Video Case Study - Caring for Patients With Head Injury

Nurse Kristin 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, RN Sarika, Nurse Kristin goes 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 Kristin recognizes important cues, including Jay’s vital signs, which are temperature 98.0 F or 36.7 C, heart rate 66 beats per minute, respirations 14 breaths per minute, and blood pressure 110/60 mmHg.

Jay reports that he has a headache, which he rates as a 2 out of 10 on the pain scale, and states he hasn’t needed medication to manage his pain.

He also tells Nurse Kristin that he continues to be fatigued. Nurse Kristin then gathers additional information about Jay’s prescribed activity restrictions.

Nurse Kristin: I know your health care provider explained that you’ll need to limit your activities for one more week. How has that been going so far?

Jay: 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 yet.

Then, Nurse Kristin analyzes these cues. She reviews the electronic health record, or EHR, 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 GCS was 13 at the time of the injury, and today RN Sarika scored the GCS at 15.

Nurse Kristin 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 Kristin realizes Jay needs support to improve his self-concept resulting from his temporary loss of independence. Now, using the information she’s gathered, Nurse Kristin reports her findings to RN Sarika, and together they choose a priority hypothesis of altered self-concept.

Then, Nurse Kristin collaborates with RN Sarika to generate solutions to address Jay’s altered self-concept; and they establish 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 Kristin then takes action to implement these solutions and re-enters Jay’s room. Nurse Kristin: Hi, Jay.

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

Jay: Hmm, maybe I could watch them practice tomorrow. I wasn’t feeling up to it last week, but I think I’m ready now.

Nurse Kristin: 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? Jay: Yeah, I guess I could see if they want to get together after the game this week.

Next, Nurse Kristin 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 Kristin 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 screentime.

At the end of the visit, Nurse Kristin evaluates the outcome 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. Alright, as a quick recap… Nurse Kristin 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 Kristin and RN Sarika 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