Nursing Care And Interventions For Subdural Hematoma And Mild Traumatic Brain Injury

Admission Assessment for Katie

Discuss about the Nursing Care and Interventions.

The term subdural hematoma refers to severe head injury characterized by the accumulation of blood covering the brain tissues (Barr et al., 2013). Also, a subdural hematoma can occur during a mild head injury. For instance, it can be when a person is knocked down by a slow moving car. Recent studies indicate that the condition is high amongst adults (Crisp et al., 2013). Moreover, in most cases clinician have reported that the condition can go unnoticed for up to two weeks; after which the person will start presenting signs of a headache, loss of consciousness, and/or slurred speech. Interestingly, the term subdural hematoma is often used along with mild traumatic brain injury. Mild traumatic brain injury abbreviated as TBI is a brain disorder associated with loss of a consciousness and severe headache (Feigin et al., 2013). As such, the case study Katie McConell is a twenty-three-year-old woman who sustains a subdural hematoma eighteen hours after she was hit by a slowly moving car. The patient is then admitted to the emergency department and later referred to a neurosurgical trauma unit. Katie is diagnosed with mild traumatic brain injury and also presents with sore ankles from years of basketball: though she does not like using painkillers. As such, the ideas in this paper seek to illustrate the use of Levett-Jones (2013) clinical reasoning cycle in the formulation of interventions for admission assessment. Notably, the paper will have several sections discussing the five steps of the clinical reasoning cycle. Furthermore, the paper will have a succinct summary of ideas concerning the thesis statement as shown below. 

The patient Mrs. Katie McConell is admitted to the acute emergency care unit. The client is a 23-year-old lady and presents to the emergency department with mild traumatic brain injury characterized by loss of consciousness. Katie’s husband states that the condition occurred eighteen hours ago and after checking with the emergency department Katie was referred to a neurosurgical trauma unit to receive ongoing assessment and rehabilitation. After assessing Katie, it is evident that she has sore ankles. The problem is underpinned by the continuous vigorous exercises and contact associated with basketball.

The data collection process was done with the help of medical equipment and by word of mouth. The oral data collected includes a severe headache, loss of consciousness, and complains of sore ankles (Levett-Jnes and Hoffman, 2013). The conceptualization of data using medical equipment includes report handed over by the former nurse indicating the following results: HR-89, BP, 142/78 mm/Hg, SpO2-96%, RR-13, and a Glasgow Coma Score of 13. Further, her husband played a significant role in helping the nurses in charge to get the past medical history of Katie. Additionally, during the data collection phase, the nurses included a Paced Auditory Serial Addition Test abbreviated as the PASAT to gauge the level of severity of Katie (Godbolt et al., 2014). The model entailed a four-hour experimental protocol completed twice by Katie. During the phase, Katie interacted with several neuropsychological testing and emotional status testing. To that end, it is possible for the clinician in charge to manipulate the provided information and implement the best medical interventions for Katie.

Considering Katie’s Situation

The section of the paper pays attention to the collected information and provides a justification. The assessment indicated that Katie had a high HR but operating within normal range of 65-100 mm/Hg. Moreover, Katie’s blood pressure is higher than the estimated normal range of 120 mm/Hg. The RR is greater than the normal range. Further, the SpO2 indicated 96% without additional oxygen. As such, it is evident that the high RR and the HR are due to a severe headache and emotional disturbances (Zetterberg et al., 2013). Again, the clinical features of struggling to remember information but recalls with some degree of prompt indicate post-injury symptoms of concussion syndrome (Skolnick et al., 2014). Notably, the reduction in the central blood volume led to increase in the HR. Besides, the examination revealed that the increased HR and RR alludes to the reduced metabolic activities such as impaired breathing (Hungerford et al., 2015). With that in mind, it is considered wise to allow Katie access a simple face mask to supplement the low levels of SpO2 at a rate of 100/min. The PASAT test indicated that Katie was slower in responding to questions as well as slow in regaining; could process presented information slowly.

The section provides a justification for the recorded information regarding loss of consciousness and sore ankles. The nurses noted that cognitive ability of Katie interfered with hence impaired communication skills, low memory, low processing and understanding of information, and impaired impulses. Attention and concentration issues: Katie presented with problems of handling long hours conversations, and she was kind of restless. As such, the clinical interventions for the problem include but are not limited to ensuring Katie communicates in a room with reduced distractions. Also, it is advisable to begin exercising Katie on attention skills such as reading short stories. Problems with processing and understanding information: Katie took a longer time to respond to nurses’ questions and when explaining herself. Therefore, it will be important for Katie’s husband to intervene and answer some questions on her behalf (Levett-Jones and Hoffman, 2013). Issues regarding cognitive results and rehabilitation for Katie calls for the implementation of two evidence-based interventions; remediation with an aim to advance impaired skills and compensation model to allow Katie learn new techniques for synthesizing and communicating (Tan et al., 2015). Subsequently, the sore ankles are a result of vigorous exercises of the sport and contact situation and less recovery time. However, it can be deduced that the sore and swollen ankles are due to poor blood circulation as a result of a blood clot on brain tissues (Johnson et al., 2013).

Collecting Cues and Information

What is more is the medical prescription for Katie; which is aimed at reducing the severe headache and the sore ankles. The medication to reduce the brain injury include: “diuretics”: given to Katie to reduce the amount of fluid in the brain tissues. “Anti-seizure drugs”-will only be administered if Katie presents with a seizure. “coma-inducing drugs”-the nurses will induce the drug to allow the comatose brain cells to use less oxygen. Subsequently, when the condition persisted, the nurses referred Katie to a neurosurgical trauma unit for surgery. The surgery is aimed towards removing hematomas, repairing the fractured skull, and at times to open a new window in the skull to drain accumulated cerebral spinal fluid (Karr et al., 2014). Further, after the surgery, Katie will be introduced to a rehabilitation program made up of the following specialist: a psychiatrist-health professional who manages rehabilitation problems and offers a medical prescription. The occupational therapist will facilitate learning and advance performance of daily activities. Physical therapist- a specialist who helps Katie with mobility and gain balance after surgery (LeMone et al., 2014). Speech and language pathologist helps Katie improve communication skills. Traumatic brain injury nurse specialist-expert who helps in coordinating care and educates family members about injury and recovery (Wintermark et al., 2015). 

In the Levett-Jones (2013) clinical reasoning cycle evaluation of outcomes is considered a vital section that determines the cost effectiveness medical prescriptions and the impact of formulated interventions in combating the situation. Furthermore, another section of interest is a reflection on the process and new learning. Reflection on the process is a period in the clinical cycle reasoning that allows the health professionals time to internalize on what s/he has been doing throughout the assessment (Levett-Jones and Hoffman, 2013). The process is important as it allows the health professional to make the best of choices regarding intervention implementation (McKenna and Mirkov, 2014). Again, the phase serves as a learning period: where new medical interventions are sought and assessed for their effectiveness before implementation (Xiong et al., 2013). In line with the case study, it is evident that from reviewing the different literature on managing traumatic brain injury the nurse in charge was able to come up with new techniques of engaging the patient. Also, the reflection phase allowed the nurse to learn from his/her mistakes. Another key thing to remember is that the reflection and new learning section renders the clinical reasoning cycle vital as it offers a platform for learning ways to solicit information from the patient without violating one’s cultural beliefs and emotional status (Roozenbak et al., 2013). Therefore, it can be concluded that the section is a platform for promoting recovery and well-being of patients presenting with lived experiences of traumatic brain injury.

Processing Information

Conclusion

That said, it is possible to discern that inclusion of Levett-Jones clinical reasoning cycle allows medical professionals time to assess, monitor, and treat patients to their satisfaction. For instance, the procedural processes outlined in the discussion ranging from considering the patient’s condition to detailing the assessment allows nurse and patients to engage with an aim to treat the disorder. Also, having family members involved in a treating plan ensures the sustainability of the program. That is having Katie’s husband around the clinical setting facilitated formulation of best intervention regarding provided past medical history. Further, the section n detailing the assessment has proved to be of significant value as it allows reflection and new learning. The nurses in charge are allowed to refer to their clinical practices and internalize; a process that allows coming up with the best alternatives t treat traumatic brain injury. Also, the phase allows a physician to learn new techniques of treating and engaging with patients through sharing of information with fellow nurses or patients. 

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