The nursing care plan of a patient with a diffuse axonal injury (DAI) would involve which of the following considerations?
a. Neurologic assessments should be performed only once a shift.
b. The patient will need a computed tomography scan for definitive diagnosis of the injury.
c. Blood pressure and temperature elevations are common.
d. The patient is at risk for volume overload because of syndrome of inappropriate antidiuretic hormone.
C
The pathophysiology of DAI is related to the stretching and tearing of axons as a result of movement of the brain inside the cranium at the time of impact. The stretching and tearing of axons result in microscopic lesions throughout the brain, but especially deep within cerebral tissue and the base of the cerebrum. Disruption of axonal transmission of impulses results in loss of consciousness. Unless surrounding tissue areas are significantly injured, causing small hemorrhages, DAI may not be visible on computed tomography or magnetic resonance imaging. DAI can be classified as one of three grades based on the extent of lesions: mild, moderate, or severe. Patients with moderate DAI may be in a coma for longer than 24 hours and exhibit periods of decorticate and decerebrate posturing. Severe DAI usually manifests as a prolonged, deep coma with periods of hypertension, hyperthermia, and excessive sweating. Treatment of DAI includes support of vital functions and maintenance of intracranial pressure within normal limits. The outcome after severe DAI is poor because of the extensive dysfunction of cerebral pathways.
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