Patient management in head injury care: a nursing perspective

Through a review of the literature, this article provides a consideration of nursing responsibilities and nursing care in the management of patients with head injuries. A brief review of the pathophysiology of head injury is followed by a description of intracranial pressure (ICP) monitoring and cerebral perfusion pressure (CPP) measurement, using the Camino fibreoptic catheter and monitor, with exploration of pulse and trend waveforms and their significance in assessing cerebral compliance. Jugular venous bulb saturation (SjO2) monitoring adds another dimension to the assessment of neurological damage by demonstrating cerebral tissue perfusion and cerebral metabolic rate, and this is also discussed. After identification of assessment as a crucial part of the nursing role, aspects of nursing care of head-injured patients are discussed. The discussion of respiratory support measures includes the controversial use of hyperventilation in reducing ICP, the prevention of hypoxia, the risk of respiratory complications, the use of suctioning and turning to prevent these and the problems associated with these nursing care measures. Other aspects of care are also considered, including careful positioning and temperature control, and the benefits of mild hypothermia.