Published
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?)
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:monkeydance:
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.
Aeronurse
3 Posts
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.
Fred