IHUMAN_Management_Plan_Samantha_Higgins_Complete_Solutions_Graded

Document Content and Description Below

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 ofMigraine/TensionHeadache - 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 ofHTN/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 ofBell’s Palsy - Glucocorticoid – Start on prednisone 60mg PO daily - if permit by Neurologist -Artificial tears - PT/OT eval Health Education and Maintenance and required follow-up care: - Routine follow-up of inpatients should be performed during each outpatient contact - Monitor BP and pain at home and take medication as prescribed. - Monitor depression, anxiety and sleep disturbance. -Any changes in neurological status or level of consciousness call 911 References Marcolini, E., & Hine, J. (2019). Approach to the Diagnosis and Management of Subarachnoid Hemorrhage. The western journal of emergency medicine, 20(2), 203–211. doi:10.5811/westjem.2019.1.37352 Singer, R., Olgivy, V., & Rordorf, G. (2019). Aneurysmal subarachnoid hemorrhage: Treatment and prognosis. Retrieved from https://www.uptodate.com/contents/aneurysmal-subarachnoidhemorrhage-treatment-and-prognosis?csi=61fd0fbe-0bd5-43eb-835a52a9c09f6a5c&source=contentShare Suarez, J.I. (2015). Diagnosis and Management of Subarachnoid Hemorrhage.Continuum (Minneap Minn). 2015 Oct;21(5 Neurocritical Care):1263-87. doi: 10.1212/CON.0000000000000217. [Show More]

Last updated: 1 year ago

Preview 1 out of 2 pages