diagnostic tests and nursing interventions. 

Identify and select appropriate interventions including diagnostic tests and nursing interventions.

· Analyze physiological and psychological responses to illness and treatment modalities

Purpose:  Examine case studies related to neurologic disease and answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.

Assignment Description: 

· Describe the pathophysiology of extradural and subdural hematomas.

· Identify the surgical emergency and provided rationale for the choice.

· Describe the most likely type of head injury and outline an appropriate treatment plan.

· Your answer must follow APA 7th edition format.

· Submit the answer to this assignment area.

Patient 1 – Two individuals come to the emergency department with head injuries. One, 25 years old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years old, has increasing confusion after a fall that happened earlier in the week.

a. Differentiate the pathophysiology of extradural hematoma and subdural hematoma.

b. Identify the patient in the above scenario requiring immediate emergency surgical intervention and provide rationale for your choice.

Patient 2 – An 38 year old was driving his 1970 Chevy Corvette to a Milwaukee Brewers baseball game when a deer jumped out in front of him on the highway. He swerved his car and hit a telephone pole instead. His head hit the windshield and he suffered severe head trauma.

a. Describe the most likely specific type of head injury he suffered.

b. Outline the treatment plan for this patient.

Estimated time to complete: 6 hours

 

Rubric

NU621 Unit 6 Case Study

 

SAMPLE PAPER

Patient Scenario-1

Two individuals come to the emergency department with head injuries. One, 25 years old, has

just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years

old, has increasing confusion after a fall that happened earlier in the week.

Extradural Hematoma vs Subdural Hematoma

McCance and Huether (2014) define extradural hematomas as 1% to 2% of major head

injuries, common in 20 to 40 year olds. Bleeding is located between the dura mater and skull.

The most common mechanism for extradural hematomas to occur is a result of motor vehicle

accidents (MVAs) with 90% being caused by temporal fracture and the temporal fossa being the

primary location. In 85% of extradural hematomas an artery is the main culprit for bleeding.

“The resulting shift of the temporal lobe medially precipitates uncal and hippocampal gyrus

herniation through the tentorial notch” (p. 585). Those with extradural hematomas initially lose

consciousness then have a lucid time period for a few hours to a day or two after depending on if

the bleeding is arterial or venous. During that lucid time is when the bleeding is increasing. This

is ultimately followed by severe headache, drowsiness, nausea, vomiting, potentially seizures,

and confusion (McCance & Huether, 2014). If the patient is not treated in time, herniation

followed by death can occur.

Subdural hematomas account for 10% to 20% of traumatic brain injuries. The most

common cause is motor vehicle accidents (McCance & Huether, 2014). In older adults, falls can

be linked to chronic subdural hematomas. Additionally, subacute hematomas can develop slower

over the course of two days to two weeks. Chronic hematomas develop over two weeks to two

months. Subdural hematomas are a result of venous blood occurring between the dura mater and

arachnoid mater (McCance & Huether, 2014). Depending how many veins are torn will depend

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CASE STUDY 3

on amount of bleeding. When bleeding begins, the blood will begin to compress the brain and

cause the intracranial pressure (ICP) to increase. As the ICP increases, the bleeding veins are

compressed eventually slowing the bleeding. Symptoms include headache, drowsiness,

confusion, slowed cognition and generalized rigidity (McCance & Huether, 2014).

Most Emergent Patient

The patient requiring immediate emergency surgical intervention would be the 25 year

old. This is in part due to the fact of extradural hematomas primarily come from the artery

causing rapid bleeding. McCance and Huether (2014) report the prognosis to be good prior to

bilateral dilated pupils noted. The authors also note these hematomas to be medical emergencies

almost always. This is not to say the 65 year old patient doesn’t need an intervention. They most

likely will due to becoming symptomatic. However with the subdural hematoma most likely

being venous it is a slower bleed than arterial. Additionally, with the fall occurring earlier in the

week and more recently developing increased confusion, he has the potential of remaining more

stable than the 25 year old patient.

Patient Scenario 2

A 38 year old was driving his 1970 Chevy Corvette to a Milwaukee Brewers baseball game when

a deer jumped out in front of him on the highway. He swerved his car and hit a telephone pole

instead. His head hit the windshield and he suffered severe head trauma.

Type of Head Injury

The patient ultimately suffered a focal traumatic brain injury, more specifically a coup

and contrecoup brain injury. Upon hitting his head, it threw his head forward hitting the

windshield (coup). This was then followed by his head going backward (contrecoup). “The focal

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CASE STUDY 4

injury may be a coup injury (directly below the point of impact) or contrecoup (on the pole

opposite the site of impact)” (p. 583).

Treatment Plan

Treatment will depend on how much injury occurred. According to the Mayo clinic

(2019), there is usually no treatment for mild traumatic brain injuries other than rest and pain

relievers. It is recommended, however, for the patient to be monitored and watched for

worsening symptoms. For moderate to severe injuries, it’s crucial to prevent further injury to the

head or neck and also to maintain sufficient blood supply and blood pressure. Additionally,

further treatment may be needed (Mayo Clinic, 2019). This could involve surgery to remove and

stop bleeding in the brain or repairing skull fractures. Medications such as diuretics, anti-seizure

medications and coma-inducing drugs to allow the body to rest may also be indicated. Lastly,

treatment for the patient may include rehabilitation. Specialists this may include are psychiatrist,

occupational therapist, physical therapist, speech pathologist, neuropsychologist, rehabilitation

providers and recreational therapist (Mayo Clinic, 2019).

References

Mayo Clinic. (2019). Traumatic brain injury: Diagnosis and treatment. Retrieved from

https://www.mayoclinic.org/diseases-conditions/traumatic-brain-injury/diagnosistreatment/drc-20378561

McCance, K. & Huether, S. (2014). Pathophysiology: The biologic basis for disease in adults and

children. 7th Edition. Elsevier Mosby: St. Louis, MO.

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NU621 Unit 6 Case Study
Criteria Ratings Pts
This criterion is linked to a Learning OutcomeContent & Concepts

NU621-CO1; NU621-CO2; NU621-CO3; PRICE-P; PRICE-I

50 pts

5

Ideas and concepts are consistently clear and always well explained. Relationships between concepts and ideas are always discussed fairly and always synthesized in a logical fashion with strong, well-founded supporting arguments. All discussion and arguments are thoroughly supported with research and/or resource materials that are pertinent, valid, and reliable.

48.34 pts

4

Ideas and concepts are clear and well explained. Relationships between concepts and ideas are discussed fairly and synthesized in a logical fashion with well-founded supporting arguments. Discussion and arguments are supported with research and/or resource materials that are pertinent, valid, and reliable

45 pts

3

Ideas and concepts are reasonably well explained. Discussion and arguments are, for the most part, supported with research and/or resource materials that are pertinent, valid, and reliable relationships between concepts, and ideas are discussed. These could be further strengthened with additional research or resource materials.

38.34 pts

2

Basic ideas and concepts are presented; however, they are under-developed and poorly explained. There is minimal evidence of a relationship between ideas and concepts. Discussion and arguments are not supported with additional research or research that is pertinent and valid.

33.34 pts

1

Some basic ideas and concepts are started, but not developed. There is no identifiable relationship between ideas and concepts. There is little or no discussion and/or argument with supporting research.

0 pts

0

There are no developed ideas or concepts. There is no supporting research.

 

50 pts
This criterion is linked to a Learning OutcomeAnalysis

NU621-CO1; NU621-CO2; NU621-CO3; PRICE-I; PRICE-P

30 pts

5

Organizes and synthesizes evidence to reveal insightful patterns, differences, or similarities related to focus.

27 pts

4

Organizes and analyzes evidence to reveal insightful patterns, differences, or similarities related to focus.

24 pts

3

Organizes evidence to reveal important patterns, differences, or similarities related to focus.

21 pts

2

Organizes evidence, but the organization is not effective in revealing important patterns, differences, or similarities.

18 pts

1

Describes evidence, but it is not organized and/ or is unrelated to focus.

0 pts

0

Lists evidence, but it is not organized and/ or is unrelated to focus.

 

30 pts
This criterion is linked to a Learning OutcomeWriting Conventions

PRICE-P; PRICE-I

10 pts

5

The paper exhibits a superior command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling.

9 pts

4

The paper exhibits a strong command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling that impair the flow of communication.

8 pts

3

The paper exhibits command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication.

7 pts

2

The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication.

6 pts

1

The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning.

0 pts

0

The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning.

 

10 pts
This criterion is linked to a Learning OutcomeAPA

PRICE-I; PRICE-P

10 pts

5

The required APA elements are all included with correct formatting, including in-text citations and references.

8 pts

4

The required APA elements are all included with minor formatting errors, including in-text citations and references.

6 pts

3

The required APA elements are all included with multiple formatting errors, including in-text citations and references.

4 pts

2

The required APA elements are not all included. AND/OR there are major formatting errors, including in-text citations and references.

2 pts

1

Several APA elements are missing. The errors in formatting demonstrate limited understanding of APA guidelines, in-text-citations, and references.

0 pts

0

There is little to no evidence of APA formatting. AND/OR there are no in-text citations AND/OR references.

 

10 pts
Total Points: 100

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