BIODATA OF THE PATIENT

Name of the patient : Daya Ram

Age : 40 Years
Sex : Male
Date of Admission : 11/02/2011
Address : Kharcha, Indore
Marital Status : Married
Religion : Hindu
Occupation : Driver/ Farmer
Family Income : 3000/-
Ward No. : Neuro ICU
O.P.D. NO. : 1522585
Diagnosis : Head injury (RTA) and Knee
dislocation.
Definition of diagnosis : It is an injury of skull which effect the
normal physiology and functioning at
the body.
AND
Knee dislocation is defined as the
Impairment at the actual position of
knee of right leg.
Consultant : Dr. Nilesh jain

HISTORY OF THE PATIENT

Socio Economic Status :
The patient economic condition is good patient's accommodation is
good. Living environment is clear and good as well as natural. The
patient is a social person living in society in his own house. The house of
patient contain 8 rooms, two kitchen, & let-bath and a ground.

Present Complain :
Mr. Daya Ram have injury on head. He have knee dislocation Rt.
He have fracture in tibia have (Rt.). Some lesions at left leg. He was
having surgical emphysema.

History at present illness :

 The patient was alright before 11th Feb 2011. Than he take a road
accident at Sankertali.
In the unconscious state he was taken to SAIMS hospital & directly
admitted to the neuro intensive care unit. At this time the patient was in
very serious condition because the bleeding had taken place too much and
he is also having a fracture in right tibia bone with some chest injury.
According to the faculty of doctor's decided the ultimate diagnosis at
"Head Injury".

History at past illness :

According to patient's brother Dayaram has not hospitalized before.
Some time he has any fever at cold occasionally.

Family History at any post illness :

All the member at his family are healthy and have normal
anatomically, physiologically and psychologically function. No member
is admitted before due to any reason in hospital.

Family History :
S. No. Member Relation Age/ Sex Health
1 Bheru Singh Father 60/M Healthy
2 Leela Bai Mother 56/F Healthy
3 Suraj Singh Brother 35/M Healthy
4 Tej Singh Brother 27/M Healthy
5 Reena Wife 28/F Healthy
6 Rajpal Son 20/M Healthy
7 Raanu Daughter 17/F Healthy
8 Rekha Daughter 13/F Healthy

Habitual Pattern:
Patient hashabit of following:
Alcohol - Occasionally
Smoking - Cigarette regularly
Tobacco - Rajshree Pan Masala regularly.

Functional Health Pattern :

Hygiene :Mr. Dayaram take bath daily once a day before admission. He
clean his tooth daily. He cuts his nails in every 15 days. He change his
clothes once in a day. He cuts his hair every month
Dietetic History :
Mr. Dayaram is non-vegetarian. He takes meal twice in a day. He
also takes breakfast in every morning. After the dinner and before going
to sleep he takes a glass of milk.

Active & Passive exercise :

Because of Dayaram is a farmer so his work is active. He times
always active and no exercise included in his routine.

Sleep / Rest :
Mr. Dayaram is usually sleep in night from 11.00 pm to 6 to 7 am
about 7.00 hours per day.
He don’t' take any rest in the afternoon.

Elimination pattern :
Usually he go for micturition six-seven times in a day and used to
go for defecation once early in the morning every day.

Values & believes :

Mr. Dayaram is a Hindu religious person. He used to go for prayer
(called pooja) once in morning daily.
He is a bhagat at Hanuman bhagwan.

PHYSICAL EXAMINATION
Height : 5'7"
Weight : 57 Kg.
Vital Signs : 18 Jan. 10.00 am
Temp : 98.4oF
Pulse : 78 / min.
Resp. : 20 / min.
B.P. : 130/70 mm of Hg.
Head :
When I examined head I found the injury on the left temporal
region. Swelling is also present on the site.

Symmetry : Symmetrical
Hair Colour : `Black
Appearance : Very fine hair

Face :
Eyes : Normal shape
Brown colour
Sclera is clear
Conjunction is raddish

Ear : Medium size (rounded)

Symmetrical shape
Tympanic membrane is normal
Ear pinna is not injured
Serum is coming out from ear.

Mouth : Oral cavity is not clear.

Teeth's colour is slight yellow.
Tongue is dehydrated
Lips are dry.

Neck : Nodes : Absent

Deformity : Absent

Chest : Haemothorax present

Surgical emphysema present
Chest tube is present

Ribs : Ribs are normal in shape

Chest tube was inserted through ribs
No injury at ribs present.

Abdomen : A minor injury is present

Skin is rough rashes
Present normal shape

Pelvis : The pelvis part is normally

The peritoneum is anatomically well
No injury are present.

Legs : Both legs are normal in shape

Rt. Knee dislocation is present
Rt. Tibia Bone is fractured.

Foot : A minor skin injuries

One present on both legs.
HEADINJURY
It is an injury of the skull by which the normal physiological at the brain
and other body's organ are affected.

The effect of the body organ depend upon the type of injuries.

Head injury is a broad classification that include injury to the scalp, skull
or brain. This is the most common cause of death from trauma.

Traumatic brain injury is the most serious form at brain injury.

DEFINITION
Brain injury is defined as an injury of scalp, skull or brain, which may
result in major physical or psychological dysfunction and can after patient
life completely.

CLASSIFICATION OF BRAIN INJURY

The most important consideration in any Head injury is wheather or not
the brain is injured. Even samightly minor injury can cause significant
brain damage as to obstructed blood flow and decreased tissues perfusion.

Mainly Head injury is classified in two types :

(1) Closed (blum) Brain injury.

(2) Open brain injury.

(1) Closed Brain Injury : CBI occurs when the head oulerates and
them rapidly deteration or colloids with another object and brain tissue is
damaged. But there is no opening through the skull and meninges.

(2) Open Brain Injury : OBI occurs when an object parentrate the
skull, enters the brain tissue in its path (penetrating injury), or when blunt
trauma to the bead is so severe that it opens the scalp, skull and dura to
expose the brain.
 TYPES OF HEAD INJURY
(1) Concussion : A cerebral concussion is a temporary loss of
neurologic function with no apparent spectral damage, after any head
injury. A concussion generally involves a period of unconsciousness
bisting from a few second to a few minutes.

The occurrence of these symptoms after injury is reffered to as post

concussion syndrome.
 Difficulty in awakening
 Difficulty in speaking
 Confusion
 Severe Headache
 Vomiting
 Weakness of one wide of the body

(2) Contusion : Cerebral confusion is a more severe injury its which

the brain is bruised, with possible surface hemorrhage.

The patient is unconscious for more than a few minutes. Clinical sign and
symptoms depend on the size of the confusion and the amount of
associated cerebral oedema.

The patient may lie motion use with a paint, pulse, shallow respiration
and cool. Pale sign, the B.P. and temperative are subnormal. This
situation may compared with the shock.

(3) Diffuse axonal injury: Diffuse axonal injury involves wide

spread damage to axone in the cerebral hemisphere, corpus collorum and
brain stem.

It can be seen in mild, moderate or severe head trauma and results in

axonal swelling and disconnection.

The patient may go in immediate comma.

(4) Intra Cranial hemorrhage:HEMATOMAS (collection of

blood) that develop which in the cranial vault are the most serious injury.

Major symptoms are frequently delayed until the HEMATOMA is large

enough to cause distolation of the brain and increased ICP.

A HEMATOMA may be epidural (above the dura), subdural (below the

dura) and intracerebral (within the brain).
(a) Epidural HEMATOMA:
(Extradural haematomy or hammthage)

After a head injury, blood may collect in the epidural (extradural) space
between the skull and the dura.

This can result from a skull fracture that cause a rapture or laceration of
the middle meningeal artery (the artery which reins between the dura and
skull to the temporal bone).

Haemmrrhage from the artery. Cause rapid pressure on the brain, a

epidural HEMATOMA is considered as an extreme emergency, maked
neuralgic deficit or even respiratory arrest can occurs within minutes.

(b) Subdural HEMATOMA:

A subdural HEMATOMA is a collection of blood between the dura and

the brain. A space normally occupied by a their cushion of fluid.

The most common cause of its is trauma but it may also occur from
coagulopathies or rupture of an aneurysm.

A subdural hemorrhage is more frequently venous, in origin and is due to

the rapture to small vessels. Their bridge the subdural space.

(c) Intracerebal hemorrhage or trauma :

Intracerebral hemorrhage is bleeding into the substance of the brain. It is

commonly seen in head injury when force is exerted to the head over a
small area.

These hemorrhage within the brain may also result from systemic
hypertension, leukemia or haemophils.

(5) Brain Death : When a patient has substained a severe head injury
incompatible within life.

Brain death indicate invisible loss of all brain function. The patient has no
neurologic activity against any stimuli.

ECG (Electro Encephalogram) and CBF (Cerebral Blood flow) studies

confusion brain death.
 ANATOMY & PHYSIOLOGY OF THE BRAIN
BRAIN :
The brain is very important part of the body. It lies in the cranical cavity
of the brain. The parts are :-
- Cerebrum
- Mid- Brain
The Brain Stem - Pons
- Medulla oblengeta
- Cerebellum

(1) Cerebrum -

It is the largest part of the Brain and it occupies the arteries & middle
cranial lossa.

The superficial (peripheral) part of cerebrum is composed of nerve cell

bodies (Gray Matter) and known as cerebral cortex and the deeper layer
consist of nerve libries or white matter.

The two cerebral haemisphere are separated by carpas collarum, which is

a mass of nerve libres (white matter) each cerebral haemisphere is
divided into four lobes :

(1) Frontal lobe

(2) Perital lobe

(3) Temporal lobe

(4) Occipetal lobe

- Deep within the cerebral hemisphere there are group of cell bodies,
called nuclei, these are :

(1) Basal ganglia

(2) Thalamus

(3) Hypothalamus

Function of the cerebral cortex :

(1) Mental activity, mental activities involves memory, intelligence, sense

if - responsibility thinking, reasoning, moral sense and hearing etc.
(2) Sensory perception, including properties of pain, temperature, touch,
sight, hearing taste and smell.

(3) Muscular activities, irritating and control of skeleton involuntary

muscle contraction.

(4) Language

(5) Personality traits

Function of the basal nuclei :

(1) Inhibiting of muscle tone.

(2) Coordination of slow sustained movements.

(3) Suppression of useless pattern of movement.

Function of Thalamus :

(1) Relay station for all synaptic input.

(2) Crude awareness of sensation.

(3) Some degree of consciousness

(4) Role in motor controle.

Function of Hypothalamus :

(1) Regulation of many haemostatic function such as temp. control.

Thirst, urine, output and load intake.

(2) Important link between nervous & endocrine system.

(3) Extensive involvement with emotions and basic behavioral pattern.

(4) Sexual behavior

(5) Biological clodes or circadian rhythm eg - sleeping and walking

cycles.

(2) Mid Brain -

The mid brain is the are of the brain situation around the cerebral
aqueduct between the cerebrum above and the pens below.

(3) Pones -
The pones is situated in front of the cerebellum, below the mid brain and
above the medulla oblengeta.

It consist mainly of white matter (N. fibres).

(4) Medulla oblengeta (Medulla) -

It extended from the pones above and is consitinues with the spinal card
below.

The better aspect is composed of white matter which passage between the
brain and spinal cord and the gray matter which lies untrally.

Function of Brain stem :

(1) Origin of majority of peripheral cranial verves.

(2) Cardio vascular, Respiratory and digestive control centre.

(3) Regulation of muscle reflex invalued with equilibrium and pressure.

(4) Reception and integration of all systemic inspect from spinal cord,
around & activation of cerebral cortex.

(5) Sleeping centre.

(5) Cerebellum -

The cerebellum is situated behind the pones and below the posterior
portion of cerebrum, occupying the posterior cranial losses.

Gray matter forms the surface of the cerebellum and the white matter lies
deeply.

Function of Cerebellum :

(1) Maintain of balance

(2) Enhancement of muscle tone

(3) Co-ordination and planning of skilled voluntary muscles activity.

The Brain
 RISK FACTORS
The leading causes of TBI are :

(1) Falls following by motor vehicle crashes and assautis.

(2) Elevated blood alcohol level.

(3) Not wearing motor cycle helmets

(4) Not wearing seat belts on four wheelers.

(5) Firearm (weapon discharged by means of explorine)

(6) Suicides or homicides.

(7) Sport injury

(8) Other occupation injury.

Adult age of 15-44 are at the greatest risk.

 Male & female ratio is 3:1

 Other risk factor is :

- Over the age of 75 year.

- Living in high crime area.

ETIOLOGY (In general)
(1) Motor vehicle accidents

(2) Driving with alcohol driving

(3) Driving without any safety guard.

(4) Faults

(5) Act of violence and shouting.

In my patient :

(1) RTA

(Road truck accident) or Motor Vehicle accident

PATHOPHYSIOLOGY

Brain suffers traumatic injury


Brain swelling / bleeding increase intracranial
volume

Rigid cranium allows no room for expansion of
contents so intracranial pressure increase

Pressure on blood vessels within the brain cause
blood flow to the brain slow.

Cerebral hypoxia and ischemia occurs

Intracranial pressure continues to rise brain merge
terminate.

Cerebral blood flow ceases

Traumatic Brain Injury (TBI)

 CLASSIFICATION OF LOC
According to Glasgow comma - scalp.

(1) Mild - GCS - 13 to 15

Loss of consciousness to 15 min.

(2) Moderate - GCS - 9 to 12

Loss of consciousness for upto 6 hrs.

(3) Severe - GCS - 3 to 8

Loss of consciousness greater than 6 hrs.

In my Patient -

GCS = 3

 He was unconscious about 62 hrs. from the accident.

 He has severe head injury or severe traumatic brain injury.

ASSOCIATED INJURY OR
EXTRA CRANIAL TRAUMA
(1) Facial trauma & skull fracture -
 Occurs in 20% of major TBI eg - lines fracture
 Basilar skull fracture
 Depressed fracture
 Facial fracture

(2) Vascular injury -

 Vertebral or carotid artery dissection.

(3) Spine fracture with or (SCI) -

(Spinal cord injury)

(4) Soft tissue injury.

CLINICAL FEATURE
(1) Disturbance in consciousness confusion to coma.
(2) Headache, vertigo

(3) Agitation, restlessness

(4) Respiratory irregularities

(5) Cognitive deficit

(6) Papillary abnormalities

(7) Sudden onset of neurologic deficit

(8) Coma & Coma syndrome

(9) Leakage of CSF from ear (Otorrhoea)

(10) Recon eyes & battle sign indicate skull fracture.

(11) Abnormal bleeding due to coagulopathy.

(12) Aggravated stress response (tachycardia, tachypenea,

Hyperthermia etc.)

(13) Cardiac arrhythmic (due to increased release of catecholamine in

stress response)

DIAGNOSTIC EVALUATION (in General)

(1) CT scan to identified and localizes lesions edema, bleeding.

(2) Skull and cerical pine fill to identify fracture displacements.

(3) Neuropsychological test during rehabilitation phase to determine

cognitive deficit.

(4) MRI to identified and diagnose, the side of injury (DAI)

(5) CBC, Coagulation prapile, electrolet and serum osmolarity, ABG

valves and other laboratories test to monitors for complication and
guide treatment.

(In Patient)

(1) CT Scan

(2) X-Ray of chest and legs

(3) Haemogram witch CBL

(4) Blood report

(5) Biochemical test in blood.

INVESTIGATION
(1) Haemogram :
Investigation Result Normal value/ unit
Blood volume 92 70 - 140 mg/dl
Area 29 15-40 mg/dl
Serum creatinine 0.98 0.5-1.5 mg/dl
Bleeding time 1.45 2-7 min.
Clotting time 4.45 2-9 min.
CBC
Haemeglobin 14.1 M. 13-17 gm%
F. 115.-13.5 gm%
R.B.C. 5.68 M 4.5-6.5 Mill/cmm
F 3.8-5.8 mill/cmm
Packed cell volume 43.7 M 41-51 %
F 36-45 %
W.B.C. 8500 4000-11000 /cmm
Neutrophils 80 40-70 %
Lymphocytes 15 20-45 %
Menocyte 03 2-10 %
Eosinophils 02 1-6 %
Platelet count 2.46 1.5 - 4.5 lacs/cmm

(2) Blood Report :

Investigation Report
Blood Group A Positive (Rh)
HIV test (Rapid immuno - concentration retroquin) Non reactive
HBS Ag. (Rapid) Negative

(3) Biochemistry Report :

Investigation Value Normal value/ unit
Blood area 21 15-40 mg/dl
RBC (Glucose Random) 132 upto 140 mg/dl
Serum Creatinine 1.20 0.5-1.5 mg/dl
GLASGOW COMA SCALE (in general)
The GlasGow Coma scale is a tool for assessing a patient response to
stimuli.

Scoring range from 3 (deep coma) to 15 (normal).

(1) Eye opening response Spontaneous 4

to voice 3
to pain 2
none 1

(2) Best verbal response Oriented 4

Confused 3
Inappropriate aloxis 3
Incomprehensible sound 2
None 1

(3) Best Motor Response Obey Command 6

Localizes pain 5
Withdraws 4
Flexion 3
Extension 2
None 1
Total 3 to 15

In my patient (Feb. 11, 2011)

(1) Eye opening response None 1
(2) Best verbal response None 1
(3) Best motor response None 1
Total 3
"So according to Glasgow coma scale my patient Dayaram is deep
unconscious." (Deep Coma)

Assessing Traumatic Brain Injury :

After or head injury we can assess following signs and symptoms.

(1) Altered level of consciousness.
(2) Confusion
(3) Papillary abnormalities
(4) Absence or altered gag reflex.
(5) Absent carneel reflex
(6) Sudden enset of nuerologic deficits.
(7) Change in cardinal signs. (Altered respiratory pattern, widened
pulse pressure, breedy cardia, tachycardia, hypothermia &
hyperthermia)
(8) Vision and hearing
(9) Sensory dysfunction
(10) Headache
(11) Seizers.

COMPLICATIONS

(1) Infection - Systemic (Respiratory, Urinary)

Neurologic (Meningitis, Ventriculitis)
(2) Increased ICP, hydrocephalus, brain heaviation.
(3) Post traumatic sezures disorder.
(4) Permanent neurologic deficits (Cognitive, motor, sensory, speech)
(5) Neurobehavioral alteration, impulsivity, unhibited aggression of
emotional liability)
(6) Persistent sympathetic storming
(7) DIC
(8) DI. SIADH
(9) DEATH

MANAGEMENT
The goal of management are to prevent further TBI and to observe for
symptoms of progressive nuerologic deficit.

The patient is resuscitated as necessary and oxygen and cardiovascular

stability are maintained.

Non depressed skull fracture generally do not require surgical treatment

however close observation of the patient is essential.

Depressed skull fracture usually require surgery, particularly if

contaminated or deformed fractures are present.
 MEDICAL MANAGEMENT
Medical management includes drug therapy :
In general -
1) Glucocarticoides (dexena) - is given to reduce cerebral credema.
2) Serum glucose concentration should be monitors because of steroid
may cause hyperglycemias.
3) Osmatic diuretic are used to treat cerebral - edema by pulling water
and from brain and it increase cerebral blood flow by decreasing
ICP.
4) Diuretic - is used to treat ICP.
5) Antiepileptic agent is given to reduce convulsion.
6) Dynapas used as analgesic drug to reduce pain.

MEDICAL MANAGEMENT
(In my patient)
Drug are :
(1) Drug : Ceffrion-T
Doze : 1.125 gm
Route : I/V
Frq. : BD
Action : Bactericidal
Side Effect : Diarrhoea
Indication : Meningitis & Typhoid
Contraindication : Hypersensitivity
Nsg. Responsibility: Should not vie to neonatal or renal /
hepatic patient.

(2) Drug : Raciper

Doze : 40 mg
Route : I/V
Frq. : OD
Action : Bactericidal
Side Effect : Headache
Indication : GERD
Contraindication : Hypersensitivity
Nsg. Responsibility: Liver patient will not taken.

(3) Drug : Dynapar

Doze : 2 ml
Route : I/V
Frq. : BD
Action : Analgesics
 Side Effect : Nausea
Indication : Pain
Contraindication : Reptic ulcer
Nsg. Responsibility: Pt. with GI ulcer will not taken

(4) Drug : Epsolin

Doze : 100 mg
Route : I/V
Frq. : TDS
Action : Antiepileptic
Side Effect : Hirsutism
Indication : Psendomotor epilepsy
Contraindication : AV block
Nsg. Responsibility: Monitor ECG during therapy is restricted.

(5) Drug : Metrogyl

Doze : 100 ml
Route : I/V
Frq. : TDS
Action : Antibiotic
Side Effect : Infection of UTI
Indication : Candida
Contraindication : Protozoa infestation
Nsg. Responsibility: Over drug is restricted.

(6) Drug : Deriphyllin

Doze : 2 ml
Route : I/V
Frq. : TDS
Action : Braonchodilators
Side Effect : --
Indication : Mucosal adema
Contraindication : Hyper Responsiveness
Nsg. Responsibility: Not be taken in overdose.

(7) Drug : Dopamine

Doze : 2 ml / hr.
Route : I/V
Frq. : 2 ml / hr.
Action : Vaso pressers
Side Effect : Hypotension
Indication : Septicemia
Contraindication : Hyperthyroidism
 Nsg. Responsibility: Drug should be diluted before I/V
administration.

SUGRICAL MANAGEMENT
(In General)
(1) Craniotomy :
It was performed by a surgery to remove the behemic tissue or
blood deformity, of sever skull fracture.

(2) Cranioplasty :
Repair of a cranial defect resulting from trauma mal formation or
previous surgical procedure artificial material used to repair
damage as last bone.

(3) Burn hale :

Opening into the cranium with a chill to remove localize fluid and
blood beneath the drug matter.

(In my patient)
In my patient Dayaram is no any surgical procedure done.

NURSING MANAGEMENT
1. Assessment of neurological signs.

2. Assessment of skin integrity and character of the skin.

3. Assessment of oral mucous membrane.

4 .Assessment of range of motion of joints.

5. Monitor for signs of merrased ICP.

6. Monitor cardiac status for hypotension and arrhythmias.

7. Monitor laboratory findings and reports abnormal values.

8. Perform cranial nerve, motor, sensory & reflex assessment.

9. Assess for behaviors that ucarrants potential for injury to self or

other.

10. Assess the other complication like spinal cord injury or any other
bone injury.
 S. Assessment Nsg. Diagnosis Expected Nursing Intervention Evaluation
No. Out Comes Planning Implementation
1 Subject data Ineffective To maintain - Encourage deep -Deep breathing - Attains
Patients attended told airway a patient
breathing and provided to prevent any effective airway
that the patient is taking clearance & airway to
coughing exercise. pulmonary clearance.
rapid breathing. impaired gasmaintain - To maintain the complication. - Achieves
Objective Data exchange airway breathing according - The patient is normal breath
I assess the condition of related toclearance to doctor in the monitored with the sound.
the patient by tachypner increased ICP related to
ventilation. ventilator.
& increased pulse rate. and brainhead injury. Establish effective - Proper suctioning is
injury. suctioning. provided.
2 Subjective Data : Ineffective To maintain - According to - The level of - Improvement
The patients attended cerebral tissue the proper & GCS, the assess the consciousness in is seen in
told that Dayaram is perfusion right adequate LOC. absented regularly. cognitive
unconscious since increase ICP. intracranial - To maintain the - Vital signs are function.
accidents. pressure. vital signs properly. monitored - ICP is
Objective Data : - Motor response to Temp. 98.2oF properly
I assess that the patient any stimuli is Pulse - 78/m maintain.
have a history of assessed. Resp. - 20/m
unconsciousness after B.P. - 130/70
the injury. To assess the
intracranial status.
- Motor function are
assessed by observing
spontaneous
 movement.
S. Assessment Nsg. Diagnosis Expected Nursing Intervention Evaluation
No. Out Comes Planning Implementation
3 Subjective Data Imbalanced The - To promote adequate - Adequate nutrition is - Attains
Rt. Attended told that nutrition less than maintance nutrition. provided. adequate
they are suspected body's of - To provide parental - Protein supplement are nutritional
about patient requirement R/T adequate nutrition. given as I/V. status.
nutrition. increased nutritional - To provide oral - Oral care is provided. - Change of
Objective Data : metabolic demand & status. hygiene. oral infection
I assessed that the fluid restriction & are presented.
patient is not well inadequate intake.
with ryles feeding.
4 Subjective Data : Deficit fluid To - To monitor serum - Serum decrolyte level - Achieve
Patient attender told volume related to maintain dectrolyte level. is properly maintained. satisfactory
me that Dayaram is decreased level of proper - To maintain proper - Blood glucose level is fluid and
having dried lips as consciousness & fluid and blood glucose level. maintained. electrolyte
well as dehydration. hormonal electrolyte - To evaluate the - Endocrine function are balance.
Objective Data : dysfunction. balance. endocrine function. evaluate by body - The study of
I observed that the - To maintain proper physiology response. urine, blood,
patient is suffering balance between extra - The study of body body fluid are
from fluid volume cellular & intracellular fluid is done. done to
deficit by I/V fluid. - The level of serum evaluate the
infusion. - To prevent sodium & controlled. physiology of
hyponatramer. - Urine analysis and the body.
- The study of urine & blood study is regularly
 blood. performed.
S. Assessment Nsg. Diagnosis Expected Nursing Intervention Evaluation
No. Out Comes Planning Implementation
5 Subjective Data Risk for injury Prevention - To provide proper - Comfort provided by - Injuries are
Patient attender told Right seizures, to comfort reduce analgesics or by avoided.
that the Dayaram can disorientation secondary restlessness. catheterization. - The patient
fall down from the psastillness on injury - To ensure that the - Proper ventilation is may oriented to
bed brain damage. oxygenation is monitored. time place and
Objective Data : adequate. - Proper hand are persons.
I assessed that the - To use padded ride wrapped to protect the
patient is sails or patient's hand patient from self injury.
unconscious so it are wrapped in mitt.
may possible.
6 Subjective Data : Disturbed thought Promoting - Assess patients - Cognitive attention are - Improvement
Patient attendant told processor (Deficit cognitive cognitive alteration. assessed. is cognitive
that they have been in intetual function - Provide - Neuropsychological functioning is
about the Dayaram function, neuropsychological therapy are provided. seen.
that it he loss his communication therapy. - Proper rehabilitation is - Improved
memory or can go in memory. - Provide cognitive maintained. memory.
Comma or any life Information rehabilitation - Visual a factory
threaten problem. processing) Right activities. gustatory.
Objective Data : Brain injury. - Provide meaningful Acoustic and active
I asses that due to sensory stimulation. stimulation are given for
brain injury the improving the cognitive
patient is in second functioning.
 stage at coma.
S. Assessment Nsg. Diagnosis Expected Nursing Intervention Evaluation
No. Out Comes Planning Implementation
7. Subjective Data Risk for impaired Maintance - To assess the patient - Positioning is provided - No pardon or
Patient relatives told skin integrity of skin in turning and in every two hrs. breakness in
that the patient can related to bed rest integrity. positioning. - Assessed skin integrity skin integrity.
have paralysis or hemisphoris - Assess all body. in every 8 hrs. The chance for
other complication humiplegia, - Assess for skin. - Sponge bath and back bed sores is
right to skin. immobility or rest - Asses skin for massage provided. prevented.
Objective Data : less ness. pressure ulcer. - Avoided the chance for - Proper
I asses that due to decubiti. hygiene is
prolonged devotion maintaince.
at bed lead to bed
sores etc.
8 Subjective Data : Deficit knowledge Effective - To teach about the - The knowledge about - They get
Patient attenders told about brain injury family head injury. head injury is provided. information
that they have no recovery and coping - To promote effective - How to manage stress about their
knowledge about his rehabilitation and coping. situation. patients injury.
injury. procedure. increasing - To provide family - Family counseling is - They will
Objective Data : knowledge counseling. provided. prepare to face
I assess that the about the - To provided - Psychological support what can be
person are villagers rehabili- psychological and is provided. happen to
and illetrald so they tation emotional support. Dayaram.
don't have process. - They can
information about the manage stress
head injury. condition.
HEALTH EDUCATION
 I teach and provide information about the injury and conditions of
the client.

 I advised them to have patience.

 I explain them, how to maintain a good health pattern of the client

after discharge as :

(i) To provide good balanced diet (rich in protein)

(ii) To take regular medicines as mainted by the doctors

(iii) To have positive attitude about the client Health.

 I provide them Psychological support.

 To told them to ensure their safety from the, infection, That can
arist in the hospital like cross injection & nosocombial infection.

 Immediately contact to doctor if any complication arises at home

after discharge.

 I told them to maintain a proper peaceful and calm environment in

the hospital.
 BIBLIOGRAPHY
(1) Brunner and Suddharth's 'Text book of Medical Surgical Nursing"
Eleventh Edition, Volume 2, Lipincott William and William
publication, first Indian Reprint 2008, New Delhi, Page No. 2233
to 2250.

(2) Lipincott "Manual of Nursing Practice" Eight Edition 2006,

Lippincott, William & William Publication Noida, Page No. 522-
526.

(3) Ross and Wilson " Anatomy of Phsyiology" tenth Edition 2006,
Anne Waugh of Allison Gant, New Delhi Page No.142-148.

(4) Basvanthapa BT "Medical Surgical Nursing" Seventh Edition,

M.C. Grand Publications, New Delhi Page No. 540-541.