SCENARIO ON EPIDURAL HEMATOMA

GROUP A

July 9, 2020, at 4 P.M. - Ed, a 14 y/o grade 8 student, is brought by his father to Hospital X after an
accidental fall from a mango tree estimated to 16 feet height hitting his head to a stone. He sustained
lacerated wound on his right temporal part of his head at 1.5 inches length affecting only the skin of the
skull but bleeding. He was unconscious for few minutes after the fall, but became conscious thereafter
but complaining of severe headache with PRS of 7 based on 0-10 pain scale as 10 is the most severe and
1 is no pain. He vomited once on their way to the hospital to previously taken in food.

Upon arrival in the ER, he became irritable but conscious, still complaining of headache. The ER nurse
checked his V/S: BP – 120/80, HR- 90, RR- 32 cpm, O2 SAT.92%. Immediately Dr. Bell the ER ROD
ordered for stat CT SCAN of the skull, stat chest x-ray, CBC, sodium/potassium determination. CBG was
checked stat with 80 mg/dl result & was ordered to be done every 6 hrs. Oxygen inhalation was
administered via nasal cannula at 3 L/min.

PLR I L was inserted regulated to 30 gtts/min, NGT was inserted and closed, FBC inserted and attached to
urobag. Wound on the head was sutured before the CT scan & chest x-ray. Tetanus toxoid 1 amp was
injected IM, Tetanus immunoglobulin was injected IM. He was ordered for NPO until further order.
Blood was extracted for stat CBC, sodium & potassium determination.

July 8, 2020, 7 p.m. – CBC results were attached to chart with the following findings: Hgb- 10 g/dl , WBC
– 11,000 /ul , Differential count: neutrophils – 72%, Lymphocytes- 55%, Monocytes – 12%, Eosinophils –
8.5%, Basophils – 1.5%

CT SCAN RESULT: With epidural hematoma on right temporal part of the brain around 30 ml, and active
bleeding of estimated amount of 5 ml.

Dr Bell visited Ed, and informed the father of the findings of the CT scan. He advised that Ed will be
observed further and if condition will continue to deteriorate, there is the possibility that surgery may
be done to evacuate the clots found in the CT scan.

July 9, 2020, 8:00 a.m. – Ed is asleep but drowsy, still complaining of headache with scale of 7-8 from 0-
10 scale as 10 is the most severe & 1 as no pain. Father claimed that Ed vomited 2 x amounting to 90 cc
watery vomitus with food particles and had 1 episode of seizure lasted for 15 sec. Metoclopromide 1 ml
was given IVTT stat, remain NPO. Ketorolac 30 mg given IVTT stat then every 8 hrs. for headache.
Mannitol 20 % 100 cc was ordered given IVTT every 6 hrs and Dexamethasone 4 mg IVTT stat, then
every 8 hrs. PLR I L is continued at 30 gtts/min.

V/S: BP – 120/60, HR- 70, RR- 30 cpm, O2 SAT. 87 %. Urine output is amounting to 1200 ml as recorded.

July 10, 2020, 8:00 a.m. – Ed was lethargic, afebrile, still vomited once in every shift, seizures noted 2x in
every shift. On assessment by the doctor, BP- 110/50, HR- 95. RR- 32, O2 SAT.87 %, both pupils are
dilated, with decerebrate posturing.

Dr Bell advise the father that Ed has to undergo emergency surgery to remove the blood clots since
condition is deteriorating.
Ed is maintained on NPO, with PLR I L infusing at 30 gtts/min., Mannitol 20 % is still administered,
Dexamethasone, Metoclopromide for vomiting, and phenobarbital for seizure were still given as
previously prescribed.

Questions:

1. identify signs of abnormal neurologic deficits that you can find in the case of Ed. Justify how it
happened. Give its rationale.
2. Make an illustration showing blood clots found in the right temporal area. What would be the
possible complication if clots will not be evacuated. Justify answer.
3. Make a pharmacologic study of the drugs prescribed to the patient.
4. Make a schematic diagram of the pathophysiology of the case to integrate the diagnostic exams,
signs & symptoms manifested by the patient and the prescribed drugs.
5. Make a comprehensive NCP to identify at least 4 priority nursing problems.
6. Presuming that you give health teachings to a mother with seizure disorder or epilepsy, what
important things should be included in your health teachings to keep the person with epilepsy
safe.