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CASE PRESENTATION ON

CASE PRESENTATION ON. CRANIOTOMY. Prepared by: Sumi Mathew. DEMOGRAPHIC DATA. NAME : Mr A M A AGE/SEX : 27YRS/ MALE MRN NO :203915 DATE OF ADMISSION :16/05/13

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CASE PRESENTATION ON

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  1. CASE PRESENTATION ON CRANIOTOMY Prepared by: Sumi Mathew

  2. DEMOGRAPHIC DATA • NAME :Mr A M A • AGE/SEX : 27YRS/ MALE • MRN NO :203915 • DATE OF ADMISSION :16/05/13 • DIAGNOSIS :ACUTE SDH, HEAD TRAUMA&FALL FRom height • SURGERY : POSTERIOR FOSSA CRANIOTOMY+SDH EVACUATION& duraplasty

  3. PHYSICAL ASSESMENT • GENERAL APPEARANCE • Patient is 27yrs old; male. • He is intubated from E.R and under sedatives. His vital signs are •  B.P :90/70mmHg • PULSE :100b/m • RESPIRATION :14b/m • TEMPREATURE :36.6 c • SpO2 :94%

  4. LEVEL OF CONSCIOUSNESS Patient was semiconscious on admission ;and was intubated from E.R on fully sedation . Gcs :8/15 • SKIN Fair complexion ;abrasions on back No palpable mass or lesions • HEAD Skull slightly asymmetric Cut wound on scalp . Maxillary ,frontal and ethmoid sinuses are not tender.

  5. EYES Redness on right eye No discharges pupils 1mm sluggish. EARS No unusual discharges noted • NOSE AND SINUSES Pink nasal mucosa;not perforated No nasal discharge

  6. MOUTH Pink and dry oral mucosa Tongue and uvula in midline position ET tube and OGT are present • NECK AND THROAT No palpable lymph nodes No mass and lesions seen • CHEST & LUNGS Thorax is symmetric Equal chest expansion

  7. No retraction of the intercostal spaces No tenderness on anterior side Abrasion present on back • CARDIO VASCULAR SYSTEM ECG reports shows normal variation and no changes noted • UPPER EXTREMITIES Decorticate position of hands Arms are unable to extend Abduction and adduction can possible

  8. ABDOMEN Its rigid and little distention present Bowel sounds are normal • GENITO URINARY SYSTEM No ulceration on perineal area; clean • LOWER EXTREMITIES Normal positions of tibia & fibula;legs can adbuct and adduct

  9. PATIENT HISTORY • PAST MEDICAL AND SURGICAL HISTORY Patient has no past medical and surgical history • PRESENT MEDICAL HISTORY Patient brought to E.R H/O FALL FROM HEIGHT with loss of consciousness .He was intubated from E.R and admitted in ICU on 16/05/13 .

  10. PRESENT SURGICAL HISTORY Patient had undergone LEFT POSTERIOR FOSSA CRANIOTOMY +EVACUATION OF SDH+DURAPLASTY on 16/05/13. • INVESTIGATIONS DONE FOR THE PATIENT • X-ray Chest • CT Brain And Lumbar Spine • MRI Scan of Brain

  11. BLOOD INVESTIGATIONS • CBC • Electrolytes • Urea Creatinin

  12. LAB VALUES

  13. MEDICATION

  14. ANATOMY and physiologyOFBRAInThe brain is one of the largest and most complex organs in the human body.It is made up of more than 100 billion nerves that communicate in trillions of connections called synapses.The brain is made up of many specialized areas that work together:The cortex is the outermost layer of brain cells. The basal ganglia are a cluster of structures in the center of the brain

  15. SKULL The purpose of the bony skull is to protect the brain from injury. All the arteries, veins and nerves exit the base of the skull through holes, called foramina. The big hole in the middle (foramen magnum) is where the spinal cord exits.

  16. sutures of the skull

  17. Brain

  18. The brain is composed of • three parts: • CEREBELLUM • CEREBRUM. • BRAINSTEM

  19. SURFACE OF BRAIN

  20. DEEP STRUCTURES • Hypothalamus • Thalamus • Pituitary gland • Pineal gland

  21. MENINGES The brain and spinal cord are covered and protected by three layers of tissue called meninges. From the outermost layer inward they are: The Dura mater, Arachnoid mater, and Piamater.

  22. Ventricles and Cerebrospinal fluid The brain has hollow fluid-filled cavities called ventricles Inside the ventricles is a ribbon-like structure called the choroid plexus that makes clear colorless cerebrospinal fluid.CSF flows within and around the brain and spinal cord to help cushion it from injury. This circulating fluid is constantly being absorbed and replenished.

  23. Nervous system The nervous system is divided into central and peripheral systems. The central nervous system (CNS) is composed of the brain and spinal cord. The peripheral nervous system(PNS) is composed of spinal nerves. That branch from the spinal cord and cranial nerves that branch from the brain.

  24. Cranial nerves

  25. THE TWELVE CRANIAL NERVES

  26. Blood supply Blood is carried to the brain by two paired arteries, the internal carotid arteries and the vertebral arteries. The internal carotid arteries supply most of the cerebrum. The vertebral arteries supply the cerebellum, brainstem, and the underside of the cerebrum

  27. Etiology • Head injury fall fromheightMotor vehicle collision Assault. • People with a bleeding disorderpeople who take blood thinners . • Elderly people are at higher risk for chronic subdural hematoma TOPIC PRESENTATION Subdural Hematoma In a subdural hematoma, blood collects between the layers of tissue that surround the brain. The outermost layer is called the durra. In a subdural hematoma, bleeding occurs between the durra and the arachnoids.

  28. ETIOLOGY • Head injury • Fallfromheight • Motorvehiclecollision • Assault. • People with a bleeding disorder • People who take blood thinners .

  29. Signs and Symptoms • Headache • Confusion • Change in behavior • Dizziness • Nausea and vomiting • Lethargy or excessive drowsiness • Weakness • Apathy • Seizures • Lose of consciousness and • coma

  30. Treatment • Burr hole trephination. A hole is drilled in • the skull over the area of the subdural • hematoma, and the blood is suctioned out • through the hole. • Craniotomy. A larger section of the skull • is removed, to allow better access to the • subdural hematoma and reduce pressure. • Craniectomy. A section of the skull is • removed for an extended period of time, • to allow the injured brain to expand and • swell without permanent damage

  31. craniotomy Craniotomy is a cut that opens the cranium.During this surgical procedure, bone flap, is removed to access the brain underneath. Craniotomies are often named for the bone being removed. Some common craniotomies include frontotemporal, parietal, temporal, and suboccipital.A craniotomy is cut with a special saw called a craniotome.

  32. STEPS OF PROCEDURE There are 6 main steps craniotomy.. Step 1: prepare the patient Step 2: make a skin incision. Step 3: perform a craniotomy, open the skull Step 4: exposure the brain

  33. Step 5: correct the problem Step 6: close the craniotomy

  34. COMPLICATIONS • Complications of anesthesia • Infection • Hemorrhage andpost-operative hematoma • Leak of cerebrospinal fluid • Brain swelling • Raised intracranial pressure • Paralysis • Hydrocephalus • Loss of sensation • Loss of vision • Loss of speech • Memory loss

  35. NURSING INTERVENTIONS • Cardiovascular/Circulation • 1 For ICU patients, vital Signs every 1 hour • 2. For non-ICU patients, vital Signs every 4 hours • Neurological • 1.For ICU patients, perform neurological assessment every1 hour. • 2. For non-ICU patients, perform neurological assessmentevery 4 hours x 24 hours, then every 8 hours or per order.

  36. 3. Assess spontaneous activity (i.e. frequent posturechanges, breathing pattern, vomiting, twitches or seizures 4.MonitorI&O per order. Fluids may be restricted to prevent fluid shift and cerebral edema. 5. Monitor for seizure activity and maintain safety 6. Evaluate patient for signs and symptoms of Increasing intracranial pressure. These include

  37. a.) Diminished response to stimuli b)Fluctuations of vital signs c.) Restlessness d.) Weakness and paralysis of extremities e.) Increasing headache f.) Changeinvision/pupillarychanges

  38. PRIORITIZATION OF NURSING PROBLEMS 1) Altered cerebral tissue perfusion related to decreased cerebral blood flow secondary to head injury 2) Ineffective airway clearance related to accumulation of secreation and decreased LOC

  39. Risk of infection related to surgical procedure. • 4)Ineffecive breathing pattern related to Neurological dysfunction • 5)Risk for injury related to disorientation & restlessness • 6)Risk for impaired skin integrity related to immobility.

  40. Health education • 1.Instruct the patient • Do not drive after surgery until discussed with surgeon. • Avoid sitting for long periods of time. • Do not lift anything heavier than 5 pounds. • Housework and yardwork are not permitted until the first follow-up office visit.

  41. 2. An early exercise program to gently stretch the neck and back. • 3. Encourage walking • 4.Instruct When to Call Doctor • A temperature that exceeds 101º F • An incision that shows signs of infection. • If taking an anticonvulsant, and notice drowsiness, balance problems, or rashes. • Decreased alertness, increased drowsiness, weakness of arms or legs, increased headaches, vomiting.

  42. CONCLUSION • Patient was intubaA case of fall from height with acute SDH was brought in ER on 16/05/13 • ted from the ER upon arrival • His GCS Was 8/15 • The patient was then shifted to OR for emergency POSTERIOR FOSSA CRANIOTOMY +SDH EVACUATION +DUROPLASTY . • Patient was shifted to ICU after surgery and was on ventillator for 10 days . • He was extubated after 10 days .

  43. BIBILIOGRAPHY • Wikipedia • Lippincatt manual nursing practice 9th edition • Mayfield clinic • Medical-Surgical Standards Review • Intensive Care Unit Standards

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