NURS 6550-I-Human Case Samantha Higgins New Study-LATEST UPDATE2023/2024

I-Human Management Plan Based upon initial neurologic examination in ED Samantha Higgins is in Grade 2 (severe headache, stiff neck, no neurologic deficit except cranial nerve palsy) according to Hunt and Hess grading system for Problem Lists: Subarachnoid Hemorrhage Migraine History of HTN/Family Hx HTN (Mom) History of Bell’s Palsy History of Tension Headache Status/Condition: Critical Code Status: Full Code Allergies: NKDA Admit to Unit: ICU Activity Level: Bedrest Diet: NPO except medication Critical Drips: None Respiratory: 2L/NC titrate to RA keep O2 saturation 92% Medications: Keppra, Labetalol, Tylenol, Morphine Sulfate, Colace Lab Tests : Diagnostic testing: Head CT scan Plan : Subarachnoid Hemorrhage - Labetalol 10 mg IVP Q8H PRN for SBP 160mmHg, hold if HR 60 - Administer Nimodipine 60mg PO Q4H – if permit by Neuro Surgeon (Singer, Olgivy, & Rordorf, 2019) - Start on Keppra 1000mg IV now, then 500 mg IV Q8H for seizure prophylaxis - Start IVF NS@100ml/hr – to maintain euvolemia - Pain control – Tylenol 650mg PO PRN Q6H for mild pain and fever 101.3F, Morphine sulfate 2mg IVP PRN Q4H for moderate to severe pain. Hx of Migraine/Tension Headache - Start on Keppra 500mg Q12H for seizure prophylaxis - Start IVF NS@100ml/hr – to maintain euvolemia - Pain control – Tylenol 650mg PO Q6H for mild pain. Morphine sulfate 2mg IVP Q4H for moderate to severe pain. History of HTN/Family Hx HTN (Mom) - Check BMP and Lipid panel - Blood glucose daily - Keep SBP between 120-160mmHg for cerebral perfusion - Labetalol 10 mg IVP Q8H PRN for SBP 160mmHg, hold if HR 60 Hx of Bell’s Palsy - Glucocorticoid – Start on prednisone 60mg PO daily - if permit by Neurologist - Artificial tears - PT/OT eval