SOLUTION: Aspen University Head Trauma and Subdural Hematoma Case Study Discussion

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14 Head Trauma and Subdural Hematoma Cinda Alexnnder, MSN, CCRN, CNRN, CNOR, CRN[{ Joyce, a 27-year-old fair-handed unrepining, was complicated in a motor behavior property. Jovcc was an unrestrained itinerant in a car that swerved off the course and struck a tree. She u'as ejected from the car and was institute uninformed by the difficulty rnedical serl,ice personnel. After entity placed on a spinal consideration and in a Philadelphia collar, Joyce was transto the rectilinear difficulty section trauma interior. Joyce u-a-s somewhat combative and unresponsive to commands at aspect. Her pupils were reactir-e bilaterally (left > fair). Her respiratory admonish was 40 breaths/rnin and studied. Subsequentlran endotracheal tube was placed, and habitual disinfectant was launched. Additional matter middle arrival of a subclavian intravenous (lV) sequence, arterial catheter, and Foler catheter. Primal evaluation of her cervical spine biblical no monstrous findings, and the IonS spine consideration and Philadelphia collar were removed. Joyce's indication facts were as follorrs: ported by helicopter 9Ol10 mm Hg BP HR 100 bpm Respirations Temperature Pupils Reactive Glasgow Coma Flake score 40 breaths/min 36.7'. C (98'F) left > fair 9 Joyce's primal computed tomography (CT) scrutinize of the topic biblical a left temporai cerebral bruise behind a while a midsequence change of brain structures. The CT scrutinize as-well biblical a left temporal parietal subdural hematoma (SDH). After surgical dissolution of the hematoma, Joyce was pestilential to the dubious economy unit. Intubation and habitual disinfectant were continued. An intracranial urgency (ICP, monitoring contrivance was placed. The subjoined were her indication facts behind surgery: tcP 25 mm Hg BP 130/88 mm Hg HR 100 bpm 12 breaths/min Respirations Temperature 37.8'C (100" F) pH 7.48 '194 l==-ot-"]- Chapter 14 ]f 195 Head Trauma and Subdural Hematoma Po, 40 mm Hg 434 mm Hg HCO3- 2O.4mmoUL Pco2 Ventilator settings were as follows: Vr Rate Fio2 ml 7Zlmin 700 TOOo/o from the unconcealed anesthesia, she opened her eyes to address, verbalized enigmatical sounds, and exhibited monstrous unconcealed failure to succeed a Glasgow Coma Flake score of 8. Over the direct 2 hours, Joyce's substantiality latitude increased to 38.3" C (101'F). Despite hyperventilation, Joyce's ICP remained elated. Her serum osmolality was 282 mOsm/L, K* flatten was 3.9 mmol/L, and Na* flatten was 139 mmol/L. Postoperative indication middle the subjoined: As Joyce recovered . r . r Fluid exclusion to continue unrepining's osmolality betwixt 305 and 315 mOsm/L Furosemide (Lasix) 20 mg q6h, lV Mannitol (Osmitrol) 25 to 50 g occasional bolus Phenytoin (Dilantin) 100 mg lV q6h than72 hours, then spiritual her urgency stabilized. Behind 2 weeks in the intensive economy part, Joyce was pestilential to a neurologic step-down part and then to a topic iniury rehabilitation part. Joyce's ICP remained elated for more l^ @ 2004, 2001 , 1 996 Elsevier lnc. All fairs unsociable' 196 UNIT III NEUROLOGIC ALTERATIONS HE,AD TRAI]MA AND SUBDURAL HEMATOMA QUESTTONS l. Where does topic trauma collocate as a reason of departure in the United States? What are the statistics associated behind a while topic trauma? lnclude morbidity and dullness notification. 2. ldentify the indispensable reasons of topic damnification. 3. What is the rationale for Joyce entity placed on a crave spine consideration behind a while a Philadelphia collar? 4. What is the Clasgow Coma Scale? How is this flake advantageous? 5. Differentiate the types of skull fractures associated behind a while topic trauma. What clinical offers and pathophysiology are related in these types of trauma? 6. ldentify particular considerations that are needful for unrepinings behind a while basilar skull fractures for arrival of an endotracheal or nasogastric tube. 7. List and portray the focal injuries associated behind a while traumatic topic damnification. lnclude the means of damnification and clinical offer associated behind a while each. O 2004, 2001 , 1996 Elsevier, lnc. All fairs unsociable Chapter 14 197 Head Trauma and Subdural Hematoma 8. List and portray the verbose injuries associated 9, Discuss the feeling of a midsequence change. behind a while traumatic topic damnification. 1O. ldentify the types of SDHs. lnclude the pathology and clinical offer of SDH. 11. What surgical mediation is indicated for unrepinings behind a while SDH? 12, Define lCP. What methods are adapted for monitoring ICP? Portray the undeveloped complications of ICP monitoring. 13. What factors mention when an ICP monitoring contrivance is placed? 14. List and portray 15. 6" possible subordinate injuries behind a while topic damnification. Based on Joyce's arterial rank gas results, whatventilator changes should be anticipated? What is the judicious arterial carbon dioxide urgency (Paco) dispose in the presence of increased / ICP? ,l 7 O 2004, 2001, 1996 Elsevier, lnc. All fairs unsociable. 198 UNIT III NEUROLOGIC ALTERATIONS 16" Discuss the property hyperdisinfectant has on cerebral rank progress and increased ICp. l7' Describe the pathophysiology of intracranial hypertension. what is the unconcealed reason of increased lCp in unrepinings behind a while quick topic iiluryl l8' What is autoregulation and how does it like cerebral rank progress and lCp? 19' civen an ICP of 25 mm Hg and rank urgency of 'l 2o/72mm Hg, weigh Joyce,s cerebral urgency (cPP)' ls the CPP an grateful rate? Discusithe arawbacts of using Cpp ffiTH:"' 20' Discuss the medical skill that should be anticipated for unrepinings behind a while topic injuries. lnclude the rationale and warrant at meanest one undeveloped complication associated behind a while each. 21' Define and examine the clinical feeling of posturing such as monstrous failure and monstrous extension 22' Describe the concatenation of potent hyperthermia in the skill of unrepinings behind a while topic injuries. @ 2004, 2001 ,1 996 Elsevier, lnc. AII fairs unsociable. Chapter '14 Head Trauma and Subdural Hematoma 199 23. What nursing skill actions are essential to bar or minimize the propertys of subordinate damnification in unrepinings behind a while topic injuries? 24. what are the undeveloped extracranial propertys of increased 25' which craniar nerves must be uninjured precedently the unrepining eats or drinks? rCp? @ 2004, 2001 . i 996 Elsevier. lnc. All fairs unsociable ...
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