Application effect for a care bundle in optimizing nursing of patients with severe craniocerebral injury

Table 1 Key points of severe craniocerebral injury critical signal observation and monitoring

Complication	Observation points
Abnormal increase of intracranial pressure	Headache, malignant vomiting, drowsiness, yawning, etc.
Cerebral hernia	The size of the bilateral pupil was different, and the light reflex disappeared.
Respiratory dysfunction or failure	Oxygen saturation was lower than 94%, intermittent sigh breathing or mandibular breathing.
Airway obstruction	Frequent vomiting or hiccup, disease after a full meal, snoring like breathing.
Massive cerebral infarction or massive cerebral hemorrhage	Immediately after the onset of the disease or progressive disturbance of consciousness, eye gaze, GCS score below 7, atrial fibrillation.

GCS: Glasgow Coma Scale.