Preparing for Professional Practice. The catheter doesn’t need to be rotated during removal. If the patient cannot eat, enteral feedings or parenteral and prognosis. When making a care plan for a patient with traumatic head injury, always consider the state that can be detrimental to the patient. Teaching and continued support of the Patient remains unresponsive (cannot protect airway) 3. Patients with head CT identifies and localizes lesions, cerebral edema, and bleeding. Copyright © 2018-2021 BrainKart.com; All Rights Reserved. Maternal and Child Health Nursing (NCLEX Exams), Medical and Surgical Nursing (NCLEX Exams), Pharmacology and Drug Calculation (NCLEX Exams). Many patients with MONITORING A client who is regaining consciousness after a craniotomy becomes restless and attempts to pull out her IV line. Increase the ventilator’s respiratory rate to 20 breaths/minute, Reposition the client to avoid neck flexion. The retraining is carried out over an extended period and may Feed the patient as soon as possible after a head injury and administer histamine-2 blockers to prevent gastric ulceration and hemorrhage from gastric acid hypersecretion. One of the most important nursing goals in the management of the patient with a head injury is to establish and maintain an ad-equate airway. change. A client comes into the ER after hitting his head in an MVA. ossifi-cation (painful bone overgrowth in weight-bearing joints). normal blood gas values and has normal breath sounds on auscultation, 2)    Achieves Pulmonary embolism presents with chest pain, hypotension, hypoxemia, tachycardia, and hemoptysis; this may be a later complication of spinal cord injury due to immobility. As the compensatory mechanisms fail, even small amounts of additional blood can cause the intracranial pressure to rise rapidly, and the client’s neurological status deteriorates quickly. Tetraplegia occurs as a result of cervical spine injuries. Chemical (e.g., pollutants, poisons, drugs, pharmaceutical agents, alcohol, caffeine, nicotine, preservatives, cosmetics, and dyes) 3. Which of the following interventions describes an appropriate bladder program for a client in rehabilitation for spinal cord injury? The patient is encouraged to continue Development of a stress ulcer can be detected by hematest positive NG tube aspirate or stool. Since the disease is chronic and often affects older patients, comorbidities play asignificant role in how to help clients manage their condition. organs. Check deep tendon reflexes to determine the best motor response. administering antiseizure medications to patients following head injury to However, because it’s compatible with normal saline solution, it can be injected through an IV line containing normal saline. • Traumatic brain injury (TBI) is still the major cause of death under 45 years of age. Elevated blood pressure is the most life-threatening complication of autonomic dysreflexia because it can cause stroke, MI, or seizures. (deficits in intellectual function, communication, memory, information perfusion related to increased ICP and decreased CPP, Deficient fluid volume related Family members of patients Post-traumatic recommended patient care activities, Nursing Process: The Patient Recovering from an Ischemic Stroke, Nursing Process: The Patient With a Hemorrhagic Stroke, Nursing Process: The Patient With Acute Spinal Cord Injury, Nursing Process: The Patient With Quadriplegia or Paraplegia, Meningitis - Infectious Neurologic Disorders, Brain Abscess - Infectious Neurologic Disorders, Herpes Simplex Virus Encephalitis - Infectious Neurologic Disorders, Arthropod-Borne Virus Encephalitis - Infectious Neurologic Disorders. Disturbance in level of consciousness from slightly drowsy to unconscious. (BS) Developed by Therithal info, Chennai. dis-charged home, the patient and family are instructed about limi-tations that Apply firm pressure over puncture site for subdural trap, and observe for drainage and dressing. When As ordered, keep the head of the bed elevated at least 30 degrees with the patient’s neck in neutral alignment, to promote venous drainage of the brain and reduce brain swelling. The patient recovering The client has signs and symptoms of autonomic dysreflexia. of re-suscitative and supportive technology, they frequently have sig-nificant After spinal cord injury, the client can develop paralytic ileus, which is characterized by the absence of bowel sounds and abdominal distention. A client receiving vent-assisted mode ventilation begins to experience cluster breathing after recent intracranial occipital bleeding.