Andres Bonifacio College

School of Nursing
College park, Dipolog City

Nursing Care and Management of a client with traumatic Brain injury,

Closed fracture forearm, open fracture left leg

Submitted by: Mr. Roeder Cuerda BSN-IV

Submitted to: Ms. Jowillene Pearl O. Jatico RN,MN
Institutional Mission.

We commit to provide affordable quality education with values in industry, intelligence, integrity and undertake relevant research
and socially-responsive community service using innovative technologies.

Institutional Vision.

A center of excellence in instruction, research, technology, extension, athletics, and the arts

Mission of the school of Nursing.

The school of nursing shall generate competent, safe and compassionate professional nurse committed to:

a. Practice high standard of nursing care utilizing research and evidenced based practices that are culturally appropriate and
sensitive.

b. Active involvement on local, national and global issues affecting nursing people’s health and the environment.

c. Ongoing holistic growth of self and others.

Table of content
--------------------------------------------------------------------------Cover Page--------------------------------------------------------------------------------

-------------------------------------------------Mission and vision of Andres Bonifacio college-----------------------------------------------------------

-------------------------------------------------------anatomy and physiology and Pathophysiology ---------------------------------------------------
----------------------------------------------------------------------Patient’s Profile-------------------------------------------------------------------------------

-------------------------------------------------------Laboratory Results and Diagnostic test results-----------------------------------------------------

------------------------------------------------------------------Physical Assessment---------------------------------------------------------------------------
----------------------------------------------------------Gordon’s 11 functional health pattern--------------------------------------------------------------

-----------------------------------------------------------------------Pharmacology-------------------------------------------------------------------------------
------------------------------------------------------------------------------NCP1-----------------------------------------------------------------------------------
------------------------------------------------------------------------------NCP2-----------------------------------------------------------------------------------
------------------------------------------------------------------------------NCP3-----------------------------------------------------------------------------------

-------------------------------------------------------------------------references---------------------------------------------------------------------------------
Patient’s Profile
Name:X
Date of Birth: November 110, 2001
Age: 16 Years Old.
Gender: Male
Church: Roman Catholic
Address: Sindangan, Zamboanga del Norte.
Weight: 47kgs
Blood Type B +:
Civil Status: Single
Attending Physician: Dr.Paraguaya
Admitting Diagnosis: T/C TRAUMATIC BRAIN INJURY SECONDARY TO MVA; T/C CLOSED FRACTURE LEFT FPOREARM; T/C OPEN FRACTURE
LEFT LEG
ward: Surgical Charity
Room no. SCW EXT 07
Chief Complaint: Allegedly involved in a MVA
History of Present Hospitalization: 2 Hours PTA, cliemnt reported he was riding his “BMX” bicycle at night in Sindanagan when a a random
person riding a motorcycle under the influence of alcohol Hit him.
Allergies: None
Immunizations: BCG,DPT,OPV,HEPB,Measles,MMR
History of Past Hospitalization:: unremarkable

Family History: + Hypertension ,- asthma , - diabetes, - cancer,

 Physical Assessment
Assessor: Roeder Cuerda
Patient: X
Vital Signs: September 22, 2018

8 AM 12 PM
Blood 120/80 120/80mmhg
Pressure mmhg
Temperature 36.0oC 36.0oC
Pulse Rate 100 BPM 101 BPM
Respiratory 31 CPM 29CPM
Rate

General Appearance:

 Received Client lying on bed awake, responsive and has high level of consciousness, very interactive and talkative with a cast on his left forearm,
and left leg operated orif plate screw, femur with oozing dark red fluid draining on syringe suction . Not well Groomed, messy hair and dirty nails.
With Continuing IVF solution 1L LRS 650 CC left on R Basilic vein to be infused at 30 gtts/min.
 Complaints of Throbbing pain on the Left operated leg, pain scale of 10/10, and Discomforts with left casted arm when moved.

Assessment Findings

Integumentary

When skin is pinched it goes to previous state immediately (2 seconds).

 Skin With fair complexion slightly pale. Sutured wound on the forehead near the temple, abrasions on the
elbows, knees and feet.
Dry Skin No petechiae.
 Assessment Findings

Scar on his elbows knees and some parts of the legs

IV infusion site on right bacilic vein no edema, phlebitis and infiltration..

 Hair Evenly distributed hair, black and messy short.

Smooth and has intact epidermis

 Nails With dirty fingernails and toenails.
Convex and with good capillary refill time of 2 seconds.
Pale nail beds
Rounded, normocephalic and symmetrical. CT scan Result (September 5, 2018): Right frontal scalp contusion no
Skull
intracranial hematoma.
Symmetrical facial movement, palpebral fissures equal in size, symmetric nasolabial folds. Dried saliva near the
Face
cheeks noted as well as early morning eye secretions.
Eyes and Vision

 Eyebrows Hair evenly distributed with skin intact.

Eyebrows are symmetrically aligned and have equal movement.

 Eyelashes Equally distributed and curled slightly outward.

 Eyelids Sunken eyelids.

Lids close symmetrically and blinks involuntary.

 Bulbar conjunctiva Transparent with capillaries slightly visible

 Assessment Findings

 Palpebral Conjunctiva Shiny, smooth, pink

 Sclera Appears white.

 Lacrimal gland, Lacrimal sac, Nasolacrimal duct No edema or tenderness over the lacrimal gland and no tearing.

Cornea
Transparent, smooth and shiny upon inspection by the use of a penlight which is held in an oblique angle of the eye
 Clarity and texture and moving the light slowly across the eye.
Has black eyes.

 Corneal sensitivity Blinks when the cornea is touched through a cotton wisp from the back of the client.

Black, equal in size with consensual and direct reaction, pupils equally rounded and reactive to light and
Pupils accommodation, pupils constrict when looking at near objects, dilates at far objects, converge when object is moved
toward the nose at four inches distance and by using penlight.

 External Nose Symmetric and straight, no flaring, uniform in color, air moves freely as the clients breathes through the nares.

 Nasal Cavity Mucosa is pink, no lesions and nasal septum intact and in middle with no tenderness.

Mouth and Oropharynx Symmetrical, pale lips.

 Assessment Findings

 Tongue and floor of the mouth Central position, pink but with whitish coating which is normal, with veins prominent in the floor of the mouth.

Uvula Positioned midline of soft palate.

Positioned at the midline without tenderness and flexes easily. No masses palpated.
Neck

Head movement Coordinated, smooth movement with no discomfort, head laterally flexes, head laterally rotates and hyperextends.

Lymph Nodes Palpable but non tender

Thorax and lungs Visible bony prominences and with ease in breathing
Posterior thorax Chest symmetrical

 Spinal alignment Spine vertically aligned, spinal column is straight, left and right shoulders and hips are at the same height.

Breath Sounds Normal breath sound, rhythm and characteristic, clear breath sounds

 Anterior Thorax Absent Normal breath sound, rhythm and characteristic, clear breath sounds.

Abdomen not distended, no tenderness

Abdominal movements Symmetrical movements cause by respirations.

 Auscultation of bowel sounds With audible sounds of 18 bowel sounds/minute.

Upper Extremities Scar on elbow casted L forearm.

Lower Extremities With minimal scars on lower extremities and Left leg surgically operated orif plate screw.
Muscles Equal in size both sides of the body.
Bones and Joints Brocken and fractured bones of the Left arm and left leg.
 Assessment Findings

Mental Status Client is alert, oriented to time and place.

Level of Consciousness A total of 15 points indicative of complete orientation and alertness.

Gordon’s Functional Health Pattern

Usual Initial Ongoing
HEALTH PERCEPTION/ HEALTH
MANAGEMENT Vital Signs 8:00 am September 21, 2018
Blood Pressure 120/80mmhg
 Does not usually seek doctor when ill Temperature 36.0oC
except for severe cases like this Pulse Rate 108 BPM
 Mostly relies on mang hililot and herbal Respiratory Rate 31CPM
medications such as sambong. vital signs 12 pm.
 Takes paracetamol sometimes when
having fever. Blood pressure 120/80mmhg
 No cough and cold on the past 3 weekss temperature 36.0oC
Pulse rate 101BPM
Respiratory rate, 29CPM

Medications:
Ongoing LRS 1L with 650 cc left infusing well on
the Right Bacilic vein @30gtts/min.
 Confined due to a MVA.

Ketorolac 300 G IV Q 8 hours

Tramadol 50Mg SLOW IV Q 6 hours
Cefuroxime 750mg IVTT Q 8 hours

Nutritional Metabolic
very hungry for food.
 Can consume upto two cups of rice ever Consumed all of the rice served for breakfast
meal and lunch and also the available pork chop 1pc.
depending on how hungry he is
 No food restrictipon and no allergies to Weight : 40kg
food
 Does not drink alcohol or smoke solution 1L LRS 650 CC left on R Basilic vein to
 Fund of eating junkfood. be infused at 30 gtts/min.
 Chippy favourite junk food. consumes approximately 120 ml/hr of ivf.
Consumes maximum of 5 glasses of Consumed 7 glasses of water.
water daily.
 No difficulty in swallowing.
 Has good appetite.
 No history of stomach anomalies.

Elimination Pattern
 Defecates once daily Urinated once in an improvised urinal amounting
 Urinates more than 6 times daily. 80 ml color yellow.
 No history of UTI and urinary problems. Did not defecate during the shift.

Bowel motility 16 ticks/minute.

Activity Exercise Pattern ADL SCALING

 attends school during weekdays CRITERIA:
 no form of exercise
  Physically active loves riding his bicycle. Mostly lie and sit on bed same routine all
 Help in house hold chores. throughout the day

Have not showered and bathed 2 days

Bathing with sponge, bath, or shower=0

Dressing=0
Toilet Use=0
Transferring= 0
Urine and Bowel Continence=1
Eating=0

Participated in bed bath

No form of exercise currently but is advised

to perform active ROM ion unaffected areas
of the body.

Sleep rest Pattern

 No difficulty sleeping. Has disturbed sleep during the first 4 hours of

sleep last night due to complaints of severe pain
 usually sleeps at 8pm and wakes up at 5 on the operated sites. But waa able to sleep
am in the morning after pain med was given.
 Take afternoon naps but not everytime.
took an afternoon nap for 1 hour and thirty
minutes.
Cognitive Perceptual

 Is a Grade 10 student and is performing No changes in the level of consciousness, .

well on school according to SO. hearing vision and mental status.
 No problems in eyesight, hearing and Alert, responsive and love to joke around with
judgement people.
 Speaks clearly and audibly Has good judgment.
Oriented to time and place.
  Not forgetful. No changes in the mental status and level of
 Doesn’t love studying consciousness and memory recently.

Self Perception/self concept Mother reported that she was worried about
 Comfortable and feel good about self. being absent in school and how long the
 He thinks of himself as a strong recovery will be. is somewhat angry to the
individual. person who hit him.

Role Relationship
 Second child of the family.

Sexually reproductive

 Not sexually active

 Doesn’t have a girlfriend
Coping/stress tolerance

Mother as her source of strength

 Laughs at Problems,doesn’t take
problems seriously Talks and jokes around to patient to relieve
 Talks and Report to mother matters that boredom and stress.
are serious
 Has a lot of friends he can rely on and Verbalized “ ikatawa nalang nato ning kasakit
can talk problems with. kay wala man tay mabuhat ani sakit man jud “
DX: Acute Pain r/t Musculoskeletal trauma

Assessment Planning Intervention Rationale Evaluation

Subjective Cues At the end of my 8 hour INDEPENDENT
duty there will relief of to ensure clients full
client verbalized” sakit kaau pain as evidenced by: 1. Establish rapport to cooperation. Nursing Care
akong till asta akong kamot mag client Plans, Edition 9 - Murr, Alice,
lisud kog tulog magabei mag 1. Report or Doenges, Marilynn,
mata mata ko” verbalization of
Moorehouse, Mary)

decreased pain, Provides information about

“ sakit kayo jud 10/10 ang kasakit 2. Evaluate pain
even when arm need for, and effectiveness
mag ngol ngol” frequently in
and leg is not of, interventions.
immediate
“ang kamot raman pud og ang tiil moved. Note: It may not always be
postoperative phase
kaning gi operahan sakit kaau 2. Pain scale will possible to eliminate
and regularly (e.g.,
usahay pero mawala rapod og decrease to atleast pain; however, analgesics
hourly per protocol)
ma hatagan kog pain killer” 8/10 and lower. should reduce pain to a
following transfer,
3. Vitals signs at tolerable
“walay undang ang sakit padayon noting characteristics,
normal range : level. A frontal and/or
rajud nga ga ngul ngul” location, and intensity
Temperature 36.5- occipital headache may
37.5oC
(0 to 10 [or similar]
scale. develop 24 to
Blood Pressure 120/80 Pulse Rate 80-
Temperature 36.0oC 120BPM
72 hours following spinal
anesthesia, necessitating
Pulse Rate 100 BPM Respiratory 18-
Rate 25CPM recumbent
Objective Cues: 4. Facial grimacing position, increased fluid
September 21, 2018 will be less noted intake, and notification of
Vital Signs 8:00 am and decreased the
frequency of anesthesiologist for
guarding alternative pain relief
behaviour on plan..(Nursing Care Plans, Edition 9 -
Murr, Alice, Doenges, Marilynn,
affected (areas left Moorehouse, Mary)
 RespiratoryRate 31CPM arm and left leg).

Facial grimacing when arm is Early evaluation and

moved.
3. Note presence of
treatment of bleeding by a
anxiety or fear, and
health care provider reduce
Guarding behavior of the left relate with nature of
the risk for complications
arm and leg and preparation for
procedure. from blood loss..(Nursing Care
Plans, Edition 9 - Murr, Alice, Doenges,
Marilynn, Moorehouse, Mary)

Requested pain killer.

Discomfort can be caused
4. Assess causes of or aggravated by other
possible discomfort factors (e.g.,
other than operative presence of indwelling
procedure. catheter causing bladder
pain, NG
tube resulting in gastric
fluid and gas accumulation,
or parenteral
lines that have infiltrated IV
fluids or medications).
(Nursing Care Plans, Edition 9 - Murr, Alice,
Doenges, Marilynn, Moorehouse, Mary)

Dependent
Analgesics given IV reach
5. Administer the pain centers
medications, as immediately, providing
indicated, for more effective relief with
example:IV smaller doses of
analgesics after medication.
reviewing anesthesia Note: Initial opioid dosage
record for should be reduced by one-
contraindications fourth
and/or presence of to one-third after use of
agents that may fentanyl (Innovar) or
potentiate analgesia droperidol
(Inapsine) to prevent
Ketorolac 30 mg IV Q respiratory depressant
8 hours X 3 Doses effects (Deglin
& Valler, 2005). .
(Nursing Care Plans, Edition 9 - Murr, Alice,
Doenges, Marilynn, Moorehouse, Mary)
DX. Impaired Physical mobility r/t Musculoskeletal impairment.
Assessment Planning Intervention Rationale Evaluation.
At the end of my 8 hour duty there INDEPENDENT
Subjective Cues: will be no signs of complications 1.Establish rapport To ensure full cooperation
brought by Impaired Physical of interventions.(Nursing Care
SO verbalized:”Dile jud ko Mobility as evidenced by: Plans, Edition 9 - Murr, Alice, Doenges,
Marilynn, Moorehouse, Mary
kalakaw kay sakit man
kaau sakit gani kaau
1. Absence of the
lihokon lang dayon samot
nag mo tindog” development of
discoloration, pallor or 2. Assist patient for Adds to gaining enhanced
cyanotic on the muscle exercises as able sense of balance and
Objective cues:
affected and operated or when allowed out of strengthens
parts , the left arm and bed; execute abdominal- compensatory body
Cast on the left Arm with
limited range of motion. the left leg. tightening exercises and parts...
(Nursing Care Plans, Edition 9 - Murr, Alice,
knee bends; hop on foot; Doenges, Marilynn, Moorehouse, Mary)
left leg undergone orif plate 2. Capillary refill of the stand on toes.
screw surgery right arm and right leg
<2 Seconds Exercise enhances
Immobilized left leg with 3. Execute passive or increased venous return,
reports of severe pain when active assistive ROM prevents stiffness, and
3. Maintenance of the
moved and not moved. exercises to all maintains muscle strength
range of motion of the
extremities. and stamina. It also
Capillary refill ofleft arm unaffected limb
avoids contracture
and left leg <2 seconds
4. Ability to move deformation, which can
Left leg color the same phalanges of the build up quickly and could
color with the un operated operated arm and leg. hinder prosthesis
leg. usage.(Nursing Care Plans, Edition 9 -
Murr, Alice, Doenges, Marilynn,
Moorehouse, Mary)
Left arm uniform in color 5. Absence in the
with the rest of the body development of bed
ulcers. 4. Present a safe These measures promote
Able to move phalanges of
a safe, secure
the operated body parts. environment: bed rails up, environment and may
bed in down position, reduce risk for falls...(Nursing
No contractures and bluish important items close by. Care Plans, Edition 9 - Murr, Alice,
discoloration, pallor. Doenges, Marilynn, Moorehouse, Mary)
6. Bowel motility present
and within normal
Ability to perform active
range 3-35
flexion, extension, pronatio,
supination of the unaffected ticks/minute.
These movements keep
limbs.
5. Promote and facilitate the patient as functionally
Bowel motility : 16 early ambulation when working as possible. Early
ticks/minute. possible. Aid with each mobility increases self-
initial change: dangling esteem about reacquiring
Skin integritry of the bony legs, sitting in chair, independence and
prominences no sign of the ambulation. reduces the chance that
development of bed or debilitation will
pressure ulcers. transpire...(Nursing Care Plans,
Edition 9 - Murr, Alice, Doenges, Marilynn,
Moorehouse, Mary)

Healthcare providers and

significant others are often
6. Let the patient
in a hurry and do more for
accomplish tasks at his or
patients than needed.
her own pace. Do not Thereby slowing the
hurry the patient. patient’s recovery and
Encourage independent reducing his or her
activity as able and safe. confidence.intake.(Nursing Care
Plans, Edition 9 - Murr, Alice, Doenges,
Marilynn, Moorehouse, Mary)
DX: Impaired Tissue Integrity r/t surgical trauma to tissue on the left arm and left leg.

Assessment Planning Intervention Rationale Evaluation

Subjective cues At the end of my 8 hour duty Independent At the end of my 8
there will be no signs of the hour duty the goal of
Client verbalized:”sakit kayo development of further injury 1.Ascertain if client is at risk for Presence of comorbidities increasing fluid intake
jud 10/10 ang kasakit mag brought by impaired tissue delayed healing (e.g., diabetes, COPD, is fully met! As
ngol ngol ang till” anemia, obesity,
integrity as evidenced by: evidenced by:
malnutrition, alcohol
Objective Cues: withdrawal; use of steroid
1. No further fracture on left arm Ability to consume 6-
and left feet. therapy) and 10 glasses of water
Damaged Tissue on the left
arm due to fracture and extremes of age can impact daily.
surgical treatment. 2. No reports of sudden change healing.(Nursing Care Plans, Edition 9 -
Murr, Alice, Doenges, Marilynn, Moorehouse,
in skin color, cyanotic or pallor Mary) 2.Show willingness to
Damaged tissue on the Left leg
due to fracture and surgical and pain sensation from increase food intake
treatment throbbing to tingling sensation.
3.Ability to answer
Oozing dark red blood draining 3.swelling will not grow in size 2. Inspect incision regularly, noting Early recognition of delayed why water is vital for
on suction syringe for and will remain localized. characteristics and integrity. healing or developing health.
drainage. complications
4.ability to still move phalanges may prevent a more serious 4.Ability of the SO to
Swollen knee.
of the operated body parts, left situation. Incisions may promt client to drink
Capillary refill ofleft arm and leg and left arm. heal more slowly in clients water.
left leg <2 seconds with comorbidity or the
5. contractures will not develop. elderly, 5. Good skin turgor <3
Left leg color the same color in whom reduced cardiac
with the un operated leg. seconds skin goes
6. Ability to perform active output decreases capillary back
Left arm uniform in color with flexion, extension, pronatio, blood
the rest of the body supination of the unaffected flow.
(Nursing Care Plans, Edition 9 - Murr, Alice,
Able to move phalanges of the limbs. Doenges, Marilynn, Moorehouse, Mary)
operated body parts. Left leg
and left arm 7. Skin integritry of the bony Close observation of surgical
prominences no sign of the 3. Observe initial surgical dressings promotes early
No contractures and bluish
discoloration, pallor.
development of bed or pressure dressings, noting accumulation of identification
ulcers. blood/other drainage. Reinforce of problems, such as
Able to perform active flexion, initial dressing or change, hematoma formation, outright
extension, pronatio, supination 8. foul smelling odor on the as indicated, using clean or sterile bleeding.(Nursing Care Plans, Edition 9 -
of the unaffected limbs. drainage system will not technique per protocol Murr, Alice, Doenges, Marilynn, Moorehouse,
Mary)
Bowel motility : 16
develop. or surgeon preference.
ticks/minute. Decreasing drainage
suggests evolution of healing
Skin integritry of the bony 5. Assess amounts and process,
prominences no sign of the characteristics of drainage.
development of bed or whereas continued drainage
pressure ulcers. or presence of bloody or
odoriferous
exudate suggests
complications, which may
include
hemorrhage, infection, and
fistula formation.needs.(Nursing
Care Plans, Edition 9 - Murr, Alice, Doenges,
Marilynn, Moorehouse, Mary)

Facilitates approximation of
wound edges; reduces risk of
6. Maintain patency of drainage
infection and chemical injury
tubes; apply collection bag
to skin and tissues.(Ferki,
over drains or incisions in 2011).
presence of copious or caustic (Nursing Care Plans, Edition 9 - Murr, Alice,
drainage. Doenges, Marilynn, Moorehouse, Mary)

Collaborative
Reduces edema formation
1.Apply ice, if appropriate. that may cause undue
pressure on
incision during initial
postoperative period.
(Nursing Care Plans, Edition 9 - Murr, Alice,
 Doenges, Marilynn, Moorehouse, Mary)

cefuroxime 750mg IV Q
9hours
2. Administer Antibiotics to prevent (Nursing Care Plans, Edition 9 - Murr, Alice,
Doenges, Marilynn, Moorehouse, Mary)
spread of infection.
Anatomy and Physiology.

Traumatic brain injury (TBI), also known as intracranial injury, occurs when an external force injures the brain. TBI can be classified based on
severity, mechanism (closed or penetrating head injury), or other features (e.g., occurring in a specific location or over a widespread area). Head
injury is a broader category that may involve damage to other structures such as the scalp and skull. TBI can result in physical, cognitive, social,
emotional, and behavioral symptoms, and outcome can range from complete recovery to permanent disability or death.

Causes include falls, vehicle collisions, and violence. Brain trauma occurs as a consequence of a sudden acceleration or deceleration within the
cranium or by a complex combination of both movement and sudden impact. In addition to the damage caused at the moment of injury, a variety of
events in the minutes to days following the injury may result in secondary injury. These processes include alterations in cerebral blood flow and the
pressure within the skull. Some of the imaging techniques used for diagnosis include computed tomography and magnetic resonance imaging

CT scan of patient with brain trauma. Caption reads, "Preoperative CT scan of patient while he had a GCS
of 14." Accompanying text in article reads, "Emergent CT imaging revealed a sagittally oriented skull
fracture extending from the vertex to the foramen magnum as well as a transverse parietal and temporal
bone fracture. Multiple frontal, parietal, and temporal lobe contusions with associated interhemispheric
hemorrhage and a left-sided subdural hematoma measuring 1.7 mm in greatest depth were appreciated.
Effacement of the basilar cisterns was noted without shift of midline structures."
What Are Fractures?
A fracture is the medical term for a broken bone.
Fractures are common; the average person has two during a lifetime. They occur when the physical force
exerted on the bone is stronger than the bone itself.
Your risk of fracture depends, in part, on your age. Broken bones are very common in childhood, although
children's fractures are generally less complicated than fractures in adults. As you age, your bones become
more brittle and you are more likely to suffer fractures from falls that would not occur when you were young.
There are many types of fractures, but the main categories are displaced, non-displaced, open, and closed.
Displaced and non-displaced fractures refer to the alignment of the fractured bone.
In a displaced fracture, the bone snaps into two or more parts and moves so that the two ends are not lined
up straight. If the bone is in many pieces, it is called a comminuted fracture. In a non-displaced fracture, the
bone cracks either part or all of the way through, but does move and maintains its proper alignment.
SOURCES:
Herdman, T. H. (2012). NANDA International Nursing diagnoses: Definitions and classification 2012-14. Chichester, U.K: Wiley-Blackwell.

HERDMAN, T. H.NANDA International nursing diagnoses (Herdman, 2012)Herdman, T. (2012). NANDA International nursing diagnoses. Hoboken, N.J.: John
Wiley & Sons.

Hodgson, B. B., & Kizior, R. J. (2014). Saunders nursing drug handbook 2014. St. Louis, MO: Elsevier.

ACKLEY, B. J., LADWIG, G. B. AND MAKIC, M. B. F. (Ackley, Ladwig and Makic, n.d.) Ackley, B., Ladwig, G. and Makic, M. (n.d.). Nursing diagnosis
handbook.
CT-Scan result:
reading date: 9/5/18
Sex: Male

Impression:
RIGHT FRONTAL SCALP CONTUSION

NO INTRACRANIAL HEMATOMA

CBC
WBC: 14.2 10^9/L = 5-10 10^9/L

RBC: 3.50 10^12/L= 4.5-5.5 10^12/L