Traumatic Brain Injury Case Study
Patient Profile
D.G., a 19-year-old male, was brought to the emergency department following a motor vehicle
accident in which he was the driver. He is transferred to the Neuro-Trauma Intensive Care Unit
with a diagnosis of traumatic brain injury.
Subjective Data
● Multiple family members and friends in the waiting room
● D.G.'s girlfriend died on the scene
● Hospital chaplain present
Objective Data
Physical Examination
● Glasgow coma scale 4
● Neurologic Assessment:
○ Pupils 4 mm and sluggish
○ Decerebrate posturing
○ Periorbital ecchymosis
● Clear drainage from nares is positive for glucose
Diagnostic Studies
● Computed tomography (CT) scan: Subdural hematoma compressing the
ipsilateral ventricle and causing a midline shift
Interprofessional Care
● Admission orders include:
○ Multiple line placements: Arterial monitoring, central venous pressure
line, ventriculostomy, and jugular bulb oximetry
○ Keep cerebral perfusion pressure (CPP) > 70 mm Hg
○ Begin standing orders for propofol, midazolam, ranitidine, and phenytoin
, ○ Continuous cardiac monitoring
○ A urinary catheter with strict I&O measurements
○ Neuro checks every hour
○ Monitor lab values (arterial blood gases, complete blood count,
electrolytes)
1) Based on the assessment data, what are the nursing priorities for D.G.?
- Based on the patient's assessment data, such as having a Glasgow coma scale 4
with a neurologic assessment of pupils 4mm and sluggish, decerebrate posturing,
and periorbital ecchymosis indicates that the main nursing priority is to maintain
the patient's to have adequate oxygenation and promote a patent airway. Another
main nursing priority relates to the patient's safety, especially if seizure activity is
indicated then implement seizure precautions. Other nursing priorities involve
completing focused neuro checks every one to two hours while watching for
changes in the level of consciousness while maintaining intracranial
pressure/cerebral perfusion (>70mmHg) within normal limits. Also, nurses should
monitor the patient's vitals while keeping the patient normovolemic while also
watching their input and outputs. Reposition the patient every two hours to
prevent pressure injuries, avoid neck and hip flexion, hold the head of the bed
elevated in the semi-fowler's position, and assess the ventriculostomy at the
required level. Since the patient is unconscious, it is essential to monitor for
infection such as listening to lung sounds, watching drainage from the nasal area,
and checking urinary color, smell, and sediment noted while maintaining clean
moist wound care to promote healing.
(Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D.
(2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems.
St. Louis: Elsevier., Pg. 1324-1325)
2) Indicate the expected outcome associated with each of the medications D.G. is ordered.
- Propofol (Diprivan) has a therapeutic effect with induction and maintaining
general anesthetics in which the desired outcome consists of sedation in
Patient Profile
D.G., a 19-year-old male, was brought to the emergency department following a motor vehicle
accident in which he was the driver. He is transferred to the Neuro-Trauma Intensive Care Unit
with a diagnosis of traumatic brain injury.
Subjective Data
● Multiple family members and friends in the waiting room
● D.G.'s girlfriend died on the scene
● Hospital chaplain present
Objective Data
Physical Examination
● Glasgow coma scale 4
● Neurologic Assessment:
○ Pupils 4 mm and sluggish
○ Decerebrate posturing
○ Periorbital ecchymosis
● Clear drainage from nares is positive for glucose
Diagnostic Studies
● Computed tomography (CT) scan: Subdural hematoma compressing the
ipsilateral ventricle and causing a midline shift
Interprofessional Care
● Admission orders include:
○ Multiple line placements: Arterial monitoring, central venous pressure
line, ventriculostomy, and jugular bulb oximetry
○ Keep cerebral perfusion pressure (CPP) > 70 mm Hg
○ Begin standing orders for propofol, midazolam, ranitidine, and phenytoin
, ○ Continuous cardiac monitoring
○ A urinary catheter with strict I&O measurements
○ Neuro checks every hour
○ Monitor lab values (arterial blood gases, complete blood count,
electrolytes)
1) Based on the assessment data, what are the nursing priorities for D.G.?
- Based on the patient's assessment data, such as having a Glasgow coma scale 4
with a neurologic assessment of pupils 4mm and sluggish, decerebrate posturing,
and periorbital ecchymosis indicates that the main nursing priority is to maintain
the patient's to have adequate oxygenation and promote a patent airway. Another
main nursing priority relates to the patient's safety, especially if seizure activity is
indicated then implement seizure precautions. Other nursing priorities involve
completing focused neuro checks every one to two hours while watching for
changes in the level of consciousness while maintaining intracranial
pressure/cerebral perfusion (>70mmHg) within normal limits. Also, nurses should
monitor the patient's vitals while keeping the patient normovolemic while also
watching their input and outputs. Reposition the patient every two hours to
prevent pressure injuries, avoid neck and hip flexion, hold the head of the bed
elevated in the semi-fowler's position, and assess the ventriculostomy at the
required level. Since the patient is unconscious, it is essential to monitor for
infection such as listening to lung sounds, watching drainage from the nasal area,
and checking urinary color, smell, and sediment noted while maintaining clean
moist wound care to promote healing.
(Lewis, S. M., Bucher, L., Heitkemper, M. M. L., Harding, M., Kwong, J., & Roberts, D.
(2017). Medical-Surgical Nursing: Assessment and Management of Clinical Problems.
St. Louis: Elsevier., Pg. 1324-1325)
2) Indicate the expected outcome associated with each of the medications D.G. is ordered.
- Propofol (Diprivan) has a therapeutic effect with induction and maintaining
general anesthetics in which the desired outcome consists of sedation in
