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Neurotrauma: Managing Patients with Head Injuries is a comprehensive, holistic, evidence-based approach to the primary, secondary and tertiary care of a person with neurotrauma. Using a patient-centred needs approach to enhance the quality of care of head injured patients, family and carers, this multidisciplinary book enables the reader to apply the knowledge, skills and attitudes learned to the practice of neurotrauma in all settings. It explores: * Anatomy and physiology of the brain * Pharmacology for neurotrauma patients * Assessment of the patient with neurotrauma * Management of…mehr
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Neurotrauma: Managing Patients with Head Injuries is a comprehensive, holistic, evidence-based approach to the primary, secondary and tertiary care of a person with neurotrauma. Using a patient-centred needs approach to enhance the quality of care of head injured patients, family and carers, this multidisciplinary book enables the reader to apply the knowledge, skills and attitudes learned to the practice of neurotrauma in all settings. It explores: * Anatomy and physiology of the brain * Pharmacology for neurotrauma patients * Assessment of the patient with neurotrauma * Management of neurotrauma in a range of settings including at the scene, in the emergency department, and at the hospital * Neuro-rehabilitation * Community care * Nursing management of the patient This practical resource includes activities, exercises, and ethical and legal considerations throughout, making it ideal reading for all staff working in neuroscience, emergency, critical and rehabilitation settings.
Produktdetails
- Produktdetails
- Verlag: John Wiley & Sons
- Seitenzahl: 368
- Erscheinungstermin: 25. Februar 2013
- Englisch
- ISBN-13: 9781118455265
- Artikelnr.: 37756774
- Verlag: John Wiley & Sons
- Seitenzahl: 368
- Erscheinungstermin: 25. Februar 2013
- Englisch
- ISBN-13: 9781118455265
- Artikelnr.: 37756774
Dr Nadine Abelson-Mitchell is Senior Lecturer in the School of Nursing and Community Studies at the University of Plymouth. She is the partnership link for the neuroscience programme and is Appointed Honorary Nurse Consultant to Rowans Rehabilitation Unit, Plymouth teaching PCT.
Preface Dedication Acknowledgements Contributor Details Abbreviations List of Tables and Figures Section 1 Foundations for Practice 1 The Patient's Journey Nadine Abelson-Mitchell 2 Philosophy Nadine Abelson-Mitchell 3 The Needs Approach Model Nadine Abelson-Mitchell 4 The Patient Matters Nadine Abelson-Mitchell, an anonymous carer and Sue Mottram 5 Multidisciplinary Management Nadine Abelson-Mitchell and Katie Searle 6 Physiotherapy Jude Fewings 7 Neuropsychology Michelle Smith 8 Social Considerations Judi Thomson and Anthony Gilbert 9 Occupational Therapy Danielle Williams Section 2 Prerequisite Knowledge 10 Epidemiology Nadine Abelson-Mitchell 11 Prevention of Head Injuries Nadine Abelson-Mitchell 12 Applied Anatomy and Physiology Nadine Abelson-Mitchell 13 Investigations Nadine Abelson-Mitchell 14 Pharmacology for Neurotrauma Patients Nadine Abelson-Mitchell and Penny Franklin 15 Applied Microbiology Nadine Abelson-Mitchell Section 3 Features of Neurotrauma 16 Classification of Traumatic Brain Injury Zuhair Noori and Nadine Abelson-Mitchell 17 Raised Intracranial Pressure Nadine Abelson-Mitchell 18 Assessment of the Patient with Neurotrauma Nadine Abelson-Mitchell Section 4 Management of Neurotrauma 19 Management of Neurotrauma at the Scene Henry Guly 20 Management of Neurotrauma on Transfer Henry Guly 21 Management of Neurotrauma in the Emergency Department Henry Guly 22 Hospital Management of Neurotrauma Kevin Tsang and Peter Whitfield 23 Nursing the Patient with Neurotrauma Nadine Abelson-Mitchell 24 Prognosis and Patient Outcome Zuhair Noori and Nadine Abelson-Mitchell 25 Dying and Death Zuhair Noori and Nadine Abelson-Mitchell Section 5 Neurorehabilitation 26 Sequelae of Neurotrauma Nadine Abelson-Mitchell 27 Neurorehabilitation Zuhair Noori and Nadine Abelson-Mitchell 28 Early Stimulation Programmes Nadine Abelson-Mitchell 29 Discharge Planning Nadine Abelson-Mitchell 30 Living in the Community Nadine Abelson-Mitchell 31 Legal Matters Andrew Warlow and Simon Parford 32 Meeting Tomorrow's Challenges Nadine Abelson-Mitchell Section 6 Appendices Appendix 1 Pre-Admission Assessment Appendix 2 Discharge Report Activity Answers Additional Resources Glossary References Index
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
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
Preface Dedication Acknowledgements Contributor Details Abbreviations List of Tables and Figures Section 1 Foundations for Practice 1 The Patient's Journey Nadine Abelson-Mitchell 2 Philosophy Nadine Abelson-Mitchell 3 The Needs Approach Model Nadine Abelson-Mitchell 4 The Patient Matters Nadine Abelson-Mitchell, an anonymous carer and Sue Mottram 5 Multidisciplinary Management Nadine Abelson-Mitchell and Katie Searle 6 Physiotherapy Jude Fewings 7 Neuropsychology Michelle Smith 8 Social Considerations Judi Thomson and Anthony Gilbert 9 Occupational Therapy Danielle Williams Section 2 Prerequisite Knowledge 10 Epidemiology Nadine Abelson-Mitchell 11 Prevention of Head Injuries Nadine Abelson-Mitchell 12 Applied Anatomy and Physiology Nadine Abelson-Mitchell 13 Investigations Nadine Abelson-Mitchell 14 Pharmacology for Neurotrauma Patients Nadine Abelson-Mitchell and Penny Franklin 15 Applied Microbiology Nadine Abelson-Mitchell Section 3 Features of Neurotrauma 16 Classification of Traumatic Brain Injury Zuhair Noori and Nadine Abelson-Mitchell 17 Raised Intracranial Pressure Nadine Abelson-Mitchell 18 Assessment of the Patient with Neurotrauma Nadine Abelson-Mitchell Section 4 Management of Neurotrauma 19 Management of Neurotrauma at the Scene Henry Guly 20 Management of Neurotrauma on Transfer Henry Guly 21 Management of Neurotrauma in the Emergency Department Henry Guly 22 Hospital Management of Neurotrauma Kevin Tsang and Peter Whitfield 23 Nursing the Patient with Neurotrauma Nadine Abelson-Mitchell 24 Prognosis and Patient Outcome Zuhair Noori and Nadine Abelson-Mitchell 25 Dying and Death Zuhair Noori and Nadine Abelson-Mitchell Section 5 Neurorehabilitation 26 Sequelae of Neurotrauma Nadine Abelson-Mitchell 27 Neurorehabilitation Zuhair Noori and Nadine Abelson-Mitchell 28 Early Stimulation Programmes Nadine Abelson-Mitchell 29 Discharge Planning Nadine Abelson-Mitchell 30 Living in the Community Nadine Abelson-Mitchell 31 Legal Matters Andrew Warlow and Simon Parford 32 Meeting Tomorrow's Challenges Nadine Abelson-Mitchell Section 6 Appendices Appendix 1 Pre-Admission Assessment Appendix 2 Discharge Report Activity Answers Additional Resources Glossary References Index
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
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