Pathophysiology of Concussive Injuries and Treatment

Running head: CONCUSSION 1
CONCUSSION
Student’s Name
University Affiliation
Course
Date

CONCUSSION 2
Pathophysiology of concussive injuries and treatment
Concussion refers to an alteration in brain functioning secondary to head blow. It is a
brain injury that is biomechanically induced and it is associated with gross absence of anatomic
lesions. Concussion is also known as Mechanical Insult which is a key initiator of neurological
homeostatic changes of the brain including disruption of energetic metabolism and neurotoxicity
due to mitochondrial dysfunctioning. Injuries of the brain are always categorized as mild,
moderate and severe. Our case study on Mr. Adams focuses on mild concussion secondary to
Motor Vehicle Accident. Treatment is fully dependent on past history of Post-Traumatic Stress
Disorder (PTSD) and the severity of the traumatic injury of the brain (Morton et al., 2017).
In most cases, head injury occurs due to the direct impact to the brain or sudden head
jerking which consequently shakes the brain. The brain acceleration leads to brain injury while
the head rotation causes lesions hence bringing forth a concussion. A person with a concussion
may initially experience dizziness, headache, nausea, some light sensitivity, impaired reaction to
time, changes in speech, judgement and memory and loss of balance (Morton et al., 2017).
According to the CDC, it is recommended that the treatment for a patient with concussion
includes: relaxing, resting and avoiding physically demanding activities or that demand for his
concentration. These activities can worsen the symptoms hence slowing down the process of
patient recovery. The patient should also avoid sport activities which can cause another
concussion. According to Federal Drug Association for Post-Traumatic Stress Disorder some of
the useful medications are Sertraline and paroxetine (Jarvis, 2016).
Neurological Assessment Tools

CONCUSSION 3
Glasgow Coma Scale is the most commonly used tool in neurological assessment. GCS is
used to measure functions such as eye opening, verbal response and motor response. The final
GCS score is always the sum of these numbers based on every category. GCS is used to
determine the severity of patient’s brain injury. Severe is denoted by a GCS of 3-8, moderate-
GCS 9-12 while mild- GCS 13-15. Diagnostic studies such as Computed Tomography (CT) scan
of the head and Transcranial Doppler studies are used to measure cerebral flow of blood and find
out cerebral blood cessation present in severe head injuries. Laboratory tests applicable in this
case of Adams include checking serum electrolytes, coagulation studies and complete blood
counts (Jarvis, 2016).
Current Best practices associated with post-traumatic stress disorder (PTSD)
Some of these practices applicable in the case study include prolonged-exposure therapy
whereby the patient is guided by a therapist in recalling traumatic memories to enable him regain
mastery of his feelings and thoughts regarding the incident. Cognitive Behavioral Therapies
such as Cognitive-processing therapy which is also used and it aims at helping the patient in
conversion of erroneous thinking associated with the traumatic incidence. Stress-inoculation
training, a form of CBT, is also used whereby the practitioners educate the patient on techniques
of managing and lowering anxiety. Some of these techniques include; breathing exercises,
positive self-talk and muscle relaxation and positive self-talk. Reprocessing and eye-movement
desensitization practices are also used (Jarvis, 2016).
Nursing interventions I would include in this patient's plan of care
These interventions for Adam’s plan of care include monitoring patient’s vital signs
every hour till normal range is achieved, keeping patient’s head at a semi-fowlers position in
order reduce intracranial pressure, stabilizing blood pressure, teaching the patient on safety for

CONCUSSION 4
prevention of falls, maintaining a quiet and calm patient environment and using therapeutic
responses during communications with the patient and encouraging the patient to express his
feelings or emotions. Additionally, serial neurological assessment will also be useful in
determining hematoma expansion, cerebral edema and development of a contusion to an
hematoma (Jarvis, 2016).

CONCUSSION 5
References
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier.
Morton, P. G., Fontaine, D., Hudak, C. M., & Gallo, B. M. (2017). Critical care nursing: a
holistic approach (p. 1056). Lippincott Williams & Wilkins.