brain, it is necessary to take care of the post-regime, when it’s impossible to read, listen to music and watch TV. A slid of memory, which in a human being, who transmits a slight chill to the brain, may develop post-traumatic neurosis, or even more serious acceleration, for example, epilepsy. Tom, in a dozen hour, he must undergo an electroencephalography and treatment with a neuropathologist.

1.5 Crack the brain

Loss of the brain is a craniocerebral trauma, which is characterized by incipient ears of the cerebral speech of the risky step gravity. The price of brain speech is insignificant, as it is in the suffering of the disease, only the bloodshed and the embryo, up to the last, with the opening and crushing of the brain tissue. Loss of mobility in case of close and open craniocerebral trauma.

Pathomorphology: changes in the middle of the brain, destruction (degradation) of speech in the brain, small punctate hemorrhages (as a result of the development of the brain after the injection of a mechanic official) in the parenchymal brain, perifocal hemorrhage of the brain, traumatic fractures of the cysts of the crypt of the skull without clenching (line and splinters), fractures of the cysts of the base of the skull (with the opening of the membranes) - vitality of the spinal cord through the nis (cranial rhinorrhea) or the fractures of the hearing from the ears coverage of internal-cranial hematomas, compression of the brain.

Hammer a lung step into the brain. Become a victim of witnesses up to 1 year old due to injuries, scargs for headache, nudota, blues. The neurological status is indicated by the rhythmically smacking of the eyes when looking to the side (nistagmus), meningeal signs, asymmetry of reflexes. On roentgenograms, there can be found fractures of the cysts of the crypt of the skull. In liquor - houses of blood (subarachnoid blood).

Hammer the middle stage of the brain. The testimony is for a few years. Vipadannya memory (amnesia) on the podії, which overwhelmed the trauma, the trauma itself and the podії of her. Skargi for head bulbs, irregular blues. There are short-term changes in the behavior, the frequency of the heart is fast, the arterial grip. Can be a derailment of the psyche. Meningeal signs are indicated. Vognischeva symptoms are manifested in vigels of uneven magnitude, weakness, weakness in symptoms, etc. Craniography often reveals fractures of the crypt and the base of the skull. In case of lumbar puncture, it is a sign of subarachnoid hemorrhage.

Hammer the hard step into the brain. It is characterized by trivial victories of svidomosty (trivial up to 1-2 types). The rude ruin of life appears important functions(Change the frequency and the pulse, equal the grip, the frequency and the rhythm of the reaction, the temperature).

The neurological status is associated with signs of damage to the brain - floating crumbs of apples, broken coughs, a change in myase tone, etc. You can see weakness in the hands and feet right up to parallels, as well as attack the ship. Hammering a heavy step is supervised, as a rule, by fractures of the crypt and the base of the skull and internal cranial hemorrhages. Residual diagnosis should be based on the results of X-ray of the skull in direct and normal projections (the appearance of multiple cysts), CT and MRI. The main method of treatment is conservative: hospitalization of obov'yazkov, post-treatment, reception of vital functions, if necessary - reanimation; brain therapy; analgesics if necessary; in case of sudom - protisudomnі zasobi; s a means to reduce cerebral blood circulation and metabolism, nootropic activity.

The triviality of the post-regime when hitting a light step becomes 10-14 dB, when hitting the middle step from 2 to 3 times in the fallowness from a normal step and results instrumental doslіdzhen... With subarachnoid hemorrhage, carry out hemostatic therapy. Lumbar puncture with a diagnostic and diagnostic method should be performed when the brain is out of sight. hirurgiclykuvannya it is shown in case of a blow to the brain with crushing of its tissue (most often it is found in the area of the poles of the frontal and early parts).

With light blows to the brain of the rukhov, sensitive and іnshі rosle, you will become more aware of 2-3 times. at more important blows As a rule, you will become overwhelmed with legacy: paresis and parallel, impaired sensitivity, discomfort, you may have epileptic seizures.

1.6 Disease of the brain

Brain damage is a progressive pathological process in the emptying of the skull, which causes the compression of the brain, which is caused by injuries. With any morphological substrate, it is possible to wear compensatory mechanisms, which can lead to pressure, dislocation, wedging in the brain and the development of the life of the camp. Pressing fractures of the crypt of the skull - the cause of local compression of the brain.

The main cause of brain depression in craniocerebral trauma is the purchase of blood in a closed intracranial space. Falsely from the insertion to the membranes and to the cerebral membrane to see the epidural (to the outer layers of the dura mater, in 20% of the subdural membranes), subdural (between the dura mater and the inner membrane to the inner membrane, 70-80%), shlunochkіv mozk) hematoma; potіm vdavlenі fractures kіstok sklepіnnya skull (osoblivo proniknennya kіstkovih ulamkіv on Glibin hope 1 cm); vognischa roztroschennya mozk; perіfokalniyotok; subduralniegіgromi (obmezhene skupchennya CSF vinikaє at nadrivі arachnoid Ilya Obolonkov, zakіnchennya lіkvoru in subdural Prostir of valve mehanіzmu) and rarely pneumocephalus (buying up the head in the empty skull).

The first signs of the clenching of the brain with a build-up of bloodshed to serve as a remedy for headaches, for a sick person, navpaki, drowsiness, appear and act on the basis of an increase in the brain, as well as when the brain is hit. Signs of wedging: improvement of swelling of hypothalamic syndrome, appearance of abnormal growth of hemispheric hemispheric and stubbrow symptoms, reduction of svdomosti. The infusion of svidomosty loss, win clutter up the life the destruction of the heart, the dichotomy, and if there is no additional help, death will come. In case of a depressed fracture, the brain suffers one hour and it is compressed, and bruised, and the bulge of the brain develops quickly.

In most cases, there is a loss of testimony at the time of injury. In general, evidence can be seen. The period of renewal of the property is called a light industry. Through a few years, or even ailments, I can know how to fall into an unacceptable camp, but, as a rule, supervise growths neurological damage in vigyads, there is either a loss of paresis of symptoms, epileptic seizures, an enlargement of the brain from one side, a pulse rate (frequency less than 60 per chilin), etc.

According to the rate of development:

1) Gostrі internal cranial hematomas, which manifest themselves in the first 3 addi from the moment of injury.

2) Pidgostri - clinically manifested in the first 2 years of injury.

3) Chronic, as they are diagnosed after 2 months from the moment of injury.

Diagnostics. If the ailment is found in svidomosty, it is necessary to recover from the circumstances and the mechanism of injuries, so as the cause of the fall and a blow to the head can be an insult or an epileptic seizure. Often, ailments could not be overdue by trauma (retrograde amnesia), without the middle of an injury (anterograde amnesia), as well as the very moment of trauma (cograde amnesia).

It is necessary to quickly look around your head for jokes in the face of injuries. Blood over the nipple-like appendage often leads to a fracture of the parasitic cyst. Bilateral hemorrhage in the orbital cell (the so-called “symptom of the ocular”) may indicate a fracture of the base of the skull. To talk about bleeding and liquorrhea from the ear canal and nose. In case of fractures of the crypt of the skull before the hour of percussion the moon has a characteristic derenchly sound - "a symptom of a shaken mountain man." The main method of treatment is surgical. Inadvertent surgery: cystoplastic or resection of trepanation, decompression (seeing blood, clots, squeezing cystic ulcers) - the assertion of the cause of brain pressure, bleeding sting. Evacuation of internal cranial hematomas was followed by visonuvati for the first 4 years after injuries. may you expedite: Abscess to the brain, subdural tempo, meningitis, repeated hematoma, post-traumatic epilepsy.

1.7 Fractures of the skull

Fractures of the base of the skull - the reduction of the cysts of the value of the skull keystroke basis anterior, middle and posterior cranial fossa.

Break the base of the skull, start to break through the dura mater, to form, empty mouth, I will empty the middle vuha, I will wake up a fossa or even a sinus, and I will zoom in to nasal, erythema and post-traumatic pneumocephalus.

Clinical picture: zahalmosis damage, symptoms of damage to the cerebral stovbur and cranial nerves Often the facial with a picture of unilateral paresis of the musculature of an individual, or auditory, due to decreased hearing, bleeding and liquorrhea from the nose, or vuha, or ochinit. In connection with liquorrhea, intracranial hypotension is stimulated.

The emergence of liquorrhea leads to a post-life threat to the diagnosis of a gnay meningitis. Win may appear in the first period, may relapse. A fracture of the base of the skull can be confirmed by craniograms, ruptured according to Stanvers or Schüller. However, overcoming the head of an injured special position in a hostile period of injuries is not always possible. Besides, small fractures on the symbols may not appear. best frequent sign fracture of the base of the skull - occlusion of the midline of the nipple-like appendage of the cryopodic sinus.

Lіkuvannya conservatively - in case of suspicion for a tricep or a fracture of the base of the skull, rupture the lining shell(Abo the nose) antiseptic wrinkle with aseptic bandages applied, the sign of massive doses of antibiotics and sulfanilamides, which is why the infarction of the skull emptying is already great. The first ailments caused by craniocerebral trauma of ailments are guilty of being put on a strict post-bed regime. You need to secure free access to food. When there is a loss of evidence, there is a chance of aspirating the bloom and sludge. Dozіlno nodnachennya cold on the head. You need to enter: the introduction of plasmas and plasma monitors, antipole, sedative, vermin. For the improvement of cerebral blood circulation, cinnarizine (stugerone) or cavinton is indicated. I will reduce the hemodynamics and activate the metabolism of the brain sermion - the drugs are stagnant for all craniocerebral injuries, not only during the period of time, or even after 3-4 weeks. Krim pathogenetic therapy stasis symptomatic. Shown are also vitamins, zalnozmіtsnyuchі zasobi.

1.8 Injury to craniocerebral trauma

In case of craniocerebral trauma, the emptying of the skull is caused by the callous middle and, moreover, the temporality of infectious diseases (meningitis, abscess to the brain, osteomyelitis). At my own devil, I can see it spread to penetrate, when I do not penetrate the dura mater, I do not penetrate. In addition to the fracture of the base of the skull, nasal or ear bleeding and the end of the liquid are supravodzhuyutsya, most often there are torn-clogged wounds of the head with fractures of the cranial cysts. Unreasonable ones also cut, cut and puncture wounds. Particularly not safe, penetrating wounds to the dura mater and speech to the brain.

The main key factors, such as the onset of severe craniocerebral trauma, are: the triviality of the loss of evidence and amnesia (in some cases without the primary loss of evidence, and the general development of blood flow to the brain) steps of rotten disease at the time of hospitalization; the manifestation of stovburovoy neurological symptoms.

Reanimation come in with important craniocerebral injuries (in the head of the brain, diffuse axonal ear) pre-hospital stage... With the help of normalization of the dysfunction, it is impossible to prevent the great passage of the upper dysfunctional paths (the sound of the blood, slime, bloating masses, the introduction of the air duct, the intubation of the need for trachea, tracheostomy), piece ventilation lungs. Dalіkuvannya spend in the stationary. The victim needs to be taken to the hospital for a long time, to be brought in at the shortest possible loss of time. On the occasion of any kind of manipulation on the cerebral wounds, do not carry out, apply a sterile bandage on the wound; insert gauze, or cotton wool in the nizdri, in vukho with bleeding from them it is not possible, so you can speed up the wound process.

Likuvannya sufferers with visible and closed ears of the skull and the brain is very spinal, so as with them, it is more likely to indicate a scab, or a brain damage, as well as protection therapy, calmness, congestive congestion.

2. A practical part. Organization of the nursing process in traumatic brain injuries

2.1 nursing process

When looking over the head and revealing the nurse can reveal the appearance of sadness, wounds, defects in the cyst, hematomas, damage to the spinal cord (lymphoma) from the nose, vuh. The shape of an individual can be a bit of a lower slit, breaking a slit, and also the loss of teeth. When the patient is obstinate, there is evidence of witness, winter and horny reflexes, the nature of the behavior, pulse, arterial grip. Palpation of cysts of the crypt of the skull, individuals are carried out even more carefully. Pressing, zapadannya, krepіtatsіya, abnormal rupture to indicate a fracture.

Tse allow you to formulate a nursing diagnosis (2nd stage of the nursing process).

Physiological problems of the patient:

· Head b_l;

· Loss of svidomostі;

· Amnesia;

· Rozlad reflexiv (zinichnyh, rogivkovyh);

· Rozlad hearing;

· Rozlad zoru;

· Rozlad movi;

· Loose bite;

· Deformation of the heads;

· Crepіtatsіya;

· Paresis, parallel;

· Zmіna frequency and pulse (bradycardia abo tachycardia);

· Zm_na value of AT;

· Rozlad dikhannya.

Psychological problems of the patient:

· Dratіvlivіst abo depression;

· Deficiency of spilkuvannya;

· Lack of knowledge about trauma inheritance;

· Fear of death.

At the 3rd stage of the nursing process, a meta and a plan for nursing are put together.

4th stage of the nursing process of assignment to the plan of the sister's plan to look at the urahuvannya m_stsya znakhozhennya paciєnta. So, at the meeting, the nurse is planning to provide additional help and help, as soon as possible before the algorithms. The neurosurgical treatment of LPZ has gotten patients up to special methods of pre-treatment:

1) Spinal puncture.

2) Craniography.

3) Computer tomography.

5) Ultrasound echoencephalography.

All patients with TBI are guilty of being examined by a neurologist and an oculist. Patients with slit-facial trauma are hospitalized in the form of slit-facial surgery. Warehouse nurse plan for preoperative training, for the operative look after the patients, who require prompt assistance, and the visitor is scheduled for nursing.

The nurse assesses the result of her work (the 5th stage of the nursing process).

injurym'yakikhfabric the result is severe bleeding due to good blood flow. With a lot of ears: shkіra, aponeurosis, mucous and okistia. Can be scalped wounds.

Priority problems of the patient: bleeding, especially when growing and rubbing wounds; zyannya; b_l.

· Zupiniti is bleeding.

· Apply an aseptic bandage.

· Zneboliti for great wounds.

· Transport to health care facilities (position - lying on the back with the head raised by 10 °).

Transport immobilization of the head. At the health care facility, a nurse will take care of the PHO with weld overlays and prophylaxis.

extraduralinjury- there is a big trauma, as it will cause the cranial cyst to be posed. Often supravodzhutsya concussion brain, hemorrhages. The price of injury is not penetrating, so as not to break the integrity of the dura mater - the cordon of the empty skull.

Intraduralinjury- the wound penetrates into the empty space of the skull, so the integrity of the dura mater will be destroyed. In conjunction with the great ruinous speeches of the brain and the life of the vital centers of the large brain, the injuries are often fatal. The severity of the injury is explained by the movement of the intracranial vise and the damage of the nuclei of the cranial nerves.

Nursing diagnosis is put on the display and the situation. Nurse vyavlya mіscevі pozhkozhennya, zagalnomoskovі and middling symptoms and formula of the problem of the patient.

Priority problems patient on misci ushkojennya ryasna bleeding; vitality of liquor and rudimentary speech to the brain (detritus); the appearance of cultural openings.

Priority problems patient, zoom we will advise internal cranial vise: loss of evidence; psychomotor zbujennya; bradycardia; blues; the rigidity of the link and the link of the link; mimovіlіnі sečovіlnі and defecation.

potential problems pacinta tied with penetration of infection into the emptying of the skull and the brain: risk of diagnosis of meningitis, abscess.

Algorithm for dolikarskoy additional help:

· Timchasova zupinka bleeding.

· The sound of the patient in the grip of the commander.

· Apply an aseptic bandage (for vibuhanna cerebral speech - with a "donut"),

Assessment of the victim's camp:

· Yakshcho vіn at svidomostі: put on a stretcher on the back, put on the head with a cotton-gauze circle or a pillow (lift the head by 10 °);

· Even without evidence: reconsider the passage of the upper dichally nobles, if necessary; layering in the style of life.

· Apply cold to the point of injury.

· Conduct sickness and simple problems, come in with great wounds.

· Transport to health care facilities.

Pid hour of transport:

· Bezpechuvati passages of the upper dichal nobles;

· Restruvati stan of the patient (pulse, AT, CHDD) skin 10 min.

sisteradditional helpatfractureskistokskull.

Fractures of the cranial cysts are subdivided into fractures of the crypt and the base.

fracturescryptskulls- there are direct injuries, the stench can be closed and visible (in the presence of injuries). Problems of a patient with severe fractures: loss of svidomosty; local soreness; hematoma; deformation. Problems of the patient with acute fractures: defect of the shkiri; zyannya; bleeding; depression or looseness of the brush.

fracturespresentskulls- there are indirect injuries: hitting the head with water on the bottom, landing on your feet when falling from the sky. The trauma of the skull is very important, as the integrity of the dura mater can be destroyed, and infection can penetrate into the empty space of the skull from the nose, sinuses, auditory passages. Priority problems of the patient: making a link with a family from home, because it is clear; sants appeared in 1-2 days with injuries. The mice of the end of the spinal cord and the formation of the sinuses lie in the localization of the fracture. Signs of a fracture of the base of the skull by localization (Div.supplement9)

Potential problems of the patient: risk of infarction of the brain and its shell, loss of pre-medication and invalidization, death through asphyxia.

Sister dopoga in case of severe skull injuries

Zakritі vidi TBI - tse strus of the brain, the reason is a blow or a fall, scho wiklikayut points of hemorrhage in the cerebral speech; hammering the brain, the reason is a blow of the brain tissue about the cranium, when the brain tissue is rattling (cutting, cutting, bleeding); Pressing the brain is drawn behind the rakhunok of the intracranial hemorrhage, the brain is filled with fragments of the cyst.

2.2 nursing care of patients with traumatic brain injury

Algorithm for getting some extra help:

Assess the victim's camp:

Yakscho win at the svidomosty: re-lay on the command on the stretcher on the back, put a cotton-gauze circle on the head, or a pillow (raise the head by 10 °) or vikoristovuti transport tire for the head.

Even without evidence: reconsider the passage of the upper dichal nobles, and, if necessary, change the position in the line.

Apply the cold to your head.

Per hour of transport to control the patient's body (arterial vise, pulse, NPV) skin 10 minutes.

All patients with TBI, behind the blame, are ears of soft tissues, hospitalized in neurosurgical services, as they require a special treatment. The role of introduction is great conservative lіkuvannya, As a sisterly look, it is of great importance.

medical sister I'll get over itє:

hittrimannya patient suvorogo, postly regime from 10 to 14 days to decile times, months (in fallowness due to the severity of the ear); podovzhennya physiological sleep, the introduction of aminazine, diphenhydramine for the signs of the drug.

carrying out dehydration therapy: Introduce hypertonic solutions (40% glucose, 10% sodium chloride, 25% magnesium sulfate) and other drugs (lasex, manitol) under the control of dyuresis. In the last few days for dehydration therapy, hormones and ganglion blockers are to be found.

training patient before lumbar paragraphs: Nurse to conduct an individual conversation for the knowledge of psycho-social stress; gotu operatsіyne field in dіlyantsі nirok; put a clear class in advance, and before the point about the need for a patient to learn about the need to check the spine for the prevention of paresis of the sphincter of the rectum and the cut. 10-15 minutes before the procedure, inject 5% of the range of ephedrine or 20% of the range of coffee for the prevention of hypotension.

prophylactics secondary information at vidkritich TBI: the introduction of antibiotics, and in case of fractures of the base of the skull with an additional snake turunda in the ear canals or the anterior nasal passages. Get lost in the empty nose and wooh! Turundi is introduced by the easy tamponadi path.

symptomatic lykuvannya: the introduction of analgesics for headache; amidopyrine with analgin high temperature for the priznachennya lykar.

infusion therapy: Intravenous injections of combined lithic sums, 20% of sodium oxybutyrate in case of important forms of TBI (cerebral congestion).

overlooked per seriously ill: Delivery of the michur from ice to the head in the first days; godvannya of the patient (soli dyeta with the neighbors of the family); hygienic procedures; look behind the catheters (clavicular, sectional) and tracheostomy; prevention of pneumonia.

post_yny control above camp patient: Vimіryuvannya arterial vise, pulse, NPV, temperature, water balance.

Sister's eye for ailments from TBI in the period of operation.

For the trepanation of the skull, transport from the operation, the transfer of the patient to the gurney, and then, in the lidzhko slide, carry it out safely. One ludina can trim her head with both hands.

The medical nurse for the recommendation of the doctor will secure the camp for the localization of the operation. If ailments are fired sedentary (posterior cranial fossa), then in a seated position for 4-6 hours, then - on the boat, slightly turning the patient to live. For trepanation to the cranial star - put on the back, or on the bow, against the bowel movement.

The medical sister is constantly watching over the monitors' demonstrations, so that you do not miss the heart and soul. To follow the camp of the winter and about the serpents of the additional priest. Pislya ekstubatsіі paciєntu needs a date of travel for viznachennya mobility. In case of unilateral paresis of the pharyngeal nerve, ask the patient to laugh or bristle for the side of the fight, and to carry out the reversal of the act of coercion in the position on a healthy boat. Until the swallowing reflex is restored to balance, it is not possible to eat through nasogastric tube... If the cough reflex is impaired, sanation of the tracheobronchial tree is carried out according to the rules of asepsis (separate sanitation with a disposable catheter). For trepanation of the skull, aseptic bandages are applied, which are closed with a bandage bandage - "ochipok". The nurse constantly spasters behind the bandage, before getting wet, and will promptly provide for an instrumental bandage for the prevention of secondary infection. Remember! Before the hour of dressing, one assistant is guilty of fixing the patient's head.

The medical nurse supervises the severity, defecation, prevents the prophylaxis of trophic disorders, pneumonia and healthy hygienic procedures.

2.3 Sister history of ailment

For an hour before the diploma practice, I spasmed for the patient.

Patient # 1

passport part

Vik: 1944 r

Date appropriate; 04/05/15 11.00

Whiskey date: prodovzhu otrimuvati likuvannya

Misce robots: pensioner

Nadezhdennya on shvidkіy additional podomozі

Diagnosis upon admission: craniocerebral trauma, strus in the brain, slaughter of the thoracic cell is malignant.

Early diagnosis: craniocerebral trauma, strus in the brain, sabotage of the thoracic cell is malignant.

Clinical diagnosis: craniocerebral trauma, strus in the brain, sabotage of the breast cancer. Suputnya anemia of the 1st stage.

Diagnosis with vipisci: craniocerebral trauma (craniocerebral trauma), strus to the brain. Suputnya anemia of the 1st stage.

Skargi: Headache, blasphemy, tediousness, pain in the area of the left half of the breast.

History of ailment.

On April 5, 2014, a year before the hopeful child D Mila woke up to the booth, standing on the stile, having lost the ravine, she fell into the stile. For an hour, the fall wondered about the chiffoner with a breastplate and bumped its head against the pidlog. On a sprinkle of hiline, I have lost some witness. If she came to you, my daughter helped me. Immediately there is a Wiclican Bula shvidka help... І after 30 hilin the shvidka came to help. The trochas were delivered annually in a car with a great help in the reception area of the State Healthcare Institution "Duldurginskaya TsRL" with scars for weakness, boredom and headache.

Life history.

Patient D. born in 1944 Shvidko know the spilnu mova with otochuyuchih, love embellish mova with humor. Rist and development of the change. Social factor of the living. The widow, the cholovik died, vin buv vyskovy in the colonel's posad. It’s not a matter of fact. At the child's turn it turned into kir, mumps. Bula appendectomy. In contact with infectious diseases did not get. History of allergic reaction to penicilin. Allergy is not revealed at the bottom of the speech.

Epidemiological history:

In contact with infectious ailments and earthy hulks of Bula. She did not suffer from viral hepatitis. For the last 6 months I didn’t cut it off. Increased temperature was not slowed down.

Early diagnosis

Skarg on display: headache, tediousness, pain in the area of the other half of the breast.

visnovok:

The diagnosis can be made on the basis of a craniocerebral trauma. Strus on the brain. Hematoma of the pylitic region of the head. Slaughter the soft tissues of the left half of the breast tissue. subutnya ischemic ailment heart. Angina pectoris. Hypertension stage II. Suputnya anemia.

X-ray of the cranial cysts 04/05/15.

Visnovok: on the roentgenogram changes (trischines, fractures) of the cysts of the skull are mute.

clinical diagnosis

At the presentation of the scarg: headache, blasphemy, pain in the area of half of the breast cancer.

The integrity of the cranial curves of the skull is saved. In the area of potential, it is determined that the size is 6 x 5 cm. The skin above it is cyanosis, thick consistency, a dilenca of ailments. The excursion leg is surrounded on the left side.

visnovok:

On the basis of ethological, differential diagnoses, it is possible to put a diagnosis: CCMT (closed craniocerebral trauma), strius of the brain. Hematoma of the pylitic region of the head. Slaughter the soft tissues of the left half of the breast tissue. Compound ischemic ailment of the heart. Angina pectoris. Hypertension stage II. Suputnya anemia.

1. Postіlny mode.

2. Coldness on the head.

4. Drug treatment:

1. Glucose 10% - 10.0 i.v.

Ascorbic acid 5% - w / w

2. Calcium chlorine 10% - 10.0 w / w

3. Magnesia sulfate 25% - 10.0 w / w

4.furasemid 1% - 2.0 w / m

5. Sulfocamphocain 10% - 2.0 i / m

6. Ampiox 0.5 3 times a day

7. Analgin 25% - 4.0 w / m

8. Diphenhydramine 1% - 2.0 / m

Gruntuvannya lykarsky signs:

Methods of dehydration therapy:

1. Glucose 10% - 10.0 i.v.

Ascorbic acid 5% - w / w

2. Magnesia sulfate 25% - 10.0 w / w

3. Calcium chlorine 10% - 10.0 w / w

4.furasemid 1% - 2.0 w / m

Methods for improving health and prevention of post-traumatic pneumonia:

1. Sulfocamphocain 10% - 2.0 / m

2. Ampiox 0.5 3 times a day

I mark zebolyuvannya:

1. Analgin 25% - 4.0 w / m

2. Diphenhydramine 1% - 2.0 / m

Turbulent pain, blasphemy, pain in the left half of the breast, the backward camp is overwhelming.

BH = 18 in khilina. Toni heart is clear, rhythmic weakening, AT = 120/90 mm Hg. Art. Heart rate = 84 per chilin.

1. Postіlny mode.

2. Coldness on the head.

3. Vykonannya lykarskikh priznachennya.

4. Drug treatment:

1.Glucose 10% - 10.0 i.v.

2.Ascorbic acid 5% - w / w

3.Calcium chlorine 10% - 10.0 w / w

4.Magnesia sulfate 25% - 10.0 w / w

5.Furasemid 1% - 2.0 w / m

6. Sulfocamphocain 10% - 2.0 i / m

7. Ampiox 0.5 3 times a day

8.Analgin 25% - 4.0 in

9. Diphenhydramine 1% - 2.0 / m

Vipisana after 7 days.

With the prediction of a vischevkazanny lіkuvannya prognosis of splendor.

1.Provovzhuvati postіlny regime.

2. do not overwhelm the nervous system.

3. get up on the shoulder to the neuropathologist.

Patient # 2

1. Oleksandr Shemelin

3. Student

6. The date of the sick person's due date: 04/11/2015. 9.30

7. Diagnosis when appropriate Zakrita craniocerebral trauma. Fuck your brain average gravity... Intracranial hematoma.

8. Rhesus belonging to Rh "+"

9. Blood group I (0)

10. Diagnosis of craniocerebral trauma. Beat the brain of average severity. Intracranial hematoma.

11. Diagnosis of conclusions Zakrita craniocerebral trauma. Beat the brain of average severity. Intracranial hematoma.

12. Operation: resection trepanation of the skull is malignant.

13. Folding: mute.

14. Ailment dumb

skargi at Upon arrival: On the head, zamorochennya, on the presence of a cystic defect of the skull in the left temporal area skargi on moment kuratsії: For a small headache

history of ailment

Vvazhaє ourselves we are sick from -02.04.15, if we have eliminated the injury - having fallen from the motorcycle, having lost the witness. On the other hand, there is a large hospital for deliveries in the reception area of the State Healthcare Institution "Agin's District Likarnia" Hospitalization in trauma treatment.

history of life

Born in 1993 rotsi. Evolving according to the article and com. With 7 years of schooling, having finished 11 grades. Vchivsya good. U 2013r. nadіyshov in ZabGSPU. In Danish hour student. Materially, but also the living conditions. Transferred illness: Grip, GRZ, angina.

The slump is not tight.

Allergological history of tightness.

Transfusion history clear

Narcotic and psychotropic drugs are not taken. Alcohol is alive with the saint. Smoking (1 pack per day). Kava is alive and well.

Planned operation: resection trepanation of the skull, malignant.

Indicated before the operation: the manifestation of a cyst defect in the crypt of the skull є is shown before plastic surgery with an allograft.

pislyaoperatsіynі value

2.Postilny mode pershi three add the operation

3. Sol. Proserini 0.05% 1.0 ml 2 times a day i / m No. 10

5. Sol. Analgini 50% - 2.0

6. Sol. Calciichloridi 10% 10 ml i.v. No. 5

7. Sol. Promedoli 2% 1.0 ml

8.Sol. Thiaminichloride 2.5% - 1 ml once a day i.m.

Self-esteem for the conducted therapy is good.

Turbulent pains in the area of operational wounds, the head of the country is backward.

Objectively: the camp is stable. The position is more active. Shkіrnі bend and see muzy clean. Dyhannavesicular, symmetric, carried out in the force of the leg. Dodatkovyh dichnyh noises are not revealed.

BH = 18 in khilina. Toni heart is clear, rhythmic weakening, AT = 130/90 mm Hg. Art. Heart rate = 84 per chilin.

Lives on palpation soft, painless.

Style of decorations. Direz without specialties.

recognition:

1. style No. 10.

2.Postilny mode

3. Sol. Proserini 0.05% 1.0 ml 2 times a day IM

4. Sol. Oxacillini 2.0 x 4 times a day i.v.

5. Sol. Analgini 50% - 2.0

Sol. Dimedroli 1% - 1.0 in one syringe 3 times a day i.v.

6. Sol. Promedoli 2% 1.0 ml at 8.00, at 15.00

7.Sol. Thiaminichloride 2.5% - 1 ml once a day IM

8. Sol. Calciichloridi 10% 10 ml i.v.

9.Ligation

10.Provesti UAC, OAM, BAK

Self-esteem for the conducted therapy is good.

Skargs are saved on the basis of pains in the area of operational injuries and headaches. Zagalny mill zadovilny, t - 37.1C.

Objectively: the camp is stable. The position is more active. Shkirni, be clean. Dyhannavesicular, symmetric, carried out in the force of the leg. Dodatkovyh dichnyh noises are not revealed.

BH = 19 in khilina. Tony heart is clear, rhythmic. AT = 125/85 mm Hg. Art. Heart rate = 84 per chilin.

Lives on palpation soft, painless.

Surgical wound is 15 cm long. 14 welds were applied. The edges of the early hyperemyovany, schilly left. Evidence of burning and suppuration is not discouraged. The edges of the wound are broken.

Style of decorations. Direz without specialties.

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