Health Assessment

Consider the Patient

The patient in the given case study is an 18-year-old male. He is having a past medical history of childhood asthma. The patient has been immunized up-to-date. He was administered with his last tetanus shot 12 months ago. The patient has reported of having no other medical condition or taking any other medication. Patient had a couple of beers with his friends at a bar. He was confronted by a male, who pushed him around. This eventually led to the patient falling and hitting his back of head. It resulted in an injury at the occipital lobe and was marked with evident bleeding at the injury site. The patient was alert and oriented at the time of the accident. He was able to narrate the whole incidence on his own to the emergency care staff. The GCS scale of the patient was normal as well as his vitals. Patient was able to respond well after hitting his head on the ground. The main concern in this given scenario is the associated risk with head injury. Patient can be observed to have an acute head injury. He might have a mild concussion after the hit experienced by him. The patient has hit his head in the occipital lobe. This is a concerning issue as the occipital lobe is responsible for multiple vital functions such as providing a visual field, recognizing objects and places, processing visual information and so on (Howard 2018, pp. 11-41). An injury to this site can hamper the functioning of these capabilities in the person. The patient in the given scenario was intoxicated with alcohol at the given time. The reading for blood alcohol content was found to be 0.06%. This reading of alcohol intoxication is observed to have a negative effect on the body movements under unperturbed and perturbed standing stance (Yadav 2019, pp. 227-245). The patient is also residing away from his family. He has family of his close friend, who he gets emotional from time and on. He has no next of his kin to inform, who might be residing in the same state as the patient. The two main health considerations for the patient in the given case study can be injury to the occipital lobe and his condition of being intoxicated at the time of incident. The state of intoxication can vary the results of the incidences reported by the patient.

Collect Cues

Patient met with an accident while he was intoxicated with alcohol. He had hit his head hard on the ground, which resulted in bleeding from the injury site. There are various nursing assessments to be carried out in the given case scenario which will help in defining the future treatment course of the patient. At the accident site the GCS reported for the patient was 15. The patient was able to recall the incidence on his own and the vitals were noted as normal. However, on arrival in the emergency department the patient had few abnormal vitals noted. His blood alcohol content was noted at a rate of 0.06%, which is considered quite high as per health standards (Altman 2019, pp. 426-438). This amount of alcohol content in the blood can cause alteration in decision-making capacity of the person. The second major concern is the patient having increased blood pressure readings. In cases of acute traumatic brain injuries, the autoregulatory mechanisms are often found to be impaired which can cause an increase in the systemic blood pressure (Meyfroidt 2017, pp. 721-729). This can be found to be directly associated with injury to the cerebral capillaries, resulting in the breakdown of the blood-brain barrier. This leads to an increase in the cerebral edema and thus, and increased intracranial pressure. In cases of traumatic brain injuries, if the blood pressure readings tend to be elevated for a longer duration, it can be a major risk factor for development of stroke in patients (Krishnamoorthy 2019, pp. 382). Generally, hemorrhagic stroke is observed in patients, which can be brought about by increased edema at the injury site and increased intracranial pressure. The other major complication reported in the case is the patient not been able to recall the turn of events after reporting to the emergency care unit. The patient was reported to be alert, but was quite teary in spite of having a significantly lower pain reading. Patient hit his occipital lobe leading to lacerating wound that required surgical management of sutures. Injury to the occipital lobe can lead to the patient having visual field blocks, difficulty in seeing objects, having hallucinations, inability to recognize the happenings in the surroundings and an impaired sense of processing the visual information. Along with high concentration of blood alcohol and injury to the occipital lobe, the incident reported by the patient cannot be relied upon (Sen 2017, pp. 103-107). The nurse should carry out a detailed mental health assessment for the patient. The patient should be further evaluated with the help of diagnostic testing, such as CT scan or MRI (Yue 2020, pp.87). This will help in providing details on the extensive injury that impacted the brain. The reported GCS for the patient in the emergency ward is 14, which can be considered under the patient having a minor brain injury (Bossers 2018, pp. 889-896). Another major underlying issue is the reporting of the incident. As the patient resides alone, with no family member staying nearby therefore, informing the next of kin is also a concern in the given case scenario.

Process Information

The importance of collecting detailed assessment for the patient is quite vital in the given case scenario, this cane done by the means of collecting the vitals and overall emotional and mental well-being of the patient. Detailed clinical assessment helps in identifying the underlying concerning issues to be focused upon. Even with the patient depicting minimal impact from the injury, it imperative that a comprehensive assessment should be carried out for the patient. This is crucial to rule out any possibilities of negative impact on the overall well-being of the patient. It is also vital in nullifying all of the risk factors that are directly associated with brain injury (Oyesanya 2018, pp. 1408-1419). The patient might not reflect on any red flags on physical appearance, but he might be having certain underlying medical concerns. Triaging the patient on the basis of clinical priorities can help in demarcating the health priorities for the patient. As in the given scenario, the few major concerns for the patient are increased blood pressure, alcohol intoxication and laceration wound at the occipital lobe area. Setting the clinical concerns as the priorities can help the nurse in opting for the best diagnostic techniques. This will help in early detection of any signs of abnormality in the patient thus, enabling positive healthcare outcomes from the patients (Varghese 2018, pp. 684). Patient in the given condition is also in a dire need of emotional support with no one having around to support him, the patient needs someone to comfort him. This is required to provide emotional and psychological comfort to the patient. Proper documentation of the turns of events is also important in the given scenario, as it will help in connecting the dots and presenting a clearer picture for best suitable intervention plan to be crafted for the patient, from a holistic point of view (Varghese 2018, pp. 684).

References for Clinical Reasoning Cycle

Altman, C.M., McQuiston, D.E. and Schreiber Compo, N., 2019. ‘How elevated blood alcohol concentration level and identification format affect eyewitness memory: A field study’. Applied Cognitive Psychology, Issue 33, Vol. 3, pp.426-438. ttps://doi.org/10.1002/acp.3535

Bossers, S.M., Pol, K.M., Ophuis, E.O., Jacobs, B., Visser, M.C., Loer, S.A., Boer, C., van der Naalt, J. and Schober, P., 2018. ‘Discrepancy between the initial assessment of injury severity and post hoc determination of injury severity in patients with apparently mild traumatic brain injury: a retrospective multicenter cohort analysis’. European Journal of Trauma and Emergency Surgery, Issue 44, Vol. 6, pp. 889-896. https://doi.org/10.1007/s00068-017-0861-z

Howard, C. and Rowe, F.J., 2018. ‘Adaptation to poststroke visual field loss: a systematic review’. Brain and Behavior, Issue 8, Vol. 8, pp. 11-41. https://doi.org/10.1002/brb3.1041

Krishnamoorthy, V., Chaikittisilpa, N., Kiatchai, T. and Vavilala, M., 2017. ‘Hypertension after severe traumatic brain injury: friend or foe?’ Journal of Neurosurgical Anesthesiology, Issue 29, Vol. 4, p.382. https://dx.doi.org/10.1097%2FANA.0000000000000370

Meyfroidt, G., Baguley, I.J. and Menon, D.K., 2017. ‘Paroxysmal sympathetic hyperactivity: the storm after acute brain injury’. The Lancet Neurology, Issue 16, Vol. 9, pp.721-729. https://doi.org/10.1016/S1474-4422(17)30259-4

Oyesanya, T.O., Bowers, B.J., Royer, H.R. and Turkstra, L.S., 2018. ‘Nurses’ concerns about caring for patients with acute and chronic traumatic brain injury’. Journal of Clinical Nursing, Issue 27, Vol. (7-8), pp.1408-1419. https://doi.org/10.1111/jocn.14298

Sen, N., 2017. ‘An insight into the vision impairment following traumatic brain injury’. Neurochemistry international, Issue. 111, pp.103-107. https://doi.org/10.1016/j.neuint.2017.01.019

Varghese, R., Chakrabarty, J. and Menon, G., 2017. ‘Nursing management of adults with severe traumatic brain injury: A narrative review’. Indian journal of critical care medicine: peer-reviewed, official publication of Indian Society of Critical Care Medicine, Issue 21, Vol. 10, p.684. https://dx.doi.org/10.4103%2Fijccm.IJCCM_233_17

Yadav, A.K. and Velaga, N.R., 2019. ‘Modelling the relationship between different Blood Alcohol Concentrations and reaction time of young and mature drivers’. Transportation research part F: traffic psychology and behaviour, Issue 64, pp.227-245. https://doi.org/10.1016/j.trf.2019.05.011

Yue, J.K., Upadhyayula, P.S., Avalos, L.N., Deng, H. and Wang, K.K., 2020. ‘The Role of Blood Biomarkers for Magnetic Resonance Imaging Diagnosis of Traumatic Brain Injury’. Medicina, Issue 56, Vol. 2, p.87. https://doi.org/10.3390/medicina56020087

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