Evidence-Based Review: Nursing Care of Adults with Severe Traumatic Brain Injury-AANN20_CPG_TU Update

AANN20_CPG_TU Update_FINAL v2

Pdf Summary

This evidence-based review summarizes nursing care for adults with severe traumatic brain injury (sTBI), defined as traumatic brain injury with an initial Glasgow Coma Scale score of 8 or less. Neuroscience nursing experts reviewed English-language research and clinical guidelines published mainly from 2008 to 2018, identifying 123 relevant articles.<br /><br />Because secondary brain injury can develop over minutes to days and worsen outcomes, care focuses on preventing further injury. Early priorities include the ABCDE trauma assessment, protecting the airway and cervical spine, preventing hypoxia and hypotension, and performing repeated neurological assessments. Consistent use of the Glasgow Coma Scale and pupil examinations helps detect deterioration and possible herniation; alternative tools such as the FOUR score or automated pupillometry may support assessment in selected situations.<br /><br />In intensive care, nurses monitor neurological status, intracranial pressure (ICP), and cerebral perfusion, while supporting oxygenation, appropriate ventilation, normothermia, and electrolyte and glucose balance. Positioning, cervical-collar fit, nursing procedures, and transport can affect ICP and should be managed carefully. ICP therapies and invasive devices require close monitoring and aseptic care. Standardized protocols and interdisciplinary approaches are emphasized.<br /><br />The review also addresses prevention of hospital-acquired complications, including pneumonia, infection, pressure injuries, falls, venous thromboembolism, and contractures. It recommends early nutrition when appropriate, attention to sleep and neuropsychiatric problems, vision and motor screening, and timely rehabilitation. Care should incorporate family involvement and account for individual preferences and needs. For older adults, baseline function, comorbidities, anticoagulant use, delirium risk, and medication safety warrant particular attention.<br /><br />The authors conclude that evidence-based nursing interventions, combined with clinical judgment and patient and family preferences, can support safer care and better outcomes across the continuum of recovery.

Keywords

severe traumatic brain injury

nursing care

Glasgow Coma Scale

intracranial pressure

secondary brain injury

neuroscience nursing

hypoxia prevention

cervical spine protection

intensive care

rehabilitation