Question

Neurology Case scenario.

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 hemorrhage, effacement of the suprasellar cistern, and effacement of the 3^rd and 4^th ventricle. He also sustained a frontal base fracture.

1. Develop a plan of care for this patient. with Two (2) actual problems and One (1) potential problem.

Answer 1

Two actual problems in ths case - subarachnoid hemorrhage and frontal base fracture

One potential problem - meningitis

PLAN OF CARE -

A) SUBARACHNOID HEMORRHAGE -

✓ it has been caused due to traumatic brain injury.

✓ ASSESSMENT - check the level of consciousness using Glasgow's coma scale.

Look for additional symptoms like headache , vertigo,etc.

Assess respiratory rate and rhythm.

Check the muscle tone and reflexes.

✓ DIAGNOSIS- Injury risk due to bleeding.

diagnosis is done by computed tomography scan to locate site of trauma.

MRI scan can also be done for better imaging.

✓ NURSING INTERVENTION - depends on severity of injury.

Surgery may be needed.

Multiple professionals are required like neurosurgeon, trauma surgeon, pulmonologist,etc.

Maintain clear airways . Monitor respiratory rate and rhythm.

Monitor intracranial pressure diligently. Observe any further leakages.

B) FRONTAL BASE FRACTURE - caused by external trauma.

✓ assessment includes checking consciousness, respiratory functions and cognitive functions

✓ DIAGNOSIS - frontal recess injury

It is diagnosed by non contrast computed tomography scan.

Xray may also be done

✓ NURSING INTERVENTION-Symptoms in this case would depend upon the extent of injury to cranial nerves. For eg - injury to seventh cranial nerve would cause a facial droop.

Interventions would also depend on location of injury

Airways must be stabilized and respiratory rate must maintained.

Frequent neurological assessment is crucial.

Continuous monitoring of intracranial pressure is must.

Any changes in symptoms is also noted.

C) MENINGITIS - Patients with basal fractures have a high risk of infection in CSF.

✓diagnosis - ineffective cerebral tissue perfusion.

Nursing interventions would focus on preventing infection.

✓ CSF is sent for culture to look for any microbial growth.

✓ Also, look for any signs of twitching,restlessness , rigidity,etc. In case you find any of these symptoms, report to the doctor.