This Is A Discussion Postplease Use At Least One Scholarly Peer Revie
This is a discussion post. PLEASE USE at least one SCHOLARLY PEER-Review REFERENCE, this book below Jarvis, C. (2016). Physical examination & health assessment (7th ed.). St. Louis, MO: Elsevier.
Randy Adams is a 38-year-old male patient of Dr. Joseph Reynolds who was admitted yesterday morning for 24-hour observation for mild concussion following a motor vehicle accident. Randy lost consciousness during the accident and was very confused when he arrived in the ER after EMS transport. He is an Iraq war veteran and he seemed to think after the accident that this all happened in Iraq. Dr. Reynolds is concerned that Randy has some residual problems from a couple of explosive incidents that occurred while he was in Iraq. The physician is unsure whether Randy's current symptoms are from the car accident or from prior injuries so he has referred him for consultations to both a neurologist and to a behavioral health specialist. Based on the above please discuss the following. 1. Pathophysiology of concussive injuries and treatment 2. Neurological assessment tools used in your current practice setting (if not presently working, please describe one used during prior employment or schooling)( We use the Glasgow Coma Scale) 3.
Current best practices associated with post-traumatic stress disorder (PTSD) 4. Nursing interventions you would include in this patient's plan of care
Paper For Above instruction
Trauma-related brain injuries, particularly concussions, entail complex pathophysiology that requires detailed understanding for effective management. Concussions are a form of mild traumatic brain injury (mTBI), often resulting from a blow to the head, with the brain experiencing rapid acceleration and deceleration forces that cause neuronal and axonal disruption (Giza & Hovda, 2014). The primary injury involves mechanical deformation of neuronal tissues, while secondary injury mechanisms include metabolic dysfunction, ionic imbalance, and neuroinflammation, which can exacerbate neuronal damage if not managed appropriately (McCrory et al., 2017). These secondary processes can lead to prolonged neurocognitive deficits and behavioral changes, especially if recurrent injuries occur.
The treatment of concussive injuries emphasizes immediate management, symptom monitoring, and gradual return to activity. Initial focus involves physical and cognitive rest to minimize metabolic demand and prevent further neuronal insult (McCrory et al., 2017). Pharmacological interventions are generally supportive, aimed at alleviating symptoms such as headaches, dizziness, and nausea. Crucially, patients
require close neurological monitoring for signs of worsening neurological status, intracranial hemorrhage, or escalating symptoms, which may necessitate neuroimaging such as CT scans. Long-term management emphasizes cognitive rehabilitation, physical therapy, and psychological support, especially in cases with persistent post-concussive syndrome (Giza & Hovda, 2014).
In my clinical practice, neurological assessment tools such as the Glasgow Coma Scale (GCS) are routinely used to evaluate neurological status following traumatic brain injury (Teasdale & Jennett, 1974). The GCS assesses eye opening, verbal response, and motor response, providing a standardized method to classify the severity of brain injury and guide treatment decisions.
Regarding post-traumatic stress disorder (PTSD), current best practices include a combination of psychotherapeutic and pharmacological approaches. Evidence-based therapies such as Cognitive Behavioral Therapy (CBT), particularly trauma-focused CBT, are effective in helping patients process traumatic memories and develop coping skills (National Institute for Health and Care Excellence, 2018). Additionally, Eye Movement Desensitization and Reprocessing (EMDR) has been shown to mitigate symptoms of PTSD by aiding in trauma reprocessing. Pharmacologically, selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine, are typically prescribed to reduce core symptoms like flashbacks, hyperarousal, and avoidance behaviors (Stein et al., 2003). Early identification and intervention are essential in improving outcomes for PTSD patients.
In the context of Randy’s care, nursing interventions should focus on comprehensive assessment, symptom management, patient education, and ensuring safety. This includes monitoring neurological status using tools like GCS, encouraging rest, managing symptoms such as headache and dizziness, and evaluating for signs of worsening neurological function. Psychological support should be incorporated, with referrals to behavioral health specialists to address potential PTSD, considering his military background and current symptoms. Education on concussion management, avoiding activities that increase intracranial pressure, and providing emotional support are vital. Additionally, screening for other neuropsychiatric conditions, promoting sleep hygiene, and facilitating follow-up care are integral components of a holistic nursing approach (Jarvis, 2016).
References
Giza, C. C., & Hovda, D. A. (2014). The new neurometabolic cascade of concussion. Experimental neurology, 261, 80-97.
Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Elsevier.
McCrory, P., et al. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British journal of sports medicine, 51(11), 838-847.
National Institute for Health and Care Excellence (NICE). (2018). Post-traumatic stress disorder: NICE guideline [NG116].
Stein, M. B., et al. (2003). Efficacy of sertraline in posttraumatic stress disorder symptoms in different trauma populations: A systematic review. Journal of Clinical Psychiatry, 64(5), 635-644.
Teasdale, G., & Jennett, B. (1974). Assessment of coma and impaired consciousness: A practical scale. The Lancet, 304(7872), 81-84.