Case study - Concussion: Nursing

Nurse Kristen works at a university health clinic and is caring for Jay a 20 year old who is being seen after a mild concussion that occurred while playing football last week.

In collaboration with the registered nurse, Aan Sarika. Nurse Kristen looks through the steps of the clinical judgment measurement model to make clinical decisions about Jay's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Kristen recognizes important cues including Jay's vital signs, temperature, 98.0 °F or 36.7 °C, heart rate, 66 BPM, respirations, 14 breaths per minute and BP.

1 10/60 millimeters of mercury. Jay reports that he has a headache which he rates as a two out of 10 on the pain scale and states he hasn't needed medication to manage his pain.

He also tells nurse Kristen that he continues to be fatigued. Nurse, Kristen then gathers additional information about Js prescribed activity restrictions.

Nurse Kristen says I know your health care provider explained that you'll need to limit your activities for one more week.

How's that been going so far? Jay responds it's been hard.

Football is such a big part of my life without it. I don't know what to do and not being able to drive doesn't help either.

I'm getting stir crazy in my dorm. It got so bad that I drove to a friend's house the other day.

Even though I know I'm not supposed to do that yet. Then nurse Kristen analyzes these cues.

She reviews the electronic health record or E Hr and notes Jay's concussion occurred following helmet to helmet contact during a football game.

She notes his score on the Glasgow coma scale or G CS was 13 at the time of the injury. And today, RN Sarika scored the G CS at 15.

Nurse Kristen knows a concussion is a type of traumatic brain injury that occurs when an event like the head striking a hard object causes the brain to hit the skull.

This leads to a temporary disruption of neural activity resulting in symptoms like a headache, fatigue and altered mental status.

She also knows that during recovery, patients with concussions need to avoid activities that require concentration like driving as well as activities that could cause another concussion like contact sports.

She also considers how activity restrictions can impact a person's self concept since patients may experience a loss of independence and aren't able to take part in activities they enjoy.

Nurse Kristen realizes Jay needs support to improve his self concept resulting from his temporary loss of independence. Now using the information she's gathered.

Nurse Kristen reports her findings to RN Sara and together they choose a priority hypothesis of altered self concept. Then nurse Kristen collaborates with RN Saic to generate solutions to address Jay's altered self concept.

And they established the expected outcome that after intervening Jay will verbalize at least two strategies to promote independence while maintaining activity restrictions.

By the end of the visit, nurse Kristen then takes action to implement these solutions and reenters Jay's room. Hi Jay.

I know you mentioned it's been difficult to deal with your activity restrictions. Are there ways you could spend your time with your teammates even while you're unable to play football?

Hm, maybe I could watch them practice tomorrow. I wasn't feeling up to it last week, but I think I'm ready now.

That's a good idea. And I think that will help you feel more involved.

What about outside of practice? Are you able to see your friends then?

Yeah, I guess I could see if they wanna get together after the game this week. Next nurse Kristen and Jay discuss ways he can compensate for being unable to drive together.

They identify places he can walk to from his dorm room and they review the campus shuttle schedule. Then nurse Kristen reinforces the teaching RN Sarika provided about how to safely resume activities after he's been cleared to do so by his health care provider by taking frequent rest breaks and reducing overstimulation.

Like limiting screen time. At the end of the visit, Nurse Kristen evaluates the outcomes of her actions.

She notes that Jay has verbalized at least two strategies to promote independence while maintaining his activity restrictions.

While he recovers, she then walks him to the front desk and helps him schedule a follow up appointment while he waits for his ride.

All right, it's a quick recap. Nurse Kristen recognized and analyzed cues related to Jay's head injury and in collaboration with RN Sarika prioritized hypotheses and generated solutions to address this problem.

Nurse Kristen and RN Saric then implemented measures and evaluated Jay's outcomes comparing them to the expected outcome.

Since Jay verbalized at least two strategies to promote independence while maintaining activity restrictions. They determined the plan of care was successful.