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A Patient with an Altered Conscious State

Sophie, a 25 year old, was admitted under your care to the High Dependency Unit from the Emergency Department for ongoing observation following diagnosis of grade one sub-arachnoid haemorrhage (SAH). A short time after admission you notice that Sophie has become less responsive and does not appear to be moving her right arm. You notify the medical officer and an urgent CT scan is ordered. Whilst awaiting her CT scan Sophie’s GCS continues to drop requiring her to be intubated for the purposes of the scan. Sophie’s scan reveals a ruptured posterior inferior cerebellar artery (PICA) aneurysm. She is promptly taken to theatre and an emergency surgical clipping is performed.

Sophie was later transferred to the Intensive Care Unit post operatively for recovery. She is intubated, sedated and ventilated with aim to wake her and assess her neurological status prior to extubation. After her condition stabilised, her sedation is ceased to allow her to waken for neurological assessment. As her registered nurse, you perform a full neurological assessment and note decreased movement in her right arm and leg, her eyes are opening spontaneously but she is not obeying commands and is attempting to pull out her endotracheal tube. To protect Sophie from self-accidental harm you request permission from the doctor to apply hand restraints.

Later, when Sophie’s husband and mother attend her bedside they expressed their concern over the use of the restraint’s and demand that they be removed. When you try to explain the need for the restraint, the husband becomes increasingly distressed and insists you remove the restraints immediately. Although you try to explain the temporary need of restraints, the husband refuses to listen and begins to remove the restraints stating "you do not have the right to do this to my wife". You then ask the husband and mother to leave the room as their behaviour was upsetting Sophie.

The husband and mother then complain to the Team Leader that they were not consulted regarding the "tying down" of Sophie and wish to make a complaint.
Managing Challenging Behaviour


From the topic objectives listed along with further study, you should now be able to:

1. Outline the major aspects of assessment of patients with challenging behaviour.

2. Discuss current evidence on the management of patients with a range of challenging behaviours.

3. Demonstrate beginning skills in communicating with disruptive patients.

Assignment 1

Use current evidence to discuss the management of the difficult situation outlined in this week’s scenario.  Please outline the key resources that you might use to prepare a plan to support Sophie and her family?


Head is a very important part of human being. Any kind of hemorrhage or injury may cause life threatening situation (Malafouris, 2012). Sophie has serious injury in subarachnoid space located in the brain (Fawcus and Moodley, 2013). This injury decreases the level of consciousness which examined by CT scan. In this situation the patient should have gone through several ups and downs. And the clipping in the particular area of injury is needed for the fastest cure of the patient. After clippings the sedation is the most important part and the behavioral changes has been seen when the patient awaken for neurological procedures (Clarke et al., 2013). Every part of the investigation is very important and the assessment of the different neurological procedure is needed for further medication. The tying of the hand is very important for the patient who undergoes some vital head injury and continuously not responding to anyone. The continuous movement of hand and leg may cause another severe injury to the patient when she may be examined through some procedures. The complex behavior of Sophie’s husband may hamper the normal procedure of analysis (Kolev, Georgieva-Zhostova and Berthoz, 2014).

The current scenario is very critical as the patient undergoes cerebral operation and surgery of clipping has been already done. The unconditional movement of right hand and leg may cause self health destruction (Heesen et al., 2013). To stop this movement the tying up of hands of the patient is a very necessary step and the doctors are also agreeing with this. The condition of Sophie is not so good because she is having injury in posterior cerebella artery and which causes the loss of consciousness and the ultimatum of this situation is death. After operation Sophie is not cure properly that is why she needs to go under some investigational procedure so the treatment is very necessary which can’t be possible without this investigation. The emotional breakdown of Sophie’s husband may cause hamper to Sophie’s life so this very important to understand the procedural requirement.

The skill is required to manage the situation because nursing the field of care and help so the situation should be handled very carefully. Brain damage is the condition where a chance of death is the common factor. The condition of Sophie is very sensitive and she already gone through a surgery. So husband of Sophie should understand the situation and help doctors and nurse to improve her situation. The way of communication to her husband may be rude but this for the betterment of Sophie and to save a life is the first choice for any medical professionals (Welter and Smallbone, 2014).  Clearer talking about the situation is very important with the guardian of the patient and they also need to understand the situation of Sophie.



Clarke, M., Wilson, K., Girdler, N. and Stassen, L. (2013). Effect of patient position and verbal interaction on recovery following intravenous sedation. Oral Surgery, p.n/a-n/a.

Fawcus, S. and Moodley, J. (2013). Postpartum haemorhage associated with caesarean section and caesarean hysterectomy. Best Practice & Research Clinical Obstetrics & Gynaecology, 27(2), pp.233-249.

Heesen, C., Köpke, S., Solari, A., Geiger, F. and Kasper, J. (2013). Patient autonomy in multiple sclerosis — Possible goals and assessment strategies. Journal of the Neurological Sciences, 331(1-2), pp.2-9.

Kolev, O., Georgieva-Zhostova, S. and Berthoz, A. (2014). Anxiety Changes Depersonalization and Derealization Symptoms in Vestibular Patients. Behavioural Neurology, 2014, pp.1-9.

Malafouris, L. (2012). More than a brain: human mindscapes. Brain, 135(12), pp.3839-3844.

Welter, F. and Smallbone, D. (2014). Institutional perspectives on entrepreneurial behavior in challenging environments. IEEE Engineering Management Review, 42(2), pp.35-50.


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