DISCHARGE PLANNING: M Medication - Advise patient to take home medications following right drug, frequency, dosage and timing

g as prescribed by the Physician such as follows: > Tramadol, 50 mg 1 cap q6h > Cecon, 500mg 1 tab OD > Flamazine E Environment - Instructed patient to stay in calm, quiet environment - Home environment must be free from slipping or accident hazards T Treatment - Informed patient to have a follow-up check up after 1- 2 weeks H Health Teachings - Inform patient to avoid lifting heavy objects for 1-2 weeks - Stress the importance of proper hygiene like hand washing, toileting, tooth brushing and bathing. - Encourage client to engage to range of motion exercises. - Instruct patient to increase intake of protein-rich foods to promote faster wound healing - Advise patient to increase adequate fluid intake for hydration purposes. - Discourage patient to participate in strenuous activities that might precipitate stress and trauma to the wound. - Tell patient not to hesitate to ask for assistance when waking up in bed or when going to comfort room. - Promote rest periods among the client but also encourage ambulation. - Advice patient to avoid touching the operative wound with hands dirty that may cause infection. - Encourage deep breathing and coughing exercises among the client. O Observable Signs and Symptoms - Instruct patient to report signs and symptoms of increased intra cranial pressure like seizures, vomiting or headache to nearest hospital to avoid

further complications. - Instruct patient to report to physician any signs of infection like inflammation, redness or swelling - Instruct patient to report any case of hemorrhage or abnormal bleeding D Diet - Encourage client to increase intake of fiber to avoid constipation - Instruct to increase fluid intake - Instruct to increase intake of nutritious foods such as fruits and vegetables S- Spirituality - Advise patient to keep believing on Gods holy will so that he could be spiritually motivated. - Tell patient to constantly participate to religious activities so that his faith could be more strengthened.

Subdural hematoma
A subdural hematoma is a collection of blood on the surface of the brain.

Causes
Subdural hematomas are usually the result of a serious head injury. When one occurs in this way, it is called an "acute" subdural hematoma. Acute subdural hematomas are among the deadliest of all head injuries. The bleeding fills the brain area very rapidly, compressing brain tissue. This often results in brain injury and may lead to death. Subdural hematomas can also occur after a very minor head injury, especially in the elderly. These may go unnoticed for many days to weeks, and are called "chronic" subdural hematomas. With any subdural hematoma, tiny veins between the surface of the brain and its outer covering (the dura) stretch and tear, allowing blood to collect. In the elderly, the veins are often already stretched because of brain atrophy (shrinkage) and are more easily injured. Some subdural hematomas occur without cause (spontaneously). The following increase your risk for a subdural hematoma:

Anticoagulant medication (blood thinners, including aspirin) Long-term abuse of alcohol Recurrent falls Repeated head injury Very young or very old age

Symptoms

Confused speech Difficulty with balance or walking Headache Lethargy or confusion Loss of consciousness Nausea and vomiting Numbness Seizures Slurred speech Visual disturbances Weakness

In infants:

Bulging fontanelles (the "soft spots" of the baby's skull) Feeding difficulties Focal seizures Generalized tonic-clonic seizure

High-pitched cry Increased head circumference Increased sleepiness or lethargy Irritability Persistent vomiting Separated sutures (the areas where growing skull bones join)

Exams and Tests

Always get medical help after a head injury. Older persons should receive medical care if they shows signs of memory problems or mental decline. An exam should include a complete neurologic exam. Your doctor may order a brain imaging study if you have any of the following symptoms: Confused speech Difficulty with balance or walking Headache Inability to speak Lethargy or confusion Loss of consciousness Nausea and vomiting Numbness Recent congitive decline in an elderly person, even without a history of brain injury Seizures Slurred speech Visual disturbance Weakness

A CT scan or MRI scan likely would be done to evaluate for the presence of a subdural hematoma.

Treatment
A subdural hematoma is an emergency condition. Emergency surgery may be needed to reduce pressure within the brain. This may involve drilling a small hole in the skull, which allows blood to drain and relieves pressure on the brain. Large hematomas or solid blood clots may need to be removed through a procedure called a craniotomy, which creates a larger opening in the skull. Medicines used to treat a subdural hematoma depend on the type of subdural hematoma, the severity of symptoms, and how much brain damage has occurred. Diuretics and corticosteroids may be used to reduce swelling. Anticonvulsion medications, such as phenytoin, may be used to control or prevent seizures.

Outlook (Prognosis)
The outlook following a subdural hematoma varies widely depending on the type and location of head injury, the size of the blood collection, and how quickly treatment is obtained. Acute subdural hematomas present the greatest challenge, with high rates of death and injury. Subacute and chronic subdural hematomas have better outcomes in most cases, with symptoms often going away after the blood collection is drained. A period of rehabilitation is sometimes needed to assist the person back to his or her usual level of functioning. There is a high frequency of seizures following a subdural hematoma, even after drainage, but these are usually well controlled with medication. Seizures may occur at the time the hematoma forms, or up to months or years afterward.

Possible Complications
Brain herniation (pressure on the brain severe enough to cause coma and death) Persistent symptoms such as memory loss, dizziness, headache, anxiety, and difficulty concentrating Seizures Temporary or permanent weakness, numbness, difficulty speaking

When to Contact a Medical Professional

A subdural hematoma requires emergency medical attention. Call 911 or your local emergency number, or go immediately to an emergency room after a head injury. Spinal injuries often occur with head injuries, so try to keep the person's neck still if you must move him or her before help arrives.

Prevention
Always use safety equipment at work and play to reduce your risk of a head injury. For example, use hard hats, bicycle or motorcycle helmets, and seat belts. Older individuals should be particularly careful to avoid falls.

Alternative Names
Subdural hemorrhage