Clinical Reasoning Cycle For Patient With Mild Traumatic Brain Injury: Essay.

Consideration of Patient's Situation

How To the Save Consideration of the Patient’s Situation?

Clinical reasoning cycle developed by Levett Jone is an important aspect of nursing practice where the nurses collect cues, information and through understanding of the problem of the patient, plan and implement the interventions (Mather, McKay & Allen, 2015). It also encompasses the evaluation of the outcomes and learn and reflect from the whole process. It is effective for the nurses as it helps to facilitate positive outcomes with effective clinical judgment. The clinical knowledge and thinking abilities of the nurses is important for the competent nursing professional practice. The following essay deals with the case study of a 23 year old woman, Katie McConnell diagnosed with mild traumatic brain injury. It encompasses the patient assessment with the help of the clinical reasoning cycle and the key elements incorporated in the assessment.

The first step in the cycle is the consideration of the patient’s situation. In the given scenario, a 23 year old woman, Katie McConnell was admitted to the hospital after being hit by a slow moving car 18 hours ago. She sustained a subdural hematoma as a result of the accident. It is a condition that is associated with the traumatic brain injury where the blood gets accumulated below the layer of arachnoid matter and dura layer (Kanamaru et al., 2016). This occurs in patients who have encountered head injury whether severe or mild. Katie was also diagnosed with mild traumatic brain injury requires neurological treatment as head injury requires detailed assessment and treatment in the neurological department.

The next step is the collection of cues and information about patient. After observing Katie’s present condition, it is important to collect the relevant information that encompasses the vital signs and significant parameters. For the clinical presentation, it is important to review the handoff information and gather the relevant information. The information handed by the previous nurse consists of the vital signs like the blood pressure 142/78, heart rate 89, RR 13 and SpO2 of 96%. The Glasgow Coma Score (GCS) was marked 14 and illustrated some difficulty with her recent information and while recalling (Teasdale, 2014). However, she was able to call with some prompting. It is a neurological scale that provides an objective and reliable way of recording a person’s conscious state for the subsequent and initial assessment. The scale provides the assessment where if the patient scores between 3 that indicates deep unconsciousness and used to assess the patient’s level of consciousness. The brain injury is classified into three categories according to the rating on the scale. The score of less than 8 to 9 indicates severe head injury. If GCS score is 9 to 12, it shows moderate brain injury and a score of more than 13 indicates mild brain injury (McMahon et al., 2014). As Katie scored 14 on the GCS, it clearly depicts that she had a mild traumatic brain injury. As a result of this, she is facing problems with her recent memory and developed mild neurological symptoms.

Collection of Cues and Information

Other vital signs of Katie like HR and blood pressure also taken into consideration. She showed normal heart rate depicting stability as her HR is 89. However, she is having high blood pressure which is 142/78. This might have resulted as a manifestation of mild traumatic brain injury. This condition occurs as the brain injury might have damaged and weakened the blood vessels of the brain making them narrow, leak or rupture. One more condition can occur where there would be formation of blood clots in the arteries that head towards the brain constricting the blood flow and raises the blood pressure (Hartvigsen, 2014). This results in hypertension where the intracranial pressure elevates due to systemic or local inflammation changing the brain blood flow. In case of Katie, SpO2 is normal as it is 96% indicating normal breathing. These vital conditions show that Katie needs serious attention towards her memory problem and her neurological symptoms.

The next step is the processing of information. In this step, the information gathered from the clinical handover is processed in this step. It presents the symptoms of the patients that is required for the further assessment. The clinical handoff highlighted the important parameters of Katie like hypertension, subdural hematoma as a result of traumatic brain injury and memory problems where it is difficult for her to recall the recent information. These symptoms are caused as a result of the traumatic head injury after was hit by a slowing moving car before she was rushed into the emergency department. As a result, there are memory problems due to the damaging of the parts of the brain that deals with remembering and learning abilities (Kristman et al., 2014). It also affects the areas of the brain that deals with recent memory and recalling of information. These problems greatly hampered her memory, attention and concentration.

The clot that is formed between the arachnoid and dura layer called subdural hematoma resulted due to the traumatic brain injury. It is caused by two mechanisms; impact and brain movement inside the skull (Rumalla, Reddy & Mittal, 2017). The sudden blow to the head by the slow moving car causes subdural hematoma. This kind of head injury can cause transient neurological loss of function and memory problem. The GCS showed 14 that shows mild traumatic brain injury which is not severe, however, requires medical attention and immediate treatment. As her past medical history says that she had painful ankle while playing football and takes no medication for it, this shows that her treatment requires proper attention to her past medical history.

Processing of Information

The next step in the cycle is the judgment of the present condition of the patient. In this critical thinking is required to focus on the health assessment and immediate treatment. The memory problems and subdural hematoma are critical parameters that require health assessment with neurological problems. After GCS, it is easy to understand the extent of neurological and memory problems in Katie. She scored 14 on the GCS which shows that it is a mild traumatic brain injury and requires special assistance and neurological rehabilitation (Reith et al., 2016).

When compared to normal individuals, the problem with memory and recalling of recent information is not witnessed in them. In normal individuals, this type of brain injury is not sustained. However, Katie had sustained subdural hematoma as a result of mild traumatic brain injury after being hit by a slow moving car. This sudden blow to the head damages the head and causes neurological problems like memory and cognition. This mild traumatic head injury may cause loss of unconsciousness along with confusion, headache and dizziness, trouble with memory, attention, concentration or thinking (Levin & Diaz-Arrastia, 2015). These symptoms were manifested as a result of mild traumatic head injury in Katie that showed trouble with recalling of recent information. Therefore, the health assessment involves the treatment of these neurological and memory problems that might progress towards the neurological disorders in Katie.

The next step involves the physical assessment that involves the technique and patient consideration. Firstly, it is required to monitor and look for the persistent cognitive, somatic or behavioral symptoms that followed the mild traumatic brain injury. A standardized scale called the Rivermead Post Concussion Symptoms Questionnaire can be used to monitor the above symptoms (De Guise et al., 2016). There should also be assessment for the symptoms like dizziness, headache, confusion or concentration or attention troubles. Further for the assessment of the mild memory problems, it is important to undertake the cognitive assessment test that helps to detect the level of memory impairment in Katie. As her memory and recalling of recent information is impaired and recovered with some promptness due to mild traumatic brain injury, it is important to assess the level of impairment of memory in her. As she is having problem with the recent information, it illustrates that she is having some problem with her limbic system in the temporal lobes that requires proper assessment (Warrington, 2014). Various tests need to be carried out that evaluates her working memory. This can be done by showing her some images or objects and then telling her to recall after a specified time. The level of cognition need to be analyzed via cognitive assessment technique where she would be asked to perform tasks that involves thought process and cognitive skills.

Judgment of Present Condition

Moreover, the neurophysiological assessment is also required to determine the treatment based on the cognitive functioning. This testing determines the level of functioning and cognition in Katie (Kotchoubey et al., 2013). As she is having problem with her memory, it is advised for her to undertake this assessment to study the psychological consequences in Katie. As a result of subdural hematoma, this assessment is important that facilitate Katie’s treatment.

The case study of Katie is the clinical presentation for mild traumatic brain injury with sustained subdural hematoma. The clinical reasoning cycle provides an appropriate framework for the health assessment of the patient. It develops the judgment and critical thinking of the nurses to carry out the assessment of the patient. With the help of clinical reasoning cycle, the assessment for Katie was done who sustained the subdural hematoma after being hit by ba slow moving car. She was diagnosed with mild traumatic brain injury that helps to determine the planning and further assessment based on symptoms and present condition.

References                                                           

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