9 52 Nervous System Alteration Case Discussion Richard Hammond Is A 48 Year Old Male Who Sustained A Traumatic Brain In 1 (34.93 KiB) Viewed 63 times
9 52 Nervous System Alteration Case Discussion Richard Hammond Is A 48 Year Old Male Who Sustained A Traumatic Brain In 2 (34.93 KiB) Viewed 63 times
9:52 NERVOUS SYSTEM ALTERATION CASE DISCUSSION: Richard Hammond is a 48-year-old male who sustained a traumatic brain injury as a result of crashing a high speed jet powered car. On admission, his blood pressure (BP) was 158/72 mm Hg. heart rate (HR) 46 beats per minute. respiratory rate (RR) 28 breaths per minute and temperature 96.2°F (35.6° C). His neurological excam reveals that his right pupil is at 6 mm and reacts skuggishly: his left pupil is 4 mm and reacts briskly. He is nonverbal extends his arms bilaterally to pain, and opens his eyes minimally to pain. He is quickly intubated and placed on mechanical ventilation. A computed tomography ICT) scan is done, which reveals a large right subdural hematoma with cingulate herniation from right to left as well as right-sided uncal herniation He is taken to surgery emergently for a craniotomy to remove the subdural hematoma. After surgery, he arrives in the critical care unit with a ventricular catheter to measure intracranial pressure (ICP). His initial ICP is 24 mm Hg. BP 130/67 mm Hg. mean arterial pressure (MAP) 88 mm H. HR 54 beats per minute. RR 12 breaths per minute (controlled ventilation, and temperature 96.1 F(35.5 C). His current Glasgow Coma Scale (GCS) score is 3, but the anesthesiologist did not reverse the anesthesia. choosing to allow it to wear off gradually. He has orders for 3% saline at 20 mL/hr intravenously QUESTIONS FOR CONSIDERATION AND CARE PLANNING 1. Based on the information provided what is Mr. Hammond's preoperative GCS calculation! 2. What is the significance of this number and how would the nurse describe this to two concerned gentlemen waiting to hear his condition and prognosis? 3. Anatomically, what is the cause of his pupilary changes? 4. Which of his postoperative findings are of the greatest concer? 5. Why is the 3% saline ordered, and how will the nurse know if it is effective? 6. Five extra points awarded if you can name the two gentlemen AND state under what circumstances you could share this information as stated in question #2
9:52 NERVOUS SYSTEM ALTERATION CASE DISCUSSION: Richard Hammond is a 48-year-old male who sustained a traumatic brain injury as a result of crashing a high speed jet powered car. On admission, his blood pressure (BP) was 158/72 mm Hg. heart rate (HR) 46 beats per minute. respiratory rate (RR) 28 breaths per minute and temperature 96.2°F (35.6° C). His neurological excam reveals that his right pupil is at 6 mm and reacts skuggishly: his left pupil is 4 mm and reacts briskly. He is nonverbal extends his arms bilaterally to pain, and opens his eyes minimally to pain. He is quickly intubated and placed on mechanical ventilation. A computed tomography ICT) scan is done, which reveals a large right subdural hematoma with cingulate herniation from right to left as well as right-sided uncal herniation He is taken to surgery emergently for a craniotomy to remove the subdural hematoma. After surgery, he arrives in the critical care unit with a ventricular catheter to measure intracranial pressure (ICP). His initial ICP is 24 mm Hg. BP 130/67 mm Hg. mean arterial pressure (MAP) 88 mm H. HR 54 beats per minute. RR 12 breaths per minute (controlled ventilation, and temperature 96.1 F(35.5 C). His current Glasgow Coma Scale (GCS) score is 3, but the anesthesiologist did not reverse the anesthesia. choosing to allow it to wear off gradually. He has orders for 3% saline at 20 mL/hr intravenously QUESTIONS FOR CONSIDERATION AND CARE PLANNING 1. Based on the information provided what is Mr. Hammond's preoperative GCS calculation! 2. What is the significance of this number and how would the nurse describe this to two concerned gentlemen waiting to hear his condition and prognosis? 3. Anatomically, what is the cause of his pupilary changes? 4. Which of his postoperative findings are of the greatest concer? 5. Why is the 3% saline ordered, and how will the nurse know if it is effective? 6. Five extra points awarded if you can name the two gentlemen AND state under what circumstances you could share this information as stated in question #2
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