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Preface xi Dedication xii Acknowledgements xiii Contributor Details xiv Abbreviations xviii List of Tables and Figures xx Section 1 Foundations for Practice 1 Introduction 1 1 The Patient???s Journey 3 Nadine Abelson–Mitchell Introduction 3 Care pathways: policies and guidelines 4 Integrated care pathways 4 2 Philosophy 6 Nadine Abelson–Mitchell Introduction 6 Conclusion 9 3 The Needs Approach Model 11 Nadine Abelson–Mitchell Introduction 11 What is a need? 11 Structure of the Needs Approach Model 11 Use of the model 12 Assessing the patient???s needs 12 Planning 13 Goal setting 14 Implementation 14 Evaluation 14 Risk 14 The miraculous recovery 23 Nursing diagnosis 26 Conclusion 28 4 The Patient Matters 31 Nadine Abelson–Mitchell, an anonymous carer and Sue Mottram The patient 31 Family and carers 31 Conclusion 37 5 Multidisciplinary Management 38 Nadine Abelson–Mitchell and Katie Searle Introduction 38 Staffing 39 Speech and language therapy services 40 6 Physiotherapy 43 Jude Fewings Introduction 43 Respiratory care 43 Positioning 43 Musculoskeletal integrity and neuromuscular status 44 Summary 44 Rehabilitation and motor control theories 45 Posture and seating 45 Conclusion 46 7 Neuropsychology 47 Michelle Smith Introduction 47 What is clinical neuropsychology? 47 Who is a clinical neuropsychologist? 47 What is the role of the clinical neuropsychologist in the management of TBI? 47 Neuropsychological functions 47 The patient???s neuropsychological journey 49 Additional factors influencing neuropsychological functioning 50 Other issues and considerations 51 8 Social Considerations 52 Judi Thomson and Anthony Gilbert The role of the social worker 52 Social issues 54 Conclusion 56 9 Occupational Therapy 57 Danielle Williams Section 2 Pre–requisite Knowledge 61 Introduction 61 10 Epidemiology 63 Nadine Abelson–Mitchell Introduction 63 Severity of injury 63 Hospital attendance 64 Incidence 64 Prevalence of head injury 64 Age distribution 65 Gender distribution 65 Race and ethnicity 65 Mechanism of injury 65 Seasonal variation 66 Predisposition 66 Use of alcohol 66 Head injury mortality 66 Conclusion 66 11 Prevention of Head Injuries 68 Nadine Abelson–Mitchell Introduction 68 Recommendations 68 Road traffic accidents (RTAs) 69 Action regarding the use of prescription, over the counter and illicit drugs 70 Prevention of sports injuries 71 Care of older people 71 Interpersonal violence 71 Conclusion 72 12 Applied Anatomy and Physiology 74 Nadine Abelson–Mitchell Introduction 74 The nervous system 74 The scalp 74 The skull 75 Structure of the brain 84 Additional concepts related to neurophysiology 102 Acid–base balance 102 Summary 105 Conclusion 106 13 Investigations 108 Nadine Abelson–Mitchell 14 Pharmacology for Neurotrauma Patients 126 Nadine Abelson–Mitchell and Penny Franklin Introduction 126 Anaesthetic agents 127 Analgesics 127 Diuretics 127 Anti–epileptic drugs 127 Anticoagulants 127 Antiemetics 127 Laxatives 127 Conclusion 127 15 Applied Microbiology 129 Nadine Abelson–Mitchell Introduction 129 Meningitis 129 Encephalitis 130 Brain abscess 131 Conclusion 133 Section 3 Features of Neurotrauma 135 Introduction 135 16 Classification of Traumatic Brain Injury 137 Zuhair Noori and Nadine Abelson–Mitchell Introduction 137 Primary and secondary brain injury 137 Open and closed head injury 139 Conclusion 140 17 Raised Intracranial Pressure 141 Nadine Abelson–Mitchell Introduction 141 Definition 141 Cause of increased intracranial pressure 141 Diagnosis 141 Investigations 142 Treatment 142 Management of the patient 142 Conclusion 143 18 Assessment of the Patient with Neurotrauma 144 Nadine Abelson–Mitchell Introduction 144 General principles 144 Neurological observations 146 Vital signs 151 Recording the observations 152 Undertaking a comprehensive CNS examination 152 Recording the assessment 160 Conclusion 160 Section 4 Management of Neurotrauma 161 Introduction 161 19 Management of Neurotrauma at the Scene 163 Henry Guly Introduction 163 Severe and moderate head injury 163 Airway with cervical spine protection 164 Breathing 164 Circulation 164 Disability 165 Exposure and environment 165 Minor head injury 166 20 Management of Neurotrauma on Transfer 168 Henry Guly Introduction 168 Airway with cervical spine protection 168 Breathing 169 Circulation 169 Disability 169 Exposure 169 Other 169 Who should accompany the patient? 169 21 Management of Neurotrauma in the Emergency Department 171 Henry Guly Introduction 171 Preparing for the arrival of a seriously injured patient 171 Severe and moderate head injury 171 Minor head injury 176 Admission 178 Discharge from the ED 178 Management of patients who are admitted for observation 178 Social aspects 179 22 Hospital Management of Neurotrauma 182 Kevin Tsang and Peter Whitfield Introduction 182 Initial assessment of trauma patients 182 Management in the neuroscience unit 184 Intensive care management 185 Further management and prognosis 191 23 Nursing the Patient with Neurotrauma 194 Nadine Abelson–Mitchell Introduction 194 Advocate 194 Essential nursing skills 195 Therapeutic practice 195 Co–ordination 196 Clinical governance 196 Advice/counselling 196 Political awareness 196 Education 196 Research 196 Ethical considerations 196 Rehabilitation nursing 196 Activities 234 24 Prognosis and Patient Outcome 235 Zuhair Noori and Nadine Abelson–Mitchell Introduction 235 Factors predicting prognosis after head injury 236 Outcome measures 236 Return to work 237 Quality of everyday life 237 Conclusion 237 25 Dying and Death 238 Zuhair Noori and Nadine Abelson–Mitchell Introduction 238 The family 239 Brain death 239 Conclusion 241 Activities 241 Section 5 Neurorehabilitation 243 Introduction 243 26 Sequelae of Neurotrauma 245 Nadine Abelson–Mitchell Introduction 245 Additional information about some sequelae 247 Conclusion 249 27 Neurorehabilitation 250 Zuhair Noori and Nadine Abelson–Mitchell Introduction 250 Definition of rehabilitation 251 Levels of rehabilitation 251 Settings for rehabilitation 252 Rehabilitation costs 252 Staffing for rehabilitation 252 Standards of rehabilitation practice 254 Rehabilitation criteria 254 The rehabilitation process 255 Goals of rehabilitation 256 Concepts underpinning rehabilitation 256 Planning the rehabilitation programme content 256 Scheduling the programme 257 Community–based rehabilitation (CBR) 257 Conclusion 260 28 Early Stimulation Programmes 263 Nadine Abelson–Mitchell Introduction 263 Definition of early stimulation programme 263 Background 263 Objectives of introducing an early stimulation programme (ESP) 263 Setting up the ESP 264 Content of the ESP 264 Specific techniques 265 How to encourage the involvement of family or friends 265 29 Discharge Planning 266 Nadine Abelson–Mitchell Introduction 266 What is discharge planning? 266 Benefits of discharge planning 266 Discharge planning process 266 Criteria for discharge planning 267 Selecting the discharge destination 267 The day of discharge 267 Conclusion 267 30 Living in the Community 270 Nadine Abelson–Mitchell Introduction 270 Integrating into the community 270 31 Legal Matters 271 Andrew Warlow and Simon Parford Introduction 271 Compensation claims arising out of head injuries 271 Brain injury and medical negligence 273 Head injuries 273 The cost of brain injury 276 32 Meeting Tomorrow???s Challenges 277 Nadine Abelson–Mitchell Conclusion 277 Section 6 Appendices 279 Appendix 1 Pre–Admission Assessment 281 Instructions 281 Pre–admission assessment 282 Family information 282 Previous health history 283 Current health status 283 Health needs 286 Appendix 2 Discharge Report 293 Instructions 293 Section A 293 Section B 294 Section C 294 Section D 294 Activity Answers 299 Additional Resources 309 Glossary 315 References 317 Index 333 Colour plate section can be found between pages 106 and 107