Hello, what are soem basic needs for a PT. with a subdural hematoma?

  1. I am a student nurse and my patient has a subdural hematoma and I need 4 basic needs that have to be match with 4 Nursing Dx. to match. The only ones I can really think of are>> Inadequate cerebral tissue perfussion r/t the hematoma. Pain r/t the intercranial pressure, Possible impaired memory r/t the intercranial pressue.<< Is there anyone that can help me either make these sound better or have better ones? Any help is greatly appriciated.


    Fred
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    About Aeronurse

    Joined: Apr '05; Posts: 3

    5 Comments

  3. by   fluffwad
    Consider:

    Comfort

    Safety ( r/t impaired memory / judgement, poss. impaired balance)

    Assistance with ADLs ( toileting, bathing, eating, etc) if he is unable to do them

    If his mobility is impaired, then assist with repositioning to avoid skin breakdown

    Emotional support ( depends on situation. esp. if patient is impaired enough d/t SDH to require long term care some place)

    Education about his condition / poss. long term effects


    Consider other any issues besides the SDH too. Also, what lead up to the SDH ( fall? mugging?)
  4. by   Maine Critical Care
    1. Basic need: A good neurosurgeon
    2.Basic hope: the bleed isn't in the frontal lobes causing permanant personality change.
    3. Basic need: Restraints for the post coma wake up wacky time
    4. Basic need: nutrition via NGT as the person usually can't swallow for a long time
    5: Basic need: airway protection if GCS is 8 or less, usually in form of an ETT and ventilator- Remember GCS 6-7-8=intubate
    6: Frequent need: ICP monitoring with an art line to keep CPP (cerebral perfusion pressure 'MAP-ICP=CPP') about 70 or greater
    7: Another frequent need: control hypertension if patient will rebleed.
    8: Old geezers on coumadin who fall and have a hematoma swell less than kids with traumatic subdural hematomas. Kids sometimes need craniectomies (frozen skull bone for a couple months) while swelling subsides.
    9: Coumadin patients get out of trouble after a load of FFP. (usually)
    10.Basic need: family members to hang out and keep patient from going too crazy when waking up
    11: Basic need: family members to sit tight and not make noise for three days after neurosurgery when you can't overstimulate or the ICP goes to 40.
    12: Code status and donor cards are also a basic need for the SDH patient.

    I don't know about nursing diagnosis as I try and keep it simple.
    Good luck with the care plan
  5. by   SkateBetty
    Risk for Injury related to overestimates abilities (climbs oob, falls)
    Risk for Injury related to intracranial bleeding
    Self Care Deficit
    Confusion, Acute
    Thought Process Altered
    Memory, Impaired
    Sensory Alterations (i/e blurry vision)
  6. by   Tweety
    Hi Fried. Welcome to Allnurses.

    The trick is to match the the diagnosises with the patient. Just looking at SDH is not enough. How is the patient presenting? Then go from there.

    You have some good ideas from folks here, however. Good luck!
  7. by   augigi
    As Tweety said, a pt is not a diagnosis. What stage are they at? If it's acute in neuro ICU, I'd go with the life threatening things: airway maintenance, hypertension, increased ICP causing further brain damage, family dynamics r/t coping, safety: self-injury (pulling tubes out etc).

    If it's longer term, rehab: as the others said: falling, swallowing, ineffective coping and adjustment, impaired family processes, memory, loss of job if unable to function at pre-illness level.

    It just depends on the patient and the progress. Hope you can get at least 4 out of the replies here.

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