Help with care plan epidural hematoma

Esme12, ASN, BSN, RN · Sep 10, 2012

We are happy to help with homework but we will not do it for you.

What did you put the first time...why do you think they were not correct. What do you think wouold be important.The biggest thing about a care plan is the assessment. The second is knowledge about the disease process. first to write a care plan there needs to be a patient, a diagnosis, an assessment of the patient which includes tests, labs, vital signs, patient complaint and symptoms.

The third is a good care plan book. I use ackley: nursing diagnosis handbook, 9th edition and gulanick: nursing care plans, 7th edition

Here are the steps of the nursing process and what you should be doing in each step when you are doing a written care plan:

assessment (collect data from medical record, do a physical assessment of the patient, assess adls, look up information about your patient's medical diseases/conditions to learn about the signs and symptoms and pathophysiology)
determination of the patient's problem(s)/nursing diagnosis (make a list of the abnormal assessment data, match your abnormal assessment data to likely nursing diagnoses, decide on the nursing diagnoses to use)
planning (write measurable goals/outcomes and nursing interventions)
implementation (initiate the care plan)
evaluation (determine if goals/outcomes have been met)

a care plan is nothing more than the written documentation of the nursing process you use to solve one or more of a patient's nursing problems. the nursing process itself is a problem solving method that was extrapolated from the scientific method used by the various science disciplines in proving or disproving theories. one of the main goals every nursing school wants its RNs to learn by graduation is how to use the nursing process to solve patient problems.

Just like you need a recipe care to make a cake from scratch. A care plan is your recipe card to caring for your patient and what to look for while you are caring for them.

Think Maslows......Thinking about what would kill the patient first. Think ABC's. What would be important to a patient that has a fresh surgical craniotomy....this site may help.

Understanding the Essentials of Critical Care Nursing

Maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.

self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

Maslow’s theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs Maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
Maslow suggested that only two percent of the people in the world achieve self actualization. e.g. Abraham Lincoln, Thomas Jefferson, Albert Einstein, Eleanor Roosevelt.
self actualized people were real maslow’s hierarchy of needs is a based on the theory that one level of needs must be met before moving on to the next step.
self-actualization – e.g. morality, creativity, problem solving.
esteem – e.g. confidence, self-esteem, achievement, respect.
belongingness – e.g. love, friendship, intimacy, family.
safety – e.g. security of environment, employment, resources, health, property.
physiological – e.g. air, food, water, sex, sleep, other factors towards homeostasis.

assumptions

maslow's theory maintains that a person does not feel a higher need until the needs of the current level have been satisfied.

b and d needs

deficiency or deprivation needs

the first four levels are considered deficiency or deprivation needs (“d-needs”) in that their lack of satisfaction causes a deficiency that motivates people to meet these needs

growth needs or b-needs or being needs

the needs maslow believed to be higher, healthier, and more likely to emerge in self-actualizing people were being needs, or b-needs.
growth needs are the highest level, which is self-actualization, or the self-fulfillment.
maslow suggested that only two percent of the people in the world achieve self actualization. e.g. Abraham Lincoln, Thomas Jefferson, Albert Einstein, Eleanor Roosevelt.
self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.

self actualized people were reality and problem centered.
they enjoyed being by themselves, and having deeper relationships with a few people instead of more shallow relations with many people.
they tended to be spontaneous and simple.

application in nursing

maslow's hierarchy of needs is a useful organizational framework that can be applied to the various nursing models for assessment of a patient’s strengths, limitations, and need for nursing interventions.

Z A C H · Sep 10, 2012

I'm not trying to fish homework answers out of you guys. I didn't state what I had already come up with, because I wanted to compare and contrast other ideas against mine in order to see if other people were on the same page as me.

1. Risk for ineffective airway clearance Risk factor ET tube.

This was shot down because risk never comes before actual(that's understandable) and because the ET tube is a treatment for this problem but not a cause.

My line of thinking on this is that yes the ET tube is a treatment to maintain a patent airway, but if that ET tube gets dislodged you know longer have an airway. For that reason I had this as my first diagnosis, because If I'm walking into a room with a patient I think ET tube placement is going to be most critical for keeping that patient alive.

2. Ineffective breathing pattern R/T epidural hematoma AEB difficulty breathing on admit

Note on this asks "what about breathing now."

Well currently the patient is on a vent breathing as many breaths as the vent is doing for them while occasionally bumping up to 12-14 respirations instead of the 10 that the vent is set at. However, I'm not sure if that slight change in wording is going to be good enough for my teacher or if she is looking for something deeper here.

3. Ineffective tissue perfusion . . . . AEB hypotension

For this one I am asked where the ineffective tissue perfusion is.

OK I guess technically there isn't any right now because the hematoma is fixed because the patient is post op and the patient isn't hypotensive anymore because of the norepinephrine drip.

Now in order to get a diagnosis I'm supposed to find abnormal assessment data and base my diagnosis on that. Airway, breathing and circulation are the top 3 from what I understood especially with a patient on a respirator. But if I look at numbers, well the O2 saturation is fine, technically the B/P is fine etc, but that's only due to external assistance when it's pretty obvious there is more wrong in this situation.

Bottom line is that when I walk in the room I'm seeing a patient who's airway is being maintained artificially, who isn't breathing fully on their own and who wouldn't have adequate B/P without the assistance of drugs, but because parameters are technically WNL am I supposed to just move on to another diagnosis? Maybe I'm just wording these in a way that my teacher just doesn't find accurate. I don't know

Esme12, ASN, BSN, RN · Sep 10, 2012

I'm not trying to fish homework answers out of you guys. I didn't state what I had already come up with, because I wanted to compare and contrast other ideas against mine in order to see if other people were on the same page as me.
1. Risk for ineffective airway clearance Risk factor ET tube.
This was shot down because risk never comes before actual(that's understandable) and because the ET tube is a treatment for this problem but not a cause.
My line of thinking on this is that yes the ET tube is a treatment to maintain a patent airway, but if that ET tube gets dislodged you know longer have an airway. For that reason I had this as my first diagnosis, because If I'm walking into a room with a patient I think ET tube placement is going to be most critical for keeping that patient alive.
2. Ineffective breathing pattern R/T epidural hematoma AEB difficulty breathing on admit
Note on this asks "what about breathing now."
Well currently the patient is on a vent breathing as many breaths as the vent is doing for them while occasionally bumping up to 12-14 respirations instead of the 10 that the vent is set at. However, I'm not sure if that slight change in wording is going to be good enough for my teacher or if she is looking for something deeper here.
3. Ineffective tissue perfusion . . . . AEB hypotension
For this one I am asked where the ineffective tissue perfusion is.
OK I guess technically there isn't any right now because the hematoma is fixed because the patient is post op and the patient isn't hypotensive anymore because of the norepinephrine drip.
Now in order to get a diagnosis I'm supposed to find abnormal assessment data and base my diagnosis on that. Airway, breathing and circulation are the top 3 from what I understood especially with a patient on a respirator. But if I look at numbers, well the O2 saturation is fine, technically the B/P is fine etc, but that's only due to external assistance when it's pretty obvious there is more wrong in this situation.
Bottom line is that when I walk in the room I'm seeing a patient who's airway is being maintained artificially, who isn't breathing fully on their own and who wouldn't have adequate B/P without the assistance of drugs, but because parameters are technically WNL am I supposed to just move on to another diagnosis? Maybe I'm just wording these in a way that my teacher just doesn't find accurate. I don't know

I didn't feel you were trying to "fish" for answers but I did want to see what got turned down. Why is this patient intubated? Are they in a drug induced coma? DO they have an ICP (intercranial pressure)monitor? What was their LOC rpior to the OP? What is it now. What are their pupils? DO they move? Follow commands? If nott? why not? are the comatose from the injury? or drugs. Why were they not breathing well prior to the surgery? Was it due to the injury itself and increased intercranial pressure?

What is a epidural hematoma? What happened to the patient with this injury?

1) Risk for ineffective airway clearance Risk factor ET tube.

Care of the Patient Following a Traumatic Injury

This is actually a real one but it can be worded differently.

Ineffective airway clearance R/T inability to maintain air way AEB ET tube and patients level of consciousness. (coma)

Care of the Critically Ill Patient

2) ineffective breathing pattern RT epidural hematoma AEB altered breathing pattern/decreased LOC

Care of the Critically Ill Patient

3) Ineffective tissue perfusion . . . . AEB hypotension

ineffective brain circulation RT swelling from injury/hematoma/surgery AEB low systemic B/P/MAP

The ICP minus the MAP equals the CPP(cerebral perfusion pressure. The patient will neded to maintain AT LEAST a MAP (mean arterial pressure) of 60mmhg to perfuse the brain.

Care of the Patient Experiencing an Intracranial Dysfunction

What about infection? Neurological injury? LOC?

Understanding the Essentials of Critical Care Nursing

Z A C H · Sep 10, 2012

So it looks like you worded yours slightly different. Perhaps I'll do that to make them more inline with what is currently going on with the patient and make the Risk for diagnosis the last one. The 3rd one you put I was actually on to the same exact thing from doing a little bit of research online, but the research I found was for someone with a current hematoma and not one that had already had surgical intervention so I didn't really know if it would apply. Thanks. If anyone else wants to critique go right ahead.

Esme12, ASN, BSN, RN · Sep 11, 2012

Remember....the danger isn't really over yet. The brains angry. It has had an injury. Just like when you fall and hit your knee. You will not only develop the bruise (the hematoma) you will develop swelling. The brain will compensate for only so long (approximately 3 days) and it will suddenly swell so much that the brain will herniate upon the brain stem.

Look up brain trauma...http://www.brain-trauma.net/(a lawyer site but some good basic information), Traumatic Brain Injury Information Page: National Institute of Neurological Disorders and Stroke (NINDS), https://www.dana.org/news/brainhealth/detail.aspx?id=9790

Look up epidural hematoma how would you care for this patient?

Look up care of the craniotomy patient.

Good luck!