System Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was
ID: 121808 • Letter: S
Question
System Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy's current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist. Based on the above please discuss the following. Pathophysiology of concussive injuries and treatment Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling) Current best practices associated with post-traumatic stress disorder (PTSD). Nursing interventions you would include in this patient's plan of careExplanation / Answer
1. Concussion is caused due to collision of brain with skull which is an impact based. It is a subcategory of a traumatic brain injury.
An impact injury ---> Collison with skull ---> disturbance in the functioning of brain ---> Brusing and swelling of the brain ---> Tearing of blood vessels and injury to nerves ---> potassium ions rush out of the cells and calcium ions goes into the cells ---> metabolic dysfunction ---> Concussion.
Treatment involves physical and mental rest followed by graded program of exertion which in turn is followed by neuropsychological testing. Generally resolves in 3 weeks but if still persists perform treadmill test if passed light aerobic exercise and if not then alternative diagnoses.
2. Glasgow coma scale; motor scoring scale; spinal cord testing; sensory assessment; sedation assessment and pain assessment.
3. Current best practiced for treating PTSD:-
i) Prolonged exposure therapy- A process in which the client is made to gain mastery of their thoughts and feelings around the incident that caused trauma.
ii)Cognitive processing therapy- Stress on cognitive strategies in order to alter the erroneous thinking that has emerged due to a bad event.
iii)Stress inoculation-A process through which the clients manage and reduce stress through breathing, meditation and positive talk.
iv)Eye-movement desensitization and reprocessing- Therapists guide client to make specific eye movements and hand taps.
v)Medications- Paroxetine (Paxil) and sertaline (Zoloft) which are selective serotonin reuptake inhibitors.
4. Nursing interventions:-
i)Establishing a good relationship with the client in order to build trust.
ii)Asssiting client to overcome different states of emotion.
iii)Desensitizing client to his/her memories of the bad event.
iv)Stressing the need of medictains to client.
v)Maintaing a positive atmosphere.
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