Cures infermeres en les persones amb traumatisme cranioencefàlic sever: revisió bibliogràfica

Abstract

Introduction: The traumatic brain injury (TBI) is defined as a non-degenerative in the brain function caused by an external force. When a person gets a ≤8 points score in the Glasgow Coma Scale (GCS) the TBI is classified as severe. It is an unattended epidemic, constituting an important public health problem. Nurses, as responsible for the care of these people, must ensure adequate care for the affected people and their relatives throughout the care process. Objectives: Getting to know the most recommended nursing interventions to control the intracranial pressure (ICP) of a person who suffers from severe TBI based on the best evidence available. Methodology: A bibliographic review was made of different databases: PubMed, Cochrane Library, CINHAL, Cuiden, NICE, TRIP and JBI, and of the following institutions: Ministry of Health, Social Services and Equality and BTF from September 2017 to May 2018. Results: A sample of fifteen results, included in this project was obtained in order to respond to the objective set. Most of the articles were published between 2012 and 2018. A number of authors point out that providing quality and effective nursing care based on evidence reduces the morbidity and mortality of adults with severe TBI. Conclusions: Nursing interventions for the treatment of a person with severe TBI are indispensable to ensure a correct evolution. There are initial and general measures of treatment: initial assessment (A, B, C, D, E), maintenance of MBP values, and ensurance and maintenance of hemodynamic stability, ensurance of a correct position, adequate nutritional support and administration of sedatives before certain interventions. Among the first-level measures we find evacuation of CSF, use of muscle relaxant, antiepileptic prophylaxis, administration of hyperosmolar solutions and moderate hyperventilation. If ICH persists, second level measures will be applied: induced therapeutic hypothermia, barbiturate coma and decompressive craniectomy