Nursing care for patients with brain injury and complications including intracranial hemorrhage, Kalasin Hospital Accident and Emergency Department : 2 case studies.

Abstract

      This study employed a case-study design aimed at comparing the medical histories, clinical manifestations, treatment plans, complications, and nursing care of two purposively selected patients diagnosed with traumatic brain injury (TBI) accompanied by intracranial hemorrhage. Both patients were admitted to the Emergency Department. The Emergency Management Concept was utilized as the conceptual framework to identify nursing diagnoses, formulate nursing care plans, and continuously evaluate nursing outcomes.

      Results:

      Case 1: A 57-year-old Thai female presented after a fall, striking her head against the floor eight hours prior to admission. She was diagnosed with intraparenchymal hemorrhage and subarachnoid hemorrhage at the right frontal lobe. Initial assessment revealed a Glasgow Coma Scale (GCS) score of E3V5M6, and motor power of grade V. A computed tomography (CT) scan of the brain confirmed the intracranial hemorrhage. Her treatment plan included pharmacological therapy and close monitoring for neurological complications. She was subsequently transferred to the inpatient department for continued neurological observation. No complications were observed, her clinical status progressively improved, and she was successfully discharged home.

      Case 2: A 60-year-old Thai male with a history of hypertension was referred from a community hospital following a traffic accident in which his motorcycle ran off the road. He experienced a loss of consciousness and post-traumatic amnesia for three hours prior to admission. He was diagnosed with a traumatic brain injury (TBI) with an epidural hemorrhage. Initial assessment showed a GCS score of E2VTM5, pupils 3 mm and reactive to light (RTL) bilaterally, with motor power of grade IV on the right and grade V on the left. The treatment plan involved a neurosurgical consultation followed by an emergency craniectomy for blood clot removal under general anesthesia (GA), combined with pharmacological management. Postoperatively, the patient was cared for in the inpatient department, showed progressive improvement, and was successfully discharged home.