A 65-year-old male was brought by the rescue squad to the emergency room after being found comatose on the floor of his

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A 65-year-old male was brought by the rescue squad to the
emergency room after being found comatose on the floor of his
garage at the bottom of a 15-ft ladder. He was intubated at the
scene for airway protection and remains unresponsive. Past medical
history is unknown as a neighbor found the patient; however, the
neighbor notes alcohol intake of unknown frequency or quantity.
Computed tomography scan (CT scan) imaging of his cervical spine
was negative but brain imaging showed diffuse, traumatic
subarachnoid hemorrhage; small right-sided epidural hematoma (EDH);
and large left subdural hematoma (SDH) with subsequent tentorial
herniation. The left-sided SDH was evacuated and a hemicraniectomy
was performed to minimize the mass effect of the cerebral edema.
The patient was admitted to the neurocritical care unit (NCCU) for
proper management and treatment. Foley catheter in place with clear
yellow urine. Urinary output is within normal range. The patient
initially regained some movement in the left upper and the left
lower extremities postoperatively. But noticed of an acute loss of
his left-sided motor function, right eye deviation, and in coma.
Subjective Data: Unable to obtain due to coma Objective Data: Vital
signs: Temperature - 97.6°F, heart rate 105 beats per minute;
systolic blood pressure 148 mm Hg; mean arterial pressure 80 mm Hg;
oxygen saturation 98% on 40% oxygen; respiratory rate is 18 breaths
per minute with a set ventilator rate of 12 breaths/minute.
Intracranial pressure is 18 mm Hg with a cerebral perfusion
pressure of 70 mm Hg. The intraventricular catheter is leveled at
10 mm Hg and is actively draining clear cerebral spinal fluid. A
normal intracranial pressure waveform is noted. Medications: Normal
Saline Solution at 75 mL/hour. Nicardipine IV infusion 5mg/hr.
Propofol infusion has been off, and Fentanyl was given 6hrs ago.
Laboratory findings: sodium 142 mEq/L, blood urea nitrogen 8 mg/dL,
creatinine 0.7 mg/dL, glucose 105 mmol/L, white blood cell count
11,000 cells/mL, hemoglobin 11 g/dL, platelets 205,000/µL,
urinalysis and toxicology screen are both negative. Diagnostic
Findings: Immediate radiographic, diagnostic testing with a
non-contrast CT scan of head. MRI – few days after - showed severe
diffuse axonal injury (DAI)
Tasks: 100 points
Create in a PowerPoint presentation or pdf Submit the output
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Guidelines for the Case Presentation:
Describe the disease / condition presented above with a minimum
of 300 words: definition, epidemiology, signs and symptoms,
treatment and management
Discuss what is meant by hemicraniectomy? Trace the
pathophysiology of the disease in relation to the patient’s
case.
Present the relevance of each of the diagnostic and/or
laboratory tests to the patient in the given case scenario.
Create at least 2 nursing care plans based on your assessment
that needs to be prioritized.