20: James

James, aged 9 years, has been transferred to your ward from his local hospital after suffering a head injury after a fall (no other injuries). He is wearing a hard collar to protect his c-spine and it was reported that he has remained stable with a GCS of 14, but his condition has deteriorated and GCS has dropped to 11. Later a CT scan revealed he had a severe brain injury. He was eventually transferred to a residential rehabilitation centre.

  • List the long-term problems that  James may have after his severe head injury.
  • What is the nurse’s role within the MDT team at the residential rehabilitation centre?

› Suggested answers 

  • List the long-term problems that  James may have after his severe head injury.

Children like James who were previously fit and well can have devastating long-term problems after a severe TBI and their recovery can be very slow.

  1. Cognitive problems could include: altered personality, word processing problems, changes in or inappropriate behaviour
  2. Reduced mobility/motor problems (e.g. right sided weakness – he was previously right handed)
  3. Significant risk of developing long term seizures – epilepsy
  4. Loss of independence: unable to perform personal care – toilet care, etc.
  5. Dysphasia: difficulty in understanding and expressing himself
  6. Difficulties with eating and drinking
  • What is the nurse’s role within the MDT team at the residential rehabilitation centre?
    1. Nursing care – maintain the activities of daily living
    2. Liaise with MDT re rehabilitation goals
    3. Daily routine – allow extra time and support, promote rest
    4. Cognitive issues – James may have difficulty with his memory – long term better but new memories re past and future – therefore important to provide orientation –time and place ongoing reinforcement
    5. Leisure – avoid over stimulation (limit screen time, music, etc. and promote rest)
    6. Administer prescribed medication
    7. Provide support to his parents and family
    8. Facilitate communication with MDT
    9. Providing psychological support (e.g. stress the importance of maintaining hope with his long-term prognosis while being realistic)
    10. Negotiating care – allow parents to be involved as much as they want to and do not over rely on them to be involved with all aspects of James’ care
    11. Show an awareness of parents juggling their everyday lives (work, other siblings, travel, etc.)
    12. Practical steps: equipment aids
    13. Environment – position in ward – need peace and quiet
    14. Environment around bed – specific needs