NR 340 Week 7 Case Study: Neuro

Ms. J, a 27 year-old right-handed patient, was involved in a motor vehicle collision.  Ms. J was an unrestrained passenger in a car that swerved off the road and struck a tree.  She was ejected from the car and was found unconscious by the emergency medical service personnel. 

After being placed on a spinal board and placed in a cervical collar, she was transported by helicopter to the nearest trauma center.………………………………………………………………………………………………………………………………………….

Ms. J’s ICP remained elevated for more than 72 hour, then gradually her pressure stabilized.  After 2 weeks in the intensive care unit, Ms J was transferred to a neurologic step-down unit and then to a head injury rehabilitation unit. 

1. Identify the leading causes of head injury.
2. What was the rationale of placing Ms. J on a backboard and cervical collar?
3. What is the Glasgow Coma Scale? How is the scale helpful?
4. Identify special considerations that are necessary for patients with basilar skull fractures for placement of an endotracheal or nasogstric tube? What clinical manifestations can be seen with basilar skull fractures?
5. Discuss the significance of a midline shift?
6. Identify the types of SDHs. Include the pathology and presentation of SDH. 
7. What surgical intervention is indicated for patients with SDH?
8. Define ICP. What methods are available for monitoring ICP?  Describe the potential complications of ICP monitoring.  How can the nurse prevent those complications? 
9. List and describe possible secondary injuries with head injury. List interventions that will prevent secondary brain injury. 
10. Based on Ms J’s arterial blood gas results, what ventilator changes should be anticipated? 
11. Given an ICP of 25 mmHg and a blood pressure of 120/72, calculate Ms J’s cerebral perfusion pressure (CPP). Is the CPP an acceptable value?
12. Discuss the collaborative management that should be anticipated for patients with head injuries. Include the rationale and identify at least one potential complication associated with each. 
13. Define and discuss the clinical significance of posturing such as abnormal flexion and abnormal extension.
14. Describe the relevance of controlling hyperthermia in the management of patients with head injuries.
15. Which cranial nerves must be intact before a patient can eat or drink?
16. What are the potential intracranial effects of increased ICP?