Nursing care for multiple trauma patients with acute subdural hemorrhage and hemothorax. : case study

Abstract

     Multiple system injuries is an accident that affects many bodies of the patient or multiple systems at the same time. The cause of the patient's death in a short time resulted from massive blood loss, airway obstruction non-effective breathing, and severe brain injury.

     A case study, Thai male patient, 67 year old, was admitted to King Narai Hospital on August 28, 2020. The patient had an accident on the road and had acute subdural hemorrhage and hemothorax and fracture clavicle. The patient was received the surgery (Craniotomy remove blood clot) and then the patient was intercostal chest drain. After the surgery, the level of consciousness decreased, therefore, the patient was received intubation and was checked the brain by computed tomography (CT Brain). It was found the re - bleeding acute subdural hemorrhage. The patient was surgery again. After the surgery, there were no additional complications. The patient was received the nursing care for monitoring the occurrence of increased intracranial pressure, preventing oxygen depletion, increasing breathing efficiency and prevention of lung infections associated with ventilator. Totally of intubation is 5 days and then the breathing tube was removed and then change to receive the oxygen by High Flow Nasal Cannula (HFNC) 60 LPM. Chest radiography show enlarged well and there is no airflow or bleeding and then the chest drain was removed.
The patient was trained physical therapy after brain surgery and physical chest to prevent lung flattening. The patient's symptoms improved accordingly. The patient train physical therapy after brain surgery and physical chest therapy for preventing lung flattening. The patient's symptoms improved accordingly. Nurse and relative of patient plan to continue care the patient at home. The patient was sent to nearby hospital for antibiotic treatment following the plan. The patient was discharged on September 7, 2020, total of 10 days of hospital admission.

     Nurses play an important role in medical treatment and must have competency in surgical nursing and understand the pathology of the disease. Disease progression of complications should be a competent person in the assessment of multiple injuries. To be informed in decision-making to provide timely assistance to patients and to define accurate and comprehensive nursing diagnosis.