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Head Injuries

Head Injuries. Case Study of Allen NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE. I THINK YOU ONLY GOT ONE IN CLASS!!!!!. What initial measures should be taken?. Airway patency Protect cervical spine Any others?. What type of head trauma do you suspect?. Contusion Concussion

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Head Injuries

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  1. Head Injuries Case Study of Allen NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE. I THINK YOU ONLY GOT ONE IN CLASS!!!!!

  2. What initial measures should be taken?

  3. Airway patency • Protect cervical spine • Any others?

  4. What type of head trauma do you suspect?

  5. Contusion • Concussion • Skull fracture

  6. What tests should be ordered?

  7. Skull x-rays • CT or MRI of head • ABG’s • Cervical spine x-rays • Basic CMP and CBC

  8. What should the nurse monitor?

  9. LOC • VS • Bleeding from cut • Check O2 sats • Watch for loss of clear liquid from nose or ears • Battles’s sign • Raccoon eyes

  10. What should the nurse discuss with the family?

  11. Parents decide…he is a minor • Call chaplain or counselor

  12. What might have happened to Allen?

  13. Could be drug or alcohol usage • Most likely a subdural hematoma

  14. What tests should be done?

  15. CT of head • Drug screen • CBC, BMP, ABG’s

  16. If subdural hematoma, what surgery would be done?

  17. Craniotomy with hemorrhage evacuation

  18. What type of nursing assessment would be done post-op?

  19. Glasgow coma scale • VS • LOC • Watch for drainage of wound or from ears or nose

  20. How would the nurse determine the origin of the clear nasal drainage?

  21. Look for halo or ring • Document color, amount and appearance • Can test liquid for glucose but not reliable

  22. What type of IV fluids will be administered?

  23. Normal saline or 0.45% normal saline

  24. What medications might be used?

  25. Corticosteroids • Mannitol

  26. What other interventions might be performed?

  27. In rehab what issues are most likely to be encountered?

  28. Case Study of Mike Parks

  29. 1. Are these blood gases acceptable? What is happening? What ventilator changes?

  30. CO2 is high and pH is low • Increase vent rate to get rid of CO2 (hyperventilate) • What will high CO2 do?

  31. Relationship between hyperventilation and cerebral blood flow?

  32. Hyperventilation blows off CO2, corrects acidosis and keeps ICP down.

  33. What is the best position for this patient?

  34. HOB up 30 degrees • Knees straight • Head in alignment

  35. What is large bruise behind the ear indicative of?

  36. Battles’s sign-basilar skull fracture • Look for rhinorrhea and otorrhea • High risk for infection • May develop hematoma

  37. ICP is 25 • BP = 90/30 • CPP?

  38. CPP=MAP-ICP. • MAP=DBP + 1/3 (SBP-DBP) • MAP=30+ (90-30) 3

  39. What do you do?

  40. Could cause ischemia • Raise MAP and lower ICP • Check IV fluids, use of diuretics or dopamine • Surgery? • HOB and body position good?

  41. Signs of diabetes insipidus?

  42. Very high urinary output

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