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Nursing Care For Depressed Occipital Fracture

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Discuss about the Nursing Care for Depressed Occipital Fracture.



Nursing care patients should be optimal, precise and patient centred. In the light of all the advancements to the health care industry nursing care has reached the pinnacle of success. There was a time when nursing care was viewed just as an add-on to the treatment by the clinical practitioners (FABIANO & SHARRARD, 2017). As the health care advanced and treatment procedures became more complex, the weightage of nursing care in the health care industry transformed completely. Now nursing care is seen as a integral part of treatment procedure, and the importance of quality nursing care in the health care industry now is clearly understood (FABIANO & SHARRARD, 2017).

With the transformation of nursing care, the approaches to it has changed radically as well. There are a lot of different and modern techniques and approaches to nursing care and treatment. Out of all the approaches, evidence based practice has shine in heath care as a whole it makes nursing care be adequately patient centred and absolutely safe for the patients as well (Ribeiro dos Santos, de Carvalho Sousa, Oliveira Lima, Nadson de Sousa Ribeiro, de Araújo Madeira, & da Silva Oliveira, 2016). This essay will attempt to string together a patent centred and optimal nursing care plan for depressed occipital fracture utilizing modern approaches to nursing care.

Case scenario:

The case scenario under consideration in this assignment describes an elderly patient named Mark Robinson aged 63, who fell from a ladder and suffered a depressed occipital fracture and lost consciousness for a while. His Glasgow coma scale showed almost normal behaviour scored at 14 to 15 regularly and the patient exhibited signs of slight drowsiness. Overnight the patient shows symptoms including slurred speech, fatigue and confusion. His nursing care must begin with thorough primary assessment.


ABCDE approach primary assessment:

The ABCDE approach is designed to provide the nursing professional a thorough examination of all the vital physiological activities. It starts with the airway examination, to ensure that the airway of the patient is not blocked in any manner and the patient is breathing enough air. Most of the emergencies turn fatal within the matter of minutes without the proper examination of the vitals, and checking the airway should be the first step to ensure that the Mark is at no risk to respiratory failure (Onakomaiya, Kruger, Highland, Kodosky, Pape, & Roy, 2017).

The second assessment in this approach is the examination of breathing, even if there are no blockages in the airway or respiratory tract of the patient there are high chances of irregular breathing patterns in the patients that could be indicative a number of respiratory distress. Hence the breathing should be checked as well.

The third assessment criteria in this assignment are checking the circulation of Mark. As this is an emergency case, hypovolemia or other cardiac condition can enforce the patient to go under shock. Hence to rule out any possibilities of impending cardiac arrest the circulation of the patient must be checked (Onakomaiya, Kruger, Highland, Kodosky, Pape, & Roy, 2017).

The fourth assessment technique uses the examination of any signs of disability in the patient. It has to be considered that the patient suffered a fall that rendered him senseless for a few minute, so possibilities of a stroke cannot be overlooked. Other than that any other fall injuries can also lead the patient to mobility distress for the time being (Tume & Jinks, 2008).

A frightening reason in emergency or critical health care that generates as a small concern but can complicate the condition of the patient easily is dehydration. According to the dehydration policy adapted by most of the health care facilities checking the patient for possible signs of dehydration is extremely important (Wu, 2016).

Lastly the patient must be taken for a full body examination for presence of any physical manifestation like rashes, inflammation and redness. This is the last step of primary assessment and it will reveal vital information about the Mark.

Respiratory care and interventions:

Pulmonary complications are very common in any brain injury, as the patient has lost consciousness for a substantial amount of time after the fall the possibilities for brain tissue injury cannot be overlooked. As the patient is showing signs of internal tissue damage indicated by slurred speech and confusion. Mark should be provided respiratory assistance in he cannot breathe properly (Meng, 2016).

In order to prevent the chances of the patient going through hypoxemia the oxygen supply must be maintained and the patient should be monitored diligently. It will stabilize Mark and minimize the risks for secondary neurological complications (Ribeiro dos Santos, de Carvalho Sousa, Oliveira Lima, Nadson de Sousa Ribeiro, de Araújo Madeira, & da Silva Oliveira, 2016).


Cardiovascular care and interventions:

Traumatic brain injury can give rise to catecholamine storm, an excessive secretion from the adrenal glands that seriously affect the cardiac functions within our body. As Mark already has suffered a depressed occipital fracture with possibilities of minor brain injury the chance of cardiac and myocardial overload and oxygen demand should not be overlooked (Gitto, Arunkumar, Maiese, & Bolino, 2015).

If the patient shows any signs of neurogenic cardiovascular dysfunctions, administering arterial pressure will help in minimizing the after affects of a catecholamine storm, by administration of b-androgenic blocking agents that can limit the myocardial dysfunctions. After catecholamine storm subsides however an ECG should also be performed to rule out any chances of further complications. Furthermore Mark should be monitored every other hour for any signs of relapse of cardiac malfunctions for the rest of the day (Wu, 2016).

Nutritional care and interventions:

A depressed skull fracture and associated brain trauma can be turn detrimental to the health and wellbeing of the patient if proper care is not taken. Nutritional requirements can vary from patient to patient however in case of skull injury the nutritional priorities will include high calorie substation with high glucose proportions (Forbes, Reig, Tomycz, & Tulipan, 2010). In case of any aftermath of trauma the metabolism rate is increased than the normal and the oxygen and glucose expenditure rate is also high. Care should e taken to compensate the rate of expenditure adequately.

As mark has been showing signs of fatigue and lack of nutrition his nutritional requirement should be judged. In case he cannot take food with the normal route intravenous administration is advised. The nursing professional must ensure that patient receives glucose supplements that allow the calorie count of the patent to reach 2500Kcal as that can help the patient with seedy recovery. The patient should be monitored for any signs of blood glucose level drop periodically and should be checked for improvement in fatigue (Balak, Aslan, Serefhan, & Elmaci, 2009).

Neuromuscular care and electrolyte balance:

A bran trauma associated to severe skull fracture can lead to neurogenic motor skill dysfunctions that can lead the patient incapable of movement. In order to treat and manage neuromuscular defect in the patient the very first step should be assessing the neuro-motor activities that the patient is still capable of (Morris, Kushner, & Tiwana, 2012).

As the patient has difficulty rousing it can be assumed that the patient is in need for adequate neuromuscular interventions. Neuromuscular blocking agents can serve the purpose of delimiting the chances of permanent neuromuscular damage and intracranial pressure can help as well in returning some of the motor skills (Sullivan, 2000). However intracranial pressure can lead to fatal consequences for patients with severe traumatic injuries hence discretion should be take to handle the administration delicately and with proper precautions  (Balak, Aslan, Serefhan, & Elmaci, 2009).


Interventions to provide comfort and reassurance:

A traumatic brain injury associated with depressed skull fracture can render the patient incapable of normal motor skills, confusion and lack of speech. In such a condition the patent has to depend completely on the dependence of the nursing professional. Dependency and incapability coupled with panic and stress can induce feelings of inhibition and irritation, hence the nursing professional has to ensure that the patient is comfortable at all times (Bell, Dierks, Brar, Potter, & Potter, 2007).

The intervention include having the patient under constant vigilance and monitoring, brain trauma patient are generally on different supportive clinical equipments that can malfunction at any time, hence the nurse must take that into consideration as well. Moreover the patient should be comfortably dressed and well hydrated to ensure hygienic and safe care practice. The nursing professionals must also be empathetic and supportive to the needs of the patients and the patient should be reassured periodically to keep him stable (Balak, Aslan, Serefhan, & Elmaci, 2009).

Communication with patient:

It has to be considered that communicating with the patient leads to the best and most focussed patient centred care. In various health care research studies communication has been discovered to e one of the most vital and important sectors of treatment and nursing care. There are a lot of complications that can arise in a complicated health care setting for the patent as well as for the health care professional (Grant, Grinspun, & Hernandez, 2010).

Effective communication between the patent and the health care professionals will ensure that there is effective harmony in the planning and implementation of the treatment patterns. Apart from that studies suggest that engaging the patent in relaxed conversation increases their sense of involvement with the treatment and boosts their psychological recovery (Gitto, Arunkumar, Maiese, & Bolino, 2015). Hence the communicational interventions of the nursing professional regarding the patient under consideration should include engaging the patent in active communication to build a mutually respectful relationship with the patient that will make him feel comfortable and reassured about his safety along with enabling him with confidence to share any grievances with the nursing professional (Sullivan, 2000).

Venous thrombosis prophylaxis:

In any case of brain trauma, the risk of the patent developing venous thrombosis is very high. In case the patient under consideration faces any risk to VTE, the intervention should not be delayed at any circumstances. The most abundantly used intervention for VTE include mechanical compression prophylaxis technique (Damkliang, Considine, Kent, & Street, 2016).

In this technique the various compression devices are used to relieve the blood statis and increase the venous outflow in leg veins. One of them most popular and abundantly used technique for this is compassion stockings that are more effective and with much lesser side effects. Apart from that the patient can also be administered with unfractionated heparin in case the mechanical prophylaxis dose not elicit any results (Mitchell, Kirkness, & Blissitt, 2015).

Infection control:

In case of brain injury patients infection is a common occurrence, with respiratory support they are more likely to develop respiratory tract infections. Interventions to avoid respiratory tract infections in the patient periodic suctioning should be done to ensure that the mucous accumulation in the airways does not lead to any infection and complete oral care should be taken with antimicrobial agents like chlorehexin so that the risk to infection can be overcome (Tume & Jinks, 2008).

Skin care and general hygiene:

General skin care and hygiene can go a long way in patient care, hence the nursing professional should take adequate actions to encourage safe and hygienic stay in the heath care setting. Using antimicrobial washes and sponge bath technique the patent should be properly cared for. Daily excretory hygiene should also be diligently followed (Ladanyi & Elliott, 2008).


Bladder care:

Brain injury can alter the bladder and bowel movements in the patients, and as Mark, the patient under consideration for this assignment is aging, the chances of him developing dysfunctional bladder are high (Balak, Aslan, Serefhan, & Elmaci, 2009).

The interventions should include cleaning the bladder periodically to keep his kidneys healthy. As the patient is incapable of movement the bladder can be cleaned with a catheter, attached to a drainage bag. The nursing professional should clean out the bladder by intermittent catheterization and proper cleaning techniques (Coco, Tossavainen, Jääskeläinen, & Turunen, 2012).

Dressing and wound care:

As the patient has experienced skull fracture due to a fall the dressing care of his wild should not be treated lightly. The dressing should be changed during every bath in a scientific and hygienic manner. Care should be taken that the wound is not contaminated at any circumstances. If there is any tender point or press palpate site in the skull fracture wound, care should be taken so that the delicate skin does not bleed. Furthermore the gauge should be removed twice a day at the least to eliminate any risk of wound infection (Tam, McKay, Sloan, & Ponsford, 2015).

Communication with relatives:

A quality patient centred care is incomplete without taking into consideration the preferences of the patient and their families. Facilitating active and effective communication with the patient family can ensure that there is a harmonious and mutually respectful relationship between both parties. Along with that care should be taken that the patient and his family is adequately informed about the severity of the patient’s conditions and the treatment procedures planned (Coco, Tossavainen, Jääskeläinen, & Turunen, 2012) .

Ethical and legal health care practice compliant with all the legislations enforced by regulatory health care authorities ensures consent and proper patient documentation to be essential in any treatment procedure. Hence it is essential that the nursing professional informs the family about the severity of the patient’s health conditions and discuss the relevance and effectiveness in the treatment procedure prior to administration of any treatment techniques and methods (Coco, Tossavainen, Jääskeläinen, & Turunen, 2012).


Nursing care is vital for any health care concern, irrespective of the severity and complications associated with it. In the face of contemporary health care outfitted with specialized multidisciplinary teams, nursing care is viewed as the most important link between the different disciplines. Without a functional nursing activity the continuum of the treatment procedure dependent upon different disciplines will be compromised. Without proper and effective transmittance of nursing cafe the ultimate goal of patent centred care can never be achieved.

On a concluding note it can be stated that a traumatic brain injury due to a severe depressed occipital fracture can lead to a variety of complications within a very short period of time. Hence a health care concern like that demands a interdisciplinary and extensive nursing care. This situation enlightens us about the need of extensive skills and knowledge that is required for comprehensive nursing care in the current scenario of health and safety. Hence the nursing professionals should enhance their skills and expand their knowledge taking the assistance of evidence based practice. A reflective and integrated practice like based on practical evidences allows the nurses to determine the cause for complication and administer required intervention is a very systematic and scientific manner. Evidence based practice in health care has strengthened the patient centred care exponentially and it can be hoped that it will continue to benefit heath care in the future as well.



Balak, N., Aslan, B., Serefhan, A., & Elmaci, I. (2009). Intracranial retained stone after depressed skull fracture: problems in the initial diagnosis. American Journal Of Forensic Medicine & Pathology , 198-200.

Bell, R., Dierks, E., Brar, P., Potter, J., & Potter, B. (2007). A protocol for the management of frontal sinus fractures emphasizing sinus preservation. Journal Of Oral & Maxillofacial Surgery , 825-839.

Coco, K., Tossavainen, K., Jääskeläinen, J., & Turunen, H. (2012). Providing informational support to the families of TBI patients: a survey of nursing staff in Finland. British Journal Of Neuroscience Nursing , 337-345.

Damkliang, J., Considine, J., Kent, B., & Street, M. (2016). Initial emergency nursing management of patients with severe traumatic brain injury: Development of an evidence-based care bundle for the Thai emergency department context. Australasian Emergency Nursing Journal , 152-160.


Forbes, J., Reig, A., Tomycz, L., & Tulipan, N. (2010). Intracranial hypertension caused by a depressed skull fracture resulting in superior sagittal sinus thrombosis in a pediatric patient: treatment with ventriculoperitoneal shunt insertion. Journal Of Neurosurgery: Pediatrics, , 23-28.

Gitto, L., Arunkumar, P., Maiese, A., & Bolino, G. (2015). A simple depressed skull fracture in an old man with Paget disease: forensic implications in a rare case. Medicine, Science & The Law, , 44-49.

Grant, A., Grinspun, D., & Hernandez, C. (2010). The revision of a workload measurement tool reflect the nursing needs of patients with traumatic brain injury. Rehabilitation Nursing , 306-354.

Ladanyi, S., & Elliott, D. (2008). Traumatic brain injury: an integrated clinical case presentation and literature review: part I: assessment and initial management. Australian Critical Care , 86-95.

Lee, B., E., H., & Poppell, M. (2010). Facial fractures take a special kind of nursing care. Nursing, , 42-46.

Meng, X. &. (2016). Traumatic Brain Injury Patients With a Glasgow Coma Scale Score of ≤8, Cerebral Edema, and/or a Basal Skull Fracture are More Susceptible to Developing Hyponatremia. Traumatic Brain Injury Patients With a Glasgow Coma Scale Score of ≤8, Cerebral Edema, and/or a Basal Skull Fracture are More Susceptible to Developing Hyponatremia , 21-26.

Mitchell, P. H., Kirkness, C., & Blissitt, P. A. (2015). Cerebral Perfusion Pressure and Intracranial Pressure in Traumatic Brain Injury. Annual Review Of Nursing Research, , 111-183.

Morris, C., Kushner, G., & Tiwana, P. (2012). Facial skeletal trauma in the growing patient. Oral & Maxillofacial Surgery Clinics Of North America , 351-364.

Onakomaiya, M. M., Kruger, S. E., Highland, K. B., Kodosky, P. N., Pape, M. M., & Roy, M. J. (2017). Expanding Clinical Assessment for Traumatic Brain Injury and Comorbid Post-Traumatic Stress Disorder: A Retrospective Analysis of Virtual Environment Tasks in the Computer-Assisted Rehabilitation Environment. Military Medicine , Military Medicine.

Ribeiro dos Santos, A. M., de Carvalho Sousa, M. E., Oliveira Lima, L., Nadson de Sousa Ribeiro, N., de Araújo Madeira, M. Z., & da Silva Oliveira, A. D. (2016). THE EPIDEMIOLOGICAL PROFILE OF TRAUMATIC BRAIN INJURY. Journal Of Nursing UFPE , 3960-3968.

Sullivan, J. (2000). Positioning of patients with severe traumatic brain injury: research-based practice. Journal Of Neuroscience Nursing , 204-209.

Tam, S., McKay, A., Sloan, S., & Ponsford, J. (2015). The experience of challenging behaviours following severe TBI: A family perspective. Brain Injury , 813-821.

Tume, L., & Jinks, A. (2008). Endotracheal suctioning in children with severe traumatic brain injury: a literature review. Nursing In Critical Care , 232-240.

Wu, H. Z. (2016). Feasibility of three-dimensional ultrashort echo time magnetic resonance imaging at 1.5 T for the diagnosis of skull fractures. European Radiology , 138-146.


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