Case Study 1: Melvin Strong
a. What do the assessment findings suggest?
The assessment shows increased intercranial pressure (ICP) due to hemorrhage in the brain from the trauma of being ejected from an automobile. It may have resulted from an epidural hematoma from the fall leading to skull fracture tearing an underlying blood vessel or a subdural hematoma from the buildup of blood on the brain’s surface (Capizzi et al., 2020).
b. What signs and symptoms does the patient exhibit related to increased intracranial pressure?
The patient exhibits severe headache, an episode of projectile vomiting, neurologic decline, high blood pressure, and one dilated pupil, indicating blurred vision, which are signs and symptoms of increased intracranial pressure. The patient further presents loss of consciousness and regaining of consciousness, a sign exhibited by people with epidural hematoma.
c. What medical and surgical treatment does the nurse anticipate for the patient?
The patient needs an emergency surgery to reduce the ICP, stop hemorrhage, and remove any possible clots in the brain. It is also important to put the individual on respiratory support in addition to monitoring and administering IV crystalloids to stabilize his blood pressure (Capizzi et al., 2020).
d. What Glasgow Coma Scale (GCS) did the patient have initially at the scene of the accident? What GCS did the patient have when he began deteriorating neurologically?
At first, the patient exhibited GCS of 15 indicated by obeys commands for movement (6), oriented to time, place, and person (5), and spontaneous eye-opening response (4). As the individual deteriorated neurologically, the GCS went to 8, as shown by eye response to pain (2), incomprehensible sounds (2), and withdrawal from pain (4).
e. What nursing interventions should the nurse provide?
Intervention will include an elevation of the head of bed (HOB) to a semirecumbent position and initiation of seizure precautions and prevention measures. Perform a prothrombin time (PT) blood test and maintain oxygenation, respiratory, and cardiovascular function, as well as, manage the patient’s fluid and electrolyte balance (Capizzi et al., 2020).
Case Study 2: Sue Landers
a. What clinical management should the nurse anticipate for the patient?
The nurse should anticipate fluid and electrolyte balance management, provide oxygen and monitor I/O, and place an ostomy for the paralytic ileus and spinal cord injury from the diving accident. The patient should be bedbound and administer glucocorticoids for suppression of inflammation of the spinal cord.
b. What are signs that the neurogenic shock is resolving?
The signs include increase in BP and HR that becomes WNL (within normal limits). Other signs include increase in temperature and increased respirations. The patient sweats again to control temperature.
References
Capizzi, A., Woo, J., & Verduzco-Gutierrez, M. (2020). Traumatic brain injury: An overview of epidemiology, pathophysiology, and medical management. Medical Clinics, 104(2), 213- 238.
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