Concussion Case Study: Analysis of John Wells's Fall and Symptoms

This case study examines the situation of John Wells, an 82-year-old man who experienced a fall from his motorcycle, resulting in a head injury. The assignment details the patient's symptoms, including nausea, headache, and fatigue, and discusses the information gathered before and during his visit to the emergency department. The study explores the potential for a concussion, highlighting the importance of nursing assessments, such as the Glasgow Coma Scale, and imaging tests like MRI and CT scans. The analysis relates the information to a likely diagnosis of concussion, emphasizing the risks associated with head injuries, especially in the elderly, and the need for immediate medical attention. The study also reviews the patient's history, vital signs, and the importance of using tools like the CEC SAGO chart for ongoing assessment. Finally, the case study concludes by emphasizing the importance of assessing the extent of the head injury to come up with early interventions to address the issue and treat a concussion.

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CONCUSSION
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Case Study
Introduction
Concussion may be defined as a slight traumatic brain injury that results from a knock on the
head or a fall (Aci.health.nsw.gov.au, 2019). Concussions are in most cases not life-threatening
and one can gain complete recovery just moments later after experiencing a concussion. It is,
however, worth noting that the effects of a concussion can be devastating to the health of an
individual especially the older adults and may, therefore, need immediate medical attention to
improve the health outcomes of an individual (GeriatricNursing.org, 2019). A concussion is
characterized by dizziness, confusion, headache, nausea, and loss of appetite (Health.qld.gov.au,
2019). This essay talks about the situation of a patient named John Wells who experienced a fall.
The essay additionally relates the information collected before an appearance at the emergency
department and the notes from the emergency department. The essay finally identifies the
problem the patient may be suffering from.
Situation
John is a man aged 82 years who had a fall from his motorcycle coming from milking his cows.
From the scenario, it is stated that John hit his head on the ground thus causing some symptoms
that may be related to a concussion. He also had a tear to his skin when he fell. John’s age shows
that he is an elderly individual. It is important to note that older adults are potentially at a higher
risk of experiencing falls when compared to other individuals. This is because the elderly are
normally frail and may in most cases have destabilizing conditions (Dollard et al., 2012, p.
2619). As a result, they may in most instances lose their balance thus leading to falls like in the
case of John Wells. Studies also suggest that the elderly rarely admit falling due to the fear of

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having their independence taken away and thus this act of denial puts them at a higher risk of
adverse effects of a fall.
There are no previous records of a concussion or head injury in John’s case. He however has a
mild hypertension but he is not diagnosed as being hypertensive. A concussion is believed to
increase the blood pressure of an individual because the brain tries to get as much flow of blood
as possible. John complains about a loss of appetite, nausea, headache, and fatigue. Concussion
may cause a blood clot in the brain leading to a headache. Vomiting and loss of appetite are other
symptoms associated with a concussion. John admits that he does not fancy wearing a helmet
while riding his bike and this increases the risks of a head injury in case of a fall.
Cues and Information
John fell from his stationary motorcycle striking his head hard on the ground. He was taken to
the ED by his son Sam after his wife noted that he was abnormally quiet and had not taken her
dinner. He also complained about nausea, headache and fatigue. He, however, denied feeling any
other pain and stiffness. At the emergency department, John reveals that he is little hazy.
Additionally, his headache is reported as 4/10. Headache may result from a blood clot due to the
fall in the region surrounding the brain. Some of his vital signs include a blood pressure of
148/84 mmHg, rate of respiration of 17 bpm, SpO2 measurement of 97% at room temperature,
pulse rate of 81 beats per minute, and a temperature of 36.7℃. Most of these signs are within the
acceptable normal range. Blood pressure measured as 148/84 mmHg may be considered slightly
elevated and this may be due to concussion because the brain tries to protect itself by getting
enough flow of blood (Centers for Disease Control and Prevention, 2010, p. 2010). Pulse rate
between 60-100 bpm may be considered normal in adults and therefore John’s pulse rate is
normal. Temperature between 36.5℃ and 37.2℃ is also considered normal as well as a

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respiratory rate of 12-20 breaths per minute in adults (hopkinsmedicine.org, 2019). Finally, a
SpO2 value should be at least 95% for an adult.
An observation using the CEC SAGO chart can also be used to assess the situation of the patient.
Using this chart, a nurse may assess the patient’s blood pressure, pain score, SpO2, and
respiratory rate after every one hour for a period of 4 hours (Cec.health.nsw.gov.au, 2019). The
CEC SAGO chart can also help in determining whether a CT scan is necessary especially for
patients older than 65 years like John Wells.
A nurse may also assess the patient to see if there is any injury to the brain or the neck region.
The extent of the head injury may also be assessed to address any potential worsening of the
condition. A Glasgow Coma Scale can be used to assess the condition of the patient’s brain and
concussion. It is a 15-point scale that helps practitioners in assessing the initial severity of a head
injury (Laker, 2011, p. 355). This assessment is done by checking the ability of an individual to
move their limbs and eyes and to follow direction. A higher score on the scale is a sign of less
severe injury. Imaging tests such as magnetic resonance imaging and computerized tomography
may also be performed to confirm the extent of a brain injury (DiFiori and Giza, 2010, p. 36).
Because John’s case was a mild injury to the head, the assessments my just be done once to
assess the severity of John’s head injury.
The sudden force of impact on the head as a result of a fall may affect the functionality of the
brain forcing the brain to work extra hard to make things work and this may worsen the
symptoms of the head injury (Mullally, 2017, p. 887). Nursing assessment is thus important to
assess the extent of the injury and come up with early interventions to address the issue and treat
a concussion.

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Relating the Information
From the information in the case study and the cues clustered from the scenario, it is possible
that John Wells suffered a concussion. Everything from the points towards a risk of concussion
from the fall and hitting his head on the ground to the symptoms he experiences after the fall.
The symptoms of a concussion may not always be immediately visible and people tend to ignore
until the condition starts getting serious (Levin and Diaz-Arrastia, 2015, p. 510). From the
scenario, it is stated that John fell from his bike but headed home assuming that he was okay. His
wife, however, realizes that he is not eating his dinner as usual and when John starts complaining
about headache, nausea, and fatigue his wife decides to call Sam; their son who takes John to the
hospital. These symptoms characterize the possibility of a concussion (Lucas, 2011, p. 408).
The risk of developing this condition is also increased by the fact that John never uses a helmet
when riding his bike. Failure to wear a helmet means that if one experiences a fall and they have
nothing to protect their head then they might hit their head on the ground hard enough to cause
trauma. The trauma may set an imbalance in the brain leading to a temporary blackout thus
causing a concussion to the victim.
Conclusion
Concussion may be defined as a mild form of traumatic brain injury that results from a blow to
the head or a fall. A concussion is characterized by dizziness, confusion, headache, nausea, and
loss of appetite. A nurse needs to assess the extent of a head injury to properly treat a concussion.
Assessment may include the use of a Glasgow Coma Scale, Magnetic Resonance Imaging, and
Computerized Tomography. Nursing assessment is important to assess the extent of the injury
and come up with early interventions to address the issue and treat a concussion. The symptoms

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of a concussion may not always be immediately visible and people tend to ignore until the
condition starts getting serious.
References
Aci.health.nsw.gov.au. (2019). Initial Management of Closed Head Injuries in Adults (ITIM,
2011) | Institute of Trauma and Injury Management | ACI. [online] Available at:
https://www.aci.health.nsw.gov.au/get-involved/institute-of-trauma-and-injury-management/
clinical/trauma-guidelines/Guidelines/head_injury_cpg [Accessed 28 Sep. 2019].
Cec.health.nsw.gov.au. (2019). [online] Available at:
http://www.cec.health.nsw.gov.au/__data/assets/pdf_file/0003/258465/cec-post-fall-guide-june-
2013.pdf [Accessed 28 Sep. 2019].
Centers for Disease Control and Prevention, 2010. Facts about concussion and brain injury:
Where to get help. Obtained via http://www. cdc. gov/TraumaticBrainInjury/outcomes. html on
November, 16, p.2010.
DiFiori, J.P. and Giza, C.C., 2010. New techniques in concussion imaging. Current sports
medicine reports, 9(1), pp.35-39.
Dollard, J., Barton, C., Newbury, J. and Turnbull, D., 2012. Falls in old age: a threat to
identity. Journal of clinical nursing, 21(17‐18), pp.2617-2625.
GeriatricNursing.org. (2019). Concussion Danger Signs You Should Be Aware Of. [online]
Available at: https://geriatricnursing.org/concussion-danger-signs-you-should-be-aware-of/
[Accessed 28 Sep. 2019].

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GeriatricNursing.org. (2019). Concussion Danger Signs You Should Be Aware Of. [online]
Available at: https://geriatricnursing.org/concussion-danger-signs-you-should-be-aware-of/
[Accessed 28 Sep. 2019].
hopkinsmedicine.org. (2019). Vital Signs (Body Temperature, Pulse Rate, Respiration Rate,
Blood Pressure). [online] Available at: https://www.hopkinsmedicine.org/health/conditions-and-
diseases/vital-signs-body-temperature-pulse-rate-respiration-rate-blood-pressure [Accessed 28
Sep. 2019].
Laker, S.R., 2011. Epidemiology of concussion and mild traumatic brain injury. PM&R, 3,
pp.S354-S358.
Levin, H.S. and Diaz-Arrastia, R.R., 2015. Diagnosis, prognosis, and clinical management of
mild traumatic brain injury. The Lancet Neurology, 14(5), pp.506-517.
Lucas, S., 2011. Headache management in concussion and mild traumatic brain
injury. PM&R, 3, pp.S406-S412.
Mullally, W.J., 2017. Concussion. The American journal of medicine, 130(8), pp.885-892.