Introduction

Gunshot wound trauma

A wound in which the projectile breaches the cranium but does not exit is referred to as
a penetrating wound. An injury in which the projectile passes entirely though the head, leaving
both entrance and exit wounds, is referred to as a perforating wound.

Craniotomy
Craniotomy is a surgery to cut a bony opening in the skull. A section of the skull, called a
bone flap is removed to access the brain underneath. A craniotomy may be small or large
depending on the problem. It may be performed to treat brain tumors, hematomas (blood clots),
aneurysms or AVMs, traumatic head injury, foreign objects (bullets), swelling of the brain, or
infection. The bone flap is usually replaced at the end of the procedure with tiny plates and
screws.

Cranioplasty
Cranioplasty is a neurosurgical procedure designed to repair or reshape irregularities or
imperfections in the skull. A bone graft from elsewhere in the body or a synthetic material may
be used to repair defects or gaps in the cranial (skull) bones.

Theoretical Framework

Dorothea Orem- Self-Care Model

Self-care--- Self-Care Deficit---Nursing System

1.Self-care comprises those activities performed independently by an individual to promote and

maintain person well-being.
2.Self care agency is the individual’s ability to perform self care activities.
3.Self- care deficit occurs when the person cannot carry out self-care.The nurse then meets the
self-care needs by acting or doing for; guiding, teaching, supporting or providing the
environment to promote patient’s ability.
4.Wholly compensatory nursing system-Patient dependent.
5.Partially compensatory- Patient can meet some needs but needs nursing assistance.
6.Supportive educative-Patient can meet self care requisites, but needs assistance with
decision making or knowledge.

Anatomy and Pathophysiology

The Skull
The skull has evolved to be as lightweight as possible while offering the maximum amount of
support and protection. In order to be light, the skull is made up by flat and irregular bones, and
has hollow spaces called the sinuses. It offers protection to the brain, eye balls, inner ears, and
nasal passages.

The human skull can be divided into two sections, the cranium and the face. In most people, the
cranium is made up of 8 bones and the face is made up of 14. Often, the ossicles of the ear and
the hyoid bone are counted as part of the skull, giving the normal human skull 29 bones (it
should be noted that variations are not necessarily abnormal).

The Brain
The brain is one of the largest and most complex organs in the human body.
It is made up of more than 100 billion nerves that communicate in trillions of connections called
synapses.

The brain is made up of many specialized areas that work together:

• The cortex is the outermost layer of brain cells. Thinking and voluntary movements begin in
the cortex.
• The brain stem is between the spinal cord and the rest of the brain. Basic functions like
breathing and sleep are controlled here.
• The basal ganglia are a cluster of structures in the center of the brain. The basal ganglia
coordinate messages between multiple other brain areas.
• The cerebellum is at the base and the back of the brain. The cerebellum is responsible for
coordination and balance.

The brain is also divided into several lobes:

• The frontal lobes are responsible for problem solving and judgment and motor function.
• The parietal lobes manage sensation, handwriting, and body position.
• The temporal lobes are involved with memory and hearing.
• The occipital lobes contain the brain's visual processing system.

The brain is surrounded by a layer of tissue called the meninges. The skull (cranium) helps
protect the brain from injury.
Pathophysiology

Gunshot at left parietal area of the skull (cranium) ----left parietal lobe
traumatized(cortex)-----interrupted signal from parietal lobe to spinal cord to peripheral
nerves----causes weakness at right peripheral side in both arm and leg, and rigidity of distal to
proximal phalanx(carpal).

Laboratory

Jun 17, 2019

CT Scan Report
-Post surgical changes with craniectomy defects are seen on the left parietal-occipital
area with associated encephalomalacic changes.

July 2, 2019
Hematology

Prothrombin 21.20 11.3-16.0 sec

time

Prothrombin 15.40 10.7-17.2 sec

control

Prothrombin 47.70 >70

activity

Platelet count 90 155-366 x10^9/L

 Clinical Chemistry

Triglycerides 2.3 mmol/L 0.45-1.8