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A pessoa em situação neurocrítica vítima de traumatismo cranioencefálico: abordagem de enfermagem especializada
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| 19.09 MB | Adobe PDF |
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O traumatismo cranioencefálico é uma das principais causas de morte e incapacidade a nível mundial, caracterizando-se pela elevada complexidade fisiopatológica e prognóstica. A pessoa em situação neurocrítica apresenta, frequentemente, alterações agudas de autorregulação cerebral e fenómenos de hipertensão intracraniana, principais indutores da lesão cerebral secundária. Na ausência de terapêutica específica, a abordagem centra-se na prevenção de novas lesões, através da deteção precoce e intervenção sistematizada, sustentada na neuromonitorização multimodal e na atuação de equipas qualificadas.
Neste contexto, o enfermeiro especialista assume um papel essencial na vigilância contínua, na identificação precoce de complicações e na implementação de intervenções direcionadas à estabilidade neurológica e hemodinâmica.
Este relatório, desenvolvido no âmbito do Mestrado em Enfermagem Médico-Cirúrgica na área de especialização em Enfermagem à Pessoa em Situação Crítica, visa descrever de forma analítica, crítica e reflexiva o percurso de aquisição e desenvolvimento de competências especializadas e a integração do conhecimento teórico na prática clínica.
O desenvolvimento deste trajeto encontra-se assente na metodologia descritiva e crítico-reflexiva, centrado na abordagem de enfermagem à pessoa em situação crítica. De modo específico são abordados os cuidados à pessoa vítima de traumatismo cranioencefálico, desde a avaliação inicial em serviço de urgência, estabilização hemodinâmica e controlo da hipertensão intracraniana, até à neuromonitorização em cuidados intensivos e vigilância pós-operatória. São ainda descritas intervenções da equipa de Emergência Médica Intra-Hospitalar e estratégias de gestão da dor.
As experiências vivenciadas fortaleceram o pensamento crítico, a tomada de decisão clínica e o compromisso ético-legal, o que fomentou a qualidade e a segurança nos cuidados. A prática baseada na evidência e as teorias de Patricia Benner e Afaf Meleis, contribuíram para corroborar conhecimento na prevenção da lesão secundária e na otimização dos outcomes da pessoa em situação neurocrítica vítima de traumatismo cranioencefálico.
Traumatic brain injury is one of the leading causes of death and disability worldwide, characterized by a high level of physiopathological and prognostic complexity. The neurocritical patient frequently presents acute disturbances of cerebral autoregulation and phenomena of intracranial hypertension, which are major contributors to secondary brain injury. In the absence of specific therapy, management focuses on preventing further injury through early detection and systematic intervention, supported by multimodal neuromonitoring and the performance of qualified multidisciplinary teams. In this context, the specialist nurse plays an essential role in continuous monitoring, early identification of complications, and implementation of interventions aimed at neurological and hemodynamic stability. This report, developed within the Master’s Degree in Medical-Surgical Nursing with specialization in Nursing Care for the Person in Critical Condition, aims to describe, in an analytical, critical, and reflective manner, the process of acquiring and developing specialized competences and integrating theoretical knowledge into clinical practice. This pathway is based on a descriptive and critical-reflective methodology, focused on nursing care for the person in critical condition. Specifically, it addresses care provided to the person with traumatic brain injury, from the initial assessment in the emergency department, hemodynamic stabilization, and control of intracranial hypertension, to multimodal neuromonitoring in intensive care and postoperative surveillance. It also describes the interventions of the In-Hospital Medical Emergency Team and strategies for pain management. The experiences developed strengthened critical thinking, clinical decision-making, and ethical-legal commitment, thus promoting quality and safety in care delivery. Evidence-based practice and the theories of Patricia Benner and Afaf Meleis contributed to reinforcing knowledge in the prevention of secondary brain injury and the optimization of outcomes for the neurocritical patient with traumatic brain injury.
Traumatic brain injury is one of the leading causes of death and disability worldwide, characterized by a high level of physiopathological and prognostic complexity. The neurocritical patient frequently presents acute disturbances of cerebral autoregulation and phenomena of intracranial hypertension, which are major contributors to secondary brain injury. In the absence of specific therapy, management focuses on preventing further injury through early detection and systematic intervention, supported by multimodal neuromonitoring and the performance of qualified multidisciplinary teams. In this context, the specialist nurse plays an essential role in continuous monitoring, early identification of complications, and implementation of interventions aimed at neurological and hemodynamic stability. This report, developed within the Master’s Degree in Medical-Surgical Nursing with specialization in Nursing Care for the Person in Critical Condition, aims to describe, in an analytical, critical, and reflective manner, the process of acquiring and developing specialized competences and integrating theoretical knowledge into clinical practice. This pathway is based on a descriptive and critical-reflective methodology, focused on nursing care for the person in critical condition. Specifically, it addresses care provided to the person with traumatic brain injury, from the initial assessment in the emergency department, hemodynamic stabilization, and control of intracranial hypertension, to multimodal neuromonitoring in intensive care and postoperative surveillance. It also describes the interventions of the In-Hospital Medical Emergency Team and strategies for pain management. The experiences developed strengthened critical thinking, clinical decision-making, and ethical-legal commitment, thus promoting quality and safety in care delivery. Evidence-based practice and the theories of Patricia Benner and Afaf Meleis contributed to reinforcing knowledge in the prevention of secondary brain injury and the optimization of outcomes for the neurocritical patient with traumatic brain injury.
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enfermagem médico-cirúrgica traumatismo cranioencefálico pessoa em situação neurocrítica pressão intracraniana cuidados de enfermagem medical-surgical nursing traumatic brain injury neurocritical patient intracranial pressure nursing care
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