Assessment of the Neurological System (graded)
Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy’s current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist.
Based on the above please discuss the following.
- Pathophysiology of concussive injuries and treatment
- Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)
- Current best practices associated with post-traumatic stress disorder (PTSD)
- Nursing interventions you would include in this patient’s plan of care
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Introduction:
This assignment will discuss the assessment of the neurological system based on a case study of a patient who was admitted to the hospital for mild concussion following a motor vehicle accident. The prompt will cover the pathophysiology of concussive injuries and its treatment, neurological assessment tools used in the current practice setting, current best practices associated with post-traumatic stress disorder, and nursing interventions for this patient’s plan of care.
1. Pathophysiology of concussive injuries and treatment:
Concussion is a common mild form of traumatic brain injury (TBI) caused by an impact or blow to the head. The pathophysiology of concussion involves the acceleration and deceleration of the brain within the skull, resulting in stretching and tearing of axons, which are responsible for transmitting nerve impulses. The severity of the injury depends on the forces applied and the duration of the injury. Treatment for concussion involves rest, avoiding activities that can worsen symptoms, and pain management. In severe cases, surgery may be necessary to reduce pressure within the skull.
2. Neurological assessment tools used in your current practice setting:
One neurological assessment commonly used in the current practice setting is the Glasgow Coma Scale (GCS). The GCS is a standardized tool that evaluates the level of consciousness in patients with traumatic brain injuries. It assesses three areas: eye-opening, verbal response, and motor response. Another assessment tool used is the National Institute of Health Stroke Scale (NIHSS), which is used to assess and quantify the severity of neurological impairment in patients with stroke.
3. Current best practices associated with post-traumatic stress disorder (PTSD):
The current best practices for PTSD involve a combination of pharmacotherapy and psychotherapy. Medications such as selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) have been shown to be effective in reducing symptoms of PTSD. Psychotherapy such as cognitive-behavioral therapy (CBT) and exposure therapy have also been found to be effective in treating PTSD.
4. Nursing interventions you would include in this patient’s plan of care:
Nursing interventions for a patient with concussion would include monitoring for signs of worsening symptoms such as headache, nausea, vomiting, dizziness, and confusion. The nurse should also ensure that the patient gets plenty of rest and avoid activities that can exacerbate symptoms. Pain medication can be administered as prescribed by the physician. In addition, the nurse should assess the patient’s mental health status and refer the patient to a behavioral health specialist or social worker if necessary. The nurse should also educate the patient and family members on the signs and symptoms of concussion and the importance of rest and recovery.
