Case study - Head injury (pediatric): Nursing

Nurse. Tasia works in a pediatric primary care clinic and is caring for Justin, a 10 year old who is being evaluated following a concussion that occurred during a soccer game one week ago in collaboration with the registered nurse, RN Christine nurse Tyesha goes through the steps of the clinical judgment measurement model to make clinical decisions about Justin's care by recognizing and analyzing cues, prioritizing hypotheses, generating solutions, taking action and evaluating outcomes.

First, nurse Taesa recognizes important cues including Justin's vital signs which are temperature 98.9 °F or 37.1 °C, heart rate 100 BPM, R 16 breaths per minute and BP 104/70 millimeters of mercury.

Justin reports a mild headache and rates it as a two out of 10 on a numeric pain scale. Justin is alert and oriented to person place and time.

There's also a small healing bruise above his left eyebrow. Nurse, Taesa gathers additional information from Justin and his caregiver Mary, whos at the bedside.

Hi, Justin, how are you feeling? Um ok.

My head feels kind of, he just hasn't been acting like himself since the injury. He's been irritable and forgetful, especially with his chores, which just isn't like him.

He's especially tired after school and I noticed he gets frustrated when working on his computer or even when he's playing video games or watching television, I can answer for myself.

Mom. I just feel tired.

It's making me grumpy and my head is kind of fuzzy. Next nurse, Taesa analyzes these cues.

She reviews the electronic health record or, EHR and notes that Justin's concussion occurred following head to head contact during a soccer game one week ago, although he didn't lose consciousness, he had poor coordination following the event.

Nurse Taesa knows a concussion is a type of closed head injury that occurs when an event like the head striking a hard object causes the brain to hit against 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 reduce the time they spend on activities that require concentration like using a computer playing video games or sending texts on a phone and avoid activities that could cause another concussion like contact sports.

Next nurse Taesa reviews his score on the Glasgow coma scale or GCS which was 13 at the time of the injury. And today RNR scored the GCS at 15.

Nurse Taesa realizes Justin and Mary need support to improve Justin's concussion symptoms. Now using the information Shes gathered nurse Taisha reports her findings to RN Cristin.

And together they choose a priority hypothesis of altered cognitive function. Nurse Tyesha collaborates with R Andrine to generate solutions to address Justin's altered cognitive function.

And they established the expected outcome that after intervening, Justin will demonstrate decreased forgetfulness and irritability by his follow up visit.

Nurse Taesa then takes action to implement these solutions. She reviews with Justin and Mary what to expect during recovery from a concussion.

She stresses the importance of avoiding activities that could result in another head injury and to limit activities that can exacerbate concussion symptoms.

She also reminds them to ask Justin teachers for additional time to complete his schoolwork and to continue to use the medical excusal note from the healthcare provider.

Do you have any additional questions? Does this mean I cant play soccer at tomorrows game?

Unfortunately? Yes, you will need to be cleared by the healthcare provider before you can start playing again.

We are just going to focus on rest and relaxation for the next week. No more screen time until youre feeling better.

Uh fine. But what about chores?

No more chores for you either? Yes, that sounds like a good plan.

One week later, Justin returns to the clinic and nurse Taesa evaluates the outcomes of her actions. She takes Justin's vital signs which are temperature 98.9 °F or 37.1 °C, heart rate 90 BPM.

Respirations, 15 breaths per minute and BP, 100/80 millimeters of mercury. Justin reports that hes feeling less tired and doesnt have headaches anymore.

Mary also reports that Justin is no longer irritable or forgetful. All right, as a quick recap, nurse Taesa recognized and analyzed cues related to Justin's altered cognitive function.

And in collaboration with RNR prioritized hypotheses and generated solutions to address this problem. Nurse Taesa then took action by implementing measures to address Justin altered cognitive function and evaluated his outcomes comparing them to the expected outcome.

Since Justin demonstrated decreased forgetfulness and irritability by his follow up visit. Nurse Tyesha and RNR determined the plan of care was