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Original Question

A twenty-two-year-old male student from Pagadian City is currently studying electrical engineering at Southern Mindanao Colleges. He was ejected from a moving vehicle, which was traveling approximately at 60 mph. His injuries included a severe closed head injury with an occipital hematoma, a Right pneumothorax, and also he sustained bilateral wrist fractures. Immediately this student was rushed to the ER and was further admitted to the ICU of a nearby community hospital. During his stay in the ICU, this patient was intubated and placed on mechanical ventilation, had a feeding tube inserted and was placed on tube feedings, had a foley catheter for dependent drainage, and had multiple IVs inserted. He developed pneumonia 1 month after admission. 1. Describe the term Primary Head Injury. 2. Describe Secondary Head Injury. 3. What are the different type of intracranial hematomas? 4. Illustrate the pathophysiology of Increased Intracranial pressure (IICP). 5. Why is increased intracranial pressure (IICP) so clinically important? 6. List at least four (4) medication classifications used in treating head injuries (NOTE: Please DO NOT list the generic and brand names of the specific medication) and eight (8) nursing measures that ICU nurses could use to control or decrease the ICP The doctor prescribed medications for this client, which includes clindamycin (Cleocin) 150 per feeding tube q6h, ranitidine (Zantac elixir) 150 mg per feeding tube BID, and phenytoin (Dilantin) 100 IVPB TID. Indicate why he is on each medication. A chest x-ray (CXR), STAT is ordered after each central venous catheter (CVC) is inserted. The doctor further requested that a portable X-ray machine be used. According to the hospital protocol, no one is permitted to infuse anything through the catheter until CXR has been read by the physician or a radiologist. What is the purpose of the CXR and why fluid isn’t infused through the catheter until after the CXR is read? This client has spent 1 and a half months in acute care and is now on your rehab unit. He easily follows commands but tends to get very agitated with too much stimulation. His tracheostomy site is well healed and the pneumonia is finally resolving. He is currently receiving supplemental tube feeding and has some continued incontinence of both bowel and bladder. He has a very supportive group of friends at school several of them are also from Pagadian City. His latest lab results are as follows: Na 149 mmol/L K 2 mmol/L Cl 119mmol/L BUN 25 mg/dl Creatinine 20 mg/dl Glucose 123 mg/dl WBC 15.4 thousand/cmm Hgb 9 g/dl Hct 39.4% Platelets 140 thou/cmm Are any of these a concern to you, and what would you suggest to correct them? Are you surprised by his agitated behavior? Explain Outline a general rehabilitation plan for this client based on the above data. ________________________________________________________________________

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