Question

Adam Simmons, 25 years old, was in a snowmobile accident. He was found lying against a tree unresponsive. In the field his blood pressure was 132/72, pulse 74, and respirations 14. When he arrived at the hospital, his pupils were unequal and reacted slowly. He moved his left side only to noxious stimuli and did not move his right side at all. His BP was 170/70, pulse 60, and respirations 22.

1. What do these findings most likely indicate and why did the vital sign changes occur?

2. Mannitol 50 g was ordered immediately. What was the purpose? What are the nursing implications of administering mannitol emergently?

3. Adam was taken to CT scan and then immediately to the OR for evacuation of an epidural hematoma. Why does the discovery of an epidural hematoma require emergent surgery?

4. On transfer to the ICU following surgery, Adam was receiving Diprivan (propofol) for sedation. Why might sedation have been required? What are the advantages and problems of using propofol for sedation in the patient with HCP?

5. In the ICU, Adam had an ICP monitor and an external ventricular drain that was to be maintained 5 cm above the tragus and drained continuously. What are the nursing responsibilities associated with maintaining such system?

6. Adam's ICP suddenly increased to 40. His pupils became fixed and he exhibited decerebrate posturing. How should the nurse have responded?

Answer 1

Answer : 1)weakness of one part of the body ,enlarged pupil in one of your eyes, loss of vision on one side and loss of consciousness are the main symptoms of epidural haematoma. This type of accidents damage the part of the brain that controls blood pressure so BP increases. Epidural haematoma increases intracranial pressure and it can lead to hemodynamic instability and bradycardia. 2) Mannitol use for reducing the intracranial pressure and cerebral edema by reducing brain mass. Nursing interventions : 1) monitor vital signs 2) monitor urine output strictly 3) Assess the patient for dehydration (decreased skin turgor, dry skin and mucous membranes) 4) check the signs of fluid overload ( check cup, edema ) 5) monitor electrolytes and random blood sugar frequently 6) check patient has any other signs and symptoms like anorexia ,muscle weakness, numbness and tingling . 3)EDH is a neurosurgical emergency. If, therefore ,requires urgent surgical evacuation to prevent irreversible neurological injury and death secondary to hematoma expansion and herniation .