Case study - Concussion: Nursing

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.