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ACUTE SUBDURAL HEMATOMA

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by

jomar deliguin

on 13 September 2013

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Transcript of ACUTE SUBDURAL HEMATOMA

photo credit Nasa / Goddard Space Flight Center / Reto Stöckli
ACUTE SUBDURAL
HEMATOMA

BIOGRAPHIC DATA
Age
history
history
pathophysiology
trauma
NURSING CARE PLAN
SEE YOUR COPY
DRUG STUDY
THANK YOU
NURSES!
REMEMBER WE ARE ALL LEADERS!
LEAD BY EXAMPLE.
-Jing Datud, RN, MSN, EMT
Sex
Nationality
Religion:
67
male
filipino
roman catholic
fall
risk factor:
swelling
bleeding
brain
of
decrease
cerebral
perfusion
cerebral hypoxia
altered
LOC
headache
(pain)
restlessness
projectile vomiting
cushing's triad
hypertension
bradycardia
bradypnea
CSF LEAK
otorrhea
ear
rhinorrhea
nose
lithmus
dextrose
test
OPERATING ROOM
PACU
SURGERY WEST
SICU
GROUP
PRESENTED BY:
intoxicated and fell from stairs
Focus
of the
problem
Left subdural hematoma
Diagnostic Procedures:
CT SCAN
BLOOD WORKS
intoxication
occupation:
farmer
Chief complaint
history of fall
decrease LOC
mild difficulty of breathing
DIAGNOSIS:
Subdural hematoma, Left secondary to trauma
patient is Lethargic
gcs of: 9
M5E2V2
Result:
LONG LINEAR, NON-DISRUPTED FRACTURE, RIGHT OCCIPITOBASAL
SUBDURAL HEMATOMA, LEFT CEREBRAL CONVEXITY

importance: to check for the presence of ishemia, hemorrhage, edema and fracture.
location, severity and classification will also be checked.
TEST and RESULT

HEMOGLOBIN-122 g/L
HEAMTOCRIT-0.33
WBC-22.75
PLATELET-280

PROTHROMBIN TIME:
PATIENT -11.5 seconds
CONTROL-11.4 seconds
INR- 0.95
%ACTIVITY-89.30%

PARTIAL THROMBOPLASTIN
TIME
PATIENT-- 36.4 seconds
CONTROL- 38.4 seconds


36.4 SECS
34.8 SECS

Significance: Hematology was indicated to determine the Patient’s Hydration status-Hematocrit; RBS’s oxygen carrying capacity-hemoglobin, Infectious state- White Blood Cells and Coagulation status –Platelet, aPTT and PT.
MANNITOL
CLASSIFICATION: osmotic diuretic
ACTION: increases osmotic pressure of glomerular infiltrate
PRIORITY NURSING INTERVENTION:1.WATCH OUT FOR HYPOTENSION, DEHYDRATION AND ELECTROLYTE IMBALANCE
2. MONITOR I/O.
LEVETIRACETAM
INDICATION: reduction of ICP and treatment of cerebral edema.
SIDE EFFECTS:DEHYDRATION, HYPOKALEMIA,N/V
ACTION: INHIBITS KINDLING IN HIPPOCAMUS, PREVENTING SIMULTANEOUS NEURONAL FIRING THAT LEADS SEIZURE
INDICATION:ADJUNCT THERAPY IN THE TREATMENT OF PARTIAL ONSET SEIZURE
CLASSIFICATION: ANTICONVULSANT
PRIORITY NURSING INTERVENTION: ASSESS LOCATION,DURATION AND CHARACT. OF SEIZURE. DO NOT STOP ABRUPT
SIDE EFFECTS:SAMNOLENCE,EMOTIONAL INSTABILITY,DIZZINESS
CITICHOLINE
CLASSIFICATION
NEUROTONICS/NOOTROPICS
INDICATION: HEAD INJURY/CVA
ACTION:INCREASES CEREBRAL METABOLISM
INCREASES LEVEL OF VARIOUS NEUROTRANSMITTER
IT HAS NEURO PROTECTIVE EFFECTS IN SITUATION OF HYPOXIA AND ISCHEMIA
SIDE EFFECT:RESTLESSNESS. ELEVATION OF BODY TEMP.,N/V,H/A,TACHYCARDIA,BLURRED VISION, LOW OR HIGH BP
PRIORITY NURSING ACTION: WOF FOR HYPOTENSION. TAKE WITH OR IN BETWEEN MEALS.

OMEPRAZOLE
CLASSIFICATION: PROTON PUMP INHIBITOR
INDICATION:USED FOR TREATING ACID-INDUCED INFLAMMATION AND ULCERS OF THE STOMACHAND DUODENUM.
ACTION: GASTRIC ACID-PUMP INHIBITOR WHICH SUPPRESSES GASTRIC ACID SECRETION.
SIDE EFFECTS: DIARRHEA, N/V, H/A, RASH AND DIZZINESS.
PRIORITY NURSING ACTION: ADMINISTER BEFORE MEALS. ADMINISTER ANTACIDS WITH OMEPRAZOLE IF NEEDED.
TRANEXAMIC ACID
CLASSIFICATION: ANTIFIBRINOLYTIC, ANTIHEMORRHAGIC
ACTION: INHIBITS ACTIVATION OF PLASMINOGEN, THEREBY REDUCING CONVERSION TO PLASMIN-A POTENT ENZYME THAT
INDICATION: HEMORRHAGE/ POSTSURGICAL TREATMENT
PRIORITY NURSING ACTION: WTCH OUT FOR FURTHER BLEEDING
NIMODIPINE
ACTION: BINDS SPECIFICALLY TO L-TYPE VOLTAGE-GATED CALCIUM CHANNELS WHICH PREVENTS ENTRY OF CALCIUM IONS INTO VASCULAR MUSCLE, CAUSING DLATION.
INDICATION: PREVENTION OF VEREBRAL VASOSPASM.
CLASSIFICATION: CALCIUM CHANNEL BLOCKER
SIDE EFFECTS: HYPOTENSIO, EDEMA, FLUSHING,COUGH, DIMINISHED TASTE.
PRIORITY NURSING ACTION: TAKE APICAL PULSE PRIOR ADMINISTERING.
WOF FOR ANY INDICATION OF HYPOTENSION.

VITAMIN K
CLASSIFICATION: ANTICOAGULANT
ACTION: CONTROLS CLOTTING MECHANISMOF BLOOD AND ITS ACTION IS DIRECTED AT THE PRECURSOR OF PROTHROMBIN.
INDICATION: ESSENTIAL VITAMIN THAT IS NEEDED BY THE BODY FOR BLOOD CLOTTING.
SIDE EFFECTS: FLUSHING SENSATION, PECULIAR SENSATION OF TASTE, ALLERGIC SENSITIVITY.
PRIORITY NURSING ACTION: WOF FLUSHING, TACHYCARDIA, WEAKNESS, HYPOTENSION.
SULBACTAM AMPICILLIN
CLASSIFICATION: AMINOPENICILLIN
ACTION:BLOCKS BACTERIA'S CELL WALL GROWTH AND SYNTHESIS DURING MICROORGANISM MULTIPLICATION.
INDICATION: PROPHYLAXIS FOR SURGERY.
TREAMTMENT OF INFECTION DUE TO STRAINS OF GRAM POSITIVE AND NEGATIVE BETA-LACTAMASE PRODUCING TRAINS.
SIDE EFFECTS: ALLERGIC REACTION, N/V, GASTRIC DISTURBANCES
PRIORITY NURSING ACTION: BE ALERT FOR ANY ADVERSE REACTION. ASK ABOUT PREVIOUS ALLERGIC REACTION TO PENICILLIN.
KETOROLAC
LACTULOSE

CLASSIFICATION: NONSTEROIDAL ANTI-INFLAMMATORY AGENTS
INDICATION: SHORT TERM MANAGEMENT OF PAIN
ACTION: INHIBITS PROTAGLANDIN SYNTHESIS, PRODUCING PERIPHERALLY MEDIATED ANALGESIA.
SIDE EFFECT GI BLEEDING, N/V, NEPHROTOXICITY
PRIORITY NURSING ACTION: ASSESS PAIN LEVEL BEFORE AND AFTER ADMINNISTRATION.
ASSESS FOR SENSITIVITY.
ASSESS FOR ANY INDICATION OF GI BLEEDING.
GIVE WITH FOOD.

CLASSIFICATION:LAXATIVE
INDICATION: TO INDUCE BOWEL EVACUATION.
ACTION:METABOLISM OF LACTULOSE BY BACTERIA RESULTS IN REDUCED COLONIC pH WHICH STIMULATES PERISTALSIS AND DECEASES STOOL TANSIT TIME.
SIDE EFFECT: ABDOMINAL DISCOMFORT WITH FLATULENCE AND CRAMPS.
PRIORITY NURSING ACTION:MONITOR ELECTROLYTES WITH LONG TERM USE. MONITOR FOR EPISODES OF DIARRHEA
OUR PRIORITY NURSING CARE PLAN
1. INEFFECTIVE BREATHING PATTERN
2. INEFFECTIVE CEREBRAL PERFUSION
3. IMPAIRED SKIN INTEGRITY
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