Complex Nursing Care of the Patient with Subdural Hematoma Tied with Traumatic Brain Injury - Case Study Example

Complex Nursing Care Name Course Tutor Date Question 1: Nature of acute problems Mike is suffering from Mike is suffering from several acute conditions. In the first case, Mike is suffering from subdural hematoma, which is normally associated with traumatic brain injury. The blood gathers around the meningeal layer near the skull because of tearing of bridging veins crossing the subdural space. This condition increases intracranial pressure that may lad of compression of the delicate brain. Since this condition is acute to Mike, it is considered life threatening. Since this is a case of acute subdural hematoma, treatment is immediately required with surgical decompression. Diagnosis and management of splenic trauma must also be taken with utmost care especially since the spleen is a very important organ in the body. Due to the nature of the accident that Mike suffered it is evident that the spleen was injured by a blunt object. The spleen is covered under the diaphragm, stomach, pancreas, and colon. Mike is experiencing a normal pulse rate but feeble. Mike is also experiencing a normal blood pressure, hence capable of proceeding to the CT scanning with IV contrast for determination of whether they're a “blush” of extra-vasated contrast is available. Presence of active extravasation indicates that there is ongoing internal bleeding which require immediate attention. However, under this case, Mike underwent splenectomy to remove the spleen since it was damaged, fractured, and bleeding following physical trauma hence cannot perform its role properly. Mike is also suffering from a broken collarbone mainly due to a fall. Confirmation is by an X-ray. These conditions are caused stressful conditions to Mike’s family especially the parents. This is because Mike has not been living with them for 3 years and was brought to the hospital smelling liquor. It is evident that Mike has been living an irresponsible life and this is creating pressure to the parents especially due to the intense nature of the injuries he is suffering. Question 2: Planning and Implementing Care for Mike Upon arrival to the hospital, the nurses and doctors must admit Mike to an emergency unit and initiate a procedure of stabilizing him. The first important step taken to start the treatment for Mike is the process of triaging him according to the guidelines provided in the Australian clinical guidelines and declared sick until proven otherwise (Harris, 2007). The second important step is to establish the ABC’s for Mike. The nurses will be able to diagnose any airway obstruction by listening to the sound produced by Mike. Presence of bubbly sound in the throat indicates an obstruction with liquid substances possibly alcohol since he was drunk at the time of the accident(Kilham, 2003). Snoring sounds heard on Mike while asleep also indicates a partial obstruction of the airway. Partial obstruction of the airway indicates presence of stridor, which also varies in terms of loudness however; the loudness has no indication of the level of severity(Hodge KM, 2007) . The nurses should then assess the severity of airway obstruction by checking the level of Mike’s alertness, heart rate and the respiratory effort. In severe cases, symptoms of decreased oxygen saturation, increased heart rate and increased respiratory effort are present. Many people have lost their lives due to hypoxia an illness that is associated with difficulty in breathing. In Mike’s case, it is important that the nurses identify the rate of which he is breathing and at the same time provide enough oxygen to improve and ease the rate of breathing. If Mike is having difficulty in breathing within a period of more than 20 seconds then it is likely that he is suffering from Apnea (Margaret, 2007). The nurses can use oximetry to determine the level of oxygen in Mike’s condition. Upon stabilizing the Mike’s breathing status, Mike can then be taken for CT scanning for diagnosis of his spleen. After this, the patient can proceed for an X-Ray to determine the extent of the damaged collarbone. The doctors and nurses should then proceed and collect relevant information regarding the patient. This is important before any treatment is initiated in the form of drugs. Parents and family members are important in providing this clinical history. The nurses should find out if Mike is suffering from any allergies. The nurses are then informed that Mike is allergic to diazepam, morphine, metronidazole, and seafood. This information immediately warns the doctors and nurses not to use these drugs while treat Mike. Nurses and doctors should be able to notice the abnormality if there is a slow heart rate accompanied by high blood pressure, which simply means that intracranial pressure is increasing (Kelley PB, 1992). Cases of confusion expressed by Mike and agitation are enough to signal the nurses that the blood circulation is not normal especially in the brain region. If the level of the urine reduces then it also indicates that there is inadequate blood circulation in the kidneys. It is also important that the nurses check the neurological alertness of the patient by checking the size and shape of his pupils(Princess Margaret Hospital for Children, 2010) . The level of reaction to light should be able to indicate the level of alertness. More information regarding Mike concerning his social, behavioral, and psychological aspects should then be collected. Blood samples should then be collected and taken to the lab for further diagnosis to determine Mike’s condition.Resulting CT scan indicates that Mike’s spleen should be removed and this requires the family’s consent. Before the doctors proceed with the operation, they should consider consulting Mike’s parents on whether to proceed with the procedure. These are legal and ethical issues that doctors must adhere to otherwise it may result to a legal tussle in case of any mistake. There should be an informed consent written by the parents to the doctor. The doctors must then clarify the risks and benefits of surgery as required by law. If an agreement is met between the doctors and the parents, Mike should then be sedated and taken to the theatre for splenectomy. Mike’s family must then undergo a small counseling session and be advised on how to take care of their son who will be required to be admitted in the hospital until his condition improves. Hopefully, from the theatre, the patient should start recuperating under care and watch of nurses and family members. Question 3 Preoperative Preparation and Nursing care for Splenectomy All patients undergoing splenectomy must receive a pneumococcus vaccine, H. Influenza, and meningococcus before the operation to reduce the chances of overwhelming post-splenectomy infections. The immunization should be given one week before the surgery but 3 weeks are recommended. However, since Mike requires an immediate attention, his immunization should be done 2 weeks after the surgery under the assumption that the patient is free of infections. There is no proven prophylaxis or antibiotic in favor or against for long-term condition after the surgery (Bader-Meunier B, 2001). Postoperative care and Nursing plan After the surgery, a nasogastric tube must be left in place for a period of 2 hours. After laparoscopic splenectomy, the tube can be removed while Mike is leaving the operating room. Mike should begin oral feeding the next day after the surgery. To enhance the recovery process, Mike requires singlepreoperative antibiotic prophylaxis in a combination with penicillin. Thrombosis prophylaxis is a routine administration that Mike should receive. This is because post splenectomy platelet count increases above normal levels leading to increased risk of potentially fatal clot formation. It is also possible that after splenectomy cases of diabetes will be on the rise. This can be reduced by insulin injections to regulate the blood sugar levels. Since it may not be possible for the splenic tissue to perform its function of providing full protection, preoperative vaccination is recommended to boost protection (Pratl B, 2007). Management during blood transfusion Blood transfusion takes as long as possible depending on the surgery. The blood is supposed to replace the lost blood an help increase the amount of oxygen hence provide more energy to the body and reduce fatigue and collapse of the tissues during the surgery. Before blood transfusion, it is important that the doctors and nurses should determine the blood group. In cases of rare blood groups, family members can be called to donate blood. Doctors may also prescribe a drug to prevent allergic reactions during blood transfusion. During the transfusion process, an intravenous IV line needle is inserted into the blood vessel. The procedure can take 1-4 hours but this is variable depending on the length of the surgery. The time may also vary depending on which part of blood you are receiving. The nurses should constantly watch Mike during this process especially to check for allergic reactions. After the transfusion, your vital organs such as the heart are checked for heart rate, blood pressure, and temperature as well. Mike requires an immediate blood test to reveal whether the body is reacting to the blood transfusion. Question 4: Discharge plan and Health education for Mike If Mike meets the discharge criteria, he will be released to go home or be transferred from surgery room to the hospital room. If Mike will be discharged to go home, he will require and assistance of a family member or a friend. This is because reflexes and coordination are usually impaired for 24 hours especially due to the se of anesthesia. The discharge plan for Mike should include clear guidelines and limitations and special instructions for care, assistance, or equipment after the surgery. Before discharge, it is important that Mike’s parents discuss the following with the doctors and nurses. Most importantly is the special dietary that Mike will require in order to help him recuperate. In addition to this, parents should find out how long Mike should take before resuming normal physical activities like driving. The parents should find out how long Mike should expect pain. Due to the broken clavicle, Mike would definitely require follow up therapy for the broken bone and for the splenectomy. How soon should Mike contact the doctors and nurses is important information that Mike requires during discharge. While discharge information is so important, Mike is required to undergo guidance and counseling since he is recovering from traumatic conditions. This requires that the patient be given enough time to rest and resist tough physical conditions in addition to avoiding alcohol at all cost. Mike should also be advised to reduce alcohol consumption and stay safe to avoid a recurrence of such accidents. Mike should also strictly take all drugs prescribed to him. He should ensure that he engages his shoulder in physical activities to enable the clavicle to recover faster and in the right way. Bibliography Bader-Meunier B, G. F. (2001). Long-term evaluation of the beneficial effect of subtotal splenectomy for management of hereditary spherocytosis. Blood, 97 (2): 399–403. Harris, D. C. (2007). Pharmacological Management. Clinical practices for management of croup in young children, 23-37. Hodge KM, G. T. (2007). Diagnostic and therapeutic efficiency in croup and epiglottitis. Laryngoscope, 97 (5): 621-5. Kelley PB, S. J. (1992). Racemic epinephrine use in croup and disposition. American journal of emergency Medicine, 10 (3): 181-3. Kilham, D. F. (2003). Croup: assessment and evidence based management. Medical journal Australia , 372-377. Margaret, P. (2007). Child and adolescent health services. Clinical practices for management of croup in children, 24-27. Pratl B, B. M. (2007). Partial splenic embolization in children with hereditary spherocytosis. EUR J Haematol, 80 (1): 76–80. Princess Margaret Hospital for Children, P. W. (2010). Guideline for dosing overweight and obese children 1 to 17 years of age. Australian Pediatric Journal, Vol 34 Issue No 65 132-146. Read More