Nursing Assignment 14: Analysis of Mr. Robert Brown's Case Study

This nursing assignment focuses on the case of Mr. Robert Brown, a 30-year-old male involved in a car accident, presenting with a head wound, confusion, and elevated vital signs including hypertension and an increased pulse rate. The assignment requires a thorough assessment of the patient's condition, including vital signs, GCS score, and existing documentation. The student is tasked with interpreting the data, relating abnormal findings to underlying pathophysiology, and forming an overall opinion on the patient's condition. The assignment further involves predicting potential outcomes without intervention, identifying key nursing problems, establishing goals, and outlining related nursing actions. The student must also evaluate the effectiveness of the care provided and reflect on how the encounter informs their future nursing practice. The report includes rationales for interventions and a discussion of the patient's emotional state and its impact on his health outcomes, as well as relevant references to support the analysis and proposed interventions.

Nursing Assignment 1
NURSING ASSIGNMENT
By Name
Course
Instructor
Institution
Location
Date

Nursing Assignment 2
Scenario 2: Robert Brown
Consider the
patient situation
Mr Robert Brown is a 30-year-old male who was hit by a car that failed to give way whilst he was crossing at a pedestrian crossing.
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 the 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

Nursing Assignment 3
Pulse: 111bpm
RR: 18
SaO2: 98%
Temp 36.6
Other data
GCS: 13 (patient seems confused/agitated) and keeps rubbing his head and mumbling that it hurts. Whilst his movements seem
purposeful, he does not obey commands or accurately answers specific questions). There appears to be no GCS documentation since
the transfer to the ward.
Patient in bed opposite refers to Mr Brown and tells you: ‘that poor young 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.
Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be
occurring before proceeding with the rest of the cycle (self-directed)

Nursing Assignment 4
Process
Information
Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
Normal Abnormal
Temp 36.6
RR: 18
SaO2: 98%
BP: 160/95
Pulse: 111bpm
GCS: 13
Relate & Infer:
 Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered
abnormal in this context.
 Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify
your answer (400 words).
Blood pressure of 160/95 is usually regarded as a high blood pressure as it is a significant stage of hypertension development. This

Nursing Assignment 5
prevailing blood pressure puts the life of Mr Robert Brown at a very high risk since he may develop problems of stroke or heart attack
challenges. This blood pressure may be hardly noticed by the patient despite its possibilities of breaking the body tissues and other
body organs and blood vessels which may result into very serious blood circulation problems within the body (Wotton et al, 2010).
The frequently affected body organs by this pressure are always the heart which might undergo a degree of enlargement resulting in
dangerous heart failure and simultaneous damages to the kidney which eventually might require dialysis. The high blood pressure
experienced by Mr Robert Brown is most probably as a result of anxiety originating from the worry the patient possess relating to his
suspicion of his dog getting lost in the accident. Another reason to be considered for this high blood pressure is due to bleeding which
was witnessed on the patient on the head after being hit by the car. In addition, hypertension is also caused through the narrowing of
blood vessels such as the aorta, kidney diseases and high cholesterol intake.
A pulse rate of 111bpm is generally regarded as a high pulse rate. The increase in pulse rate experienced by the patient is most
probably as a result of pain which originates from the blood soaked wound (Allen, 2013). This pain triggers the increase in the rate of
the pulse. The anxiety experienced by the patient relating to the patient being worried about his lost dog at the scene of the accident
also forms a source of origin for the increased pulse rate.
Mr. Brown also poses a GCS of 13 which is mainly caused by the injury he sustained on the back of the head and the blood soak on
the wound which normally bleeds. The patient is somehow confused and seems not to know where he is. In addition to this, he seems
concerned and worried about a dog he loved so much and feels he will never see the dog again due to the injury and him being
admitted to the hospital. He suggestively blames himself for not being available for the dog. The anxiety which is accompanied by the
mentioned thoughts of the patient may be one of the reasons for the increased pulse rate experienced by Mr Robert. Nevertheless, the

Nursing Assignment 6
pain experienced by the patient as a result of bleeding and pain originating from the wound is believed to be the main source and
trigger of the increased pulse rate (Yuan, 2011).
Predict:
What may happen to your patient if you take NO action and why? (100 words)
The patient may develop very serious health problems when a counselling programme is not immediately conducted to aid in building
confidence in Mr Robert that he is in the right and safest place and his health would soon get back to normal since his safety and
whereabouts formed major worries to him as he was not aware he was in the hospital due to the injuries obtained from the accident.
Additionally, the increased blood pressure may lead to the distraction of most of the patient's body organs such as the heart and the
blood vessels hence actions such as advising and helping the patient to calm down and avoid worries resulting from the lost dog would
help regulate and prevent the already high blood pressure. In addition, the patient must be made to understand the implications of her
emotions towards his health with an emphasis on his rising blood pressure, breathing rate and pulse rate that had already been
worsened through bleeding from the back of his head.
Identify the
Problem/s
List in order of priority at least three key nursing problems (not included in word count)
 The blood-soaked dressing from the head wound
 The GCS score of 13

Nursing Assignment 7
 The hypertensive blood pressure
Establish Goals &
Take Action
From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and then list
related actions you would undertake, including detailing any relevant nursing considerations (350 words)
Problem 1 Goal Related Actions Rationale
The blood-soaked dressing
from the head wound
Healing of the wound  Relief from
high blood
pressure and
proper nursing
care
 The proper and
reliable dressing
of the head
wound and
 Provision of
adequate and
relevant food
 Introduction of
the patient to
protein-rich
foods or diets as
it facilitates the
recovery of
wounds from
both inside the
body and
outside.
 With an aim of
preventing

Nursing Assignment 8
and nutrition
that encourages
wound healing
process and
reduction o
blood pressure
(Codier, 2012).
pressure ulcers,
the patient
should be made
to constantly lie
down as it
reduces loading
of fat and
muscle tissues
compared to
when the patient
is sitting.
 The sufficient
and reliable
dressing of the
wound is
necessary to
maintain good
hygiene and

Nursing Assignment 9
prevent wound
infections as a
result of
moisture
presence that
could result
from constant
soaking of
blood at the
wound (Davies,
2018).
Problem 2 Goal Related Actions Rationale
The GCS score of 13 Enhancing behaviour or
emotions, cognition and
physical awareness and skills
 Introduction to
rehabilitation
programmes
that triggers the
normal
functioning of
 The patient
should be
introduced to
rehabilitation
process that
focusses on

Nursing Assignment 10
the brain
 Administration
of drugs and
medication
which
normalises the
regular and
desired
functionality of
brain and
response
triggering his
brain response
time and
achievement of
the desired and
most
appropriate
feedback
 Relevant drugs
and medications
need to be
prescribed for
the patient to
help him to
quickly respond
to the
expectations
and objectives

Nursing Assignment 11
of rehabilitation
programme that
is aimed at
enhancing his
cognitive,
emotional and
physical
behaviour
(LaBranche,
2011).
Evaluate outcomes
& Reflect on new
learning
Briefly describe how you would evaluate the effectiveness of the care provided and reflect on how this encounter has informed your
nursing practice if you were to encounter a similar situation in the future (150 words).
The effectiveness of the nursing care provided to Mr Brown is determined by knowledge of the patients prevailing health conditions
and its impacts on his emotional and mental being. Mr Brown is required to overcome stress and curiosity that is with him and which

Nursing Assignment 12
originates from his lack of knowledge on the whereabouts of his dog that he loved so much after the occurrence of the accident.
Implementation of this would act as the patient’s initial nursing care which is aimed at outdoing further development of high blood
pressure and the pulse rate. Additionally, the nursing care should achieve its objectives of reducing or eradicating the pain felt by Mr
Robert from the wound which exposed his body to bleeding after the car accident (Inangil, 2017). This achieved through the proper
intake of prescribed medications. Eventually, it is expected that the breathing rates of the patient will be brought down.
My interaction as a practising nurse has resulted to a better understanding of the significance and urgency of establishing a good and
proper communication mechanism involving nurses and patients which has aided in developing an improved nursing care and service
aimed consistently making the health and emotion conditions of patients better.

Nursing Assignment 13
References
Allen, P., 2013. Preparing nurses for tomorrow’s healthcare system. American Nurse Today, 8(5), pp.46-50.
Codier, E., 2012. Emotional intelligence: Why walking the talk transforms nursing care. American Nurse Today, 7(4), p.3p.
Davies, R., 2018. Clinical and Observational Psychoanalytic Research: Roots of a Controversy-Andre Green & Daniel Stern.
Intangible, D., 2017. Theoretically Based Game for Student Success: Clinical Education. International Journal, 10(1), p.464.
LaBranche, B., 2011. Rapid clinical information drives patient safety. Nursing management, 42(12), pp.29-30.
Rajput, R.N., 2015. Effect of dhanyamla parisheka in the Management of sandhigata vata-a comparative Clinical study on conventional method over Classical
method (Doctoral dissertation, KLE University, Belgaum, Karnataka).
Wotton, K., Davis, J., Button, D. and Kelton, M., 2010. Third-year undergraduate nursing students’ perceptions of high-fidelity simulation. Journal of Nursing
Education, 49(11), pp.632-639.
Yuan-song, Y.E., 2011. Clinical Observation of 38 Case of Chinese Medicine Treatment of Diabetic . Medical Information, 3, p.120.