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  • 1. POLYTECHNIC COLLEGE OF DAVAO DEL SUR MacArthur Highway, Digoc City A CASE STUDY OF Status Post Craniectomy IN PARTIAL FULFILLMENT OF THE REQUIREMENTS IN RLE/NCM 102 Presented to Ms. Mary Jane Sulla, RN Presented by Radee King R. Corpuz January, 2009
  • 2. INTRODUCTION The brain is enclosed in the skull, which is a rigid, solid bone. Surrounding the brain is a tough, leathery outer covering called the dura (door-uh). The dura attaches to the brain, just beneath the skull bone. The dura normally protects the brain and keeps it nourished with blood and spinal fluid. When a person receives a severe blow to the head, the brain bounces within the cavity. This movement of the brain structures may cause shearing or tearing of the blood vessels surrounding the brain and dura. When the blood vessels tear, blood accumulates within the space between the dura and the skull. This is known as an epidural hematoma (epi-door-ul hem-a-to-ma), or blood clot at the covering of the brain. When the blood accumulates between the dura and skull, swelling of the brain occurs. There is no extra room within the skull to allow for the brain to swell and for the blood to accumulate. The only way the brain can compensate is to shift the delicate structures out of the way. This can cause pressure on vital functions, such as eye opening, speech, level of awakeness (or consciousness) or even breathing. Generally, an epidural can cause serious problems and must be removed to prevent increased swelling of the brain. The procedure of choice for removal of an epidural hematoma is surgery to remove the blood clot. An epidural hematoma can happen to anyone, at any age. Some common causes of epidural hematoma include: A blow to the head, such as in a motor vehicle crash, assault or bicycle accident, falling down and striking the head and people at particular risk are those who, are elderly and have trouble walking or fall often, take a blood thinner, such as Coumadin Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone. CT scans reveal subdural or epidural hematomas in 20% of unconscious patients. In the hallmark of epidural hematoma, patients may regain consciousness during what is called a lucid interval, only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow. Brain damage caused by head injury can have dramatic consequences for those affected; it has been reported in prospective studies that children with a history of CET suffer from twice as many psychiatric and cognitive disorders as controls (2). It has also been reported that CET patients, in particular very serious cases, make normal personality development more difficult, leaving people with serious deficits in areas such as introspection, planning, social judgment, emotional control, empathy and reasoning (3).
  • 3. In the industrialized countries, physical injury and in particular cranioencephalic trauma (CET), is a significant clinical and social problem of epidemic proportion. According to Kraus (1), epidemiological studies on this pathology are incomplete, since none of them groups all CET patients within a defined population; however, in general it is considered that the annual incidence in the developed countries is from 200 to 300 per 100,000 inhabitants. In the different epidemiological studies, it has been found that the percentages of affected patients of pediatric age is around 20%; the accidents are mainly car crashes and sports falls (bicycles, skate-boards ...) involving a bang on the head in movement on a static surface.
  • 4. IDENTIFICATION OF THE CASE A. PERSONAL PROFILE Name : Lady L. Address : Asbang, Matanao, Digos, Davao del Sur Age : 13y/o Gender : female Civil status : single Birth date : Occupation :helper Admitting Doctor : Dr. Armando Admitting Diagnosis : vehicular accident Religion: Baptist Nationality: Filipino Educational Attainment: Grade 6 Father’s name: Mr. E Occupation: Farmer Mother’s name: Mrs. V Occupation: Housewife Date of admission: January 6, 2009 B. Background/History DM HPN CA ASTHMA Maternal Paternal
  • 5. C. Medical History The patient had her complete immunization. According to her father, she had never been hospitalized. Though she had some fever on her younger years, hospitalization was not an option for her parents. They usually use “haplas” and any other herbal medicines for treatment. D. History of Present Illness Few minutes prior to admission, the patient was hit by a private vehicle while riding on a bicycle and was referred to this institution (Davao Medical Center) for STAT craniectomy. E. Socio-economic background Patient L, the eldest of the five siblings was a helper in Digos City. She has an income of Php. 1000/month which she uses to send herself to school. Her father works as farmer on a land owned by their neighbor, while her mother only stays at home taking care of the children.
  • 6. DEFINITION OF TERMS Cerebrum or telencephalon – together with the diencephalon, constitute the forebrain. It is the most anterior or, especially in humans, most superior region of the vertebrate central nervous system. "Telencephalon" refers to the embryonic structure, from which the mature "cerebrum" develops. The dorsal telencephalon, or pallium, develops into the cerebral cortex, and the ventral telencephalon, or subpallium, becomes the basal ganglia. The cerebrum is also divided into symmetric left and right cerebral hemispheres CerebralConcussion – from the Latin concutere ("to shake violently"),[1] is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion may be used interchangeably, although the latter is often treated as a narrower category. The term 'concussion' has been used for centuries and is still commonly used in sports medicine, while 'MTBI' is a technical term used more commonly nowadays in general medical contexts. Frequently defined as a head injury with a transient loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms. Craniectomy – is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury and stroke. Use of the surgery is controversial.[1] Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering intracranial pressure (ICP), the pressure within the skull. Epidural hematoma (EDH) occurs outside the brain and is usually caused by a damaged artery. Arteries carry blood under high pressure; therefore, a large EDH can cause pressure to build up within minutes, even seconds. This condition requires immediate surgery to relieve pressure and prevent severe permanent damage or death Glasgow Coma Scale or GCS – is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).
  • 7. ANATOMY AND PHYSIOLOGY • The cerebrum consists of two cerebral hemispheres connected by a bundle of nerve fibers, the corpus callosum. The largest and most visible part of the brain,
  • 8. the cerebrum, appears as folded ridges and grooves, called convolutions. The following terms are used to describe the convolutions:  A gyrus (plural, gyri) is an elevated ridge among the convolutions.  A sulcus (plural, sulci) is a shallow groove among the convolutions.  A fissure is a deep groove among the convolutions. The deeper fissures divide the cerebrum into five lobes (most named after bordering skull bones)—the frontal lobe, the parietal love, the temporal lobe, the occipital lobe, and the insula. All but the insula are visible from the outside surface of the brain. A cross section of the cerebrum shows three distinct layers of nervous tissue:  The cerebral cortex is a thin outer layer of gray matter. Such activities as speech, evaluation of stimuli, conscious thinking, and control of skeletal muscles occur here. These activities are grouped into motor areas, sensory areas, and association areas.  The cerebral white matter underlies the cerebral cortex. It contains mostly myelinated axons that connect cerebral hemispheres (association fibers), connect gyri within hemispheres (commissural fibers), or connect the cerebrum to the spinal cord (projection fibers). The corpus callosum is a major assemblage of association fibers that forms a nerve tract that connects the two cerebral hemispheres.  Basal ganglia (basal nuclei) are several pockets of gray matter located deep inside the cerebral white matter. The major regions in the basal ganglia—the caudate nuclei, the putamen, and the globus pallidus—are involved in relaying and modifying nerve impulses passing from the cerebral cortex to the spinal cord. Arm swinging while walking, for example, is controlled here. • The diencephalon connects the cerebrum to the brain stem. It consists of the following major regions:  The thalamus is a relay station for sensory nerve impulses traveling from the spinal cord to the cerebrum. Some nerve impulses are sorted and grouped here before being transmitted to the cerebrum. Certain sensations, such as pain, pressure, and temperature, are evaluated here also.
  • 9.  The epithalamus contains the pineal gland. The pineal gland secretes melatonin, a hormone that helps regulate the biological clock (sleep-wake cycles).  The hypothalamus regulates numerous important body activities. It controls the autonomic nervous system and regulates emotion, behavior, hunger, thirst, body temperature, and the biological clock. It also produces two hormones (ADH and oxytocin) and various releasing hormones that control hormone production in the anterior pituitary gland. The following structures are either included or associated with the hypothalamus.  The mammillary bodies relay sensations of smell.  The infundibulum connects the pituitary gland to the hypothalamus.  The optic chiasma passes between the hypothalamus and the pituitary gland. Here, portions of the optic nerve from each eye cross over to the cerebral hemisphere on the opposite side of the brain. • The brain stem connects the diencephalon to the spinal cord. The brain stem resembles the spinal cord in that both consist of white matter fiber tracts surrounding a core of gray matter. The brain stem consists of the following four regions, all of which provide connections between various parts of the brain and between the brain and the spinal cord.
  • 10.  The midbrain is the uppermost part of the brain stem.  The pons is the bulging region in the middle of the brain stem.  The medulla oblongata (medulla) is the lower portion of the brain stem that merges with the spinal cord at the foramen magnum.  The reticular formation consists of small clusters of gray matter interspersed within the white matter of the brain stem and certain regions of the spinal cord, diencephalon, and cerebellum. The reticular activation system (RAS), one component of the reticular formation, is responsible for maintaining wakefulness and alertness and for filtering out unimportant sensory information. Other components of the reticular formation are responsible for maintaining muscle tone and regulating visceral motor muscles. • The cerebellum consists of a central region, the vermis, and two winglike lobes, the cerebellar hemispheres. Like that of the cerebrum, the surface of the cerebellum is convoluted, but the gyri, called folia, are parallel and give a pleated appearance. The
  • 11. cerebellum evaluates and coordinates motor movements by comparing actual skeletal movements to the movement that was intended. The limbic system is a network of neurons that extends over a wide range of areas of the brain. The limbic system imposes an emotional aspect to behaviors, experiences, and memories. Emotions such as pleasure, fear, anger, sorrow, and affection are imparted to events and experiences. The limbic system accomplishes this by a system of fiber tracts (white matter) and gray matter that pervades the diencephalon and encircles the inside border of the cerebrum. The following components are included: • The hippocampus (located in the cerebral hemisphere) • The denate gyrus (located in cerebral hemisphere) • The amygdala (amygdaloid body) (an almond-shaped body associated with the caudate nucleus of the basal ganglia) • The mammillary bodies (in the hypothalamus) • The anterior thalamic nuclei (in the thalamus) • The fornix (a bundle of fiber tracts that links components of the limbic system)
  • 12. ETIOLOGY AND SYMPTOMATOLOGY Etiology Ideal Actual Justification Location (+) The location varies a lot in incidence number of the Vehicular Accident. Those people who live nearby from the highways are more prone to those people that are away from the highway. In our pt, their house is near the highway. Weather (+) Weather does also have a large effect of most vehicular accident such as rain which may interferes or blocks the visualization of those who are involve. Age (+) Younger ones have lots of playtime than the old ones making them more at risk in any form of Accidents. Symptomatology Ideal Actual Justification dizziness (+) -Pt. manifested Lightheadedness or dizziness because dizziness happens when there is not enough blood getting to the brain. This can happen if there is a sudden drop in your blood pressure Confusion (+) -because of Low levels of oxygen, Concussion, Fever Fluid and electrolyte imbalance, Head trauma or head injury or a sudden drop of temperature Different Size Pupils (+) -due to bleeding inside the skull caused by head injury Shock (+) - because of Low blood volume secondary to bleeding
  • 13. COMPLICATION Post-Concussion Syndrome Post-concussion syndrome (PCS) is a common but controversial disorder that presents with variety of symptoms including- but not limited to- headache, dizziness, fatigue, and personality changes. PCS occurs in approximately 23- 93% of persons with mild to severe head injuries. Seizure A seizure is a sudden change in behavior characterized by changes in sensory perception (sense of feeling) or motor activity (movement) due to an abnormal firing of nerve cells in the brain. Epilepsy is a condition characterized by recurrent seizures that may include repetitive muscle jerking called convulsions Infection is the detrimental colonization of a host organism by a foreign species. In an infection, the infecting organism seeks to utilize the host's resources to multiply (usually at the expense of the host). The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss of an infected limb, and even death Chronic Head Injuries occurs when an outside force traumatically injures the brain. TBI can be classified based on severity (mild, moderate, or severe), mechanism (closed or penetrating head injury), or other features (e.g. occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull.
  • 14. PATHOPHYSIOLOGY Predisposing factors Age Accident prone area Vehicular Accident Precipitating factors Work Awareness Type(s) of vehicle Head Injury Skull fracture Rupture or laceration of the Middle meningeal artery HEMORRHAGE Blood collect in the epidural Space between the skull and dura Epidural HematomaInc. ICP S/Sx * momentary loss of Consciousness Interval apparent Recovery or lucid recovery CRANIECTOMY Good prognosis
  • 15. Epidural Hematoma is acquired through many causes. One of these causes is the vehicular accident because during a vehicular accident, one’s head maybe injured. After a head injury, blood may collect in the epidural space between the skull and the dura. This can result from a skull fracture that causes a rupture or laceration of the middle meningeal artery, the artery that runs between the dura and the skull inferior to a thin portion of temporal bone. Hemorrhage from this artery causes rapid pressure on the brain. Symptoms are caused by the expanding hematoma. Usually, a momentary loss of consiousness occurs at the time of injury, followed by an interval apparent recovery. Although the lucid interval is considered a classic characteristics of an epidural hematoma, no lucid interval has been reported in many patients with this lesion and therefore it should not be considered a critical defining criterion. An epidural hematoma is considered an extreme emergency; marked neurologic deficit or even respiratory arrest can occur within minutes. Treatment consists of making openings through the skull (burr holes) to decrease ICP emergently, remove the clot, and control the bleeding. A craniotomy may be required to remove the clot and control the bleeding. A drain is usually inserted after creation of burr holes or a craniotomy to prevent reaccumulation of blood But on the other hand, if treatment is being applied, there is great chance of recovery through what we so call surgery and to be more specific, the procedure called craniectomy. Craniectomy is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. Through this procedure the Increase intracranial Pressure due to pain will be relieve or be lowered because increase intracranial pressure is very fatal to the brain since it compresses the brain and restricted the cerebral blood flow. When surgery is being done, it is still very important to follow any medication being prescribe t him by the doctor. If this medical management will be done to the patient correctly, it is pretty sure that the recovery of the patient will be great and fast and the most desirable thing that everyone who’s sick would like to have, TOTAL RECOVERY or BEING WEL
  • 16. MEDICAL MANAGEMENT 01/06/09 Referred to Dr. Armando 8:30am  For repeat cranial CT scan STAT  Monitor NVS every hour and record  Refer 01/07/09 10:30am  NPO  Start Ranitidine 50mg IVTT every 8 hours  Shave full head  Refer 01/08/09  May have DAT  Continue medz  Continue IVF: PLR 1L to run at 130cc/hr  D/C PNSS  D/C omepirazole  Open dressing  Keep Jackson’s Pratt drain in negative 5:55pm  D/C all medz  Change dressing  Refer 01/09/09 5:30  DAT  Continue medz  Change dressing  Keep Jackson’s Pratt Drain in negative  Full body bath  Remove FBC 01/10/09
  • 17.  DAT with SAP  ROM: Laboratory Test Result Normal Values Clinical Significance Remarks CBC Hemoglobin – 142 115-155 -normal range- Hematocrit – 0.41 0.30-0.48 Normal volume of Red Blood Cells -normal range- RBC – 5.00 4.20-6.10 Adequate number of Red Blood Cell primarily to ferry oxygen in blood to all cells of the body -normal range WBC – H 13.77 5.0-10.0 Infection, leukemia, tissue necrosis -increased- Neutrophil – 90 55-75 Infection, ischemic neurosis, metabolic d/o acute gout -increased- Lymphocyte s – L4 0.2-.35 TB, hepatitis, infectious mononucleosis, mumps, rubella, lymphocytic leukemia -increased- Monocytes – 6 2-10 -normal range- Eosinophil – L0 1-8 Cushings’s syn. -decresed- Basophil – 0 0-1 -normal range- Platelet – 257x10^3/uL 150-400 Glucose- RBS – 5.4 3.90-6.8 -normal range- Creatinine – L27.00 Umol/L 53.00-115.00 Kidney dysfunction -decreased- CT-scan
  • 18. (+)Epidural hematoma, Right parietotemporal convixities NURSING ASSESSMENT B. Physical Assessment Assessment Normal Findings Yes No Body Build, Height and Weight Proportionate, varies with lifestyle  Posture and Gait Clean, neat  Body and Breath odor No body or breath odor  Signs of Distress No distress noted  Signs of Health or Illness Healthy appearance  Attitude Cooperative  Affect/Mood Appropriate to situation  Quantity, Quality and Organization of Speech Understandable, moderate pace, exhibits thought association 
  • 19. Relevance and Organization of Thoughts Logical sequence, makes sense, has sense of reality  Assessment Normal Findings Yes Poor Uniformity of skin color Uniformity except in areas exposed to the sun  Edema No edema  Skin Lesions No freckles, No birthmarks, no abrasions or lesions  Skin Moisture Moisture in skin folds and the axillae  Skin Temperature Uniform, within normal range  Skin Turgor Skin springs back to previous state when pinched  Assessment Normal Findings Yes No Scalp Evenly distributed  Hair Thickness Thick hair 
  • 20. Hair Texture Silky, resilient hair  Amount of Body Hair Variable  Assessment Normal Findings Yes No Nail Plate Shape Convex curvature  Texture Smooth  Nail Bed Color Highly vascular, pink, prompt return of pink color  Assessme nt Normal Findings Good Fair Poor A. Skull and Face Head Rounded, symmetrical, smooth skull contour, no nodule  B. Eyes and Vision Eyebrows Hair evenly distributed, symmetrical, skin intact  Eyelid Skin intact, no discharges, no discolorations, 
  • 21. symmetrical Eyelashes Equally distributed, slightly curved outward  Conjunctiv a Transparent, sometimes appear white, shiny, smooth, pink or red  Lacrimal Gland No edema or tearing  Cornea Transparent, shiny and smooth, blinks when cornea is touched  Pupils Black color, equal size  Near Vision Able to read newsprint  C. Ears and Hearing Auricles Color is uniform, symmetric, mobile, firm, pinna recoils when folded  Response to Normal Voice Tone Normal voice tone audible  D. Nose and Sinuses
  • 22. Nares Symmetric and straight, no discharges, no swelling, uniform color, not tender  Lining of nose Nasal septum in midline  E. Mouth Lips Buccal Mucosa Uniform pink, soft, symmetrical  Teeth and Gums Complete child teeth, smooth, white tiny tooth enamel, pink gums, moist, firm, no retractions  Tongue Centrally located, pink in color, freely movable  Palates, Uvula, Tonsils Light pink, smooth, no discharges, present gag reflex  Assessment Normal Findings Good Fair Poor Shape and Symmetry Symmetrical  Spinal Deformities Spine vertically aligned 
  • 23. Assessment Normal Findings Good Fair Poor Inspect Neck Muscles Symmetrical with head centered  Observe Head Movement Coordinated, smooth, movement with no discomfort, equal strength 
  • 24. Assessment Normal Findings Good Fair Poor Muscle Size is symmetrical, no contracture, normally firm  Movement Smooth coordinated movements, equal strength  Bones No deformities, no swelling or tenderness  Joints No swelling, tenderness  Range of motion Varies to some degree 
  • 25. NURSING MANAGEMENT Ideal Goal Responsibilities Maintain Patent Airway Check the orders for and aaply supplemental Oxygen. Assess RR and depth, ease of respirations, oxygen saturation, and breath sounds. Encourage patient to turn frequently and take deep breath and cough at least every two hours. -Administer pain medication to permit more effective coughing; suction patient as needed. Maintain Cardiovascular stability -Monitor cardiovascular stability by assessing patients mental status; vital sings; cardiac rhythm; skin temperature, color and moisture; and
  • 26. urine output. -Assess patency of all intravenous line. -Assess output from wound drainage system and amount of bloody drainage on the surgical dressing frequently. Mark and time spots of drainage; report excess drainage or fresh blood to surgeon immediately. -Observe the surgical site for bleeding, type and integrity of dressing , and drain (eg, Jackson-pratt) Assessing and Managing pain -Assess pain level using a verbal or visual analog scale, and assess the characteristics of the pain. -Discuss options in pain relief measures with patient to determine the best medication. Assess effectiveness of medication periodically beginning 30 minutes after administration. -Provide other pain relief measures (changing patients position, using distraction, applying cool washcloths to the face, and rubbing the back with a soothing lotion) to relieve general discomfort temporarily. Maintain normal body temperature -Monitor body system function and vital sings with temperature every 4 hours and every shift thereafter. -Report sings of hypothermia to physician. -Maintain the room at a comfortable
  • 27. temperature, and provide blankets to prevent chilling. -Monitor patient for cardiac dysrhythmias. -Take efforts to identify malignant hyperthermia and to treat it early. Assess mental status -Assess mental status (level of consciousness, speech, and orientation) and compare to pre- operative baseline; change maybe related to anxiety, pain, medications, oxygen deficit, or hemorrhage. -Address source of discomfort, and report signs of complication for immediate treatment. Promote nutrition and fluid balance - Assess patient to return to normal dietary intake gradually at a pace set by patient (liquid first then soft foods such as milk and creamed soak are added gradually) -Eat nutritious food and take and instruct patient to take multivitamins, Iron and Vitamin C as prescribe. -Assess potency and intravenous lines, ensuring that appropriate fluids are administered at prescribe rate. -Record intake and output.
  • 28. HEALTH TEACHINGS PRIMARY 1. Instruct the patient to have a proper diet that she can tolerate, such as fruits, to help promote wellness. 2. Instruct the patient to have deep breathing exercise, to promote non- pharmacological treatment 3. Advice the patient to have fluid intake or adequate hydration, to help her body re-hydrate to prevent fluid imbalance. 4. Assist patient to perform self-care activities she cannot tolerate, to help her maintain her activities of daily living. 5. Encourage patient to perform self care activities within her level of own ability. 6. Initiate and encourage patient to perform bed exercises to improve circulation ( ROM to arms, hands and fingers, feet and legs; leg flexion and leg lifting; abdominal and gluteal contraction) 7. Ask patient to perform as much as possible and then to call for assistance. Collaborate with patient for progressive activity before and after schedule activity. SECONDARY 1. Administer medications as ordered by the physician 2. Advice patient to have proper nutrition to enhance immune system TERTIARY
  • 29. 1. Instruct patient to comply for medication regimen 2. Discuss the importance of having a regular check-up with his physician DISCHARGE PLAN When the doctor noted that the patient is for discharge it is very important to continue the medication depending on the duration the doctor ordered for the total recovery of the patient. Patient with epidural hematoma and undergone post craniectomy needs to have a light exercise such as motor development in both arms and feet, clear verbalization and spontaneous with the duration of 10-15 minutes and must get enough rest. It is also important to maintain proper hygiene to prevent further infection that may happen to the patient because she was undergone surgery; the operated site is very susceptible to any diseases. He also needs to minimized smoking and drinking alcoholic beverages. She also need to stop her school because to much exposed to a pressure and positive atmosphere can be a high risk factor that may cause severity of her condition. The diet of the patient is also a factor for fast recovery. She is encourage to eat nutritious foods such as juices that are rich in Vitamin C. the family of the patient plays a big role for the fast recovery. Regular consultation to the physician can be factor for recovery to assess and monitor her condition
  • 30. PROGNOSIS Good Fair Poor Justification Duration of Illness - Duration of illness is good since the incident was stat and she was given ample treatment. Onset of Illness - The onset is stat since right after the she was diagnosed, she was automatically brought to the Operating room for a stat craniectomy. Compliance to Medication - Patient can afford to sustain the needed laboratory exams and the feasibility of having a surgery. Family Support - The family members supported the patient both financially and emotionally. Environment - The hospital setting is not well ventilated and may promote for further infection of the patient’s
  • 31. current situation. Age - Patient is 13 years old therefore she has a greater chance of recovering for her immune system is still generating in the process of development. Precipitating Factors - The patient manifested all the factors that may lead to epidural hematoma which urged the health care team to bring her for an operation. EVALUATION Through our hardship in preparing for this research, tried to interact and communicate our patient in good manner for us to gather the specific and accurate data that we need that could help us in studying the disease which could lead us into successful research. The patient’s condition is in recovery period as she had already undergone surgery, which thereby prevented occurrence of complications They are financially capable in sustaining such surgery and the medications after. Her father is the one taking good care of her in throughout her hospitalization.
  • 32. IMPLICATION Nursing Practice - this can be used as a guide for practice by other nurses. They may get many relevant ideas in giving proper care and interventions to patients with related illness or those who have the same illness (Epidural hematoma, Brain Injury) Nursing Education - this study may serve as a helpful learning tool for student nurses. They may utilize this complied study as their reference for research; this will also give them good examples on nursing managements, and nursing diagnoses, which will be a very useful guide when they will be making their own Nursing Care Plans. Nursing Research - students may use this compilation as their guide for research. This will hand them good views and factual ideas which will be very essential for their added learning an knowledge for Epidural hematoma, Brain Injury
  • 33. REFERENCES http://www.neurologychannel.com/tbi/types.shtml http://en.wikipedia.org/wiki/Cerebrum http://en.wikipedia.org/wiki/Glascow_Coma_Scale http://en.wikipedia.org/wiki/Infection http://www.alasbimnjournal.cl/revistas/8/ceballos.html http://www.muhealth.org/neuromed/epidural.shtml