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Discussion

Questions on Study Questions

My prof. gave my class a study guide for our upcoming test in our Complex Healthcare Problems course. I have a few questions that I cannot seem to find the answers to. I have also posted this on my class message board for classmate help but figured I would see what you all have to say :-) My questions so far are mostly on traumatic brain injuries:

1. How do you suction a pt. with a TBI? This is on the guide yet I can't find anything in my notes or textbook.

2. I just want to make sure I am understanding this. Positioning of these pts basically means we need to make sure to place them in a position where they are not lying on their injury if it's a skull fracture, have the HOB raised d/t increased ICP, etc correct?

Thanks in advance for any help you guys can give me!

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    You would also be careful with nasopharyngeal suctioning as if there is a skull fracture there could be a compromise between the skull & nasal cavity. (i.e. you can be suctioning the brain and not the nasopharynx) I was always taught to stick with oral suctioning.

    How high the HOB is raised is also dependent on the injury. Think about recovery position and possible other injuries relative to the mechanism of injury (fall vs. unrestrained driver in a car accident).

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    You would also be careful with nasopharyngeal suctioning as if there is a skull fracture there could be a compromise between the skull & nasal cavity. (i.e. you can be suctioning the brain and not the nasopharynx) I was always taught to stick with oral suctioning.

    How high the HOB is raised is also dependent on the injury. Think about recovery position and possible other injuries relative to the mechanism of injury (fall vs. unrestrained driver in a car accident).

    I know the HOB level depends on the injury. I have the information on how high per injury...just didn't feel like typing it all out. Thanks though! And as far as oral suctioning, I'm pretty sure that is what my teacher is going for. Is there anything special to know in regards to that?

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    Does this help? It has some basics with details but should point you in the right direction...

    http://www.traumaticbraininjury.com/content/treatmentsfor/tbi-treatments-for.html

    Suction care do it carefully & mindfully. Hopefully pt is intubated otherwise watch timing (length of suctioning) so that the patient is not deprived of oxygen. If a trach is in place, follow trach care procedures but take care to not induce coughing as that can raise ICP. The respiratory therapists I worked with always used sterile saline bullets to try and loosen secretions to minimize amount of time spent suctioning.

    You'd be surprised how many staff members don't realize how important proper HOB positioning is when caring for TBI (or other patients).

    Turn & reposition is important (a special bed that rotates patient laterally may be used) to prevent skin breakdown.

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