LYCEUM NORTHWESTERN UNIVERSITY

COLLEGE OF NURSING

CASE STUDY

ON

CEREBRAL CONTUSION
R/O IC BLEEDING

Surgical Ward- Group 4

Job David Parado

Dianne Perez
Catherine Pimentel
Juliezen Poblacio
Marifel Quimson
Rizza Rocacorba
Jan Deo Santos
Kareen Pearl Solis
Kevin Jake Tagaban
Juliet Torio
Allen May Valdez
Zandro Villanueva
Victor Francis Vinluan

Ms. Desiree Bauzon

Clinical Instructor

TABLE OF CONTENTS
 Page Number

I. Introduction . . . . . . . . . . . . . . . . . . . . . . . . 3

II. Objectives
A. General Objectives . . . . . . . . . . . . . . . . . . 4
B. Specific Objectives . . . . . . . . . . . . . . . . . . 4

III. Anatomy and Physiology . . . . . . . . . . . . . . . 5

IV. Patient’s Profile . . . . . . . . . . . . . . . . . . . . . . 6

V. History . . . . . . . . . . . . . . . . . . . . . . . . . . . 6

VI. Course of Confinement . . . . . . . . . . . . . . . . . 8

VII. Laboratory Results . . . . . . . . . . . . . . . . . . . . 9

VIII. Comprehensive Drug Study . . . . . . . . . . . . . . 12

IX. Assessment . . . . . . . . . . . . . . . . . . . . . . . . . 14

X. Pathophysiology . . . . . . . . . . . . . . . . . . . . . 17

XI. Nursing Care Plan . . . . . . . . . . . . . . . . . . . 19

XII. Medical Management . . . . . . . . . . . . . . . . . 22

XIII. Nursing Management . . . . . . . . . . . . . . . . . 22

XIV. Discharge Planning . . . . . . . . . . . . . . . . . 23

I. Introduction

2
 Cerebral Contusions are scattered areas of bleeding on the surface of
the brain, most commonly along the under surface and poles of the frontal
and temporal lobes. They occur when the brain strikes a ridge on the skull or
a fold in the dura mater, the brain’s tough outer covering. A Cerebral
Contusion can occur directly beneath the site of impact when the brain
rebounds against the skull from the force of a blow or when the force of a
blow drives the brain against the opposite side of the skull or when the head
is hurled forward and stopped abruptly. The brain continues moving and slaps
against the skull and then rebounds which may result to bruises. These
bruises may occur without other types of bleeding or they may occur with
acute subdural or epidural hematomas.

Most patients with Cerebral contusions have had a serious head injury.
The signs and symptoms of a contusion include sever headache, dizziness,
increased of one pupil or sudden weakness in an arm or leg. The person may
seem restless, agitated or irritable. Often, the person has memory loss or
seems forgetful. These symptoms may last for several hours to weeks,
depending on the seriousness of the injury. Cerebral edema, or swelling
typically develops around the contusion within 48 to 72 hours after injury.
Any period of loss of consciousness or amnesia of the head injury should be
evaluated by a health-care professional. As the brain tissue swells, the person
may feel increasingly drowsy or confused. If the person is difficult to awaken,
medical attention should be sought immediately. This could be a sign of more
severe injury.

As with other types of Intracranial Pressure hemorrhages, cerebral

contusions are most rapidly and accurately diagnosed using Computed
Tomography (CT) brain Scans. If pressure on the brain increases significantly
or if the hemorrhages from a sizeable blood clot in the brain (an intracerebral
hematoma), a craniotomy to open a section of the skull may be required to
surgically remove the cerebral contusion.
Recovery after the brain injury varies widely. Treatment outcomes vary
according to size and location of the Cerebral contusion. Other predictors
include age, the initial Glasgow coma score and the presence of other types
of Brain injuries.

II. Objectives
General:
To gain knowledge and attitude in the care of a patient with

3
 cerebral contusion

Specific:
To gain more knowledge
To review the anatomy and physiology of the brain
and circulatory systems
To provide an individualized plan of care for the patient
To understand the physiologic processes associated with the condition

III. Anatomy and Physiology

The Brain

The brain, when fully developed, is a large organ which fills the cranial
cavity. Early in its development the brain becomes divided into three parts
known as the forebrain, the midbrain and the hindbrain.

The forebrain is the largest part and is called the cerebrum; it is

divided into the right and left hemispheres by a deep longitudinal fissure.
The separation is complete t the front and back but in the center, the
hemispheres are joined by a broad band of nerve fibres called the corpus
callosum. The outer layer of the cerebrum is called the cerebral cortex and is
composed of grey matter (cell bodies) thrown into numerous folds or
convolutions called gyri, separated by fissures called sulci. This enables the
surface area of the brain, and therefore the number of cell bodies, to be
increased greatly. The general pattern of the gyri and sulci is the same in all
humans; three main sulci divide each hemisphere into four lobes, each
named after the skull bone under which it lies. The central sulcus runs
downwards and forwards from the top of the hemisphere to a point just above
the lateral sulcus; the lateral sulcus runs backwards from the lower part of
the front of the brain and the parieto-occipital sulcus runs downwards and
forwards for a short way from the upper posterior part of the hemisphere.
The lobes of the hemispheres are the frontal lobe, lying in front of the central
sulcus and above the lateral sulcus; the parietal lobe lying between the
central sulcus and the parieto-occipital sulcus and above the line of the
lateral sulcus; the occipital lobe, which forms the back of the hemisphere and
the temporal lobe lying below the lateral sulcus and extending back to the
occipital lobe.

The area lying immediately in front of the central sulcus between is

known as the pre-central gyrus and is the motor area from which arise many
of the motor fibres of the central nervous system. Immediately behind the
central sulcus lies the sensory area, called the post-central gyrus, in the cells
of which several kinds of sensation are interpreted.

Longitudinal section of a hemisphere shows grey matter (cell bodies)

on the outside and white matter (nerve fibres) forming the interior. The nerve
fibres connect one part of the brain with the other parts and with the spinal
cord, but within the white matter groups of nerve cells can be seen forming
areas of grey matter. These areas of grey matter are called cerebral nuclei.

4
The main function of these areas is coordination of movement and posture of
the body: disorders affecting these areas cause jerky movements and
unsteadiness.

The cavities within the brain are called ventricles. There are two lateral
ventricles, a central third ventricle and a fourth ventricle between the
cerebellum and the pons. All are filled with cerebrospinal fluid.

The midbrain lies between the forebrain and the hindbrain. It is about 2
cm in length and consists of two stalk-like bands of white matter called the
cerebral peduncles, which convey impulses passing to and from the brain and
spinal cord, and four small prominences called the quadrigeminal bodies,
which are concerned with sight and hearing reflexes. The pineal body lies
between the two upper quadrigeminal bodies.

The hindbrain has three parts:

1. The pons, which lies between the midbrain above and the medulla
oblongata below. It contains fibres which carry impulses upwards and
downwards and some which communicate with the cerebellum.

2. The medulla oblongata lies between the pons above and the spinal
cord below. It contains the cardiac and respiratory centres which are also
known as the vital centres and which control the heart and respiration.

3. The cerebellum projects backwards beneath the occipital lobes of the

cerebrum. It is connected to the midbrain, the pons and the medulla
oblongata by three bands of fibres called the superior, middle and inferior
cerebellar peduncles respectively. The cerebellum is responsible for the
coordination of muscular activity, control of muscle tone and maintenance
of posture. It is continuously receiving sensory impulses concerning the
degree of stretch in muscles, the position of joints and information from
the cerebral cortex. It sends information to the thalamus and the cerebral
cortex.

The midbrain, the pons and the medulla have many functions in
common and together re often known as the brain stem. This area also
contains the nuclei from which originate the cranial nerves.

IV. Biographical Data

Name: C. D

Age: 54 years old

Sex: Female

5
Civil Status: Single

Religion: Roman Catholic

Address: Carael, Dagupan City, Pangasinan

Chief Complaint: Multiple Bruises and Abrasions

Admitting Diagnosis: Cerebral Contusion r/o IC Bleeding

Date Admitted: October 24, 2009

Time: 09:20 AM

Admitting Physician: Dr. Maria Camilla Rosario

V. History
A. History of Present Illness

This is the case of ., a female client from Carael, Dagupan City

who was admitted at Region 1 Medical Center last October 24, 2009
around 9 o’clock in the morning with chief complain of multiple injury
with diagnosis of Cerebral Contusion r/t Intracranial bleeding. The
present condition started prior to admission when she was accidentally
hit by a car. She was rushed to the institution for proper medical
treatment and was assessed to have sustained a cerebral wound,
abrasion and hematoma on the right eye. There were episodes of
vomiting of custard-like substance, a short state of loss of
consciousness and other sensory and neural deficits like ptosis,
hemiparesis and slurred speech which did not last for long.

During Mrs. F. S’s stay in the institution her blood pressure was
constantly high, with an on and of fever, thready pulse and a
respiration rate within normal range. She also has abrasions and
wounds in different parts of the body specifically on arms and legs
which were cleaned and dressed. Further more, the patient had a
wound on the left side of her forehead, it was cleaned, sutured and
dressed upon admission. The patient was given the following meds:

Dexamethasone
Captopril
Chloramphenicol
Penicillin G Sodium

Work- ups were done to detect other abnormalities that the client
might have sustained from the accident. A CT- Scan was ordered, along

6
with a CXR, a CBC typing, Urinalysis and a Fecalysis by her attending
physician.

B. Past Medical History

The patient’s present history of illness is her first admission to

the institution but she have had consultations before for her diabetes
wherein he was prescribed of a maintenance medication which was
“Euglocon”. The patient does not regularly take her medication
because she claims that she does not need it for she doesn’t feel
anything wrong with herself. She also has a history of hypertension
with BP ranging from 140/90- 160/100 which she tries to treat with
herbal meds and concucsions such as using garlic.

During the clients childhood years she suffered from asthma

which she still has until the present. She recalls that she have had only
few childhood illnesses like mumps, flu, colds, cough and chickenpox.

The client cannot recall if she had completed her immunizations

and aside from her diabetes and hypertension the client have no other
diseases an according to her, she can still perform household chores
just as long as she doesn’t feel any symptoms of elevated BP and she
doesn’t feel fatigue.

C. Socio- cultural

The client is living with her oldest daughter, together with her
son-in-law and three grandchildren in a semi- bungalow house. She
takes care of her grandchildren and does all of the household chores
including laundry and the like while her daughter and son-in-law
manages a small buy and sell store. She depends on her daughter in
times of financial needs and during her stay in the hospital, her other
four children helps in paying for her hospital charges.

The patient is a Dagupeña, she was born and raised in Dagupan.

She is an active member of Jehovah’s Witness and believes that blood
transfusion is a mortal sin because blood is a sacred and it should not
be drank, eaten nor transfused or used for any other purposes.

The patient used to smoked tobacco but stopped after she have
joined Jehovah’s Witness.

D. Heredofamilial History

The patient had a family history of hypertension. The patient’s

father passed away more than 20 years ago due to a stroke as a
complication of hypertension. The patient also had history of

7
 heredofamilial disease like bronchial asthma and DM which she
acquired or inherited from her mother’s side. The patient’s mother had
passed away after her husband’s death due to old age.
The patient has 5 children aged 52, 45, 42, 39, 38 respectively. All of
them are apparently well which with no illnesses/diseases at the time
of interview.

VI. Course of Confinement

This case of Patient X, 54 years old, female who was admitted on

October 24, 2009 at Region 1 Medical Center with the chief complain of
multiple bruises and abrasions of arms and, forearms and forehead.

The following diagnostic test were done: Hematology test which

revealed elevated and decreased results---- White blood cell which
revealed elevated results, Neutrophils which revealed elevated results,
Lymhocytes which revealed decreased results, Red blood cells which
revealed decreased results, Hemoglobin which revealed decreased
results and Hematocrit which revealed decreased result, T Cage which
revealed no definite fracture, dislocation, lytic nor blastic lesion is
demonstrated and bones and joints are intact, CT Scan which revealed
on the First CT Scan--- there is a 27 x 23 x 19mm (CC x AP x Tr), acute
hemorrhage extravasations in the Right basal ganglia with minimal
surrounding edema. The ensuing mass effect compresses the Right
lateral ventricle. In addition, there is a subarachnoid hemorrhagic
accumulation predominantly in the left temporal lobe along the Slyvian
Cisterm and adjacent sulci There is no localized tumor or dystrophic
calcification. The rest of the ventricles are enlarged, the midline
structure are undisplaced. The corpus callosum, centrum semi ovale,
thalani, brainstem, cerebellum, cranial base and calvarium show no
findings of note. The Second CT scan revealed there is no reduction in
the attention with unchanged size of the right Basal Ganglionic-
hemorrhage. The Subarachnoid hemorrhage in the Left Slyvian cistern
has diminished in size and density. The rest of the findings have
remained the same.

The following medications were ordered: Pen G Na 5M “u” IV q 8

hours, Chlaramphenicol 500 mg IV q 8 hours, Dexamethasone 8 mg IV
q 8 hours, Ranitidine iv Q 8 HOURS, Captopril 25 mg SL now then q 30
minutes 3 doses.

The patient received D5LR 15-16 gtts/min and replaced with the
same Intravenous fluid.

The following Nursing diagnosis were identified: Acute pain r/t

trauma, ineffective cerebral tissue perfusion r/t hematoma on frontal
lobe

8
 The following Nursing interventions were done: Continuous
monitoring of Vital signs especially the Blood pressure, meticulous skin
care, health teaching (advising the patient to eat foods rich in protein
and Vitamin C), Glasgow coma assessment is done to determine the
consciousness of the patient and encouraged verbalization of her
feelings and concerns.

VIII. Laboratory Results

A. CBC Typing

- Identifies the total number of blood cells (leukocytes,

erythrocytes and platelets) as well as the hemoglobin,
hematocrit and RBC indices. Because cellular morphology is
particularly important in most Hematologic disorders. In this test,
a drop of blood is spread on the glass slide, stained and
examined under a microscope. The shape and size of the
erythrocytes and platelets, as well as the actual appearance of
Leukocytes, provide useful information in identifying hemotologic
conditions.

Result Normal Value Significance

High. Acute Infection

*The WBC is an
White Blood 12. 59 5.00-10.00 indicator of Immune
Cell function of the body.
Elevation is seen
during the ongoing
infection of
inflammation.
High. Stress and
Acute Infection

* Neutrophils are
Neutrophils 85.0 50.00-70.00 recruited to the site of
injury within the
minutes following
trauma and are the
hallmark at acute
inflammation
Low. Chronic
Infection; Viral
Infection

* A lymphocyte count

9
 Lymphocytes 9.3 20.00-44.00 is usually a pary of a
peripheral complete
blood cell count and is
expressed as
percentage of
lymphocytes to total
white blood cells
counted.
Low. Anemia

* Erythrocytes also
play a part in the
body’s immune
Red blood cell 4. 04 4.20-5.40 system: when lysed by
pathogens such as
bacteria, their
hemoglobin release
free radicals that
break down the
pathogen’s cell wall
and membrane, killing
it.
Low. Chronic Blood
loss
Hemoglobin 118 125-160
* This is used to
evaluate the
hemoglobin content of
erythrocytes.

Low. Hemorhage;
hemorrhage
Hematocrit 35.6 37.0-47.0
*This test is useful in
the diagnosis of
anemia.

B. CT Scan

-provides cross-sectional images of soft tissue and visualizes the

area of volume changes to an extremity and the compartment where
changes takes place. CT Scan has a high degree of sensitivity for
detecting lesions.

Results:

First CT Scan: There is a 27 x 23 x 19mm (CC x AP x Tr), acute

hemorrhage extravasations in the Right basal ganglia with minimal
surrounding edema. The ensuing mass effect compresses the Right

10
 lateral ventricle. In addition, there is a subarachnoid hemorrhagic
accumulation predominantly in the left temporal lobe along the Slyvian
Cisterm and adjacent sulci There is no localized tumor or dystrophic
calcification. The rest of the ventricles are enlarged, the midline
structure are undisplaced. The corpus callosum, centrum semi ovale,
thalani, brainstem, cerebellum, cranial base and calvarium show no
findings of note.

Second CT: scan revealed there is no reduction in the attention

with unchanged size of the right Basal Ganglionic-hemorrhage. The
Subarachnoid hemorrhage in the Left Slyvian cistern has diminished in
size and density. The rest of the findings have remained the same.

Impression:

Acute Right basal Ganglionic hemorrhage with minimal mass

effect as described.
Acute subarachnoid hemorrhage predominantly in the Left
temporal region, as described.

C. T Cage

- which revealed no definite fracture, dislocation, lytic nor blastic

lesion is demonstrated and bones and joints are intact.

VIII. Comprehensive Drug Study

A. DEXAMETHASONE
Brand name: Decadron, Deronil, Dexone, Hexadrol
Drug Classification: Steroid

Mechanism of action: Decreases the inflammation, mainly by

stabilizing leukocyte lysosomal membranes. Also suppresses the
immune response, stimulates bone marrow and influences protein, fat
and carbohydrate metabolism.

Indications
• Cerebral Edema
• Inflammatory Conditions
• Shock

11
Adverse Reaction
CNS: Psychotic Behavior, Euphoria
CV: Congestive hart failure, Hypertension, Edema
Skin: Delayed wound healing, various skin eruptions
Other: Muscle weakness, susceptibility to infections.

Nursing Considerations
• Gradually reduce drug dosage after long term therapy. Tell
patient not to discontinue drug abruptly or without doctor’s consent.
• Monitor patient’s weight, blood pressure and serum electrolytes.
• Watch for depression or psychotic episodes, especially in high-
dose therapy.
• Inspect patient’s skin for petechiae
• Not used for alternate day therapy

B. CAPTOPRIL
Brand Name: Capoten
Drug Classification: ACE inhibitors

Mechanism of Action: By inhibiting Angiotensin- converting enzyme,

prevents pulmonary conversion of Angiotensin I to Angiotensin II

Indications
• Hypertension
• Congestive heart Failure

Adverse Reactions
Blood: Leukopenia, Agranulocytosis
CNS: Fainting
CV: Tachycardia, Congestive heart failure
Skin: Pruritis
Other: Angioedema on the face and Extremities

Nursing Consideration
• Monitor Patient’s Blood Pressure and Pulse rate frequently
• Perform WBC and differential counts before starting treatment
every 2weeks for the first 3 months of therapy and periodically
thereafter
• Advice patient to report any sign of infection
• Should be taken 1 hour before meal since food in the G.I tract
may reduce absorption.

C. CHLORAMPHENICOL
Brand name: Chloromycetin, Mychel
Drug Classification: Antibiotic

12
Mechanism of Action: Inhibits bacterial protein synthesis by binding
to the 50S subunit of the ribosome.

Indications
• Severe infections caused by sensitive salmonella species
• Various sensitive gram- negative organisms causing meningitis

Adverse Reactions
CNS: Headache, confusion, mild depression, delirium,
GI: Nausea, vomiting
Other: Infections by nonsusceptible organisms, hypersensitivity
reaction

Nursing Considerations
• Culture and Sensitivity test may be done before first dose and
p.r.n
• Monitor CBC, platelets, serum iron and reticulocytes before and
every 2 days during therapy. Stop drug immediately if anemia,
leukopenia develops
• Instruct patient to report adverse reactions to the doctor,
especially nausea and vomiting and confusion.
• Give IV slowly over 1minute
•Monitor for evidence of super infection by nonsusceptible
organisms

D. PENICILLIN G Na
Brand Name: Crystapen
Drug Classification: Anti infective

Mechanism of Action: Bactericidal against microorganisms by

inhibiting cell-wall synthesis during active multiplication. Bacteria resist
penicillin by producing penicillinases-enzyme that converts penicillin to
inactivate penicillin acid.

Adverse Reactions
CNS: Convulsion
Local: Vein irritation
Others: Hypersensitivity (edema), overgrowth of nonsusceptible
organisms.

Nursing Considerations
• Obtain cultures for sensitivity tests before first dose. Unnecessary
to wait for test results before beginning therapy.
• Before giving penicillin, ask patient if she had any allergic
reactions to this drug.
• If patient has High blood level of this dug, she may have
convulsions. Be prepared by keeping side rails up on bed.
• Give IV intermittently to prevent vein irritation. Change site every
48 hours.

13
 • Give penicillin at least 1 hour before bacteriostatic antibiotics.
• With prolonged therapy bacterial or fungal super infections may
occur especially patient’s who are elderly, debilitated or who have
low resistance.

E. Ranitidine Hydrochloride
Brand Name: Zantac
Drug Classification: Anti ulcer

Mechanism of Action: Competi

Adverse Reactions
CNS: Convulsion
Local: Vein irritation
Others: Hypersensitivity (edema), overgrowth of nonsusceptible
organisms.

Nursing Considerations
• Assess patient for abdominal pain. Note the presence of blood
in the emesis, stool, or gastric aspirate.
• Ranitidine may be added to total parenteral nutrition solutions
• Don’t confuse Ranitidine with Ramantidine; Don’t confuse
Zantac with Xanax or Zyrtec.

IX. Assessment

I P P A Result Significanc Indication

e
Neurologic * >responsive
al >conscious
>oriented in date Normal
and place
>with GCS of 15
Skin * * >positive Abnormal Indicates
abrasions in both tissue trauma
arms
>sagging skin
>positive bruises
in left arm
>pale colored
skin
>positive freckles
Head * >positive suture Normal
at the back of the
head
>negative

14
 dandruff
>head is
symmetrical
Eyes * >coordinated Normal
extra ocular
movement
>shiny white and
moist
>pinkish
conjunctiva
Ears * >negative Normal
hearing disorder
>negative
tinnitus
Nose * >negative nasal Normal
discharges
>negative Normal
sinusitis
Mouth * >negative Normal
stomatitis
>positive halitosis
>22 teeth noted
>moist Normal
>positive taste
with good
swallowing reflex
Neck * >negative vein Normal
distention
>negative goiter Normal

15
 I P P A Result Significanc Indication
e
Upper * >positive bruises Abnormal
Extremitie in both extremities
s >unclean nails
>negative fracture Normal
noted
Chest * * * >negative mass Normal
noted

>negative Normal
abnormal breath
sound
>with 72 beats
per minute
Breast * * >negative mass Normal
noted
>brown colored Normal
nipple
>negative
inversion of nipple
Abdomen * * * * >negative Normal
abdominal
distention
>negative Normal
gastroenteritis
>negative Normal
abrasions Normal
>negative swelling
Genitourinar * * >negative dysuria Normal
y >negative Normal
hematuria Normal
>negative pain on
suprapubic Normal
>negative burning
sensation when
urinating
Lower * >positive abrasion Abnormal Indicates
Extremitie >positive bruises Abnormal tissue trauma
s in both extremities Indicates
>unclean nails tissue trauma
>negative fracture Normal
noted

16
X. Pathophysiology

Vehicular Accident

Direct and Indirect Head Trauma

Brain strikes the skull

Cortical injury occurs adjacent to the floor of the

anterior/posterior cranial fossa, the sphenoid wing,
the petrous ridge, the convexity of the skull,
and the falx or tentorium

Vascular Injury Acute traumatic damage

to the brain

Parenchymal bruises on
the surfaces of the brain Blood extend bidirectionally
to white matter, subdural and
subarachnoid spaces

Multiple shearing Multiple

injury microhemorrhages Brain herniation Neuronal Injury

Edematous Multifocal
lesions hemorrhagic Subdural
contusion Tissue Hematoma
injury

Tearing and bleeding Burst lobe

of arteries Vascular
response

Mortality
Decreased blood circulation
Edema

17
 Decreased oxygenation
Ischemia Change in Vital signs
rising blood pressure or widening
pulse pressure between systole
and diastole pulse changes-
bradycardia to tachycardia as
intracranial pressure rises
Increased Intracranial Pressure
Crushing of Brain Tissue
Change in level of responsiveness
lethargy, slowing of
speech, quietness to
Headache restlessness, orientation to
confusion, stupor, increasing
drowsiness, coma and
progressive deterioration
constant/increasing intensity
aggravated by movement
18
XII. Medical Management
Assessment and diagnosis of the extent of the injury are
accomplished by the initial physical and neurological examinations. CT
and MRI are the primary neuroimaging diagnostic tools & are useful in
evaluating the brain structure. Positron Emission Tomography (PET) is
available in some trauma centers; this method of scanning examines
brain function rather than structure.

Any patient with head injury is pressured to have cervical spine

injury until proven otherwise. The patient is transported from the scene
of the injury on a board with the head & neck maintain in alignment
with the body. All therapy is directed toward preserving brain
homeostasis & preventing secondary brain injury, which is injury to the
brain that occurs after the original traumatic event. If increase ICP, it is
managed by maintaining adequate oxygenation, elevating the head of
the bead & maintaining normal blood volume. Devices to monitor ICP
or drain CSF can be inserted during surgery or at the bedside using
aseptic technique. In managing intracranial bleeding, allow the brain to
recover from the initial insult to prevent or minimize the risk for
rebleeding and to prevent or beat complications. Primarily supportive
and consists of bed rest with sedation to prevent agitation & stress,
management of vasospasm & surgical medical treatment to prevent
rebleeding.

XIII. Nursing Management

The following are the nursing diagnosis:

 Hyperthermia r/t disturbance in the Hypothalamus

 Ineffective cerebral tissue perfusion r/t space occupying
lesion

The following interventions are done during the patient’s stay in the
hospital:

• Continuous monitoring of Vital Signs of the patient

especially the blood pressure and body temperature
• Meticulous skin care
• Advising the patient to eat foods rich in protein and
Vitamin C.
• Glasgow Coma Scale to determine the patient’s
consciousness
• As part of the therapeutic communication, encourage the
patient and watcher to verbalize their feelings and concerns.

19
 XIV. Discharge Planning
Nursing Considerations:

 A neurologist should be consulted if the patient is believed at risk

for complications
 Special care is taken in the positioning of the head of the patient
to avoid flexion of the neck which might impair circulation to the
brain
 Emotional supports are required to keep the person comfortable
and calm
 During convalescence the nurse maybe called on to assist the
patient in developing self help capabilities
 On Diet as Tolerated
 The treatment for a contusion is usually to watch the patient
closely for any change in level of consciousness

Further Outpatient Care:

• Glasgow coma scale level should be determined

• It is important to keep in mind that recovery from a traumatic
brain injury can be slow
• It is best to ask the health-care providers if any change have
occurred
• Enough rest and nutrition should be needed for outpatient care

Patient Education:

 Patients should be instructed to avoid opening their

mouths widely to prevent recurrent dislocation
 Application of cold may limit the development of a
contusion
 Elevate the head of the bed to promote venous drainage
and to lower increase intracranial pressure
 Watch the person closely for any change in level of
consciousness
 If the headaches persists or becomes severe, it is best to
seek medical attention

20