Health Teachings

The researchers reinforced the importance of health education with the goal of
gaining a quick and full recovery, recognizing the potential range of post-concussive
symptoms, which can be part of the normal healing process and are generally not signs of
permanent damage or serious problems, and preventing these symptoms. Provision of
TBI education early after diagnosis of mild TBI has been shown to decrease symptom
prevalence (Ponsford, 2010). Patient education focused around the natural history of mild
TBI recovery that provides recommendations to facilitate sleep hygiene, coping
strategies, stress management and avoidance of excessive alcohol and drug use would be
most useful.
The following are the potential post-concussive symptoms that the patient may
experience as well as the corresponding health education provided by the researchers to
the patient and the significant others:
Headache and Neck Pain
After the vehicular accident, the patients neck may have experienced some
trauma as well. Some people recover quickly from this type of injury while others
continue to have pain or stiffness in their necks related to poor posture. This neck pain
can become head pain. (Defense and Veterans Brain Injury Center, 2010)
1. Educate on the use of ice/heat. Instruct the patient to use ice on the neck and
head at least two to three times a day. Leave it there as the patient relaxes for
about 20 minutes (or until the pack is no longer cold). Heat is good for relaxing
muscles. Use of a warm gel pack can also be done. A 1020 minute shower works
just as well. Most respond to ice better than heat. Try both to see which one works
best for the patient. When using heat or ice with neck stretches (below), use heat
to relax muscles before stretching, then use ice after stretching to calm the
muscles.

2. Instruct to do neck stretches. Before stretching in any direction, pull up the

spine as straight as possible, then retract the chin towards the neck. The muscles
the patient are stretching are small and delicate: start low, and go slow.
3. Teach proper sleep posture. Whatever position the patient sleeps in, educate
the patient on the importance of keeping the head and neck neutral to avoid
twisting and straining. Avoid the use of too many pillows during sleep.
4. Explain the importance of massage. Massages can be relaxing. Explain to the
patient that headaches can be obtained from neck tension.
5. Reinforce the importance of strict compliance with take home medications.
Be sure to tell the health care provider about all of the medications and
supplements you are taking. Consult with a health care provider prior to using any
OTC medications. Be advised that OTC medications may make your headaches
worse. If you are prescribed headache and/or neck pain medication, take it only as
directed and be aware that it may take two to four weeks to show improvement.
6. Instruct to do follow-up visits. If the conservative approaches are not effective
after two to four weeks of consistent use, it is important to consult the health care
provider.
Dizziness
Dizziness is one of the symptoms that you may experience after a head injury.
Often this is related to a problem with the inner ear, which is where balance is controlled.
The dizziness may also be related to other problems with the inner ear or problems with
your neck. It is common to also experience ringing/ buzzing in your ears, ear pain,
hearing loss, neck pain/stiffness or headaches. (Defense and Veterans Brain Injury Center,
2010)
1. Instruct to do neck stretches. Before stretching in any direction, pull up the
spine as straight as possible, then retract the chin towards the neck. The muscles
the patient are stretching are small and delicate: start low, and go slow.

2. Educate on modification of activities. If your dizziness is brought on by a

change in position for example, sitting to standing, bending forward, etc., move
slowly and allow yourself a minute in the new position before moving again.
Avoid sleeping on the bad side.
3. Teach about change in sleep postion. Instruct patient to consider sleeping in a
semi-recumbent postion if the patient experiences dizziness when getting out of
bed in the morning.
4. Instruct home vestibular rehabilitation exercises:
Hold each of these position for 30 seconds:
a. Start by stting upright in bed.
b. Turn head to the left.
c. Lie back.
d. Turn head to the right.
e. Roll over to the right side.
f. Sit up straight again.
g. Repeat in the opposite direction,e.g., start by turning head to the right.
h. Repeat the entire sequence three times.
Expected results: The vestibular rehabilitation exercises will likely bring on
typical dizziness symptoms, but over time these exercises help train the body to
overcome the dizziness. It is best to do these exercises on bed right before
bedtime. If your symptoms get worse after these exercises and do not return to
baseline within one to two hours, consult the health care provider.
5. Instruct to do follow-up visits. If these exercises do not help in about two
weeks, consult the health care provider, who will evaluate the patients condition
and set up a treatment plan.
Sleep Problems

Getting a good nights sleep has to do with many factors. The following are
helpful health teachings for good sleep hygiene and treatment of insomnia. (Defense and
Veterans Brain Injury Center, 2010)
1. No caffeine-containing foods or drinks three hours prior to bedtime
2. No heavy exercise three hours prior to bedtime
3. No alcohol, nicotine or heavy meals within three hours of bedtime
4. Avoid bright light exposure near bedtime
5. Keep regular bedtime and wake-up hours, even on the weekend
6. Foster a quiet, pleasant sleep environmenta cool room and soft lighting
7. Have a relaxing bedtime routinewarm soak in the tub or warm shower, relaxing
thoughts, meditation, progressive muscle relaxation exercises or Yoga
8. Stop work or TV viewing of disturbing or stimulating television shows at least
one hour before bedtime
9. Use of the bed is for sleep and sex, which means no watching TV, work or reading
10. Go to bed only when sleepy
11. Go to another room if sleep does not come within 2030 minutes
12. Get up at the same time each morning
13. Do not take naps
14. If you have been prescribed sleep medications, take them as instructed and at the
same time every night
15. Consult with a health care provider before taking any OTC medications or
supplements
Mood Changes
Patients who have had a mild traumatic brain injury may experience trouble
concentrating, irritability, anxiety, depression and an overwhelming feeling. As health
care providers, it is important to help the patient manage these feelings. (Defense and
Veterans Brain Injury Center, 2010)

Help the patient understand that it is okay to have these feelings and these are
normal and very common after a concussion/ mild traumatic brain injury. To manage
these feelings:
1. Instruct the patient deep breathing exercises and educate that these feelings will
pass and will get better with time.
2. Reinforce diversional activities, such as things the patient enjoys, to avoid focus
on these worries and troubles.
3. Encourage the patient to verbalize feelings. To understand the patient, the nurse
and significant others must understand from the patients perspective.
Encouraging the client to verbalize feelings fully may relieve the tension the
patient is experiencing and might be less likely to dwell on ideas that are negative.
4. Instruct significant others to always empathize with the patients feelings and
develop understanding.
5. Inform to consult physician if these mood changes are causing problems at work
or at home.
Improving Memory
The following health education helps improve the patients memory: (Defense
and Veterans Brain Injury Center, 2009)
1. Get seven to eight hours of sleep. Keep a quiet, cool environment; go to sleep at
the same time nightly; no napping; avoid high energy video games, movies and
television prior to bedtime; avoid exercise before bedtime
2. Write it down. Keep a notebook and pen with you and write things down, it will
keep you on track and help remind you of important things, like taking your
medication; day planners or small calendars also help
3. Avoid alcohol, tobacco, excessive caffeine and energy drinks. These increase
sleep problems, anxiety, blood pressure levels and overall stress

4. Prioritize. Make a list of things that need to be taken care of, place them in order
of importance and check them off when completed
5. Get a routine. For example: Put your keys in the same spot every day; park in the
same areas; being consistent helps memory and lowers anxiety
6. Keep mentally active. Work crossword puzzles; read a book; play a board or card
game like solitaire or concentration; try to learn something new every day
7. Decrease your stress level. Dont take on too much at one time; keep stress to a
minimum; stress hormones can damage your brain and add to depression and
anxiety; learn to say no when feeling overwhelmed; its also OK to ask for help
when you need it; make time for you
8. Stay physically active. Take the dog for a walk; take the stairs instead of the
elevator; small spurts of exercise add up; the higher blood flow to your brain
helps promote cell growth; exercising is also a mood booster and helps with
mental clarity
9. Feed your brain. Eat high quality foods at regular intervals; fish, colorful fruits
and veggies, milk, eggs, whole grain breads, nuts and beans all help to keep the
brain and body healthy
10. Avoid further brain injury. Consider swimming, walking or running instead of
playing football or boxing; wear a helmet when riding your bike or motorcycle;
drive safely; stay sober
Wound Healing
To promote wellness and to assist the patient in the promotion of wound healing:
1. Promote the importance of skin inspection on a daily basis, describing the wound
characteristics and the changes observed.
2. Instruct the patient and significant others to keep the wound areas clean/dry,
carefully dress wounds, prevent infection and stimulate circulation to assist the
bodys natural process of repair.

3. Reinforce strict compliance with the prescribed medications aiding in wound

healing.
4. Emphasize the importance of adhering with the proper diet. Enhancing wound
healing requires a well-balanced diet (proteins, carbohydrates, fats, vitamins, and
minerals), keeping yourself and your environment clean and dry, and increasing
activity levels to promote good circulation. (Kifer, Z. 2012)

Prevention of Head Injuries

There are many ways to minimize the risk of a concussion and other injuries:
(Centers for Disease Control and Prevention, 2011)
1. Instruct the patient to wear a seat belt and use a safety seat for children.
2. Intstruct the patient the use of a helmet that fits properly when biking, riding a
motorcycle or playing contact sports.
3. Education on falls prevention at home setting:
a. Reinforce the use the grab bars in the bathroom and handrails by stairs.
b. Instruct significant others to assist patient at all times as the patient recovers.
c. Removing trip hazards in the house.
d. Improving lighting.
e. Installing safety gates by stairs and safety guards by windows to protect
young children at home.