Critical case study mariam fahad (1)
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This document discusses intracranial hemorrhage, also known as bleeding within the skull or brain. It provides objectives to explain what intracranial hemorrhage is, discuss anatomy and physiology of the skull and brain, identify symptoms, diagnostic studies, drug treatment, and appropriate nursing interventions. It then outlines the case study of a 40-year-old male patient admitted with decreased consciousness found to have a large left parietal hematoma on CT scan. Relevant diagnostic test results are presented along with the patient's medications, nursing care plan, health teaching points, and references.
![References:
1. Cleveland Clinic. (2019). Cerebral & Intracerebral Hemorrhage | Cleveland Clinic.
[online] Available at: https://my.clevelandclinic.org/health/diseases/14480-
intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke
[Accessed 29 Nov. 2019].
2. Emedicine.medscape.com. (2019). Intracranial Hemorrhage Medication:
Antihypertensive agents, Osmotic diuretics, Antipyretics, analgesics,
Anticonvulsants, Antidotes, Antacids. [online] Available at:
https://emedicine.medscape.com/article/1163977-medication [Accessed 29
Nov. 2019].
3. Emedicine.medscape.com. (2019). Brain Imaging in Hypertensive Hemorrhage:
Practice Essentials, Computed Tomography, Magnetic Resonance Imaging.
[online] Available at: https://emedicine.medscape.com/article/338055-
overview [Accessed 29 Nov. 2019].](https://image.slidesharecdn.com/criticalcasestudy-mariamfahad1-201210194340/85/Critical-case-study-mariam-fahad-1-30-320.jpg)
Critical case study mariam fahad (1)
- 1. BY : MARIAM FAHAD AL-HARBI / nusrat Intracranial Haemorrhage (non-traumatic )
- 2. Objective of the case study: At the end of this presentation the listeners will be able to: . Explain what is intracranial Haemorrhage. Discuss the anatomy & physiology of skull and brain . Enlist the sign and symptoms of intracranial Haemorrhage Identify method of diagnostic studies for intracranial Haemorrhage Discuss drug study for patient with intracranial Haemorrhage Explain the basic and appropriate nursing intervention , treatment, plan and prognosis of intracranial Haemorrhage.
- 3. Outlines 1. Biographical Data 2. Physical Assessment Form 3. Anatomy & Physiology 4. Pathophysiology 5. Diagnostic Studies 6. Drug Study 7. Nursing Care Plan 8. Reference.
- 5. PATIENT DATA : Name of Patient: XXXXX MR:XXXXX Gender: Male Nationality: Age : 40 years old Marital Status: Married DOA (Date of Admission): 20/10/2020 Medical Diagnosis: Intracranial Hemorrhage (non traumatic) Reason for admission : Decrease Level of conscious ,sever Hypertension
- 6. PATIENT DATA : History of present Illness: General Appearance: The patient was unconscious , disoriented . Chief complain: A 40 years old male patient who was found unresponsive on the floor of his house by his relatives and was brought to emergency department with decrease Level of conscious.
- 7. PATIENT DATA : History of present Illness: Vital signs: • Blood pressure :230/110mmhg • Heart rate:90bpm in sinus rhythm, • temperature:37.6c • Respiratory rate25bpm • O2:94% • cbs:149mg/dl • Hight:170cm • Weight:86kg
- 8. History of present Illness: Family History: Hypertension ,heart disease. 03 Immunization: He received all vaccination when he was child None in Erfan hospital . . 04 Type of Diet: Resource plus 4 cans+ water 800 ml ,with NGT 05 Past medical and Surgical History: The relatives mentation that the patient have sever headache since 3 weeks and his take analgesic ,after that his fall down at the house, none surgical history. 01 Social history: - Patient :M.H.R 40 years old , married ,he lives with his family - He have 3 suns and 2 daughters. - He is retired - smoker 02
- 9. Physical Assessment (by body systems):
- 10. • Heart rate:90pbm sinus rhythm • Apical and radial pulse regular • Peripheral skin colour: Abnormal • Peripheral skin temp: warm • Capillary refill: less tan 2sec • BP : 230/110mmhg Cardiovascular system: Respiratory system • Respiratory rate within normal limits • Respiratory with efforts rhythm: regular • Breath sound :clear upon auscultation • RR:25/min Endocrine system -All glands on normal condition and Functioning . -No excess or deficiency hormones .
- 11. Unconscious No Responsiveness to verbal stimuli, touch and painful stimuli GCS:5/15 No moves all extremities equally Neurological system • Patient with foley catheter and diapers. • Urine: yellow adequate >0.5mls/kg/hr • Within normal limits Renal system Musculoskeletal system • Weakness in the muscle strength
- 12. Abdomen: soft , no tender , non distended -The bowel sound active and normal (8per minute). Digestive system • Dry skin • Intact, no rashes or other lesions. Integumentary system Reproductive system -All organs are normal .
- 14. ANATOMY
- 15. Physiology: Intracranial hemorrhage: Intracranial haemorrhage (ICH) is a type of bleeding that occurs inside the skull . Disease process: Haemorrhage that occur within the skull or brain generally happen suddenly, from either external or internal causes. A haemorrhage can rapidly cause brain damage and can be life- threatening, Since the brain cannot store oxygen, it relies upon a series of blood vessels to supply oxygen and nutrients. When a haemorrhage occurs, oxygen may no longer be able to reach brain tissue supplied by leaky or broken blood vessels. Pooling of blood from an intracranial haemorrhage or cerebral haemorrhage also puts pressure on the brain and deprives it of oxygen . When a haemorrhage or stroke interrupts blood flow around or inside the brain, depriving it of oxygen for more than three or four minutes, the brain cells die. The affected nerve cells and the related functions they control are damaged as well.
- 16. Physiology: The signs and symptoms: • Sudden tingling, weakness, numbness, or paralysis of the face, arm or leg, particularly on one side of the body • Sudden, severe headache • Difficulty with swallowing or vision • Loss of balance or coordination • Difficulty understanding, speaking (slurring nonsensical speech), reading, or writing • Change in level of consciousness or alertness, marked by stupor, lethargy, sleepiness, or coma. Risk Factors include: • a family history of Intra cranial haemorrhage. • heavy alcohol use. • Hypertension. • cigarette smoking. • the use of certain drugs, including amphetamines, cocaine, and MDMA (often called “ecstasy”). • extreme physical exertion.
- 17. Physiology: Intracranial haemorrhage has a number of causes, including: • Head trauma, such as that caused by a fall, car accident, sports accident. • Hypertensive (high blood pressure) damage to blood vessel walls that causes the blood vessel to leak or break. • Ruptured cerebral aneurysm • Smoking, excessive alcohol use, or use of illegal drugs such as cocaine.
- 19. Name of Diagnostic Study CT scan(brain) Brain MRI Normal Values - - Results -Large left parietal hematoma 5*7.4*3.6cm. With compression of the mild line shift to the right . Minimal intraventricular haemorrhage . - Intracerebral hematoma with the current examination Implications He was diagnosed with intra cranial haemorrhage , High blood pressure is the most common causes of ICH. Hematoma can result from any injury to any type of blood vessel , hematoma usually describe bleeding which has more or less clotted.
- 20. Name of Diagnostic Study Normal Values Results Implications Hematology: Hemoglobin: Hematocrit: Platelets count Red blood cell count White blood cell count 14.8-185gm/dl 42-52% 130-400*10(3)/mcl 4.70-6.10*10(6)/mcl 4.8-10.8*10(3)/mcl 15.2gm/dl 43% 326*10(3)/mcl 5.51L 7.7L Normal Normal Normal Normal Normal Anticoagulant: INR: 1.1or below is considered normal 1 Normal (partial thrombolastin time)PTT 25-35second 23second Low ,can caused by blood thinning medication this patient he is take heparin
- 21. Drug study:
- 22. Drug Name Classification Indication Action Adverse Reaction Contraindication Nursing Consideration Generic Name: labetalol hydrochlorid Brand Name: Trandate Dosage: 10mg Beta-Blockers, Alpha Activity Labetalol is used with or without other medications to treat high blood pressure (hypertension). Lowering high blood pressure helps prevent strokes, heart attacks, and kidney problems Chemical effect : used to treat high blood pressure. Labetalol is in a class of medications calle d beta blockers. Therapeutic effect: It works by relaxing blood vessels and slowing heart rate to improve blood flow and decrease blood pressure. fatigue, weakness blurred vision, dry eyes dizziness, drowsiness, insomnia -People with overt cardiac failure, greater-than-first- degree heart block, severe bradycardia, cardiogenic shock, severe hypotension -Anyone with a history of obstructive airway disease including asthma, and those with hypersensitivity to the drug. -Patients receiving labetalol IV must be supine during and for 3 hr after administration. -Vital signs should be monitored every 5– 15 min during and for several hours after administration. -Monitor intake and output ratios and daily weight. -Assess patient routinely for evidence of fluid overload (peripheral enema, dyspnea, fatigue, weight gain, jugular venous distention. -Monitor patients receiving beta blockers for signs of overdose (bradycardia, severe dizziness or fainting, severe drowsiness, dyspnea, bluish fingernails or palms, seizures.
- 24. BRAND NAME GENERIC NAME DOSAGE FREQUENCY ROUTE DATE D/C ONGOING Heparin Adalat Pentazole Nimotop Physiotens Multiparin Heparin Nifedipine Pantoprazole Nimodipine Moxonidine Multiparin 5000units 90mg 40mg 60mg 0.4mg 5ml TID Daily Daily Q4 Daily TID SC NGT IV NGT NGT SC 20/10 20/10 20/10 20/10 20/10 20/10 7days 7days 7days 7days 7days 1day
- 26. Assessment Nursing Diagnosis Planning Intervention Rational Evaluation Subjective: He have sever headache since 3 weeks “as verbalized by the relative” Objective: Restlessness Hypertension Pale Looks tired Vital sign taken : BP: 230/110mmhg left Arm. HR:90bpm in sinus rhythm, TEMP:37.6c RR:25bpm O2:94% cbs:149mg/dl Ineffective cerebral tissue perfusion related to brain bleeding. After 8 hours of nursing intervention the patient will be able to display decrease signs of ineffective tissue perfusion as evidence by gradual improvement of vital signs Nursing Management(5): 1-closely monitor the vital Sign. 2-monitor neurologic status include: Glasgow coma scale and LOC. 3- elevate the head of the bed 30 degrees . 4-establish iv line 5-Maintain bed rest, provide quiet and relaxing environment, restrict visitors and activities. Cluster nursing interventions and provide rest periods between care activities. Limit duration of procedures. 1-changes in the vital signs may indicates changes in patient status. 2-to detect changes indicative of worsening or improving Condition 3-Reduces arterial pressure by promoting venous drainage and may improve cerebral Perfusion 4- to give any kind of MEDICATION 5-Continuous stimulation or activity can increase intracranial pressure (ICP). Absolute rest and quiet may be needed to prevent re bleeding in the case of haemorrhage. After 8 hours of nursing intervention the patient shall have displayed a decreased sign of tissue perfusion and gradual improvement of vital signs. BP:180/100mmhg left Arm. HR:95bpm in sinus rhythm, TEMP:36.7c RR:20bpm O2:99% cbs:120mg/dl
- 27. Medical: interventions: administer medication as order by physician : 1-Anticoagulants: Heparin 5000 units - used to improve cerebral blood flow and prevent further clotting when embolism and/or thrombosis is the problem. 2-tranexamic acid 500mg - Used with caution in hemorrhagic disorder to prevent lysis of formed clots and subsequent re bleeding. 3-analgesic paracetamol 1gm - used to trait the pain 4-antihypertensive trandate infusion 12mg/hr - Chronic hypertension requires cautious treatment because aggressive management increases the risk of extension of tissue damage. 5- Follow up the CT scan after the test - the results of CT scan should be available to the doctor within 24hours after the test.
- 28. HEALTH TEATCHING 1-Check your blood pressure as directed - High blood pressure can increase your risk for a stroke , Follow your healthcare provider's directions for controlling your blood pressure. 2-Eat a variety of healthy foods - To provide the body with all important elements and vitamins. 3-Do not drink alcohol – Because it is cause of bleeding. 4-Exercise as directed- it can lower the blood pressure, cholesterol, weight, and blood sugar levels. 5-Manage stress – it can raise blood pressure. Find new ways to relax, such as deep breathing or listening to music.
- 29. QUISTIONS ?
- 30. References: 1. Cleveland Clinic. (2019). Cerebral & Intracerebral Hemorrhage | Cleveland Clinic. [online] Available at: https://my.clevelandclinic.org/health/diseases/14480- intracranial-hemorrhage-cerebral-hemorrhage-and-hemorrhagic-stroke [Accessed 29 Nov. 2019]. 2. Emedicine.medscape.com. (2019). Intracranial Hemorrhage Medication: Antihypertensive agents, Osmotic diuretics, Antipyretics, analgesics, Anticonvulsants, Antidotes, Antacids. [online] Available at: https://emedicine.medscape.com/article/1163977-medication [Accessed 29 Nov. 2019]. 3. Emedicine.medscape.com. (2019). Brain Imaging in Hypertensive Hemorrhage: Practice Essentials, Computed Tomography, Magnetic Resonance Imaging. [online] Available at: https://emedicine.medscape.com/article/338055- overview [Accessed 29 Nov. 2019].