Case Study : Traumatic Brain Injury, Patient Profile: Mario, a 21-year-old jeepney driver, suffered a compound fracture of the skull and facial fractures in a motor vehicle accident. During their admission to the hospital, he was immediately taken to surgery for evacuation of a right subdural hematoma in the temporal region and repair of facial fractures. On the third postoperative day, the nurse discovers the following findings during his assessment.
• Increasingly difficult to arouse Objective Data
• GCS score decreased from 11 to 6
• Signs of nuchal rigidity
• Vital signs: Temp: 39.1°C, BP: 120/60, HR: 110 bpm
• Intracranial Pressure: ranges between 20 and 30 mm Hg despite CSF drainage and mannitol
Critical Thinking Questions:
1. What is the probable cause of Mario’s change in neurologic status?
2. What were the contributing factors that put Mario at risk for complications after a head injury and surgery?
3. On the basis of the nursing assessment, what are the priority interventions?
4. Discuss the possible areas for organisms to gain access to the meninges in the case of Mario
5. Based on the assessment data presented, what are the priority nursing diagnoses?