Medical-Surgical Nursing
30 year old man is admitted to the neurosurgery ward for the surgical elevation of depressed skull fracture.
He has episodic severe headache with seizure and is unable to concentrate. Which of the following initial nursing problem needs more attention?
الشرح
Core Concept: Increased Intracranial Pressure (ICP) and high seizure risk following a traumatic brain injury (depressed skull fracture).
Clinical Presentation:
- Severe, episodic headache
- Altered level of consciousness, inability to concentrate
- Seizures, focal neurological deficits
Diagnosis:
- First-line: Non-contrast CT scan of the head to evaluate the fracture, hematoma, and cerebral edema.
- Gold Standard: Invasive intracranial pressure (ICP) monitoring in severe TBI cases.
Management:
- Acute: Implement strict seizure precautions (padded side rails, suction/oxygen at bedside, bed in low position); elevate HOB 30 degrees; administer antiepileptic drugs.
- Long-term/Definitive: Surgical elevation/debridement of the depressed fracture, long-term EEG monitoring, and neurorehabilitation.