Page Utilities
Don Kautz, Linda Holtzclaw, Angelica Ford, and Kimberly Shuster. Edited by Kathy Helmick, Brain Injury Association of Kentucky (page 2 of 2) Page 2 of 2
The stress of a brain injury may make some individuals prone to some bleeding from the stomach. This bleeding is called a stress ulcer. The patient may be treated with medications to prevent these stress ulcers from forming. Medications may also be given to help combat any infections in the bloodstream. A catheter may be placed in the bladder to drain urine.
By now it may seem that everything can go wrong. The important thing to remember is that the nurses and doctors will be monitoring the patient very closely, so they can treat all these problems as soon as they occur.
If the patient was in an accident, there might be other injuries beside the brain injury that require treatment. Often, patients have broken bones, therefore may have splints or casts, or may be placed in traction. A broken rib can puncture a lung. If this happens, the patient may have a chest tube to drain off blood or fluid from around the lungs. The patient may have internal bleeding and need medications or surgery to stop that bleeding.
Once stabilized in the ER, the patient will be transferred to the ICU. If surgery was necessary, the patient will go from the Operating Room to the ICU. The patient's family and friends will be allowed to see him or her, but because he or she is so sick, visiting hours will be limited and there will be rules about how many people can come at one time. These rules ensure that the nurses can provide the patient with the best care. Family and friends are usually directed to wait in a nearby lounge between the times for visiting. The times for visiting are usually posted on a sign outside the ICU, in special circumstances, it may be possible to visit at times other than those posted times. This must be arranged with a person at an information desk outside the ICU.
Most patients with a severe brain injury will initially appear to be in a deep sleep. They may not be able to move or open their eyes or talk. The nurses and physicians monitor the ability of the patient to respond using a scale, called the Glasgow Coma Scale (GCS). (See the page in the reference section of this book.)
After testing the patient's eye, motor and verbal response, the patient is assigned a score that best describes the nature of the response. The patient may respond in a strange way, arms and legs may spasm into strange positions. He or she may say strange things. The GCS is helpful for the doctors and nurses to evaluate how well the patient is doing and whether further treatment or tests are needed. Ask the physicians and nurses what the patient's score is. Sometimes patients are more responsive to family and friends than the doctors and nurses, so family and friends may get a different score than the doctors and nurses.
It may be very hard to visit a patient in the ICU who cannot talk or respond. Even if the patient cannot respond, act as if he or she can understand you. Speak to the patient each time you go into the ICU. Call the patient by name. Tell the patient who you are and that you care about him or her, and are hoping he or she will get better. The patient may be able to hear even if they are not able to respond, so do not say things that you do not want the patient to hear or know. You may feel awkward talking to a person who doesn't appear to be awake, but the more you talk to the patient the less strange it will seem.
The patient will stay in ICU until the doctors determine that the equipment and constant monitoring are no longer necessary. The ICP catheter in the head will have been removed and the ventilator may no longer be needed. The patient may not need to have heart rate and blood pressure monitored and may not need as many IV medications that have to be monitored closely. How long will this take? Some patients may be ready to leave the ICU in only a few days; others may require weeks or months. This is usually a very tough time for families and friends. Ask the doctors and nurses any questions you have to be sure you understand what is happening. Although both the nurses and doctors are busy, they want to keep you informed. Write questions down if that helps. If you don't understand, ask again.
Families and friends will also want to know how much damage was done to the brain, and when the patient will "wake up." Will the patient be like he/she was before the accident? Will he/she be able to go back to work? Will he/she be able to come home? Unfortunately, it's usually difficult for doctors to answer these questions. Some patients "wake up" and become responsive while in the ICU. Other patients may leave the ICU still unresponsive. A patient who is still unresponsive or comatose will leave the ICU and be transferred to a regular nursing unit when he no longer needs the ventilator, the heart monitor, and his condition is considered stable.
Some hospitals have "Family Groups" or "Family Support Groups" to help family members talk about what is going on and share how they feel. These groups are an excellent place to get information about what is happening, or to talk about your concerns. If you feel the need to talk to someone, the nurse will be able to put you in contact with a counselor or chaplain.
Usually after severe brain injury, patients will be different than they were before the injury. They may think, act, or speak differently. They may have trouble remembering. As the patient starts becoming more responsive, he/she may become agitated and may try to pull out the tubes, making it necessary to use restraints. Because of these changes, the doctors usually ask a rehabilitation medical doctor to evaluate the patient.
The doctors, nurses, social worker or discharge planner may all be talking with the family and friends about rehabilitation needs following discharge from the acute care hospital. Arranging for an admission to an appropriate rehabilitation facility takes time. The doctors and discharge planner often start talking with families about rehabilitation before the patient is out of ICU. This may seem to you too early to be talking about a rehabilitation referral. However, these early referrals need to be made to ensure that arrangements are in place when the patient is ready for discharge from the acute care hospital.
From the Brain Injury Association of Kentucky. Reprinted with permission. Third-party publishing restricted. www.biak.us.
