POLYTECHNIC COLLEGE OF DAVAO DEL SUR MacArthur Highway, Digoc City

A CASE STUDY OF Status Post Craniectomy

IN PARTIAL FULFILLMENTOF THE REQUIREMENTS IN

RLE/NCM 102

Presented to Ms. Mary Jane Sulla, RN

Presented by

Radee King R. Corpuz

January, 2009

INTRODUCTION

The brain is enclosed in the skull, which is a rigid, solid bone. Surrounding the brain is a tough, leathery outer covering called the dura (door-uh). The dura attaches to the brain, just beneath the skull bone. The dura normally protects the brain and keeps it nourished with blood and spinal fluid. When a person receives a severe blow to the head, the brain bounces within the cavity.

This movement of the brain structures may cause shearing or tearing of the blood vessels surrounding the brain and dura. When the blood vessels tear, blood accumulates within the space between the dura and the skull. This is known as an epidural hematoma (epi-door-ul hem-a-to-ma), or blood clot at the covering of the brain.

When the blood accumulates between the dura and skull, swelling of the brain occurs. There is no extra room within the skull to allow for the brain to swell and for the blood to accumulate. The only way the brain can compensate is to shift the delicate structures out of the way. This can cause pressure on vital functions, such as eye opening, speech, level of awakeness (or consciousness) or even breathing. Generally, an epidural can cause serious problems and must be removed to prevent increased swelling of the brain. The procedure of choice for removal of an epidural hematoma is surgery to remove the blood clot.

An epidural hematoma can happen to anyone, at any age. Some common causes of epidural hematoma include:

A blow to the head, such as in a motor vehicle crash, assault or bicycle accident, falling down and striking the head and people at particular risk are those who, are elderly and have trouble walking or fall often, take a blood thinner, such as Coumadin

Epidural hematomas may occur in combination with subdural hematomas, or either may occur alone. CT scans reveal subdural or epidural hematomas in 20% of unconscious patients.

In the hallmark of epidural hematoma, patients may regain consciousness during what is called a lucid interval, only to descend suddenly and rapidly into unconsciousness later. The lucid interval, which depends on the extent of the injury, is a key to diagnosing epidural hemorrhage. If the patient is not treated with prompt surgical intervention, death is likely to follow.

Brain damage caused by head injury can have dramatic consequences for those affected; it has been reported in prospective studies that children with a history of CET suffer from twice as many psychiatric and cognitive disorders as controls (2). It has also been reported that CET patients, in particular very serious cases, make normal personality development more difficult, leaving people with serious deficits in areas such as introspection, planning, social judgment, emotional control, empathy and reasoning (3).

In the industrialized countries, physical injury and in particular cranioencephalic trauma (CET), is a significant clinical and social problem of epidemic proportion. According to Kraus (1), epidemiological studies on this pathology are incomplete, since none of them groups all CET patients within a defined population; however, in general it is considered that the annual incidence in the developed countries is from 200 to 300 per 100,000 inhabitants. In the different epidemiological studies, it has been found that the percentages of affected patients of pediatric age is around 20%; the accidents are mainly car crashes and sports falls (bicycles, skate-boards ...) involving a bang on the head in movement on a static surface.

IDENTIFICATION OF THE CASE

A. PERSONAL PROFILE

Name : Lady L.

Address : Asbang, Matanao, Digos, Davao del Sur

Age : 13y/o

Gender : female

Civil status : single

Birth date :

Occupation :helper

Admitting Doctor : Dr. Armando

Admitting Diagnosis : vehicular accident

Religion: Baptist

Nationality: Filipino

Educational Attainment: Grade 6

Father’s name: Mr. E

Occupation: Farmer

Mother’s name: Mrs. V

Occupation: Housewife

Date of admission: January 6, 2009

B. Background/History

DM HPN CA ASTHMA

Maternal

Paternal

C. Medical History

The patient had her complete immunization. According to her

father, she had never been hospitalized. Though she had some fever on

her younger years, hospitalization was not an option for her parents. They

usually use “haplas” and any other herbal medicines for treatment.

D. History of Present Illness

Few minutes prior to admission, the patient was hit by a private

vehicle while riding on a bicycle and was referred to this institution (Davao

Medical Center) for STAT craniectomy.

E. Socio-economic background

Patient L, the eldest of the five siblings was a helper in Digos City.

She has an income of Php. 1000/month which she uses to send herself to

school. Her father works as farmer on a land owned by their neighbor,

while her mother only stays at home taking care of the children.

DEFINITION OF TERMS

Cerebrum or telencephalon – together with the diencephalon, constitute the forebrain. It is the most anterior or, especially in humans, most superior region of the vertebrate central nervous system. "Telencephalon" refers to the embryonic structure, from which the mature "cerebrum" develops. The dorsal telencephalon, or pallium, develops into the cerebral cortex, and the ventral telencephalon, or subpallium, becomes the basal ganglia. The cerebrum is also divided into symmetric left and right cerebral hemispheres

CerebralConcussion – from the Latin concutere ("to shake violently"),[1] is the most common type of traumatic brain injury. The terms mild brain injury, mild traumatic brain injury (MTBI), mild head injury (MHI), and minor head trauma and concussion may be used interchangeably, although the latter is often treated as a narrower category. The term 'concussion' has been used for centuries and is still commonly used in sports medicine, while 'MTBI' is a technical term used more commonly nowadays in general medical contexts. Frequently defined as a head injury with a transient loss of brain function, concussion can cause a variety of physical, cognitive, and emotional symptoms.

Craniectomy – is a neurosurgical procedure in which part of the skull is removed to allow a swelling brain room to expand without being squeezed. It is performed on victims of traumatic brain injury and stroke. Use of the surgery is controversial.[1] Though the procedure is considered a last resort, some evidence suggests that it does improve outcomes by lowering intracranial pressure (ICP), the pressure within the skull.

Epidural hematoma (EDH) occurs outside the brain and is usually caused by a damaged artery. Arteries carry blood under high pressure; therefore, a large EDH can cause pressure to build up within minutes, even seconds. This condition requires immediate surgery to relieve pressure and prevent severe permanent damage or death

Glasgow Coma Scale or GCS – is a neurological scale which aims to give a reliable, objective way of recording the conscious state of a person, for initial as well as continuing assessment. A patient is assessed against the criteria of the scale, and the resulting points give a patient score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (the more widely used modified or revised scale).

ANATOMY AND PHYSIOLOGY

The cerebrum consists of two cerebral hemispheres connected by a bundle of

nerve fibers, the corpus callosum. The largest and most visible part of the brain, the

cerebrum, appears as folded ridges and grooves, called convolutions. The following

terms are used to describe the convolutions:

A gyrus (plural, gyri) is an elevated ridge among the convolutions.

A sulcus (plural, sulci) is a shallow groove among the convolutions.

A fissure is a deep groove among the convolutions.

The deeper fissures divide the cerebrum into five lobes (most named after bordering

skull bones)—the frontal lobe, the parietal love, the temporal lobe, the occipital lobe,

and the insula. All but the insula are visible from the outside surface of the brain.

A cross section of the cerebrum shows three distinct layers of nervous tissue:

The cerebral cortex is a thin outer layer of gray matter. Such activities as

speech, evaluation of stimuli, conscious thinking, and control of skeletal

muscles occur here. These activities are grouped into motor areas, sensory

areas, and association areas.

The cerebral white matter underlies the cerebral cortex. It contains mostly

myelinated axons that connect cerebral hemispheres (association fibers),

connect gyri within hemispheres (commissural fibers), or connect the cerebrum

to the spinal cord (projection fibers). The corpus callosum is a major

assemblage of association fibers that forms a nerve tract that connects the two

cerebral hemispheres.

Basal ganglia (basal nuclei) are several pockets of gray matter located deep

inside the cerebral white matter. The major regions in the basal ganglia—the

caudate nuclei, the putamen, and the globus pallidus—are involved in relaying

and modifying nerve impulses passing from the cerebral cortex to the spinal

cord. Arm swinging while walking, for example, is controlled here.

The diencephalon connects the cerebrum to the brain stem. It consists of the

following major regions:

The thalamus is a relay station for sensory nerve impulses traveling from the

spinal cord to the cerebrum. Some nerve impulses are sorted and grouped here

before being transmitted to the cerebrum. Certain sensations, such as pain,

pressure, and temperature, are evaluated here also.

The epithalamus contains the pineal gland. The pineal gland secretes

melatonin, a hormone that helps regulate the biological clock (sleep-wake

cycles).

The hypothalamus regulates numerous important body activities. It controls

the autonomic nervous system and regulates emotion, behavior, hunger, thirst,

body temperature, and the biological clock. It also produces two hormones

(ADH and oxytocin) and various releasing hormones that control hormone

production in the anterior pituitary gland.

The following structures are either included or associated with the hypothalamus.

The mammillary bodies relay sensations of smell.

The infundibulum connects the pituitary gland to the hypothalamus.

The optic chiasma passes between the hypothalamus and the pituitary gland.

Here, portions of the optic nerve from each eye cross over to the cerebral

hemisphere on the opposite side of the brain.

The brain stem connects the diencephalon to the spinal cord. The brain stem

resembles the spinal cord in that both consist of white matter fiber tracts surrounding

a core of gray matter. The brain stem consists of the following four regions, all of

which provide connections between various parts of the brain and between the brain

and the spinal cord.

The midbrain is the uppermost part of the brain stem.

The pons is the bulging region in the middle of the brain stem.

The medulla oblongata (medulla) is the lower portion of the brain stem that

merges with the spinal cord at the foramen magnum.

The reticular formation consists of small clusters of gray matter interspersed

within the white matter of the brain stem and certain regions of the spinal cord,

diencephalon, and cerebellum. The reticular activation system (RAS), one

component of the reticular formation, is responsible for maintaining

wakefulness and alertness and for filtering out unimportant sensory information.

Other components of the reticular formation are responsible for maintaining

muscle tone and regulating visceral motor muscles.

The cerebellum consists of a central region, the vermis, and two winglike lobes, the

cerebellar hemispheres. Like that of the cerebrum, the surface of the cerebellum is

convoluted, but the gyri, called folia, are parallel and give a pleated appearance. The

cerebellum evaluates and coordinates motor movements by comparing actual skeletal

movements to the movement that was intended.

The limbic system is a network of neurons that extends over a wide range of areas of the

brain. The limbic system imposes an emotional aspect to behaviors, experiences, and

memories. Emotions such as pleasure, fear, anger, sorrow, and affection are imparted to

events and experiences. The limbic system accomplishes this by a system of fiber tracts

(white matter) and gray matter that pervades the diencephalon and encircles the inside

border of the cerebrum. The following components are included:

The hippocampus (located in the cerebral hemisphere)

The denate gyrus (located in cerebral hemisphere)

The amygdala (amygdaloid body) (an almond-shaped body associated with the

caudate nucleus of the basal ganglia)

The mammillary bodies (in the hypothalamus)

The anterior thalamic nuclei (in the thalamus)

The fornix (a bundle of fiber tracts that links components of the limbic system)

ETIOLOGY AND SYMPTOMATOLOGY

Etiology

Ideal Actual JustificationLocation (+) The location varies a lot in incidence

number of the Vehicular Accident. Those people who live nearby from the highways are more prone to those people that are away from the highway. In our pt, their house is near the highway.

Weather (+) Weather does also have a large effect of most vehicular accident such as rain which may interferes or blocks the visualization of those who are involve.

Age (+) Younger ones have lots of playtime than the old ones making them more at risk in any form of Accidents.

Symptomatology

Ideal Actual Justificationdizziness (+) -Pt. manifested

Lightheadedness or dizziness because dizziness happens when there is not enough blood getting to the brain. This can happen if there is a sudden drop in your blood pressure

Confusion (+) -because of Low levels of oxygen, Concussion, Fever Fluid and electrolyte imbalance, Head trauma or head injury or a sudden drop of temperature

Different Size Pupils (+) -due to bleeding inside the skull caused by head injury

Shock(+)

- because of Low blood volume secondary to bleeding

COMPLICATION

Post-Concussion Syndrome

Post-concussion syndrome (PCS) is a common but controversial disorder that presents with variety of symptoms including- but not limited to- headache, dizziness, fatigue, and personality changes. PCS occurs in approximately 23-93% of persons with mild to severe head injuries.

Seizure

A seizure is a sudden change in behavior characterized by changes in sensory perception (sense of feeling) or motor activity (movement) due to an abnormal firing of nerve cells in the brain. Epilepsy is a condition characterized by recurrent seizures that may include repetitive muscle jerking called convulsions

Infectionis the detrimental colonization of a host organism by a foreign species. In

an infection, the infecting organism seeks to utilize the host's resources to multiply (usually at the expense of the host). The infecting organism, or pathogen, interferes with the normal functioning of the host and can lead to chronic wounds, gangrene, loss of an infected limb, and even death

Chronic Head Injuriesoccurs when an outside force traumatically injures the brain. TBI can be

classified based on severity (mild, moderate, or severe), mechanism (closed or penetrating head injury), or other features (e.g. occurring in a specific location or over a widespread area). Head injury usually refers to TBI, but is a broader category because it can involve damage to structures other than the brain, such as the scalp and skull.

PATHOPHYSIOLOGY

Epidural Hematoma is acquired through many causes. One of these

causes is the vehicular accident because during a vehicular accident, one’s head

maybe injured.

Predisposing factorsAgeAccident prone area

Vehicular Accident

Precipitating factorsWorkAwarenessType(s) of vehicle

Head Injury

Skull fracture

Rupture or laceration of theMiddle meningeal artery

HEMORRHAGE

Blood collect in the epiduralSpace between the skull and dura

Epidural HematomaInc. ICP

S/Sx* momentary loss of

ConsciousnessInterval apparent

Recovery or lucid recovery

CRANIECTOMY

Good prognosis

After a head injury, blood may collect in the epidural space between the

skull and the dura. This can result from a skull fracture that causes a rupture or

laceration of the middle meningeal artery, the artery that runs between the dura

and the skull inferior to a thin portion of temporal bone. Hemorrhage from this

artery causes rapid pressure on the brain.

Symptoms are caused by the expanding hematoma. Usually, a

momentary loss of consiousness occurs at the time of injury, followed by an

interval apparent recovery. Although the lucid interval is considered a classic

characteristics of an epidural hematoma, no lucid interval has been reported in

many patients with this lesion and therefore it should not be considered a critical

defining criterion.

An epidural hematoma is considered an extreme emergency; marked

neurologic deficit or even respiratory arrest can occur within minutes. Treatment

consists of making openings through the skull (burr holes) to decrease ICP

emergently, remove the clot, and control the bleeding. A craniotomy may be

required to remove the clot and control the bleeding. A drain is usually inserted

after creation of burr holes or a craniotomy to prevent reaccumulation of blood

But on the other hand, if treatment is being applied, there is great chance

of recovery through what we so call surgery and to be more specific, the

procedure called craniectomy. Craniectomy is a neurosurgical procedure in

which part of the skull is removed to allow a swelling brain room to expand

without being squeezed. Through this procedure the Increase intracranial

Pressure due to pain will be relieve or be lowered because increase intracranial

pressure is very fatal to the brain since it compresses the brain and restricted the

cerebral blood flow. When surgery is being done, it is still very important to follow

any medication being prescribe t him by the doctor. If this medical management

will be done to the patient correctly, it is pretty sure that the recovery of the

patient will be great and fast and the most desirable thing that everyone who’s

sick would like to have, TOTAL RECOVERY or BEING WEL

MEDICAL MANAGEMENT

01/06/09

Referred to Dr. Armando

8:30am For repeat cranial CT scan STAT Monitor NVS every hour and record Refer

01/07/0910:30am

NPO Start Ranitidine 50mg IVTT every 8 hours Shave full head Refer

01/08/09

May have DAT Continue medz Continue IVF: PLR 1L to run at 130cc/hr D/C PNSS D/C omepirazole Open dressing Keep Jackson’s Pratt drain in negative

5:55pm D/C all medz Change dressing Refer

01/09/095:30

DAT Continue medz Change dressing Keep Jackson’s Pratt Drain in negative Full body bath Remove FBC

01/10/09

DAT with SAP ROM:

Laboratory

Test ResultNormal Values

Clinical Significance

Remarks

CBC Hemoglobin – 142

115-155 -normal range-

Hematocrit – 0.41

0.30-0.48 Normal volume of Red Blood Cells

-normal range-

RBC – 5.00 4.20-6.10 Adequate number of Red Blood Cell primarily to ferry oxygen in blood to all cells of the body

-normal range

WBC – H 13.77

5.0-10.0 Infection, leukemia, tissue necrosis

-increased-

Neutrophil – 90

55-75 Infection, ischemic neurosis, metabolic d/o acute gout

-increased-

Lymphocytes – L4

0.2-.35 TB, hepatitis, infectious mononucleosis, mumps, rubella, lymphocytic leukemia

-increased-

Monocytes – 6

2-10 -normal range-

Eosinophil – L0

1-8 Cushings’s syn. -decresed-

Basophil – 0 0-1 -normal range-Platelet – 257x10^3/uL

150-400

Glucose-RBS – 5.4

3.90-6.8 -normal range-

Creatinine – L27.00 Umol/L

53.00-115.00 Kidney dysfunction -decreased-

CT-scan(+)Epidural hematoma, Right parietotemporal convixities

NURSING ASSESSMENT

B. Physical Assessment

Assessment Normal Findings Yes No

Body Build,

Height and

Weight

Proportionate, varies with

lifestyle

Posture and Gait Clean, neat

Body and Breath

odor

No body or breath odor

Signs of Distress No distress noted

Signs of Health

or Illness

Healthy appearance

Attitude Cooperative

Affect/Mood Appropriate to situation

Quantity, Quality

and Organization

of Speech

Understandable,

moderate pace, exhibits

thought association

Relevance and

Organization of

Thoughts

Logical sequence, makes

sense, has sense of reality

Assessment Normal Findings Yes Poor

Uniformity of

skin color

Uniformity except in

areas exposed to the sun

Edema No edema

Skin Lesions No freckles, No

birthmarks, no abrasions

or lesions

Skin Moisture Moisture in skin folds

and the axillae

Skin

Temperature

Uniform, within normal

range

Skin Turgor Skin springs back to

previous state when

pinched

Assessment Normal Findings Yes No

Scalp Evenly distributed

Hair Thickness Thick hair

Hair Texture Silky, resilient hair

Amount of Body

Hair

Variable

Assessment Normal Findings Yes No

Nail Plate Shape Convex curvature

Texture Smooth

Nail Bed Color Highly vascular, pink,

prompt return of pink

color

Assessme

nt

Normal

Findings

Good Fair Poor

A. Skull and Face

Head Rounded,

symmetrical,

smooth skull

contour, no

nodule

B. Eyes and Vision

Eyebrows Hair evenly

distributed,

symmetrical,

skin intact

Eyelid Skin intact, no

discharges, no

discolorations,

symmetrical

Eyelashes Equally

distributed,

slightly curved

outward

Conjunctiv Transparent,

a sometimes

appear white,

shiny, smooth,

pink or red

Lacrimal

Gland

No edema or

tearing

Cornea Transparent,

shiny and

smooth, blinks

when cornea is

touched

Pupils Black color,

equal size

Near

Vision

Able to read

newsprint

C. Ears and Hearing

Auricles Color is uniform,

symmetric,

mobile, firm,

pinna recoils

when folded

Response

to Normal

Voice

Tone

Normal voice

tone audible

D. Nose and Sinuses

Nares Symmetric and

straight, no

discharges, no

swelling,

uniform color,

not tender

Lining of

nose

Nasal septum in

midline

E. Mouth

Lips

Buccal

Mucosa

Uniform pink,

soft, symmetrical

Teeth and

Gums

Complete child

teeth, smooth,

white tiny tooth

enamel, pink

gums, moist,

firm, no

retractions

Tongue Centrally

located, pink in

color, freely

movable

Palates,

Uvula,

Tonsils

Light pink,

smooth, no

discharges,

present gag

reflex

Assessment Normal Findings Good Fair Poor

Shape and

Symmetry

Symmetrical

Spinal

Deformities

Spine vertically aligned

Assessment Normal Findings Good Fair Poor

Inspect Neck

Muscles

Symmetrical with head

centered

Observe Head

Movement

Coordinated, smooth,

movement with no

discomfort, equal strength

Assessment Normal Findings Good Fair Poor

Muscle Size is symmetrical, no

contracture, normally firm

Movement Smooth coordinated

movements, equal strength

Bones No deformities, no

swelling or tenderness

Joints No swelling, tenderness

Range of motion Varies to some degree

NURSING MANAGEMENT

Ideal

Goal Responsibilities

Maintain Patent Airway Check the orders for and aaply

supplemental Oxygen. Assess RR and

depth, ease of respirations, oxygen

saturation, and breath sounds.

Encourage patient to turn frequently

and take deep breath and cough at

least every two hours.

-Administer pain medication to permit

more effective coughing; suction

patient as needed.

Maintain Cardiovascular stability -Monitor cardiovascular stability by

assessing patients mental status; vital

sings; cardiac rhythm; skin

temperature, color and moisture; and

urine output.

-Assess patency of all intravenous line.

-Assess output from wound drainage

system and amount of bloody drainage

on the surgical dressing frequently.

Mark and time spots of drainage; report

excess drainage or fresh blood to

surgeon immediately.

-Observe the surgical site for bleeding,

type and integrity of dressing , and

drain (eg, Jackson-pratt)

Assessing and Managing pain -Assess pain level using a verbal or

visual analog scale, and assess the

characteristics of the pain.

-Discuss options in pain relief

measures with patient to determine the

best medication. Assess effectiveness

of medication periodically beginning 30

minutes after administration.

-Provide other pain relief measures

(changing patients position, using

distraction, applying cool washcloths to

the face, and rubbing the back with a

soothing lotion) to relieve general

discomfort temporarily.

Maintain normal body temperature -Monitor body system function and vital

sings with temperature every 4 hours

and every shift thereafter.

-Report sings of hypothermia to

physician.

-Maintain the room at a comfortable

temperature, and provide blankets to

prevent chilling.

-Monitor patient for cardiac

dysrhythmias.

-Take efforts to identify malignant

hyperthermia and to treat it early.

Assess mental status -Assess mental status (level of

consciousness, speech, and

orientation) and compare to pre-

operative baseline; change maybe

related to anxiety, pain, medications,

oxygen deficit, or hemorrhage.

-Address source of discomfort, and

report signs of complication for

immediate treatment.

Promote nutrition and fluid balance - Assess patient to return to normal

dietary intake gradually at a pace set

by patient (liquid first then soft foods

such as milk and creamed soak are

added gradually)

-Eat nutritious food and take and

instruct patient to take multivitamins,

Iron and Vitamin C as prescribe.

-Assess potency and intravenous lines,

ensuring that appropriate fluids are

administered at prescribe rate.

-Record intake and output.

HEALTH TEACHINGS

PRIMARY

1. Instruct the patient to have a proper diet that she can tolerate, such as fruits, to help promote wellness.

2. Instruct the patient to have deep breathing exercise, to promote non-pharmacological treatment

3. Advice the patient to have fluid intake or adequate hydration, to help her body re-hydrate to prevent fluid imbalance.

4. Assist patient to perform self-care activities she cannot tolerate, to help her maintain her activities of daily living.

5. Encourage patient to perform self care activities within her level of own ability.

6. Initiate and encourage patient to perform bed exercises to improve circulation ( ROM to arms, hands and fingers, feet and legs; leg flexion and leg lifting; abdominal and gluteal contraction)

7. Ask patient to perform as much as possible and then to call for assistance. Collaborate with patient for progressive activity before and after schedule activity.

SECONDARY

1. Administer medications as ordered by the physician2. Advice patient to have proper nutrition to enhance immune system

TERTIARY

1. Instruct patient to comply for medication regimen2. Discuss the importance of having a regular check-up with his physician

DISCHARGE PLAN

When the doctor noted that the patient is for discharge it is very important

to continue the medication depending on the duration the doctor ordered for the

total recovery of the patient. Patient with epidural hematoma and undergone post

craniectomy needs to have a light exercise such as motor development in both

arms and feet, clear verbalization and spontaneous with the duration of 10-15

minutes and must get enough rest. It is also important to maintain proper hygiene

to prevent further infection that may happen to the patient because she was

undergone surgery; the operated site is very susceptible to any diseases. He

also needs to minimized smoking and drinking alcoholic beverages.

She also need to stop her school because to much exposed to a pressure

and positive atmosphere can be a high risk factor that may cause severity of her

condition. The diet of the patient is also a factor for fast recovery. She is

encourage to eat nutritious foods such as juices that are rich in Vitamin C. the

family of the patient plays a big role for the fast recovery.

Regular consultation to the physician can be factor for recovery to assess

and monitor her condition

PROGNOSIS

Good Fair Poor JustificationDuration of Illness -

Duration of illness is good since the incident was stat and she was given ample treatment.

Onset of Illness

-

The onset is stat since right after the she was diagnosed, she was automatically brought to the Operating room for a stat craniectomy.

Compliance to Medication

-

Patient can afford to sustain the needed laboratory exams and the feasibility of having a surgery.

Family Support -

The family members supported the patient both financially and emotionally.

Environment

-

The hospital setting is not well ventilated and may promote for further infection of the patient’s current situation.

Age - Patient is 13 years old therefore she has a greater chance of recovering for her immune system is still generating in the process of

development.Precipitating Factors

-

The patient manifested all the factors that may lead to epidural hematoma which urged the health care team to bring her for an operation.

EVALUATION

Through our hardship in preparing for this research, tried to interact

and communicate our patient in good manner for us to gather the specific and

accurate data that we need that could help us in studying the disease which

could lead us into successful research.

The patient’s condition is in recovery period as she had already

undergone surgery, which thereby prevented occurrence of complications

They are financially capable in sustaining such surgery and the

medications after. Her father is the one taking good care of her in throughout

her hospitalization.

IMPLICATION

Nursing Practice

- this can be used as a guide for practice by other nurses. They may get many relevant ideas in giving proper care and interventions to patients with related illness or those who have the same illness (Epidural hematoma, Brain Injury)

Nursing Education

- this study may serve as a helpful learning tool for student nurses. They may utilize this complied study as their reference for research; this will also give them good examples on nursing managements, and nursing diagnoses, which will be a very useful guide when they will be making their own Nursing Care Plans.

Nursing Research

- students may use this compilation as their guide for research. This will hand them good views and factual ideas which will be very essential for their added learning an knowledge for Epidural hematoma, Brain Injury

REFERENCES

http://www.neurologychannel.com/tbi/types.shtml

http://en.wikipedia.org/wiki/Cerebrum

http://en.wikipedia.org/wiki/Glascow_Coma_Scale

http://en.wikipedia.org/wiki/Infection

http://www.alasbimnjournal.cl/revistas/8/ceballos.html

http://www.muhealth.org/neuromed/epidural.shtml