1. Head Injuries Case Study of Allen
NOTE: THERE ARE ANSWERS TO 2 CASE STUDIES HERE.
I THINK YOU ONLY GOT ONE IN CLASS!!!!!

2. What initial measures should be taken?

3. Airway patency
Protect cervical spine
Any others?

4. What type of head trauma do you suspect?

5. Contusion
Concussion
Skull fracture

6. What tests should be ordered?

7. Skull x-rays
CT or MRI of head
ABG’s
Cervical spine x-rays
Basic CMP and CBC

8. What should the nurse monitor?

9. LOC VS
Bleeding from cut
Check O2 sats
Watch for loss of clear liquid from nose or ears
Battles’s sign
Raccoon eyes

10. What should the nurse discuss with the family?

11. Parents decide…he is a minor
Call chaplain or counselor

12. What might have happened to Allen?

13. Could be drug or alcohol usage
Most likely a subdural hematoma

14. What tests should be done?

15. CT of head
Drug screen
CBC, BMP, ABG’s

16. If subdural hematoma, what surgery would be done?

17. Craniotomy with hemorrhage evacuation

18. What type of nursing assessment would be done post-op?

19. Glasgow coma scale VS
LOC
Watch for drainage of wound or from ears or nose

20. How would the nurse determine the origin of the clear nasal drainage?

21. Look for halo or ring
Document color, amount and appearance
Can test liquid for glucose but not reliable

22. What type of IV fluids will be administered?

23. Normal saline or 0.45% normal saline

24. What medications might be used?

25. Corticosteroids
Mannitol

26. What other interventions might be performed?

27. In rehab what issues are most likely to be encountered?

28. Case Study of Mike Parks

29. 1. Are these blood gases acceptable?
What is happening?
What ventilator changes?

30. CO2 is high and pH is low
Increase vent rate to get rid of CO2 (hyperventilate)
What will high CO2 do?

31. Relationship between hyperventilation and cerebral blood flow?

32. Hyperventilation blows off CO2, corrects acidosis and keeps ICP down.

33. What is the best position for this patient?

34. HOB up 30 degrees
Knees straight
Head in alignment

35. What is large bruise behind the ear indicative of?

36. Battles’s sign-basilar skull fracture
Look for rhinorrhea and otorrhea
High risk for infection
May develop hematoma

37. ICP is 25
BP = 90/30
CPP?

38. CPP=MAP-ICP.
MAP=DBP + 1/3 (SBP-DBP)
MAP=30+ (90-30) 3

39. What do you do?

40. Could cause ischemia
Raise MAP and lower ICP
Check IV fluids, use of diuretics or dopamine
Surgery?
HOB and body position good?

41. Signs of diabetes insipidus?

42. Very high urinary output