Presented by: Neil William G.

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Head injuries are caused by a sudden impact or force to the head or inertial forces within the skull. It is the trauma that leads to the potential injury to the scalp, skull, or brain in which it can range from a simple bump to the skull to serious brain injury. Head injuries can cause traumatic brain injury which is an insult to the brain that is capable of producing intellectual, emotional, social, and vocational changes.

Motor-vehicle accidents are the leading cause of head injuries. Clients admitted to the emergency department, most are males younger than 30 years and 50% have evidence of ingestion of alcohol or other substances of abuse. Alcohol slows down there flexes and alters cognitive processes and percept ion. These physiologic changes increase the chances of being involved in an accident or altercation. A second risk factor is driving without seatbelts. Peak occurrence is during evenings, nights, and weekends. Other causes are assaults, falls, and sports related injury.

This study includes the compilation of information particularly to the clients health condition. The study also includes the assessment of the physiological and psychological status, competence of support systems and care given by the family as well as other health care providers.

The scope of this study would include: Data collected via assessment, interviews with the patient, family members and clinical records. Actual and ideal problems for 3 days including the initial assessment and its appropriate nursing intervention that would be applied within his stay in the hospital at NMMC hospital.

Developing a plan of care that will reduce identified predicaments and complications. Coordinating and delegating interventions within the plan of care to assist the client to reach maximum functional health. Further evaluating the effectiveness of nursing interventions that have been rendered to the client.

An array of factors influencing the limitations of this study includes: Data collected is limited only to assessment and interview to the patient, patients chart and nurse on duty. The interaction, assessment and care were only limited to a total of 16 hours (2 days clinical duty, 1 day assessment) with actual nursing intervention done. The lack of complete family history obtained was due to lack of laboratory examinations or diagnostic examinations results.

Socio-demographic data

This is a case of 19 years old, Male, Filipino, Roman Catholic, a resident of Camp Evangelista, Patag, Cagayan de Oro City. Patient X was born on August 24, 1992. He is single and living with his family. Patient X is a college student. Patient X was admitted on June 19, 2012 for the first time in Northern Mindanao Medical Center in Male Surgical Ward due to Epidural Hematoma at the Right Frontotemporoparietal secondary to vehicular accident.

A. VITAL SIGNS:

Upon assessment, the following data was obtained from Patient X; Blood Pressure: 140/90mmHg, Heart Rate: 20cpm, Pulse Rate: 75bpm, Temperature: 36.9C. Patient X weighs 75 kg and is 57 in tall.
B. Reason for hospitalization/Chief Complaint

Patient X had loss his consciousness.

C. Family Health Illness History Patient X verbalized that they have known genetic disease that run in the family such as hypertension. D. HISTORY OF PRESENT ILLNESS 30min. prior to admission, patient had loss his consciousness due to vehicular accident, noncollision. Patient had a severe head injury, bleeding at the head was also noted.
E. STATEMENT OF THE PATIENTS GENERAL APPERANCE Patient X looked pale, weak, but he was responsive and cooperative whenever questions were asked at him.

F. NUTRITIONAL AND METABOLIC PATTERN

Pre-hospitalization: Patient X eats three times daily. He consumes whole share with good appetite. He drinks 8-10 glasses of water a day. During hospitalization: Patient X eats three times daily. He consumes half share with fair appetite. He drinks 4-6 glasses of water a day.

ACTIVITIES OF DAILY LIVING

Feeding

2 assists with person

Bathing
DRESSING Grooming Meal preparation Cleaning Laundry Toileting Bed mobility

2 assists with person

2 assists with person 2 assists with person 2 assists with person 2 assists with person 2 assists with person 2 assists with person 2 assists with person

Chair/toilet transfer
Ambulation R.O.M

2 assists with person

2 assists with person 2 assists with person

G. ELIMINATION Pre hospitalization: Patient X defecates every day, with yellowish to brownish stool and soft in consistency and no discomfort felt during defecation. He urinates three to five times daily with dark yellow colored urine in variable amount.

During hospitalization: Patient X defecates once in 2 days. On the first day of admission he was in catheter attached to urobag, but on the fifth day of admission catheter was removed and was able to urinate three times daily with yellow colored urine amounting 800 ml for 8hours with no discomfort felt during urination.

H. ACTIVITY AND EXERCISE PATTERN When Patient X was not yet admitted he always had his regular exercise every day.

I. COGNITIVE AND PERCEPTUAL PATTERN Patient X speaks Visayan-Cebuano language and has no learning difficulties. He was oriented to time, place and person. He was conscious and coherent. However he felt worried about his condition. J. SLEEP REST PATTERN Pre- hospitalization: Patient X sleeps 8 hours a day. For him it was adequate.

During hospitalization: Patient X sleeps only 46 hours a day.

K. ROLE RELATIONSHIP PATTERN Patient X has a good relationship with his family. It was his family who helped him during these days. Patient X family was worried about his condition.

L. COPING- STRESS TOLERANCE Patient X was worried about his condition but he is very cooperative whenever interventions were done to improve his condition.
M. VALUES BELIEF PATTERN Patient X is a Roman Catholic. He believes that religion is important as it is the only outlet he has whenever he has a problem. He goes to church every Sunday and prays as part of his religious practices.

The human cranium and the facial bones are the foundation for the soft tissues of the face and head. Thus, much of the visible appearance of the human face depends upon the shapes and qualities of these bones. The cranium is that part of the skull that holds and protects the brain in a large cavity, called the cranial vault. Eight plate-like bones form the human cranium by fitting together at joints called sutures. The most important of these cranial bones for the appearance of the face is the frontal bone, which underlies the top of the face above the eyeballs. The human skull also includes14 facial bones that form the lower front of the skull and provide the framework for most of the face that is important to psychological research. These 22 skull bones form other, smaller cavities besides the cranial vault, including those for the eyes, the internal ear, the nose, and the mouth. The important facial bones include the jaw bone or mandible, the maxilla or upper jaw, the zygomatic or cheek bone, and the nasal bone.

The skull base forms the floor of the cranial cavity and separates the brain from other facial structures. This anatomic region is complex and poses surgical challenges for otolaryngologists and neurosurgeons alike. Workin g knowledge of the normal and variant anatomy of the skull base is essential for effective surgical treatment of disease in this area. The 5 bones that make up the skull base are the ethmoid, sphenoid, occipital, paired frontal, and paired parietal bones. The skull base can be subdivided into 3 regions: the anterior, middle, and posterior cranial fossae. (See the image below.) The petro-occipital fissure subdivides the middle cranial fossa into 1 central component and 2 lateral components. This article discusses each region, with attention to the surrounding structures, nerves, vascular supply, and clinically relevant surgical landmarks.

RESULT

UNIT

REFERENCE

INTERPRETATION

White Blood Cells(WBC) Hemoglobin

13.3

103/uL

5.0-10.0

Bacterial infections, leukemia, trauma, inflammation, or stress are also symptoms of high WBCs in blood. A low hemoglobin indicates your blood is lacking in iron.

11.2

106/uL

12.0-16.0

Hematocrit

31.8

37.0-47.0

MCHC

35.2

g/dL

31.5-35.0

PDW

8.1

fL

9.0-16.0

A low hematocrit is referred to as being anemic. There are many reasons for anemia. Some of the more common reasons are loss of blood (traumatic injury, surgery, bleeding, and colon cancer), nutritional deficiency (iron, vitamin B12, folate), bone marrow problems (replacement of bone marrow by cancer, suppression by chemotherapy drugs, kidney failure), and abnormal hemaglobin (sickle cell anemia). One reason that the MCHC level would be too high is because of spherocytosis. Spherocytosis is the presence of spherocytes in the blood. Spherocytes are types of red blood cells that contain an abnormally high amount of hemoglobin. If the hemoglobin is not stable, this can also cause the MCHC level to be too high. A low platelet count, also called thrombocytopenia, may be caused by a number of conditions and factors. The causes typically fall into one of two general categories:

Disorders in which the bone marrow cannot produce enough platelets

Conditions in which platelets are used up (consumed) or destroyed faster than normal

MPV

7.7

fL

8.0-12.0

Basically all it means is you have a low platelet count. This in turn puts you at a risk for bruising and bleeding. The causes of low MVP are varied and not always known. Low levels can be caused by viral infections, especially AIDS; Genetic disorders like Lupus; Hemolytic disorders, like Anemia; an overactive spleen, and taking drugs that low your count; like heparin.

DIFFERENTIAL COUNT Eosinophils(%) 3.2 % 1.0-3.0 High numbers of eosinophils (eosinophilia) are usually associated with allergic diseases and infections from parasites such as worms. A high eosinophil count may be due to:

Asthma Autoimmune diseases

Eczema
Hay fever Leukemia

TEST
White Blood Cells(WBC)

RESULT
14.7

UNIT
103/uL

REFERENCE
5.0-10.0

INTERPRETATION
Bacterial infections, leukemia, trauma, inflammation, or stress are also symptoms of high WBCs in blood.

MCHC

36.2

g/dL

31.5-35.0

One reason that the MCHC level would be too high is because of spherocytosis. Spherocytosis is the presence of spherocytes in the blood. Spherocytes are types of red blood cells that contain an abnormally high amount of hemoglobin. If the hemoglobin is not stable, this can also cause the MCHC level to be too high.

PDW

7.9

fL

9.0-16.0

A low platelet count, also called thrombocytopenia, may be caused by a number of conditions and factors. The causes typically fall into one of two general categories:

Disorders in which the bone marrow cannot produce enough platelets Conditions in which platelets are used up (consumed) or destroyed faster than normal

MPV

7.5

fL

8.0-12.0

Basically all it means is you have a low platelet count. This in turn puts you at a risk for bruising and bleeding.

The causes of low MVP are varied and not always known. Low levels can be caused by viral infections, especially AIDS; Genetic disorders like Lupus; Hemolytic disorders, like Anemia; an overactive spleen, and taking drugs that low your count; like heparin.
DIFFERENTIAL COUNT Lymphocyte(%) 9.7 % 17.4-48.2 Low level of lymphocyte can be due to conditions such as lymphoma cancer, bone cancer or leukemia. Because of these immune system diseases, body cannot manufacture the lymphocytes. It is also affected when the spleen, thymus, tonsils or lymph nodes are not well. Bone marrow is a tissue found in bones and is also involved in the production of lymphocytes. Low production of bone marrow due to some reason or the diseases affecting bone marrow such as cancer impacts lymphocytes production. Having an abnormally high number (over 8000 or so) means that something has triggered your immune system fairly drastically, but it come come from a plethora of factors. Stress, infection, renal (kidney) failure, anemia (iron deficiency), eclampsia (pregancy complication), and in some cases cancer.

Neutrophil(%)

77.4

43.4-76.2

Eosinophils(%)

3.8

1.0-3.0

High numbers of eosinophils (eosinophilia) are usually associated with allergic diseases and infections from parasites such as worms. A high eosinophil count may be due to:

Asthma Autoimmune diseases Eczema Hay fever Leukemia

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-Instruct the patient to take the prescribe medications. -Teach the patient on how to take the medicine in the right time, right dose and right route as prescribed by the physician. -Educate the client about the effect of his medication.

-Promote a calm and clean environment. -Encourage the relative to promote good ventilation and free from pollution environment. -Promote an infection-free environment by cleaning the surroundings.

-Advise the patient and as well as the relatives to have a healthy lifestyle. -Advise the patient to avoid smoking area and avoid alcohol beverages intake.

-Encourage the patient to have a proper hygiene by taking a bath and hand washing using water and mild soap.

-Advise the patient to have a monthly check-up to a physician. -Encourage the patient for the compliance of his take home medications.

-Advise the client to have a proper diet and adequate fluid intake.

-Provide safety by keeping things in the right place specially those which can injured. -Encourage the relatives to be sensitive enough about the things that can harm the patient. -Be careful all the time.