NU621 Unit 6 Case Study Solution -Describe the pathophysiology of extradural and subdural hematomas
NU621 Unit 6 Case Study Solution (Describe the pathophysiology of extradural and subdural hematomas, Identify the surgical emergency and provided rationale for the choice and Describe the most likely type of head injury and outline an approriate treatment plan)
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Assignment Objectives:
- Identify and select appropriate interventions including diagnostic tests and nursing interventions.
- Analyze physiological and psychological responses to illness and treatment modalities
Purpose: Examine case studies related to neurologic disease and answer the assigned questions. This assignment should help refine your clinical/critical thinking skills.
Assignment Description:
- Describe the pathophysiology of extradural and subdural hematomas.
- Identify the surgical emergency and provided rationale for the choice.
- Describe the most likely type of head injury and outline an approriate treatment plan.
- Your answer must follow APA 6th edition format.
- Submit the answer to this assignment area.
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Patient 1 – Two individuals come to the emergency department with head injuries. One, 25 years old, has just been in a motor vehicle accident (MVA) and has a temporal lobe injury. The other, 65 years old, has increasing confusion after a fall that happened earlier in the week.
a. Differentiate the pathophysiology of extradural hematoma and subdural hematoma.
b. Identify the patient in the above scenario requiring immediate emergency surgical intervention and provide rationale for your choice.
Patient 2 – An 38 year old was driving his 1970 Chevy Corvette to a Milwaukee Brewers baseball game when a deer jumped out in front of him on the highway. He swerved his car and hit a telephone pole instead. His head hit the windshield and he suffered severe head trauma.
a. Describe the most likely specific type of head injury he suffered.
b. Outline the treatment plan for this patient.
Estimated time to complete: 6 hours
Rubric
NU621 Unit 6 Case Study Solution
Patient Case Scenario-1
Case 1 involves two patients who present to the emergency department (ED) with head traumas. One is 25 years old with a temporal lobe injury due to a motor vehicle accident (MVA). The other patient is a 65-year-old who continues to experience increasing confusion after having a fall the week before.
Difference between the Pathophysiology of Extradural Hematoma and Subdural Hematoma
Kuleza et al. (2020) note that a subdural hematoma is often caused by a skull fracture leading to damage to a meningeal artery (located between the dura and the skull whereas a subdural hematoma is linked to an underlying parenchymal injury that includes diffuse axonal injury. The youth is likely to have suffered an epidural hematoma, typically a skull fracture triggering damage to the middle meningeal artery causing arterial bleeding within the potential epidural space. On the other hand, the older man might have had a subdural hematoma after the fall caused blood to enter the subdural space after a blood vessel running across the brain and the skull is torn, broken, or stretched bleed within the subdural space hence the progressive confusion.
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Patient Requiring Immediate Emergency Surgical Intervention
In my view, the 25-year-old patient should undergo an emergency surgical evacuation, the patient’s Glasgow Coma Scale (GCS) notwithstanding. This is premised because the brain’s adverse effect is mainly due to life-threatening herniation due to mass effect causing structural distortion (Aromatario et al., 2021).
Patient Case Scenario 2 and Description of Most Likely Type of Head Injury Suffered
Case 2 entails a 38-year-old who hit the windshield and suffered a severe head injury after the car he was driving hit a telephone pole. According to Ng et al. (2019), this patient is likely to have suffered a contusion as it is the one that results when a passenger’s or driver’s head hits fixed objects on the car upon impact.
Outline of the Treatment Plan for the Patient Diagnosed with Contusion
Galgano et al. (2017) note that TBIs ending in contusions may take several days or even weeks for symptoms to develop after the accident. Medications to be administered for this patient include Methylphenide for 3 mg/kg two times a day. Other medications that can be used include Agomelatine, Modafinil, and Amantadine (Anghinah et al., 2018). The medication should be reinforced with non-pharmacological interventions. Non- pharmacological intervention would entail using the RICE approach, with R representing resting the head whenever possible, I stands for ice to apply a cold compress, C means to compress the head, and E is for elevating to raise the affected organ.
References
Anghinah, R., Amorim, R. L. O. D., Paiva, W. S., Schmidt, M. T., & Ianof, J. N. (2018). Traumatic brain injury pharmacological treatment: recommendations. Arquivos de neuro-psiquiatria, 76(2), 100-103.
Aromatario, M., Torsello, A., D’Errico, S., Bertozzi, G., Sessa, F., Cipolloni, L., & Baldari, B. (2021). Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. Medicina, 57(2), 125.
Galgano, M., Toshkezi, G., Qiu, X., Russell, T., Chin, L., & Zhao, L. R. (2017). Traumatic brain injury: current treatment strategies and future endeavors. Cell transplantation, 26(7), 1118-1130.
Kulesza, B., Mazurek, M., Rams, Ł., & Nogalski, A. (2020). Acute epidural and subdural hematomas after head injury: distinguishing clinical features. Indian Journal of Surgery, 1-9.
Ng, S. Y., & Lee, A. Y. W. (2019). Traumatic brain injuries: pathophysiology and potential therapeutic targets. Frontiers in cellular neuroscience, 13, 528.
Week 6 Case Study on Advanced Pathophysiology –
Introduction
The advanced pathophysiology practitioner requires a solid foundation in pathophysiological disease processes across the life span to deliver quality care (Zambas et al., 2016). Through advanced pathophysiology, the practitioner endeavors to fathom the biophysical processes, the deviations emanating from these processes, and the concepts in science connected to disease processes biology.
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Patient Case Scenario-1
Case 1 involves two patients who are presented to the emergency department (ED) with head traumas. One is 25 years old with a temporal lobe injury due to a motor vehicle accident (MVA). The other patient is a 65-year-old who continues to experience increasing confusion after having a fall the week before. The youth is likely to have suffered an epidural hematoma, typically a skull fracture triggering damage to the middle meningeal artery causing arterial bleeding within the potential epidural space(Kulesza et al., 2020). On the other hand, the older man might have had a subdural hematoma after the fall caused blood to enter the subdural space after a blood vessel running across the brain and the skull is torn, broken, or stretched bleed within the subdural space hence the progressive confusion. In my view, the 25-year-old patient should undergo an emergency surgical evacuation, the patient’s Glasgow Coma Scale (GCS) notwithstanding. The adverse effects are mainly due to life-threatening herniation that may cause structural distortion (Aromatario et al., 2021).
Patient Case Scenario 2
Case 2 entails a 38-year-old who hit the windshield and suffered a severe head injury after the car he was driving hit a telephone pole. According to Ng et al. (2019) this patient is likely to have suffered a contusion as it is the one that results when a passenger’s or driver’s head hits fixed objects on the car upon impact. It is unlikely to be a penetration since no external object penetrated the skull. Diffuse axonal was ruled out as there was no severe rotation or shaking of the head, and coup- countercoup was ruled out since these types of injuries occur when the car accident is highly violent and usually involves a rollover. Similarly, a concussion was considered unlikely as the patient was not reported to have suffered temporary loss of consciousness nor amnesia, amongst other clinical manifestations. Galgano et al. (2017) note that TBIs ending in concussions may take several days or even weeks for symptoms to develop after the accident. Medications to be administered for this patient include Methylphenide for 3 mg/kg twice a day. Other medications that can be used are Agomelatine, Modafinil, and Amantadine(Anghinah et al., 2018). The medication should be reinforced with non-pharmacological interventions. Non- pharmacological intervention would entail using the RICE approach, with R representing resting the head whenever possible, I stands for ice to apply a cold compress, C means compress the head, and E is for elevating to raise the affected organ.
Conclusion
TBI recovery calls for effective treatment to avoid complications. Diagnosing the correct type of TBI from concussions to coup countercoup may call for scans before one can decide whether to use a surgical process, medication intervention, non-pharmacological measures, or a combination of all three for optimal patient outcomes.
References
Zambas, S. I., Smythe, E. A., & Koziol-Mclain, J. (2016). The consequences of using advanced physical assessment skills in medical and surgical nursing: A pragmatic hermeneutic study. International journal of qualitative studies on health and well-being, 11(1), 32090.
Kulesza, B., Mazurek, M., Rams, Ł., & Nogalski, A. (2020). Acute epidural and subdural hematomas after head injury: distinguishing clinical features. Indian Journal of Surgery, 1-9.
Aromatario, M., Torsello, A., D’Errico, S., Bertozzi, G., Sessa, F., Cipolloni, L., & Baldari, B. (2021). Traumatic Epidural and Subdural Hematoma: Epidemiology, Outcome, and Dating. Medicina, 57(2), 125.
Ng, S. Y., & Lee, A. Y. W. (2019). Traumatic brain injuries: pathophysiology and potential therapeutic targets. Frontiers in cellular neuroscience, 13, 528.
Galgano, M., Toshkezi, G., Qiu, X., Russell, T., Chin, L., & Zhao, L. R. (2017). Traumatic brain injury: current treatment strategies and future endeavors. Cell transplantation, 26(7), 1118-1130.
Anghinah, R., Amorim, R. L. O. D., Paiva, W. S., Schmidt, M. T., & Ianof, J. N. (2018). Traumatic brain injury pharmacological treatment: recommendations. Arquivos de neuro-psiquiatria, 76(2), 100-103.
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| NU621 Unit 6 Case Study | ||
| Criteria | Ratings | Pts |
| This criterion is linked to a Learning OutcomeContent & Concepts NU621-CO1; NU621-CO2; NU621-CO3; PRICE-P; PRICE-I | 50 pts 5 Ideas and concepts are consistently clear and always well explained. Relationships between concepts and ideas are always discussed fairly and always synthesized in a logical fashion with strong, well-founded supporting arguments. All discussion and arguments are thoroughly supported with research and/or resource materials that are pertinent, valid, and reliable. 48.34 pts 4 Ideas and concepts are clear and well explained. Relationships between concepts and ideas are discussed fairly and synthesized in a logical fashion with well-founded supporting arguments. Discussion and arguments are supported with research and/or resource materials that are pertinent, valid, and reliable 45 pts 3 Ideas and concepts are reasonably well explained. Discussion and arguments are, for the most part, supported with research and/or resource materials that are pertinent, valid, and reliable relationships between concepts, and ideas are discussed. These could be further strengthened with additional research or resource materials. 38.34 pts 2 Basic ideas and concepts are presented; however, they are under-developed and poorly explained. There is minimal evidence of a relationship between ideas and concepts. Discussion and arguments are not supported with additional research or research that is pertinent and valid. 33.34 pts 1 Some basic ideas and concepts are started, but not developed. There is no identifiable relationship between ideas and concepts. There is little or no discussion and/or argument with supporting research. 0 pts 0 There are no developed ideas or concepts. There is no supporting research. | 50 pts |
| This criterion is linked to a Learning OutcomeAnalysis NU621-CO1; NU621-CO2; NU621-CO3; PRICE-I; PRICE-P | 30 pts 5 Organizes and synthesizes evidence to reveal insightful patterns, differences, or similarities related to focus. 27 pts 4 Organizes and analyzes evidence to reveal insightful patterns, differences, or similarities related to focus. 24 pts 3 Organizes evidence to reveal important patterns, differences, or similarities related to focus. 21 pts 2 Organizes evidence, but the organization is not effective in revealing important patterns, differences, or similarities. 18 pts 1 Describes evidence, but it is not organized and/ or is unrelated to focus. 0 pts 0 Lists evidence, but it is not organized and/ or is unrelated to focus. | 30 pts |
| This criterion is linked to a Learning OutcomeWriting Conventions PRICE-P; PRICE-I | 10 pts 5 The paper exhibits a superior command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling. 9 pts 4 The paper exhibits a strong command of written English language conventions. The paper has no errors in mechanics, grammar, or spelling that impair the flow of communication. 8 pts 3 The paper exhibits command of written English language conventions. The paper has minor errors in mechanics, grammar, or spelling that impact the flow of communication. 7 pts 2 The paper exhibits a limited command of written English language conventions. The paper has frequent errors in mechanics, grammar, or spelling that impede the flow of communication. 6 pts 1 The paper exhibits little command of written English language conventions. The paper has errors in mechanics, grammar, or spelling that cause the reader to stop and reread parts of the writing to discern meaning. 0 pts 0 The paper does not demonstrate command of written English language conventions. The paper has multiple errors in mechanics, grammar, or spelling that cause the reader difficulty discerning the meaning. | 10 pts |
| This criterion is linked to a Learning OutcomeAPA PRICE-I; PRICE-P | 10 pts 5 The required APA elements are all included with correct formatting, including in-text citations and references. 8 pts 4 The required APA elements are all included with minor formatting errors, including in-text citations and references. 6 pts 3 The required APA elements are all included with multiple formatting errors, including in-text citations and references. 4 pts 2 The required APA elements are not all included. AND/OR there are major formatting errors, including in-text citations and references. 2 pts 1 Several APA elements are missing. The errors in formatting demonstrate limited understanding of APA guidelines, in-text-citations, and references. 0 pts 0 There is little to no evidence of APA formatting. AND/OR there are no in-text citations AND/OR references. | 10 pts |
| Total Points: 100 |
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