Patient Assessment: Mr Robert Brown

Read about the patient assessment of Mr Robert Brown who was hit by a car and is suffering from mild traumatic brain injury. Learn about the normal and abnormal data of the patient, the consequences if no action is taken, and the priority nursing diagnosis related to the case.

Student number:
CNA253 AT2 Scenario: Mr Robert Brown
Consider the patient
situation
Mr Robert Brown is a 30-year-old male who was hit by a car. The impact caused him to be thrown into a nearby garden bed. Passers-by came to
his aid immediately. They helped him up and noticed he was bleeding from a laceration to the back of the head. He sustained no other obvious
injuries. An ambulance was called. He has been at hospital for nearly 24 hours and was transferred to your ward overnight. It is now 0800 and
you have just come on shift. You enter his room and he seems to be unsure of where he is (requires orientation) and keeps asking other patients
the location of his dog (whom Robert was walking at the time of the accident).
Collect Cues Review:
Examine existing documentation via the assessment resources folder in MyLO.
Gather new information (patient assessment):
Upon undertaking an assessment of Mr Brown, you obtain the following new information:
Vital signs
BP: 160/95 (high) NORMAL 120/80
Pulse: 111bpm (high) NORMAL 60-100
RR: 18 NORMAL 12-20
SaO2: 98% NORMAL 95-100%
Temp 36.6O C NORMAL 36.1oC – 37.2OC
O2 flow rate: ≤ 3 NORMAL 2-6 LPM
Other data
GCS: 15 (patient seems confused/agitated) and keeps rubbing at his head and mumbling that it hurts. Whilst his movements seem purposeful, he
does not obey commands or accurately answer specific questions). The patient in the adjacent bed says to you 'that poor bloke, he's been up half
the night. He keeps going on about his dog and gets lost when he goes to the bathroom'.
Wound chart: no further documentation evident. However, upon looking at Mr Browns head wound from a distance, dressing appears blood
soaked and has partly come off. There are smears of blood on his pillow.
Interpret:
List of normal and abnormal data of the patient.
Normal (Subjective & Objective) Abnormal (Subjective & Objective)
Temperature = 36.6O C NORMAL 36.1oC – 37.2OC
SO2 = 98% NORMAL 95-100%
Respiratory rate = 18 NORMAL 12-20
GCS = 13 Severe: GCS 8 or less Moderate: GCS 9-12 Mild: GCS 13-15
High blood pressure = 165/95 (Hypertension) NORMAL 120/80
Pulse rate high = 111bpm NORMAL 60-100bpm

O2 flow rate = ≤ 3 NORMAL 2-6 LPM
(Scanlon and Sanders 2014).
Bleeding from laceration to back of head
Poor orientation
(Kumar and Gandhi 2014).
Relation and Inference according to the data and symptoms:
Through, evaluation of Mr Brown case study, it is noted that GCS score of Mr Brown is 13 as compared with the normal range which is near to 15. GCS
level is used to record the level of consciousness in a person by assessing the eye response, motor response and verbal response of person due injury in Brain
(McNett et al 2014). The score below 3 depict there is permanent damage of cells in Brain. Reviewing the pathology of brain injury, it can be understood that
GCS score of 13 depict mild traumatic brain injury which show temporary neurological indications (McKee and Robinson 2014). By Considering the study
of neurological observation of Mr Brown, sign of confusion, bewilderment and deficient in attention was noticed. (Kehoe et al 2016). In Mild traumatic
injury the brain cells are affected which might result in loss of consciousness, concentration problem and profound confusion (Kristman et al 2014). The
reason behind such is changes in white mater of brain which cause disruption of neurological signal transmission. (Johnson, Stewart and Smith 2013). In
relation to symptoms of pathophysiology of brain injury it can be inferred that Mr Brown is undergoing mild cognitive impairment. The diagnosis calls for
behavioural treatment by monitoring Mr Brown closely at home regarding occurrence of any other symptoms (cook et al 2013).
Another abnormal result observed in Mr Brown is high blood pressure after the injury because after giving pain killer, the blood pressure was high. On
observation at 2100 and 2300, blood pressure was slightly high however, on reviewing at 0800, his pressure was got to 160/95. Looking into the pathology of
hypertension after injury, the brain cell gets damaged and diffusion of cerebral edema cause in increase in ICP which result in complex interaction of
neuroendocrine response by stimulating autonomic system of brain with disruption of catecholamine pathway (Kinoshita 2016). Hypertension also result
from increase in blood flow due to injury, which might also result in high heart rate in Mr Brown (Sheriff and Hinson 2015). Thus, needs clear monitoring,
proper treatment and medication.
Based on the interpretation of all information, the disorientation in behaviour of Mr Brown is due to his changes in brain functions after injury. Mr Brown
was hit by a car, which might have altered his brain signalling pathway and cause high blood pressure and high pulse rate. (Stocchetti and Maas 2014).
However, matter of concern in case of Mr Brown is his condition has not been better as he is constantly looking for his dog and is in state of confusion. There
is a great need to control his blood pressure otherwise this may lead to severe consequences of blood vessel damage and wound healing. There is also need to
manage his wound as because his wound was found soaked in blood.
Result and consequences to the patient if no action is taken:
The patient who have mild brain traumatic injury, face severe consequence if no action is taken in time of if left untreated. The brain injury can cause severe
problem both physical and emotional which might cause depression. Brain traumatic injury cause damages of brain cell and signalling pathway, there can be
extreme neurological failure. If the injury has cause hypertension then, this may cause blockage or heart failure if no immediate action has taken. As the poor
result of this, the patient may face loss of vison, hearing capability as well as problem in speech as because there is disruption in signalling pathway of sense
organs (Hutchinson, et al 2013). Patient may also undergo mental retardation. Where he may face problem in remembering thing or may struggle in reading
and writing (Li and Liu 2013).

Priority nursing diagnosis related to case:
The three prioritise nursing diagnosis given to Mr Brown are as follows:
1. There is need to diagnose the reason behind high blood pressure even after given paracetamol, as this may cause late recovery.
2. To determine the behaviour changes and cognitive problem like profound confusion and loss of consciousness.
3. Need to deal with wound soaked in blood as this may cause loss of blood from body.
Goals, Actions and Evaluation:
Diagnosis 1 Goals Related actions Rationale Evaluate outcomes
Raise of blood pressure in
patient after injury in head.
To decrease the level of
blood pressure to normal
range for faster recovery and
to control the loss of blood
due to injury (Bodenheimer
and Smith 2013).
1. Nurse need to
carefully monitor the
blood pressure at
regular interval.
2. Anti-hypertensive
medicine should be
administered to the
patient (Ma et al
2014).
3. Nurse need to keep
regular observation
on the rate and
rhythm of apical and
peripheral pulse
(Peeters et al 2014).
1. This will keep a
regular record of
blood pressure and be
useful to observe the
changes when given
medicine.
2. This will allow to
bring the blood
pressure down to
normal range and
recover fast from
mild traumatic injury.
3. To notice the
consequence of
hypertension on heart
and blood vessel.
(Mersal and Mersal
2015).
1. After proper
diagnosis and setting
plan and action
accordingly, Mr
Brown will be able to
manage the
consequences that he
might have face if he
was left untreated
with the issue
connected with
hypertension.
2. Medication will help
to control blood
pressure. By
checking the blood
pressure at regular
interval will help to
know the
effectiveness of
medicine provided to
him.
3. His wound infection
will be treated fast,
which can be
evaluated by
continuous dressing
of his wound.

4. Bleeding will be
controlled soon.
5. Brain traumatic
injury will not cause
damage to his brain
after controlling his
hypertension.
Diagnosis 2 Goal/s Related actions Rationale Evaluate outcomes
1. To determine the
behaviour changes
and cognitive
problem like
profound confusion
and loss of
consciousness.
To improve the neurological
disorder of patient and to
recover from the
consciousness and
confusion.
The related action taken to
contradict the issue are
1. Keen observation on
the patient’s
behaviour and level
of consciousness
need to be assess.
2. Mr. Brown was seen
to be confused and
anxious about his
dog, so nurse need to
give him mental
support and keep him
calm (Giacino et al
2014).
3. The patient must be
indulged in regular
conversation with
nurse and keep him
reminding about the
date, time and family.
1. This will evaluate the
improvement of
neurological
condition of patient
on giving proper
medicine.
2. This will help him to
manage his emotion
and level of
depression.
3. As patient with
traumatic brain injury
may cause memory
loss, so this will
make him keep all
his memories.
1. By keeping check on
his behaviour and
maintaining daily
record his outcome
can be better
evaluated.
2. His recovery
symptoms will be
monitored and related
action shall be taken.
3. Neurological disorder
will be treated and
managed well.
4. The consequence
related to
neurological disorder
will be diminished.
5. He will be in
hydrated state.
6. Early recovery.
Reference list:
Bodenheimer, T.S. and Smith, M.D., 2013. Primary care: proposed solutions to the physician shortage without training more physicians. Health
Affairs, 32(11), pp.1881-1886.
Cook, R.S., Gillespie, G.L., Kronk, R., Daugherty, M.C., Moody, S.M., Allen, L.J., Shebesta, K.B. and Falcone Jr, R.A., 2013. Effect of an educational
intervention on nursing staff knowledge, confidence, and practice in the care of children with mild traumatic brain injury. Journal of Neuroscience
Nursing, 45(2), pp.108-118.

Giacino, J.T., Fins, J.J., Laureys, S. and Schiff, N.D., 2014. Disorders of consciousness after acquired brain injury: the state of the science. Nature Reviews
Neurology, 10(2), p.99.
Hutchinson, P.J., Kolias, A.G., Czosnyka, M., Kirkpatrick, P.J., Pickard, J.D. and Menon, D.K., 2013. Intracranial pressure monitoring in severe traumatic
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Johnson, V.E., Stewart, W. and Smith, D.H., 2013. Axonal pathology in traumatic brain injury. Experimental neurology, 246, pp.35-43.
Kehoe, A., Smith, J.E., Bouamra, O., Edwards, A., Yates, D. and Lecky, F., 2016. Older patients with traumatic brain injury present with a higher GCS score
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