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 “It is a weariness disease

to preserve health by to
strict a regimen.” Our
body is the mirror of
whatever lifestyle we
have. It is the one who
suffers on what we put
inside.
 Subdural hemorrhages may cause an increase
in intracranial pressure (ICP), which can cause
compression of and damage to delicate brain
tissue. Acute subdural hematoma (ASDH) has a
high mortality rate and is a severe
medical emergency. Subdural hematomas most
often affect people who are prone to falling.
Only a slight hit on the head or even a fall to the
ground without hitting the head may be enough
to tear veins in the brain, often without
fracturing the skull. There may be no external
evidence of the bruising on the brain's surface.
 Head injuries account for
approximately 70% of these
traumatic deaths and most of the
persisting disabilities in accident
survivors. Many of these patients
are comatose on admission.
However, approximately 50% of
patients with head injuries who
require emergency neurosurgery
present with moderately severe or
mild head injuries (Glasgow Coma
Scale [GCS] scores 9-13 and 14-15,
respectively).
 These patients may be more likely to benefit
from medical and surgical intervention when
instituted in a timely fashion.

 Many of these patients harbor intracranial


mass lesions. In a large series of patients who
developed intracranial hematomas requiring
emergent decompression, more than half had
lucid intervals and were able to make
conversation between the time of their injury
and subsequent deterioration. In a more
comprehensive review of the literature on the
surgical treatment of acute subdural
hematomas, lucid intervals were noted in up
to 38%
 General Objectives

 This study aims to develop the


knowledge, skills and attitudes of the
student nurses through effective
utilization of nursing process in dealing
with the course of patient with ACUTE
SUBDURAL HEMATOMA.
 Specific Objectives
 At the end of the study, the student nurses will
be able to:

 Identify the patient’s profile, past medical


history, as well as the family history, personal
history, social history, psychological history
and the patient’s history of present illness for
further understanding his condition.
 Analyze the physical appearance of the patient
using Inspection, Palpation, Percussion and
Auscultation method that may help in
determining the clinical manifestation
presented by the disease.
 Identify, interpret and analyze the laboratory
and diagnostic examination and its significant
findings to justify the presence of the disease.
 Identify and enumerate the anatomical part of
the body that is involved and affected by the
disease and its respective functions.
 Explain the nature and identify the causes and
predisposing factors that contribute to the
development of the disease.
 Formulate Nursing Care Plan for better
delivery of care based on the client’s needs
and concerns.
 Determine the effects of different drugs that
were administered to the patient.
 Note changes in the condition of the patient
and the degree of development of his
condition
 Enumerate all the references used to make the
case more effectively and much clearer.
Having this case to be studied is a one
great opportunity.This will help not only
but the whole group In assesing a
client that have a subdural hematoma.
 This will surely enhance our skills and
knowledge that will make as to be a
competent nurse someday.
 NAME: Ms.X
  
 AGE: 23 years old
  
 SEX: Female
  
 DATE OF BIRTH: November 18,1985
  
 CIVIL STATUS: Single
  
 ADDRESS: #18 Los Remedios, Bauan,
Batangas
 NATIONALITY: Filipino
  
  
 
 RELIGION: Roman Catholic

 DATE OF ADMISSION: November 28, 2008 @


1:20pm
 PHYSICIAN: Dr. Lantig
  
 CHIEF COMPLAINT: Loss of consciousness
  
 ADMITTING DIAGNOSIS: Acute subdural
hematoma, left fronto temporal area cerebral
contution, right frontal fracture closed linear non
depressed right occipital area secondary to
vehicular accident.
 Past Health History

 The patient was born in their house via


normal delivery. She received all the
vaccine for her immunization .This was
her first time to be hospitalized due to
vehicular accident. She does have a
skin allergy.
 Family History

 Ms. X once told me that


their family had a history
for having a hypertension.
 Personal History
 Ms. X is the youngest
child of Mr. and Mrs. X. She is
now on working at Keppel
located at Bauan. The accident
happened while she is at work.
 Social History
 Ms. X is an employee at
Keppel. They earn pesos
monthly, but according to
them, it is not enough for
their daily expenses. But
inspite of life’s challenges
they are not willing to give
up.
 Psychologic History

According to them they
became stressful due to her
situation now. They are not use
to stay in the hospital for so
long. What they usually do is to
ask for some help to our
almighty God.
 History of Present Illness
 Loss of consiousness, she was
admitted last November 28,2008 at
Batangas Regional Hospital. She was
diagnosed having acute subdural
hematoma related to vehicular
accident. She is presently taking
Phenytoin as anticonvolsants
mannitol as diuretics.
 For the general appearance the findings was
she has a poor body coordination and we
consider it as abnormal for she may suffer a
seizure disorder that affect her posture and
movement; the body and breath odors we
also found out that she is having a foul mouth
odor and it is abnormal because it can result
from poor oral hygiene. The next one was
about the psychological presence and as we
inspect the dressing, grooming we found out
that she is dress appropriately which is
normal regarding personal

  
 hygiene she has a poor hygiene due
to self care deficit. The second one
was mood and manner not like those
patients that I handle she is not
cooperative, unable to speak
because the patient is having a
difficulty in doing so therefore affect
her movement and gesture. Third
was about distress, she has a poor
eye contact and it is usually seen in
depressed clients.
Temperature – 37c
Blood pressure-110/80 mmhg
Pulse Rate- 86 beats per min.
Respiratory Rate- 22 breaths per
minute
 
BODY PART METHOD FINDINGS ANALYSIS

SKIN: >Inspection >dark >Normal


   
   
>Not tender >Normal.
   
   
>Absence of>Normal.
edema  
 
>Palpation >Warm to >Normal.
touch
Hair >Inspection >long and >Normal.
black with
normal
distribution
 

>Palpation >Absence of >Normal.


Scalp   nodules  
     
>Inspection >with dandruff >Abnormal,
    Excessive
  scaliness may
indicate
dermatitis,
poor hygiene
may indicate a
need for client
teaching
assistance with
activities of
daily living
Nails >Inspection >capillary refill >Normal.
every 3
seconds
>Abnormal,
>Dirty, long dirty nails may
nails be seen with
poor hygiene.
They may be
also result from
the client’s
hobby or
occupation
>Inspection
Head >Normal.
>Symmetrical,
aligned at the
>Palpation midline
>Abnormal,
>with lumps lesion or lumps
on the head
may indicate
recent trauma
Face >Inspection
 
>facial features>Normal.
& facial  
movements are
symmetrical

Neck
>Inspection & >Neck is >Normal.
Palpation symmetrically
  aligned
 

Thyroid >Inspection & >No >Normal.


Palpation enlargement of
Gland the thyroid
gland
 
>symmetrically >Normal.
aligned
 
Eyes
>Inspection >Hair evenly >Normal.
 >Eyebrow distributed  
 
>Eyelashes
>Inspection >Normal >Normal
Distribution

>Pupillary >Inspection >reactive to >Normal


light

Reaction
>Inspection >Normal
>clear,moist
and smooth
>Conjuctiv underlying
a structures are
clearly visible
sclera is white
Ear >Inspection >Pinna recoils >Normal.
after being  
folded  
   
>Auricles are >Normal.
mobile, firm &  
not tender.  
   
>symmetrically >Normal.
aligned  
   
   
>with >Abnormal,
discharge impacted
  cerumen
blocking the
view of the
external
earcanal,
conductive
hearing loss
Nose >Inspection >symmetrically >Normal.
aligned.  
   
Mouth
   
>Lips >Palpation >Not tender. >Normal
      
  >dry with >Abnormal. Dry
    cracks lips indicate
    mouth
  breathing or
    dehydration.
>Teeth >Inspection    
  >with yellow >Abnormal.
    cavities. Due to oral
      hygiene
>Tongue >Inspection   practice.
  >dry, with  
  patches >Abnormal. It
    indicates
  dehydration.
>moves freely  
>Normal.
>uvula >Inspection >Presence of >Normal.
  uvula

Chest and >Inspection & >equal chest >Normal


Lungs Auscultation expansion
       
    >symmetrically >Normal.
       
  >Inspection >no bowel >Normal.
Abdomen   sound noted  
       
>Auscultation > Dull sound >Normal. Bowel
  heard Sound results
    from the
  movement of
  air & fluid
through the
  GIT.
>Percussion >Not tender
    >Normal
>Palpation >Strong grip  
    >Normal.
Upper
extremities
 
 
-Hands >Inspection & >Presence of >Abnormal.
  Palpation IV (PNSS) Fluids are
      regulated to
      replace losses
  and aid to
immobilizatio
n of
  secretions.
-Pulse >Palpation >distal pulses  
    are palpable >Normal.
       
     
Lower >Inspection & >No edema  
Extremities Palpation
>Normal
 
 
SUMMARY OF PHYSICAL ASSESSMENT
 
 Ms. X is diagnosed with subdural hematoma.
Physical Appearance of the patient was assessed
through inspection, palpation, percussion and
auscultation. This will serve as a baseline guide to
recognize the signs and symptoms of the incident.
 Assessment of the mouth the finding was there
is a presence of yellow cavities and it is due to poor
oral hygiene. About his chest and lungs it has a
abnormal crackle sound and it become audible
when there is a sudden opening of small airway
that contain fluid, and it indicates a presence of
secretion causing failure of lungs to expand.
 CHEST:Lungs fields are clear

 Heart is magnified
 No demonstrable pneumothorax or hemothorax
 Visualized bony thorax is intact
 Impression: clear lung fields
 Magnified heart

 PELVIS:
 AP view of pelvis shows no demonstrable fracture or
dislocation
 Puncture hyperdense foci are noted in both inferior frontal
lobes with associated undue hypodensity of the cerebral
hemisphere,bilaterally. Hyperdense called is also noted along
the frontal parasagittal cortical sulci.no midline shift is
noted.the posterior fossa and sellar structures are intact.
 Impression:
 Acute hemorrhagic contusion changes both frontal lobes
with associated edema of both cerebral hemispheres minimal
acute subarchnoid hemorrhage along the frontal sagittal sulci
negative for fracture.
RESULT NORMAL VALUES ANALYSIS

1) Erythrocytes 4.07 X 10^12/ L F:3.6-


5.0X10612/L NORMAL

NORMAL
2) Hgb 124.2g/L F:120-140g/L

0.377% F:0.36-0.48% NORMAL


3) Hct
4.5-10.5 x10 9/L

1.2-6.6 x 10 9/L
4) Leukocytes 17.23 x10 9/L Infection
0-0.7 x 10 9/L
5) Neutrophil 0.910% Neutrophenia
0.02-0.05 x 10 9/L
6) Eosinophil 0.0010% Eosinophilia
1.5-4.0 x 10 9/L
7) Basophil 0.003%
Basophenia
1) Lymphocyte 0.037% 1.5-4.0 x 10 9/L Lymphopenia

2) Monocyte 0.040 x 10 9/L 0.1-0.5 x 10 9/L NORMAL


3) Thrombocyte
211x 10 9/L 150-400 x 10 9/L NORMAL

27-31
4) MCH 30.51 NORMAL
80-96
5) MCV 92.57 NORMAL
0.32-0.36
6) MCHC 0.33 NORMAL
1.5-4.0 x 10 9/L
7) Atyphical
Lymphocyte 0.002 Abnormal
lymphocytes,
can be also
associated with
viral infection
 REMARK: Blood type (O+)

 BLEED TIME: 1minutes and 30 second


(Normal value 1-3 minutes) –NORMAL

 CLOTTING TIME: 5minutes


(Normal value 2-6 minutes)-
 NORMAL

 DATE TAKEN: NOVEMBER 28,2008


1) Erythrocytes 3.29 X 10^12/ L F:3.6- NORMAL
5.0X10612/L
132.7g/L
2) Hgb F:120-140g/L NORMAL
0.403%
3) Hct F:0.36-0.48% NORMAL
8.57 x10 9/L
4) Leukocytes 4.5-10.5 x10 9/L NORMAL

0.713 1.2-6.6 x 10 9/L


5) Neutrophil Acute
hemorrhage,neu
0.0023% 0-0.7 x 10 9/L trophenia
6) Eosinophil Eosinophenia
0.004% 0.02-0.05 x 10
7) Basophil 9/L Basophenia
1) Lymphocyte 0.141% 1.5-4.0 x 10 9/L Lymphopenia

2) Monocyte 0.119 x 10 9/L 0.1-0.5 x 10 9/L NORMAL

3) Thrombocyte 380 x 10 9/L 150-400 x 10 9/L NORMAL

27-31pg
4) MCH 30.94 pg NORMAL
80-96 fl
5) MCV 93.95 fl NORMAL
0.32-0.36
6) MCHC 0.33 Abnormal
lymphocytes,
can be also
associated
with viral
infection
DATE TAKEN:
NOVEMBER
28,2008
DATE:Nov. RESULT NORMALVALUES ANALYSIS
28,2008

BUN 2.58mmol/L 6.26-8.33 NORMAL

Creatinine 49.10 53.1-115.0 NORMAL

Sodium 142.6 135-148 NORMAL

Potassium 3.05 3.5-5.5 NORMAL

Protime test 11.6 sec. 10-15 sec. NORMAL

Control 12.2 sec. 10-14 sec. NORMAL

%act 89.7% 70-120 NORMAL

INR 0.97 < or = 1.2 NORMAL


DATE:DEC.6,2008 RESULT NORMALVALUES ANALYSIS

Sodium 141.0mmol/L 135-148mmol/L NORMAL


Potassium 4.38mmol/L 3.5-5.5mmol/L NORMAL

DATE:DEC.4,2008 RESULT NORMALVALUES ANALYSIS

Sodium 137.9mmol/L 135-148mmol/L NORMAL


Potassium 2.75mmol/L 3.5-5.5mmol/L Hypokalemia

DATE:DEC.4,2008 RESULT NORMALVALUES ANALYSIS

Sodium 143.0mmol/L 135-148mmol/L NORMAL


Potassium 3.51mmol/L 3.5-5.5mmol/L NORMAL
RESULT ANALYSIS

Color Light turbid NORMAL

Characteristics Slightly turbid Presence of


pus,RBC/bacterial cell
Specific gravity 1.020(1.015-1.025) NORMAL

Reaction 6.0 (4.5-8) NORMAL

Albumin Negative NORMAL

Sugar Negative NORMAL

Pus cells 1.3Hpf (0-4 Hpf) NORMAL


RBC To numerous to count NORMAL
Amorphous urates Moderate NORMAL
Epithelial cells Moderate Hematuria

Mucus threads Few NORMAL


 As I analyses the laboratory results of may patient first
about the hematology I found out that the component of her
aggranulocytes has decreases and this may indicate that she
may have an infection. Regarding her atypical lymphocytes
which is abnormal indicates viral infection.
 Secondly regarding her BUN and creatinine level are
normal. Her sodium level was normal but her potassium level
was once decrease and it indicates hypokalemia.
 Third was on the urine content and the test shown other
abnormalities like the presence of pus and blood.
 
The brain is covered by a membrane
called the dura.  If the veins located
below the dura leak blood, then
pressure in this area may build up and
injure the brain.  Head injuries may
injure these veins, causing them to be
torn and leak.  This blood collects into a
mass called a hematoma. Hence the
name, Subdural Hematoma.  For an
acute hematoma, symptoms generally
occur in the first 24 hours, while for a
sub acute Hematoma, they occur in the
first 2-10 days after a head injury.
 The Central Nervous System
 The CNS consists of the brain and spinal
cord, which are located in the dorsal body
cavity. The brain is surrounded by the
cranium, and the spinal cord is protected
by the vertebrae. The brain is continuous
with the spinal cord at the foramen
magnum. In addition to bone, the CNS is
surrounded by connective tissue
membranes, called meninges, and by
cerebrospinal fluid.
 Meninges
 There are three layers of meninges around
the brain and spinal cord. The outer layer,
the dura mater, is tough white fibrous
connective tissue. The middle layer of
meninges is arachnoid, which resembles a
cobweb in appearance, is a thin layer with
numerous threadlike strands that attach it
to the innermost layer. The space under
the arachnoid, the subarachnoid space, is
filled with cerebrospinal fluid and contains
blood vessels. The pia mater is the
innermost layer of meninges. This thin,
delicate membrane is tightly bound to the
surface of the
 brain and spinal cord and cannot be
dissected away without damaging the
surface.
 Meningiomas are tumors of the nerve tissue
covering the brain and spinal cord.
Although meningiomas are usually not likely
to spread, physicians often treat them as
though they were malignant to treat
symptoms that may develop when a tumor
applies pressure to the brain.
 Brain
 The brain is divided into the cerebrum,
diencephalons, brain stem, and cerebellum.
 Cerebrum
 The largest and most obvious portion of the brain is
the cerebrum, which is divided by a deep
longitudinal fissure into two cerebral hemispheres.
The two hemispheres are two separate entities but
are connected by an arching band of white fibers,
called the corpus callosum that provides a
communication pathway between the two halves.
Each cerebral hemisphere is divided into five lobes,
four of which have the same name as the bone over
them: the fontal lobe, the parietal lobe, the occipital
lobe, and the temporal lobe. A fifth lobe, the insula or
Island of Reil, lies deep within the lateral sulcus.
 Diencephalon
 The diencephalons is centrally located and is
nearly surrounded by the cerebral hemispheres.
It includes the thalamus, hypothalamus, and
epithalamus. The thalamus, about 80 percent of
the diencephalons, consists of two oval masses
of gray matter that serve as relay stations for
sensory impulses, except for the sense of smell,
going to the cerebral cortex. The hypothalamus
is a small region below the thalamus, which
plays a key role in maintaining homeostasis
because it regulates many visceral activities. The
epithalamus is the most dorsal portion of the
diencephalons. This small gland is involved with
the onset of puberty and rhythmic cycles in the
body. It is like a biological clock.
 Brain Stem
 The brain stem is the region between the
diencephalons and the spinal cord. It consists of
three parts: midbrain, Pons, and medulla
oblongata. The midbrain is the most superior
 portion of the brain stem. This region primarily
consists of nerve fibers that form conduction
tracts between the higher brain centers and
spinal cord. The medulla oblongata, or simply
medulla, extends inferiorly from the pons. It is
continuous with the spinal cord at the foramen
magnum. All the ascending (sensory) and
descending (motor) nerve fibers connecting the
brain and spinal cord pass through the medulla.
 Cerebellum
 The cerebellum, the second largest
portion of the brain, is located below
the occipital lobes of the cerebrum.
Three paired bundles of myelinated
nerve fibers, called cerebellar
peduncles, form communication
pathways between the cerebellum and
other parts of the central nervous
system. Ventricles and Cerebrospinal
Fluid.series of interconnected, fluid-
filled cavities are found within the
brain. These cavities are the ventricles
of the brain, and the fluid is
cerebrospinal fluid (CSF).
 Spinal
The spinal cord extends from the foramen
magnum at the base of the skull to the
level of the first lumbar vertebra. The cord
is continuous with the medulla oblongata
at the foramen magnum. Like the brain,
the spinal cord is surrounded by bone,
meninges, and cerebrospinal fluid.
 The spinal cord is divided into 31
segments with each segment giving rise
to a pair of spinal nerves. At the distal end
of the cord, many spinal nerves extend
beyond the conus medullaris to form a
collection that resembles a horse's tail.
This is the cauda equina. In cross section,
the spinal cord appears oval in shape.
 Summary of the Pathophysiology
 The usual mechanism that produces an acute SDH is high-
speed impact to the skull. This causes brain tissue to
accelerate or decelerate relative to the fixed dural structures,
tearing blood vessels, especially bridging veins. The primary
head injury may also cause associated brain hematomas or
contusions, subarachnoid hemorrhage, and diffuse axonal
injury. Secondary brain injuries may include edema,
infarction, secondary hemorrhage, and brain herniation.
 Often, the torn blood vessel is a vein that connects the
cortical surface of the brain to a dural sinus (termed a
bridging vein). Alternatively, a cortical vessel, either a vein or
small artery, can be damaged by direct injury or laceration.
An acute SDH due to a ruptured cortical artery may be
associated with only minor head injury, possibly without an
associated cerebral contusion. In one study, the ruptured
cortical arteries were found to be located around the sylvian
fissure.
 n elderly persons, the bridging veins may already be
stretched because of brain atrophy (shrinkage that occurs
with age). 
 Like other masses that expand within the
skull, SDHs may become lethal by
increasing pressure within the brain,
leading to pathologic shifts of brain tissue
(brain herniations)..
 With progressive transtentorial herniation,
pressure on the brainstem causes its
downward migration. This tears critical
blood vessels that supply the brainstem,
resulting in Duret hemorrhages and death.
Increased intracranial pressure (ICP) may
also decrease cerebral blood flow, possibly
causing ischemia and edema and further
increases the ICP, causing a vicious circle of
pathophysiologic events.
ACUTE SUBDURAL
HEMATOMA

NON-MODIFIABLE FACTOR

Occlusion of the major


Socio Economic Status Cerebral hemmorhage
vessel by embolism

Cerebral Infraction

ISCHEMIA Decrease flow of blood


HYPOXIA To brain

Inadequate ATP Compression of


Neurotransmitter depletion tissue
Impaired function

Vascular Congestion

Cerebral Edema
 S>:”Hindisiya
nakakakilos ng ayos
O>
Physical immobility
Restless
Facial grimace
While moving
 Impaired physical mobility
related to decreased
muscle strength
 Limitation in independent,
purposeful physical movement
of the body or of one or more
extremities
>After 6 hours of nursing
intervention, the client will
exhibit enhanced physical
mobility
 >Evaluated  >Identifies
patient’s ability impairments and
function and allows for
Injury identification of
appropriate
  intervention
 >Provides a baseline on
 >Assessed patient which to base
intervention, patient may
for degree of only require minimal
immobility assistance or be
   completely dependent on
caregiver’s for all body
needs
 >Performed ROM  >Helps to maintain
exercises every 4 mobility and
hours function of joints
  

 >Instructed  >Helps patient to


patient or family regain some
member in ROM control and allows
exercises and family some
mobility aids involvement in
reconditioning
 program
The client has enhanced
physical mobility as
evidenced by the client
participating in ROM
exercises
S> ”Hindi siya umiinom
ng ayos”
O> less fluid intake
 Dry lips with cracks
 Dry skin
Risk for deficient fluid
volume related to
decrease intake
 Decreased intravascular, interstitial,
and/or intracellular fluid. This refers to
dehydration, water loss alone without
change in sodium
After 2 hours of nursing
intervention the client will
increase fluid intake
> Monitored  > Increase HR and
decrease BP may
vital signs. indicate hemorrhage
and presence of
shock. Close
monitoring of V/S
promotes
identification of
changes in status to
allow for
interventional care
 >Measured I and O > Urinary output
q1. Notify physician if
<30cc/hr or gives indication of
>200cc/hr fluid balance; low
urinary output
may indicate
hypovolemia
> Monitored > Increase
specific gravity specific gravity
may indicate
of urine q2-4
hypovolemia
hours as
 
ordered
 Poor skin turgor and
 Assessed patient’s dry mucous
skin turgor and membrane are signs
mucous membrane of dehydration
hydration atleast  
every shift. Notify
physician significant
changes.
 > Monitored Lab  > Increase Hct
work, especially Hgb and Hgb indicate
and Hct, as well as dehydration
electrolytes .Significant fluid
loss may result in
   Encourage patient
 >Instructed and family
patient and participation in care,
family in reasons fosters patients
for maintaining sense of control and
fluid intake provide knowledge
 > The client has enhanced
fluid intake required for
her body
O>Inability to speak
 Inability to
comprehend language
 Impaired
verbal
communication related
to weakness
 Decreased, delayed, or absent
ability to receive, process,
transmit, and use a system of
symbols
 After1 hour of nursing
intervention the client will be
able to participate and verbalize
her feelings
 >Provides a
 >Evaluated baseline data
patient’s ability from which to
to speak or begin planning
understand intervention
language Determination of
specific areas of
brain injury
involvement will
be required
 >Evaluated patients  >Inability to follow
response to simple simple commands
commands may indicate
receptive aphasia
 >Provided method of  >Allows for
communication for communication of
the patient; needs and allays
 such as a writing anxiety
board to which a
patient may point
 >Assisted patient >Provides methods
and family to for patient to
identify and used communicate his
methods for or her needs
communication
The client has
participated in
verbalizing her feelings
as evidence by the
patient shows smile on
her face.
 Generic Name:
 Phenytoin Sodium

 Brand Name:
 Dilantin
 Anticonvulsants
 
 To stabilize neuronal membranes and limit
seizure activity either by increasing efflux
or decreasing influx of sodium ions across
cell membranes in the motor cortex
during generation of nerve impulses
 To control tonic clonic(grandmal) and
complex partial (temporal lobe)
seizures.
 
 To prevent ant treat seizure accruing
during neurosurgery
 Use cautiously in patient with hepatic
dysfunction, hypotension, myocardial
insufficiency, diabetes or respiratory
depression in elderly or rehabilitated
patient.
 
 Elderly patient tend to metabolize drug
slowly and may need reduced dosages
 CNS: Mental
 confusion
 Dizziness
 Headache
 
 GI: Nausea
 Vomiting
 Constipation
 Don’t stop drug suddenly because
this may worsen seizures. Call
prescriber immediately if adverse
reaction develop
  Monitor drug level
 Monitor CBC and Calcium level every
6 months and periodically monitor
hepatic function.
 May increase alkaline phosphatase, GGT
and glucose levels. May decrease urinary
17 hydroxysteroids, 17 ketosteroid and
Hgb and Hct level.
 May increase urine 6 hydroxycortisol
excretions 
 May falsely bound iodine or free thyroxin
level test results.
Generic Name:
Mannitol

Brand Name:
Osmitrol
 > Diuretics
  
 Increase osmotic pressure of glomerular
filtrate inhibiting tubular reabsorption of
water and electrolytes. Drug elevates
plasma osmolality, increase water flow
into extracellular fluid
 
Oliguria
 To prevent oliguria or acute
renal failure
 To reduce intraocular or
intracranial pressure
 Contraindicated in patient with
anuria, severe pulmonary
 Congestion; frank pulmonary
edema, active intracranial
bleeding ; severe dehydration;
metabolic edema
 CNS: Seizures
 Dizziness
 Headache
 Fever
 CV: Hypotension
 Hypertension
 Edema
 Tachycardia

 GI: Thirst
 Drymouth
 Nausea
 Vomiting
 
 Metabolic:
 Dehydration
 >Monitor vital signs including central
venous pressure and fluid input and
output hourly report oliguria.
 Check weight ,renal function, fluid
balance and serum and urine sodium
and potassium levels daily
  To relieve thirst, give frequent mouth
care or fluids
> Monitoring increasing or
decreasing electrolytes level
 
 >May interfere with tests for
inorganic phosphorus and
ethylene glycol level.
METHODS
M: >Instructed the client to take his medication
such as phenytoin,co-amoxiclav and mefenamic
acid
 Reinforced importance of medication compliance
to patient and his relatives: it’s time, route,
dosage, frequency and duration.
 Advised to report unusual manifestations and
side effects of drug to physician.
E > Instructed the patients relative to provide calm
and non stressful environment.

 Maintained clean and safe environment


 Provided environment with normal room and
body temperature.
 Encouraged patient to have mild exercise
 T> Teaches the patient on how to
deal and manage the pain that she’s
suffering from.
H> Explained to patient’s relative
regarding disease and its manifestations.
>Discussed possible complications of
disease and its signs and symptoms.
>Instructed the client to have proper
hygiene.
 O>Informed the patient and
the relative that follow up
check up as scheduled by the
physician to ensure the
patient’s wellness.
 

 Ms. X, 23 year old client was admitted last November


28, 2008 at BRH with the chief complaint of loss of
consciousness under the care of Dr. Lantig. The admitting
impression was acute subdural hematoma.
 Medication, laboratory tests and nursing care are
rendered to the patient to improve client’s condition.
Hematology, urinalysis and CT scan was done.
  
 The client’s condition is still improving.

 
 Making things is a hard task. That's
why I would like to extend my
deepest gratitude to those who
patiently help me in fulfilling this
task and to whom who I owe this
success of our endeavor.
 First and foremost, to our almighty God for
the knowledge and wisdom he showered
upon us; for His continuing guidance, for
giving us the strength to overcome our trials
and every little thing He’d done for us
 To our dear parents,from assisting us in our
needs, finacially and emotionally; for being
there whenever we need them, for stating on
our side through ups and downs and most of all
for making us responsible individuals.
 To our clinical Instructor, Dra. Iturralde for
sharing her knowledge to the best of her
ability; for guiding us the right way, we will
treasure all the learning's that she had taught
us.
 To stuff of the IMC for letting I lend books and
assisting us in our needs without hesitations.
 To the members of the group for giving extra
information even in the smallest thing that
they know.
 To the entire person in our lives.For
suggestions they gave for the enrichment of
this work. THANK YOU
 Delmar’s Pediatric Nursing Care Plans, 3rd edition,Luxner
  
 Nursing Care Plan,7th edition, Doenges, et.al
  
 Medical-surgical nursing, Smeltzer,et al.
  
 Medical- Surgical Nursing Critical Thinking for collaborative
care, vol.1,5th edition,
 Ignatius,
  
 Delmar’s Manual of Laboratory and Diagnostic Test, Rick
Daniels
  
 Health Assesment & Physical Examination, Estes 
 Health Assesment in Nursing 3rd edition, Janet Weber &
Jane Kelley
 Medical-Surgical Nursing, Brunner and Suddharts,
Smeltzer,vol.1 & 2b 
 Nurse’s Pocket Guide, Doenges,et.al 
 Laboratory and diagnostic tests with nursing implications
 Seventh Edition,Joyce Lefever Kee
 Current Dignosis and treatment,Marcus A.Krupp and Milton
J. Chatton 
 www.yahoo.com