Promoting Home and Community-Based Care
Teaching Patients Self-Care
Teaching early in the course of head injury often focuses on reinforcing information
given to the family about the patient's condition and prognosis. As the patient's status
and expected outcome change over time, family teaching may focus on interpretation
and explanation of changes in the patient's physical and psychological responses.
If the patient's physical status allows discharge to home, the patient and family are
instructed about limitations that can be expected and complications that may occur. The
nurse explains to the patient and family, verbally and in writing, how to monitor for
complications that merit contacting the neurosurgeon. Depending on the patient's
prognosis and physical and cognitive status, the patient may be included in teaching
about self-care management strategies.
If the patient is at risk for late posttraumatic seizures, antiseizure medications may be
prescribed at discharge. The patient and family require instruction about the side effects
of these medications and the importance of continuing to take them as prescribed.
Continuing Care
Rehabilitation of the patient with a head injury begins at the time of injury and
continues into the home and community. Depending on the degree of brain damage, the
patient may be referred to a rehabilitation setting that specializes in cognitive
restructuring after brain injury (Ashley, 2004). The patient is encouraged to continue
the rehabilitation program after discharge, because improvement in status may continue
3 or more years after injury. Changes in the patient with a head injury and the effects of
long-term rehabilitation on the family and their coping abilities need frequent
assessment. Continued teaching and support of the patient and family are essential as
their needs and the patient's status change. Teaching points to address with the family
of the patient who is about to return home are described in Chart 63-6.
Depending on his or her status, the patient is encouraged to return to normal activities
gradually. Referral to support groups and to the Brain Injury Association may be
warranted.
During the acute and rehabilitation phases of care, the focus of teaching is on obvious
needs, issues, and deficits. The nurse needs to remind the patient and family of the need
for continuing health promotion and screening practices after these initial phases.
Patients who have not been involved in these practices in the past are educated about
their importance and are referred to appropriate health care providers.
Evaluation
Expected Patient Outcomes
Expected patient outcomes may include the following:
Attains or maintains effective airway clearance, ventilation, and brain
oxygenation
o Achieves normal blood gas values and has normal breath sounds on
auscultation
o Mobilizes and clears secretions
Achieves satisfactory fluid and electrolyte balance
o Demonstrates serum electrolytes within normal range
o Has no clinical signs of dehydration or overhydration
Attains adequate nutritional status
o Has less than 50 mL of aspirate in stomach before each tube feeding
o Is free of gastric distention and vomiting
o Shows minimal weight loss