Assessing And Treating Robert Brown’s Head Injury

Interpret:

Normal (Subjective & Objective)

Abnormal (Subjective & Objective)

Blood Pressure: 160/ 95 mmHg

Heart Rate: 80s

Temperature: 36.6°C

O₂saturation: 98%

Respiratory Rate: 18breaths/ minute

O₂flow rate: less than 3LPM

Pain from the wound.

Lacerations are concrete waterworks in the brain tissue. They are initiated by fine force or pressure applied to the brain, or may be because of penetration of some object in the skull and brain portions (Malik et al. 2016). The degree of injury depends entirely on the complexity and position of the laceration, as reasonable as on whether the associated blood vessels and the cranial nerves witness damage (Malik et al. 2016). When Robert Brown met with the rad accident, he injured his back of the head, so the staff addressed the Lacerations of the head, also GCS was also examined it order to understand his consciousness and it was found stable. The oxygen flow rate was observed to be fluctuating the day he was admitted (Taher et al. 2016). The normal range of the O₂flow rate should be 5 – 8 LPM in a healthy person (Veenith et al. 2016). But in case of Robert Brown, the O₂flow rate was observed to be decreased. It was equal to or less than 3LPM which a matter of concern for a patient who has met an accident. This was because of the blood loss that Robert faced while he got hit by the car. The oxygen flow rate reduction might cause complication in his health and treatment condition. He was also having pain in his back of the head, so he was provided with paracetamol in order to reduce pain. There may have a chance of complication with providing him with paracetamol as side effects of paracetamol includes breathing issues and Robert was already having a low flow rate of oxygen. In order to resolve the issue, Robert needs to be provided with oxygen in order to reduce the risk of more severe complications. Oxygen is one of the chief medication for any kind of treatment and as Robert had a head injury, low oxygen flow may cause condition where he might witness coma or other brain damages due to reduced oxygen supply in the brain region. Treatment must begin with the addressing of the source of oxygen flow rate, since the longer the low oxygen flow rate continues, the more complicated the damage will become (Taher et al. 2016). The effects of low oxygen flow rate to brain are quite similar to any kind other brain damages. The projection depends on the fact that how severe is the lack of oxygen supply to the brain is, the degree of the neuron death, and the superiority of the medical and treatment care (Chua 2017). With a quality physical and medical therapy, the injured brain may acquire to pay off for the damaged regions, so proper oxygen flow rate may help Robert Brown to recover from the head injuries he has been witnessing. Till then Robert needs to be monitored frequently to check the condition and improving of his health.

Predict:

The cases of head injuries can sometime become very complicated and life risking for patients if not treated with proper procedure and accuracy. A slight avoidance in the treatment procedure may lead to various worst outcomes such as memory loss, loss of body part sensations, stroke risk, loss of body balance, Alzheimer’s and Parkinson’s condition and may lead the patient to Come. In case of Robert, the same above mentioned cases may take place if he is not diagnosed or treated properly. He is found is stable condition for the present time period, but it may happen that the condition grows serious in coming time. As he had blood loss from the effected region, it is usual that there must be some wound. So there can be chances of tetanus infection, and to avoid such condition, he should be firstly injected with tetanus vaccine. Headache and vomiting is starting symptoms of the intracranial pressure which should not be neglected. Their might be another situation of Intracranial hypertension which can cause vasomotor paralysis or autoregulation loss in Robert. The nurse should provide proper ventilation, oxygenation, fluid supply and output in order to avoid much sever outcome from intracranial hypertension, as he was found complaining about headaches (Yuan et al. 2015). Ineffective tissue perfusion is found to be an effective measure to avoid such circumstances, it will help in improving circulation and supply of oxygen to the capillaries which will help is restoring the damage that may have caused in the brain (de Abreu Almeida et al. 2015).

Develop, Articulate and Prioritise Nursing Diagnoses –

1. Ineffective tissue perfusion

2. Injury risk

3. Decreased intracranial adaptive capacity.

The above mentioned are the three nursing diagnosis that are needed to be followed in case if serious head injury.

Diagnosis 1	Goal/s	Related actions	Rationale	Evaluate outcomes
Ineffective tissue perfusion	The goal of the diagnosis is to remove vasoconstriction aspects, refine exterior blood flow, and reduce metabolic difficulties on the body (de Abreu Almeida et al. 2015). It also focuses on the reduction of pressure in the brain due to head injury which may lead to a situation called Intracranial hypertension (IH) where the patient might witness vasomotor paralysis (Yuan et al. 2015).	Monitoring and documentation of the neurological condition of the patient frequently and compare it with the baseline (Mowry 2018).	It influences the choice of interventions. Worsening in any kind of neurological signs and sever symptoms or failure to progress even after a proper treatment may reflect diminished intracranial adaptive ability, which states that the patient requires a monitoring session Ineffective tissue perfusion and if any kind of worse effects and symptoms are observed then a proper intervention should be incorporated.	The patient will witness improved circulation, observe changes in lifestyle, growing tolerance to various activities, lesser cases of patient witnessing difficulties, reduced pain in the effected region (Doenges et al. 2016). It also increases circulation, and supply of oxygen in patients’ capillaries, which will reduce the chances of paralysis or coma in patients with head injury (Yuan et al. 2015).
Diagnosis 2	Goal/s	Related actions	Rationale	Evaluate outcomes
Injury risk	It helps the patient to reduce the chances of any further injuries. It provides knowledge about prevention of any furfure worse effects. It provides proper judgment of appropriate treatment measures (Urden et al. 2017).	Application of various favourable injury anticipation program is one of the important part of the nursing care in any healthcare setting and it requires a multidimensional approach. Nurses here also have a substantial role in providing education to the patients, families, and the associated caregivers about the deterrence of the falls outside the care scale.	The nursing diagnosis is used to address the critical condition of a patient with head injury. It is used to reduce the risk associated with the injury witnessed by the patient. Robert Brown needs a proper nursing diagnosis to reduce its head injury risk factor. This is also used to determine the patient’s health condition that may lead to worsen of the injury (Nordström and Nordström 2018).	It will help the nurses to help Robert to reduce the risk factors that are associated with his head injury. As the oxygen flow rate is observed to be decreased, the nurse should use proper measures to improve the flow rate as it might cause a sever health injury for Robert.

References:

Chua, J., Salter Labs Inc, 2017. Method and system with divided cannula having low oxygen flow rate and improved end-tidal CO2 measurement. U.S. Patent 9,814,854. Retrieved from: https://patents.google.com/patent/US20140276169A1/en

de Abreu Almeida, M., Barragan da Silva, M., Paulsen Panato, B., de Oliveira Siqueira, A.P., Palma da Silva, M., Engelman, B., Marques Severo, I., Nomura, G. and Tsuma, A., 2015. Clinical indicators to monitor patients with risk for ineffective cerebral tissue perfusion. Investigacion y educacion en enfermeria, 33(1), pp.155-163. Retrieved from: https://www.scielo.org.co/scielo.php?pid=S0120-53072015000100018&script=sci_arttext&tlng=en

Malik, A., Gupta, A., Luthra, N. and Gupta, V., 2016. Ocular manifestations of head injury: A clinical study. Sudanese Journal of Ophthalmology, 8(2), p.46. retrieved from: https://www.sjopthal.net/article.asp?issn=1858-540X;year=2016;volume=8;issue=2;spage=46;epage=50;aulast=Malik

Mowry, M., 2018. Cardiothoracic Geriatric Trauma: Nursing Considerations. In Geriatric Trauma and Acute Care Surgery (pp. 441-445). Springer, Cham. Retrieved from: https://link.springer.com/chapter/10.1007/978-3-319-57403-5_47

Nordström, A. and Nordström, P., 2018. Traumatic brain injury and the risk of dementia diagnosis: A nationwide cohort study. PLoS medicine, 15(1), p.e1002496. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S1552526019300093

Taher, A., Pilehvari, Z., Poorolajal, J. and Aghajanloo, M., 2016. Effects of normobaric hyperoxia in traumatic brain injury: a randomized controlled clinical trial. Trauma monthly, 21(1). Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4869427/

Veenith, T.V., Carter, E.L., Geeraerts, T., Grossac, J., Newcombe, V.F., Outtrim, J., Gee, G.S., Lupson, V., Smith, R., Aigbirhio, F.I. and Fryer, T.D., 2016. Pathophysiologic mechanisms of cerebral ischemia and diffusion hypoxia in traumatic brain injury. JAMA neurology, 73(5), pp.542-550. Retrieved from: https://jamanetwork.com/journals/jamaneurology/article-abstract/2506519

Yuan, Q., Wu, X., Sun, Y., Yu, J., Li, Z., Du, Z., Mao, Y., Zhou, L. and Hu, J., 2015. Impact of intracranial pressure monitoring on mortality in patients with traumatic brain injury: a systematic review and meta-analysis. Journal of neurosurgery, 122(3), pp.574-587. Retrieved from: https://thejns.org/view/journals/j-neurosurg/122/3/article-p574.xml

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