Brain Injury Induced Concussion

NURSING 6 6CASE STUDY CASE STUDY ON NURSING Student Name University Name Author Note Nursing Case Study – John Wells A concussion is a form of a brain injury which is mainly caused by trauma, shock or a major blow to the head of an individual (Zuckerman et al. Mr John Wells has been brought to the hospital by his wife, Mavis after she observed him be feeling dizzy, nauseating and experiencing a headache. When the patient was brought

Running head: NURSING
CASE STUDY ON NURSING
Student Name
University Name
Author Note

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CASE STUDY
Nursing Case Study – John Wells
A concussion is a form of a brain injury which is mainly caused by trauma, shock or a
major blow to the head of an individual (Zuckerman et al. 2017). The delicate cells present
inside the brain get damaged as a result of a sudden shock which can further damage the
proper functioning of the brain. Concussion can be sustained by an individual for a number of
reasons like ports, accidental falls or car crashes. Athletes who play basketball, football or
wrestling are at a major risk of suffering from a concussion (Patricios et al. 2018). It is
expected of the person to feel dizzy, nausea, confusion and fatigue. There is also a possibility
of irritability, excessive crying or changes in the sleeping and eating pattern among the
patients who have suffered from a concussion (Grool et al. 2016). In the following report, a
patient named John Wells has been brought to the hospital after suffering a concussion. The
first three stages of the clinical report cycle will be discussed to understand his case from the
point of view of a registered nurse.
Mr John Wells has been brought to the hospital by his wife, Mavis after she observed
him be feeling dizzy, nauseating and experiencing a headache. When he was questioned
further by his wife, it was clear that he was experiencing difficulty in recollecting the tasks
that he had undertaken in the morning. John is an 82-year-old man who has suffered a hit in
the head with a skin tear while riding a motorbike without the helmet in his farm (Sone et al.
2017). There is an increased risk at this age to lose balance and fall which might result in a
grave injury in the head. His choice of not wearing a helmet has turned out to be causing fatal
symptoms leading to a suspected concussion. He is admitted in the emergency department of
the hospital because of the symptoms that he has been presenting with. The patient was
closely monitored by the registered nurse with administration of mild painkillers for the
constant headache. The medical history of Mr John has not been mentioned in the case study.
The wife of the patient had called up her son to assist them in travelling to the hospital for

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treatment. When the patient was brought in, the first thing that was assessed is whether he
was suffering from any sort of external bleeding. It was observed, that he indeed has an
external injury in the form of a skin tear. The registered nurse cleaned the wound and sealed
it with a bandage to avoid the spread of infection. In addition to this, there is also a high
probability of the patient experiencing internal bleeding in the form of a haemorrhage. If it
gets untreated for a long time, it may turn out to be fatal for the patient. It is usual for elderly
patients to lose balance and sustain a head injury. In the event of a patient suffering a
concussion, it is very likely for them to not acknowledge
To understand the situation of the patient medically, several assessments need to be
conducted to make it easier for the nursing professionals and the physicians to properly
provide the treatment. When Mr John was brought in, his orthostatic vital parameters like
blood pressure, respiratory rate, heart rate and the oxygen saturation level were assessed. In
addition to this, it was also assessed whether there was any external bleeding which might
have taken place due to cuts or lacerations in the head. In case of patients who have suffered
a head injury, their blood pressure is expected to be elevated than the normal level due to less
amount of oxygen transferred from the heart to other parts of the body. Due to this, the heart
has to work more to push the blood which makes the body temperature of the individual go
up (Choe 2016). It is because of this reason that the body temperature of Mr John will be
measured. These are the objective data that will be obtained by the registered nurse on duty.
During the assessment, subjective data from the patient needs to be gathered to
understand what he is feeling. The patient would have to share the areas where distress is felt.
It is shared by the patient that he has been experiencing headache, fatigue, nausea and a loss
in his appetite (Elkington & Hughes 2017). On further questioning, he told that when he
returned in the afternoon, he was still feeling dizzy and had headaches. The nurse, then
applied ice packs on the head of the patient to relieve him of the constant headache with

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administration of mild painkillers. For nausea and vomiting tendencies of the patient, anti-
nausea tablets are given with strict advice of no food and water to be taken. It is generally
advised by the physicians to not feed the patient during this critical condition. The patient is
elderly in whom the impact of this kind of accident can have detrimental effects. During the
accident, it is possible for the patient to suffer from a neck injury due to the fall. An x-ray of
the neck region can help in ascertaining the physician of a possibility of a neck fracture.
Further assessments for Mr John will be carried out which will involve objective
questions asked and scored on the basis of the Glasgow Coma Scale (Willmot et al. 2017).
This is a reliable scoring system to be used on patients suffering from traumatic brain injury.
The verbal, motor and the ability to open eyes are the chief measurements which are observed
in this scale. The scale is from zero to fifteen with characteristics of a mild, moderate and
severe medical condition. A score of thirteen to fifteen implies mild concussion in which CT
scan or MRI will not be able to detect the damage.
It can be understood by the tests that have been conducted on Mr John that he might
be suffering from a mild form of concussion. The orthostatic parameters that will be collected
from the patient will probably be above the normal level indicating a traumatic injury to the
brain of the patient. It is usual for a patient to experience headache, fatigue and dizziness in
case of a concussion. As per the balance test conducted, it reveals him to be experiencing
imbalance as he feels dizzy. Antibiotics with regular monitoring must be administered to
improve the medical condition of Mr John (Akella et al. 2019). Abstaining him from work
and proper bed rest for 5 days will ensure complete recovery from the severity of the medical
condition. This recovery plan will help his brain from causing too much stress and wounds
will be healed. In the meantime, careful monitoring of his vital parameters will be carried out
to assess the changes and developments in her health.

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In concluding remarks, it can be understood that Mr John is diagnosed with a mild
form of concussion. The nurse will be conducting an examination to check his hearing,
vision, reflexes, balance and memory. These are the basic diagnostic tests that are used by
nurses to help doctors determine the severity of the concussion. The recovery plan will be
implemented to make him regain his strength. Proper medications need to be administered on
a timely basis so that the concussion heals and restores the proper functioning of the brain.
Proper brain functioning will help him in regaining the physical strength he had lost due to
the injury.

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References
Akella, K., Ibrahim, S., Boden, B. and Chendrasekhar, A., 2019. Anticoagulation is
Associated With Increased Morbidity and Mortality in Concussive Injury Among Elderly
Trauma Patients. International Journal of Scientific Research, 8(5).
Choe, M.C., 2016. The pathophysiology of concussion. Current pain and headache
reports, 20(6), p.42.
Elkington, L.J. and Hughes, D.C., 2017. Australian Institute of Sport and Australian Medical
Association position statement on concussion in sport. Medical Journal of Australia, 206(1),
pp.46-50.
Grool, A.M., Aglipay, M., Momoli, F., Meehan, W.P., Freedman, S.B., Yeates, K.O., Gravel,
J., Gagnon, I., Boutis, K., Meeuwisse, W. and Barrowman, N., 2016. Association between
early participation in physical activity following acute concussion and persistent
postconcussive symptoms in children and adolescents. Jama, 316(23), pp.2504-2514.
Patricios, J.S., Ardern, C.L., Hislop, M.D., Aubry, M., Bloomfield, P., Broderick, C., Clifton,
P., Echemendia, R.J., Ellenbogen, R.G., Falvey, É.C. and Fuller, G.W., 2018. Implementation
of the 2017 Berlin Concussion in Sport Group Consensus Statement in contact and collision
sports: a joint position statement from 11 national and international sports organisations. Br J
Sports Med, 52(10), pp.635-641.
Sone, J.Y., Kondziolka, D., Huang, J.H. and Samadani, U., 2017. Helmet efficacy against
concussion and traumatic brain injury: a review. Journal of neurosurgery, 126(3), pp.768-
781.

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Wilmott, C., McIntosh, A.S., Howard, T., Mitra, B., Dimech-Betancourt, B. and Rosenfeld,
J.V., 2017. Stability of the scat3 and association with game-day head impacts in non-
concussed amateur Australian rules football players. Br J Sports Med, 51(11), pp.A76-A77.
Zuckerman, S.L., Kuhn, A.W., Yengo-Kahn, A.M., Kerr, Z.Y., Totten, D.J., Solomon, G.S.
and Sills, A.K., 2017. Age and sport are associated with higher odds of playing through a
concussion and delayed removal from play. Br J Sports Med, 51(11), pp.A79-A79.