Discharge And Home Healthcare Guidelines

PREVENTION. Teach the patient to use a condom and spermicide for sexual encounters to prevent STIs. Encourage the patient to continue to increase fluid intake and to empty the bladder frequently.

POSTOPERATIVE TEACHING. If the patient had an epididymectomy, teach him to report incisional bleeding, unusual difficulty in starting the urine stream, blood in the urine, or increasing pain and swelling. Remind him of his postoperative appointment and that sexual activity is prohibited until after the postoperative checkup. Suggest the patient use an ice pack and athletic supporter to relieve minor discomfort from the surgery. Tepid sitz baths may also help relieve pain. Remind the patient to avoid strenuous activity and heavy lifting until he is seen by his physician.

COMPLICATIONS. Teach the patient to report problems of impotence to his physician immediately.

MEDICATIONS. Be sure the patient understands any medication prescribed, including dosage, route, action, and side effects. Emphasize the need to complete the course of antibiotic medications, even if symptoms have diminished.

Epidural Hematoma

DRG Category: 014

Mean LOS: 6.4 days

Description: MEDICAL: Specific Cerebrovascular

Disorders Except TIA DRG Category: 002 Mean LOS: 9.8 days Description: SURGICAL: Craniotomy for Trauma, Age > 17

Epidural hematoma is a rapidly accumulating mass of blood, usually clotted, or a swelling confined to the space between the skull and the dura mater. It is usually found in the temporopari-etal region where a skull fracture will cross the path of the middle meningeal artery or the dural branches. It is categorized as a focal brain injury, and it accounts for approximately 50% of all head injuries and 60% of the mortality rate in head-injured patients. If an epidural hematoma expands rapidly, such as when the bleeding is arterial in origin, the injury is potentially fatal. The accumulation of blood rapidly displaces brain tissue and can result in cerebral herniation downward into the posterior fossa or toward the midline into the tentorial notch. If the hematoma is evacuated and bleeding is controlled promptly, the patient's prognosis is good. Mortality rates range from 5% to 30%.

Generally, head trauma involves both a primary injury and a secondary injury. The primary injury results from the initial impact, which causes immediate neurological damage and dysfunction. The secondary injury follows the initial trauma and probably stems from cerebral hypoxia and ischemia, which lead to cerebral edema, increased intracranial pressure (ICP), and brain herniation.

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