Nutritional Support
Nutritional support needs are higher during the acute phase following brain injury and appropriate management is necessary to support recovery.  Dietetic advice is essential.  During PTA the patient may be experiencing restlessness, agitation, behavioural disturbances, wandering and a disrupted sleep/wake cycle.  Therefore it is important that nutritional support be commenced to ensure increased calorific intake.  Helpful strategies may include:

  • Provide clear orientation to mealtimes.
  • Reduce external distractions.
  • Ensure the patient is comfortable, pain free and appropriately positioned before commencing eating/drinking.
  • Provide appropriate levels of support for eating/drinking.
  • Consider providing frequent small meals rather than three large ones. This may be easier for the patient to manage if they are dysphagic, fatigue rapidly, have attentional difficulties and/or are restless and agitated.
  • For patients who require enteral nutrition, provide clear, simple explanation of the procedure and reasons for the intervention before commencing feeding. Give the patient time to process the information and acknowledge that they have understood. Repeat as necessary.
  • Implement other helpful strategies to maintain tube in situ and feeding regimen.

Fatigue and Sleep
During PTA a disrupted sleep pattern and fatigue are common problems which may result in an exacerbation of other difficulties including confusion, anxiety, agitation and aggression.  Strategies to reduce fatigue and improve sleep pattern during PTA are helpful:

  • Promote a regular sleep-wake cycle: allow exposure to some light during the day (but avoid overstimulation) and ensure light levels are lower at night.
  • Ensure noise levels are reduced and other sources of stimulation are kept to a minimum at night.
  • Try carry out minimum interventions during the night.
  • Extra sleep is required during PTA. Support the patient to get the extra sleep they may need during the day as long as this does not begin to affect their ability to sleep at night.
  • Seek advice on appropriate medication to support the establishment of a normal sleep-wake cycle if necessary. If possible, minimise the use of medication which may have an adverse effect on energy levels and the sleep-wake cycle e.g. antipsychotics and benzodiazepines.
  • Reduce fatigue by trying to ensure that activities /interventions do not take too long or become tiring. Pacing interventions and activity is helpful.
  • Manage pain as this may be a significant contributory factor to fatigue and a disrupted sleep-wake cycle.