Bifrontal Contusions Ppt

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Case Presentaion

Transcript of Bifrontal Contusions Ppt

Bifrontal Contusions

Bifrontal ContusionsLuz, Kathleen Mapili, AnjelikaMarquez RichMendiola, BessieSadol, BryanSantos, Raphael IISingh, HarmandeeepZamora, Miguel

On Completion of this Case Presentation, we will be able to:1. Describe the nursing management of Bifrontal Contusions.

2. Discuss the Pathophysiology of Bifrontal Contusions and describe the appropriate nursing interventions.

3. Use the nursing process as a framework for care of patients with Bifrontal Contusions

Objectives

Bifrontal ContusionsA form of traumatic brain injury, is a bruise of the brain tissue. Like bruises in other tissues, cerebral contusion can be associated with multiple microhemorrhages, small blood vessel leaks into brain tissue. Contusion occurs in 2030% of severe head injuries. A cerebral laceration is a similar injury except that, according to their respective definitions, the pia-arachnoid membranes are torn over the site of injury in laceration and are not torn in contusion. The injury can cause a decline in mental function in the long term and in the emergency setting may result in brain herniation, a life-threatening condition in which parts of the brain are squeezed past parts of the skull. Thus treatment aims to prevent dangerous rises in intracranial pressure, the pressure within the skull.

Introduction

Health History:Name: E.AAge: 39Address: Quezon CityHospital #: 351699Attending Physician: Dr. Legaspi , Dr. YeoDate Admitted: June 11,2012Chief Complaint: Fall/ decreased sensationFinal Diagnosis: Bifrontal ContusionOperation Performed: Bifrontal

DEMOGRAPHIC DATA

Present history:Few minutes prior to admission, the client was just seen unconscious.Family History:(+) cancer mother(+) diabetes mellitus motherPersonal/Social History:NON-smokerNON-alcohol drinker

HISTORYSelf-Care Deficit Nursing Theory of Dorothea OremOrem developed the Self-Care Deficit Theory of Nursing, which is composed of three interrelated theories: (1) the theory of Self-Care, (2) the theory of Self-Care Deficit, and (3) the theory of Nursing System.

Theoretical Framework

Pattern of FunctioningBefore HospitalizationDuring HospitalizationAnalysis/ InterpretationHealth Perception and ManagementThe patient is taking multivitaminsthe patients wife still provides him daily vitamins including the medication given to him.The patient is well aware of the medical diagnosis that was given to him.Nutritional and metabolic patternHe usually eats times 6 a day including 3 snacks and drinks lots of water. The patient has decreased appetite due to his condition, though the wife makes sure that her husband eats his food.Due to the patients condition it affects his eating pattern.Elimination patternThe patient does not experience pain during urination and does not feel any discomfort during defecation. The patient does not feel any difficulty in urination and defecation. There was no change in his elimination pattern.Patients condition did not affect his elimination pattern.Gordons Pattern of Functioning

Activity and Exercise patternThe patient has no particular exercise. But plays a lot outdoors. Like basketball,etcDue to his condition patient usually sleeps and just watch tv.Patient has no difficulty in moving but due to his condition he needs to rest.Sleep and Rest patternThe patient usually wakes up early around 6 am and has no trouble of sleeping. He has no nightmares. Due to his condition patient has a disturbed sleeping. This is because of his vital signs needed to be checked by nurses. Patient is having irregular sleep because of his condition checked regularly.Role and Relationship PatternPatient is a 39 y/o man living with is wife onlyPatient is accompanied by his wife and sometimes have visitors. They entertain him so that he will cooperate with any procedures that is being done.Patient is well supported by his wife. Sexuality and Reproductive patternDID NOT ANSWERValues and Beliefs patternPatient is roman catholic and goes church regularly with his wife. Patient cannot go to church due to being hospitalized and his condition. Due to his condition his the patient cannot go to church but pray.Coping stress pattern The patient does listen to music to cope up from stress.The patient cooperates well with the nurses activities to cope up.Patient does not show any signs of stress.Cognitive and Perceptual patternThe patient doesnt wear glasses and doesnt have hearing impairment. And does not have any lesions and/or bruises. During the interview patient was very cooperative and had interacted with us very well. He was aware of his surroundings and what was going on. Patient is aware about his condition and the procedures that he had undergone.Self perception and Self ConceptPatient is quiet but gets to be fun around people. Patient gets more attention since his wife is always there beside him. Patient has poor energy due to his condition. Physical Assessment:

Parts of the bodyNormal FindingsFindingsAnalysisA. Upper ExtremitiesArmsWarm to touch and tendernessWarm to touch, no lesionsnormalPalms and dorsal surfacePinkish and slightly roughPinkish, slightly roughnormalNailsTransparent, convex and five fingers eachTransparent, convex and five fingers each handNormalShouldersPerform w/o any difficultyCan move without difficulty and have a tattoo of his wife on left shoulderNormalElbowsPerform without any difficultyCan bend without difficultyNormal 1.skullGenerally roundNot semmetricalBecause of the surgery head is not symmetrical 2.scalpLighter in color, moist, free from liceMoist or oily, free from lice and flakes. There is an incisionBecause of the procedure done it marked or made a scar 3.hairCan be black, brown, depending on the race; evenly distributedNot evenly distributed because an incision was made. It was there is a part where in its hairless Because his head is been incised therefore the hair havent grown yet.B.EyesNon protrudingVisual acuity : 20/20Normal 1.eyelashesEvenly distributedEvenly distributedNormal 2.eyelidsNo ptosisNo signs of ptosisNormal 3.lacrimal glandNon-palpabaleNon-palpable; no regurgitationNormal 4.conjunctivaPink-palpebralPink-palpebral conjunctivaNormal 5.scleraAnicteric sclera (white in color)Anicteric scleraNormalC. EarsBean-shaped earlobes, no lesions or open woundsNo lesions or any dischargesNormalD. NoseNose in the midline; no discharges; no bone or cartilage deviation noted.No tenderness noted; no signs of any dischargesNormalE. NeckNo visible mass or lumps; symmetrical; no jugular venous distentionNo mass or lumps; symmetricalNormal 1.lymph nodesMay not be palpable; non-tender IF PALPABLE; less than 1cm in size.Firm; non-tender and less than 1cm in sizeNormal 2.thyroidNormally non-palpable; no nodules palpableNo nodules presentNormalF. Thorax 1.lungsIllustrate voluntary soundVoluntary sounds presentNormalG. CardiovascularPulse visible; no lift or heaves.apical pulsations is presentNormalH. BreastMay or may not be completely symmetrical; no orange peel skin present; no presence of obvious massesNo retractions or any dimpling; no obvious massesNormalI. AbdomenSkin color is uniform, no lesions; some may have presence of striae or scarsNo venous engorgement; no tenderness noted; no muscles guardingNormalK. Lower extremitiesEqual in size; no edema; no crepitusAsymmetrical in size.Normal

Anatomy and Physiolgy

Frontal Lobe - Front part of the brain; involved in planning, organizing, problem solving, selective attention, personality and a variety of "higher cognitive functions" including behavior and emotions.The posterior (back) of the frontal lobe consists of the premotor and motor areas. Nerve cells that produce movement are located in the motor areas. The premotor areas serve to modify movements.

LABORATORY AND DIAGNOSTIC TESTS:

CT Scan ResultDate: June 11, 2012

CT of the HeadMultiple axial images of the head were obtained without intravenous contrastCerebral contusion hematoma with perilesional edema is noted in both frontal lobes. This causes slight posterior compression of the adjacent unaffected frontal lobes and anterior horns of the lateral ventricle. Extraaxial hemorrhagic collection is also seen in the fronto temporal region extending into parietal region in both region. The ventricles and cisterns are normal in size and shape. The rest of the parenchymal gray-white pattern is intact.Subgaleal hematoma is seen in the parietooccipital region and mucoperiosteal thickening is also noted in the ethnoid and sphenoid sinuses. Polypoid densities are seen in the left maxillary sinus. The mastoids and the rest of parangeal sinus are well-aerated and intact. Linear fractures are seen in the frontal bones as well as in the occipital bone extending down the margin of the foramen magnum. The rest of the visualized osseous structures are normal.

IMPRESSION:Contusion hematoma, bilateral frontal lobeAcute subdural hemorrhage with subarachnoid component, bilateral protemporal region extending into parietal region, as well as epidural focus in the left and right parietal region.Subgaleal hematoma, frontal and occipital bonesPolysinusitisMucus retention cysts or polyps, left maxillary sinusPolysinusitis

TestResultUnitNormal ValueRemarksSodium136mmol/L136-145NormalBiochemistry:Date of Examination-June 15, 2012TestResultUnitNormal ValueRemarksFT4 (RIA)29.46Pmol/L11-5-23highTSH(IRMA).84ul/ml.27-3.75normalNuclear Medicine TestDate of examination-June 25, 1012

FT4-It avoid any change the proteins could have, giving us the real value of T4 (thyroid function test)TSH- use to diagnose a thyroid disorder in a person with symptomsTestResultUnitNormal ValueRemarksHemoglobin*120g/dl135-160LowHematocrit**.37.40-.48LowEryhtrocyte***3.9110^12/l4.5-5lowMCV93.90fl80-96NormalMCH30.70pg27.33NormalMCHC32.70g/dl33-36Nor