Collaborative Care for a Woman With Traumatic Brain Injury During Pregnancy

Abstract

In this case study, we focus on a woman who experienced a traumatic brain injury (TBI) during pregnancy. Special considerations regarding care of the pregnant woman in a rehabilitation setting, development of vancomycin-resistant enterococci colonization in open cranial flap, current immunization recommendations during pregnancy, methods for screening for gestational diabetes mellitus in an aphasic woman, and the importance of a team approach in collaborative care are presented. The woman had an open cranial flap (approximately 10 cm in diameter) with vancomycin-resistant enterococci colonization. She had a history of marijuana and methamphetamine use and pre-existing epilepsy. Her mother, who was her primary support person, was not granted guardianship during the woman’s hospitalization; instead, there was a court-appointed guardian. The woman experienced malnutrition following TBI. She was immobile, required a two-person transfer, and was aphasic and combative. She experienced silent aspiration with thin liquids and was hypokalemic and hypoalbuminemic. The borderline low estimated fetal weight and chronic opioid use for pain following TBI raised concern regarding neonatal abstinence syndrome of the newborn. Implications for nursing practice include reviewing current immunization guidelines during pregnancy (influenza, Tdap, and pneumonia), identifying alternate methods for gestational diabetes mellitus screening in an aphasic patient, considering the timing of birth, and being aware of the potential for neonatal abstinence syndrome. We also discuss the value of interdisciplinary planning before, during, and after hospitalization.