Case Study: John Wells - Assessment of Mild Traumatic Brain Injury

The case study centers on John Wells, an 82-year-old man who experienced a bike accident resulting in a mild traumatic brain injury (TBI). The analysis details the incident, the patient's immediate symptoms like dizziness, headaches, and nausea, and the delayed behavioral changes noticed by his family. The case explores his medical history, including hypertension, and the potential risk factors. It outlines the process of collecting cues and information, vital signs, and both objective and subjective symptoms. The core of the analysis focuses on processing the information to confirm a mild TBI diagnosis, discussing cognitive problems, and post-concussive syndrome symptoms. The case study emphasizes the importance of organized patient assessment, nursing interventions, and the diagnostic methods like MRI and CAT scans, while also referencing relevant research papers.

Running head: JOHN WELLS CASE STUDY
JOHN WELLS CASE STUDY
Name of the Student
Name of the University
Author note

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Table of Contents
Consideration of the patient.............................................................................................................2
Collecting cues and information......................................................................................................3
Processing the information..............................................................................................................4
Reference.........................................................................................................................................6

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Consideration of the patient
The provided case study is about an 82 years old man, whose name was John Wells. He
used to work on the farm and spend most of the day on the farm only. John faced an accident
while he was returning home from his farm. The reason for the crash was that he could not
regulate his balance while he was on his bike. He admitted that he knew the importance of
wearing a helmet at the time of riding on a motorcycle but on the day of the accident he forgot to
carry the helmet. He got trapped on the ground while fell on his left side. The incident happened
in the summer season because of which the land was harsh and John got hurt on his head as the
head got stuck on the hard ground. The immediate reaction of the patients after the accident was
dizziness. Except for this symptom, the other effects of the crash were reduced hunger,
headaches, nausea and fatigue. John overlooked the accident and went back to work. His family
members noticed the changes in his behavior when he returned to his home after completing his
work. His family members noticed that he became quieter than usual, and they thought it wise to
admit him in the emergency department in the nearby hospital.
The patient has not suffered from any injury in head or concussion before. As per
the medical history, the patient had only the issue of hypertension, but the doctor did not
administer with any antihypertensive medicines. The risk factors of hypertension are increased
weight, family medical history, and sedentary lifestyle, excessive smoking diet containing a high
concentration of salt and potassium and excessive drinking alcohol (Wäljas et al., 2015). Certain
chronic health diseases like increased blood pressure, diseases of kidney and diabetes are the
other risk factors. In the case study, diet and stress level were not mentioned. So the only reason
that can be connected with the case study was hypertension.

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Collecting cues and information
The patient of the case study was admitted to the hospital with the clinical issues of
headaches, slight confusion and nausea. He was feeling dizzy and was also suffering from pain.
When the pain score was measured, it scored 4/10. However, the patient did not lose
consciousness. He complained that he was only not feeling well. The vital signs were checked
after he took admission in the emergency department. His temperature was 37 degree Celsius,
the blood pressure reduced to 148/84, and the heart rate became 81 beats per minute. The level of
oxygen concentration was 97%, and the respiration rate was 17 beats per minutes.
The objective symptoms noticed were dizzy feeling, reduce hunger, tiredness and
signs of absent-mindedness. John’s family members saw that he was not able to remember any
incidences happened on that morning only. The subjective symptoms were reduced blood
pressure, improved heart rate and diminished respiratory rate.
The critical cues of the patient were reduced memory and feeling of dizziness; all
of these symptoms happened after the accident. The other signs and indications were an
increased rate of heart, reduced rate of respiration, loss of appetite, and severe headaches
(Marshall et al., 2015).
The first thing that the nurse needs to do was to connect with the patients. The nurse must
establish a steady helpful connection with the patient (Koski et al., 2015). The nurse must asses
the exact source of memory damage and then start and pursue with the management. John was
facing from enhanced heart rate, and the reason for the heart rate to increase was nothing but
hypertension. The nursing assessment in decreasing the heart rate is checking all the vital signs

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repeatedly and after that administration of proper medicines, specifically the anti-hypersensitive
ones (Katz Cohen & Alexander, 2015).
The symptoms, including the subjective ones, showed by the patient, showed that he was
attacked with mild traumatized brain injury after the accident. The noticeable symptoms of the
mild traumatic injury are headaches, troubles of sleep, weakness, loss of memory, sickness,
getting lost or getting confused very often, mood swings and reduction in capability of thinking
(Dikmen, Machamer & Temkin 2017). So it could be concluded that the patient was suffering
from mild traumatized brain injury. The effective method to evaluate patients of mild traumatic
injury was a organized assessment of the patient. This involves studying the signs, patient
investigation, and palpation of the head to determine severe neurologic damage. Specific tests for
describing the mental status and checking the mental situation can also be done.
Processing the information
After assembling the information and indication of the patient, it can be confirmed that
John had been suffering from mild traumatized brain injury. The disease of traumatic brain
injury can be considered mild when the mindfulness or the misunderstanding and confusion is 30
minutes or less than that. The doctors most recommend MRI and CAT scans for diagnosing an
individual who had been suffering from mild traumatic brain injury (Lumba-Brown et al., 2018).
A person mainly suffers different cognitive problems like reduced abilities of thinking,
nuisances, memory loss, and issues of attention, mood swings and obstacle. Frequently, the
doctors and the nurses overlook mild injuries. Though the selected disease was mild, the family
members usually can feel the pain, and the effects may sometimes be upsetting (Gardner et al.,
2015). Almost 15% of people who are suffering from slight TBI are unnoticed at the earlier
stages as the signals last for almost on year or more than that. The disorder can also be

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determined as the significance of the head movement if done influentially or the effect of
producing a quick change in mental condition (confusion or loss of memory) or dropping the
sense for littler than 30 minutes (Levin & Diaz-Arrastia 2015). The symbols of the post-injury
are mostly demarcated as post-concussive syndrome. The clues of mild traumatic injury are
fatigues, visual syndromes, and loss of thought, loss of remembrance, faintness, and loss of
balance, sadness and seizers. All the warning sign that John was suffering from were similar to
the symptoms of mild traumatized injury.

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Reference
Dikmen, S., Machamer, J., & Temkin, N. (2017). Mild traumatic brain injury: longitudinal study
of cognition, functional status, and post-traumatic symptoms. Journal of
neurotrauma, 34(8), 1524-1530.
Gardner, R. C., Burke, J. F., Nettiksimmons, J., Goldman, S., Tanner, C. M., & Yaffe, K. (2015).
Traumatic brain injury in later life increases risk for P arkinson disease. Annals of
neurology, 77(6), 987-995.
Katz, D. I., Cohen, S. I., & Alexander, M. P. (2015). Mild traumatic brain injury. In Handbook
of clinical neurology (Vol. 127, pp. 131-156). Elsevier.
Koski, L., Kolivakis, T., Yu, C., Chen, J. K., Delaney, S., & Ptito, A. (2015). Noninvasive brain
stimulation for persistent postconcussion symptoms in mild traumatic brain
injury. Journal of neurotrauma, 32(1), 38-44.
Levin, H. S., & Diaz-Arrastia, R. R. (2015). Diagnosis, prognosis, and clinical management of
mild traumatic brain injury. The Lancet Neurology, 14(5), 506-517.
Lumba-Brown, A., Yeates, K. O., Sarmiento, K., Breiding, M. J., Haegerich, T. M., Gioia, G. A.,
... & Joseph, M. (2018). Centers for Disease Control and Prevention guideline on the
diagnosis and management of mild traumatic brain injury among children. JAMA
pediatrics, 172(11), e182853-e182853.
Marshall, S., Bayley, M., McCullagh, S., Velikonja, D., Berrigan, L., Ouchterlony, D., &
Weegar, K. (2015). Updated clinical practice guidelines for concussion/mild traumatic
brain injury and persistent symptoms. Brain injury, 29(6), 688-700.

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Wäljas, M., Iverson, G. L., Lange, R. T., Hakulinen, U., Dastidar, P., Huhtala, H., ... & Öhman,
J. (2015). A prospective biopsychosocial study of the persistent post-concussion
symptoms following mild traumatic brain injury. Journal of neurotrauma, 32(8), 534-
547.