Question

Neurology Assignment 1

Bystanders found a 28-year-old, unhelmeted, male prone and unconscious after he had lost control of his motorcycle and went off the road. He was brought to the Emergency Department via ambulance intubated. The physical examination revealed a GCS of 3T, 4 mm bilaterally fixed pupils, negative corneal response, right parietal cephalohematoma, and cerebral spinal fluid (CSF) otorrhea on the right. CT of the head showed subarachnoid hemorrhage with left frontal and temporal subdural haemorrhage, effacement of the suprasellar cistern, and effacement of the 3^rd and 4^th ventricle. He also sustained a frontal base fracture.

1. Briefly explain how TBI is diagnosed.
2. Describe the pathophysiology of traumatic brain injury
3. What are the signs and symptoms associated with TBI?
4. Outline the medical and surgical treatment of TBI
5. Briefly describe three (3) classes of medications used in the treatment of patients suffering from TBI
6. What are the nursing considerations/management for this patient?
7. Develop a plan of care for this patient. Two (2) actual problems and One (1) potential problem.

Answer 1

Assessment usually includes a neurological testing . This test includes an evaluation of thinking, motor function (movement), sensory function, coordination, and reflexes. Imaging tests, including computerized tomography scans (CT scans) and magnetic resonance imaging (MRI) tests do not diagnose TBI.

Pathophysiology

Injury >> may b open or closed type >> ischemia, inflammation and cytotoxicity >> cell death, blood brain barrier destruction, glucose enters to brain >>> calcium and protein changes in csf >> retension of fluids in the brain >>> signs and syptoms of TBI

persistent headache, a temporary moment of clarity, bleeding, bone fracture, bruising, depression, loss of smell, nerve injury, post-traumatic seizure, ringing in the ears, or sensitivity to sound. Racoon eye( bruised puffy eyes) , batlles ring(behind the ear)

surgical intervention include craniectomy to excise the damaged bone, evacuation of hematoma, dura repair and ICP monitoring. Medical rx = pain killers, osmotic diuretics, antianxiety drugs Sometimes sedation is needed

The 3 classes of medications are

Dietetics = these drugs drains the excess fliuds from the brain

Anti siezures = these drugs prevent the pt from the extra damage from the seizures

Analgesics= these drugs are given to control pain in the pt

The nsg considerations in this pt are to provide comfort to the pt and save them from falls,pain management etc

Nursing care plan. . ..

Asessement = pt is neurological status is altered

Nsg diagnosis = risk for injury related to altered neurological status (potential problem)

Intervention = assess need for assistance, side railings, head of the bed should b low , do that restraint the pt unless needed

Assessment = pt complains of pain

Nsg diagnosis = pain related to brain injury (actual problem)

Intervention = assess pain levels in the pt, provide the calm and noise free environment , administer analgesics

Assessment = pt is anxious, fearful related to incident

Nsg diagnosis = anxiety related to injury

Intervention = provide psychological support, communicate pt about the recovery from TBI, involve pt in doing his activities under supervission etc