Subllel Hematoma Case Study: Subdural Trauma

Case Study- Subdural Hematoma A head injury is any trauma to the brain, skull, or scalp. Statistical documentation of a head trauma is thought to be one in five Canadians. This is an estimate as casualties occur before treatment can be obtained or the injury is minor and no treatment is sought (Laskowski-Jones, 2010). Head injuries are associated with poor outcomes as the severity of injury is not known at the time of the trauma and complications frequently arise. Patients with known injuries need to be continuously watched for up to three weeks, if they are not killed on impact, as the extent of the damage is not immediately known and secondary injury occurs to the rest of the bodies organs (Laskowski-Jones, 2010). A closed head injury is …show more content…
Patients initially present as drowsy and confused, with complaints of a headache, slurred speech, numbness, weakness, and visual disturbances (Copstead & Banasik, 2010). As bleeding continues and ICP rises patients are at an increased risk for developing seizures, patients motor responses become weaker, reflexes diminish, speech becomes unclear and unorganized, patients orientation and level of consciousness deteriorates, and the patients pupils can become unequal, dilated, and fixed (Urden et al., 2014). As nurses, emergency management of the patient would be to learn how the injury occurred to assist in developing a course of treatment (Laskowski-Jones, 2010). Next a primary search of the body is necessary to determine if there is blood, fractures, or edema especially in the head, neck, face, or eyes (Laskowski-Jones, 2010). A respiratory assessment is key as decreasing level of consciousness affects the patients ability to protect their airway (Laskowski-Jones, 2010). Lastly, an assessment of the central nervous system is needed to determine extent of injury. This includes evaluating pupil response, movement of limbs and facial muscles, speech, orientation and level of consciousness, elimination control, posturing, reflexes, and monitoring for seizures (Laskowski-Jones, 2010). From this assessment the nurse will …show more content…
Throughout the patients treatment at the very minimum nurses are required to monitor for neurologic changes through frequent neurologic assessments and monitor vital signs (Laskowski-Jones, 2010). Maintaining the head of the bed at 30-45% is essential to maintain correct body alignment as well as to reduce inter-cranial pressure (Lewis et al, 2014). Intravenous access is needed to administer fluids and medications. Fluids are administered at slow rates to prevent fluid overload and prevent an increase in inter-cranial pressure (Lewis et al, 2014). Hemodynamic monitoring with arterial catheters is needed as cerebral perfusion needs to be maintained above 60mm Hg. If perfusion dips below 60mm Hg organ failure can occur. Pressures are maintained by administering intravenous fluids, diuretics, or vasopressures (Lewis et al, 2014). Additionally, monitoring the body temperature is necessary as damage to the brain could compromise the bodies ability to regulate temperature. An increased temperature may also be indicative of an infection which will need to be treated with antibiotics (Laskowski-Jones, 2010). Environment control is necessary as pain, agitation, or discomfort could increase inter-cranial pressure. Analgesics as well as sedatives are given to allow the patient to rest. Additionally, controlling the surrounding light and noise level is required (Urden et al., 2014). Monitoring inter-cranial pressure can be