Reference no: EM133541710
Olivia Reynolds, 17 years-old is a victim of a motor vehicle collision (MVC) and was unresponsive at the scene for approximately 2-minutes. She had a large laceration to the back of her head and several abrasions and possible fractures. She had serosanguinous drainage from the left ear. At the scene paramedics placed her on a long spine board and applied C-collar.
On arrival at the hospital Olivia was unresponsive. Bloodwork, x-rays, and CT were ordered.
Results:
Hgb: 79
CK: 1879
CT of spine: no fracture or dislocation seen
CT of head: Right side shows acute subdural hematoma and small focal areas of fresh hemorrhage to frontal and temporal lobe, and midline shift.
Effacement of cerebral sulci which suggests brain edema
Skull x-ray: transverse and longitudinal fracture of temporal bone
1. What is the rationale for Olivia being placed on a long spine board with a Philadelphia collar? At what point would collar be removed?
2. A trauma alert is called. Explain initial assessments of patient in ER. Olivia initially had a GCS of 12 and now has a GCS of 8. What is the significance of the GCS and what would nurse anticipate?
3. Differentiate the types of skull fractures associated with head trauma. What clinical presentations and pathophysiology are pertinent in these types of trauma?
4. Define ICP. What methods are available for monitoring ICP? Describe the potential complications of ICP monitoring.
5. Olivia is ordered to receive mannitol. Why would this medication be ordered? What assessment is required? What are potential complications of this therapy?
6. Olivia is experiencing hyperventilation and has a PaCO2 level of 52. She has an ICP of 20 mm Hg. As the nurse what do you know this could lead to? How will you control it? Please relate to Monro-Kellie hypothesis.
7. Olivia's BP IS 130/88 and ICP is 12 mm Hg. What is her CPP? How did you calculate it and how would you interpret the result?
8. 36 hours later in the ICU, Olivia's urine output suddenly increases to 500 mL per hr. What does the nurse suspect? What lab findings would support this? What is causing this symptom and what treatment would the nurse anticipate?
9. Olivia's BP is 180/40, heart rate 42 beats per minute and respiratory rate of 8 breaths per minute. What does the nurse suspect and why? Please explain significance of this finding.
10. Olivia had signed a donor card. TGLN has been notified. Explain the procedure involved in declaration of neurological determination of death and nurse's role.