Case
NUR 463 Neurological Case Study
- Institution
- University Of Rhode Island
This is a comprehensive and detailed case study on Neurological Case Study for Nur 463. *Essential Study Material!!
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NUR 463Neurological Case Study
Name:
Date: November 17, 2017
Mr. S. is a 23-year-old male who sustained a traumatic brain injury as an
unrestrained driver in a motor vehicle crash. On admission, his blood
pressure (BP) was 158/72 mm Hg, heart rate (HR) 46 beats per minute,
respiratory rate (RR) 28 breaths per minute, and temperature 96.2° F
(35.6° C). His neurological exam reveals that his right pupil is at 6 mm and
reacts sluggishly; his left pupil is 4 mm and reacts briskly. He is nonverbal,
extends his arms bilaterally to pain, and opens his eyes minimally to pain.
He is quickly intubated and placed on mechanical ventilation. A computed
tomography (CT) scan is done, which reveals a large right subdural
hematoma with cingulate herniation from right to left, as well as right-sided
uncal herniation.
He is taken to surgery emergently for a craniotomy to remove the subdural
hematoma. After surgery, he arrives in the critical care unit with a
ventricular catheter to measure intracranial pressure (ICP). His initial ICP is
24 mm Hg, BP 130/67 mm Hg, mean arterial pressure (MAP) 88 mm Hg,
HR 54 beats per minute, RR 12 breaths per minute (controlled ventilation),
and temperature 96.1° F (35.5° C). His current Glasgow Coma Scale
(GCS) score is 3, but the anesthesiologist did not reverse the anesthesia,
choosing to allow it to wear off gradually. He has orders for 3% saline at 20
mL/hr intravenously.
1. Based on the information provided, what is Mr. S.’s preoperative
GCS? What is the significance of this number, and how would the
nurse describe this to his family?
Mr. S.’s preoperative GCS score was five. He received a one for being
nonverbal, a two for opening his eyes minimally to the response of pain and
another two for extending his arms to pain which indicates decerebrate
posturing. Based on his score of five, Mr. S would be described as in a
comatose state. I would explain to the family that this scale is a
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