CASE SCENARIO. (NURSING)TRAUMA (Found down by sister).

AGE/SEX 51years Male.

Unit: Q00000017

Admitted 12/17/2008

Attending doctor: Coronae,Vincent.

Medical record number:Q00009594332

Location : Transfer from ICU South to MedTelemetry .

FULL CODE: Full Code.

Diagnosis Found down,ICH,IVH(resolved).Seizure disorder.

Found down by sister. Right hemiparesis.Aphasia,

Nonverbal, dysphagia.

Secondary Diagnosis: Hypertension.

Weight 162lbs

Height 5ft 6inches.

TREATMENT:

Head CT : left basal ganglion bleed with massive left ventricular hemorrhage.

CT/MRI Slight increases in bleed – resolved. Monitor Q6hours .SBP GOAL 120- 160.

Extubated, placed on OXYGEN.02 4L NC.Transfer patient from ICU to MedTelemetry floor.

PT/OT for evaluation and treatment.

Peg tube feeding. Glucerna 1.0 at 65ml/hour.Flush 30ml of water Q6hours .

Keppra 1000mg IV Q8hrs .

Cardone, Esmolol,Fentanyl

and Precedex titrate off,

CPAP ×Q12.

Nonverbal, nonresponsive to pain,tactile stimuli, dysconjugate gaze.

Head staples removed as ordered by the doctor.

Patient is placed on BIPAP

Left forearm saline lock.

LABS:

WBC 8.6mm

Hgb 12.7g/dl

HTC 39.5%

K 3.7mEqkcl

NA 141mEqkcl

PLAN

Transfer to MedTelemetry and to continue with current doctor orders.

Questions:

(1)The nurse will explain that Patient with severe traumatic brain injury that hypocapnia causes:

Answer :Cerebral vasoconstriction ( because with hypocapnia carbondioxide is lower than normal.

Rationale Hypocapnia is simply a medical definition of a deficiency of carbon dioxide in the blood which leads to Celebra vasoconstriction.A decreased in alveolar and blood carbon dioxide (CO2)level lower than normal reference range of 35mmHg.

(2)The most important preventable cause of death in trauma patient is:

Answer: Uncontrolled hemorrhage. So it very important to stop the bleeding.

Rationale: Uncontrolled hemorrhage requires lots of blood transfusions therapy. Early identification and prevention might be challenging but it is very important to control bleeding and prevent death.

(3)The nurse cares for a 45years old man who was involved in an auto accident the previous day.The patient has a double lumen tracheostomy tube with a cuff. The nurse should include which of the following in the patient plan of care.

Answe: Change the tracheostomy dressing Q8hours and prn aseptically to prevent infection, use precut gauze pads.

Rationale:Cuffed tracheostomy tube permits mechanical ventilation and seals off lower airway. Inject air with a syringe into one valve in pilot line.

Nursing Responsibilities :

Change patient’s position frequently provide humidification,and hydration ,suction as necessary.

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