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Key Topics
- Requirement
- Solution
- Introduction
- Consideration of the Patient
- Anatomy of Concussion
- Ageing in concussion leads to cognitive impairment
- Hematoma- subdural and subarachnoid concussion
- Vital signs including AUPU GCS concussion
- Cranial nerves screening in concussion
- Evaluation Assumption and consideration
- Neurological Assessment that can be carried out on a patient with sports concussion
- Conclusion
- Reference List
Requirement
1- Write report on Clinical Reasoning Report Case Study of John Wells in approx 1200 words with reference to Havard style of writing.
Solution
Introduction
This clinical reasoning report is based on the case study of John Wells, who is an 82 years old dairy farmer. He has been brought to the hospital in the emergency ward by her son Sam who has received a call from her mother and come to know about the condition of his old father. Mavis wife of John notices that suddenly, John remains silent and has not had his dinner(Prins and Scheltens, 2015). From the case study of John, his background has been known. He told his wife that he had a fall from the motorbike in the morning while he was returning from the dairy. He has not worn helmet hence his left portion of head strikes on the hard ground. Returning home while explaining to Mavis, he refused to have any injury and pain on the chest, neck and in other organs(Zori, 2016).
Consideration of the Patient
It has been exposed that John has no prior head injury. The old man has no such hypertension. The high blood pressure that he had is normal, which is not required for medication for anti-hypertensives. John leads a normal life where there is no conflict in his family. As he lives with her good wife, and they had only one son, who is Sam, lives in their neighboring land(Stevens et al., 2017). Sometimes, Sam comes to his parents when his parents require his assistance. Sam also finds himself happy in assisting his parents. So the family is happy, and there is no such dual between them; hence, it means that there is no internal reason for the pressure of the brain.
In the emergency ward, the doctor performs several tests on John. He is experiencing a headache, nausea and mild confusion in mind. These all he receives after the fall from the stationary fall from the motorbike (Scheffers et al., 2017).He states that he is feeling “hazy” that current moment and complains a headache. The physician ranges the headache on the scale as 4 out of 10. He also tells about the dizzy feelings but denies losing his consciousness. He states to the physician that currently, he is not feeling right.
From the case study, every physical measurement of John has been received. His body temperature is 36.7 degree Celsius which is considered to be normal. He has blood pressure about 148/84 mmHg, which is near to hyper sensitives, but for this range, the physician has not prescribed anti-hypersensitive medications to him. He has a normal pulse rate with 81 bpm, and his respiratory rate is 17 bpm. His SpO2 is 97% in room air which is the estimation of oxygen in the blood that is normal(Zori, 2016).
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Anatomy of Concussion
A concussion can occur from the fall and severe injury in the head from the fall. The traumatic brain injury (TBI) happens due to blowing in the head, and it causes the head to move backward and forward. Various symptoms, signs and cognitive difficulties have been identified of concussion (Prins and Scheltens, 2015). This required to have a neurocognitive test before and after receiving the injury in the head. The previous history of the patient needs to be enquired in order to have a previous connection with the patients. Patient in concussion possesses the complete sense, but they have a very poor memory which makes them fade memory (Rosenfeldt, Pilkey and Butler, 2017).Bonny structure of the brain keeps surrounded by a liquid CSF or Cerebrospinal Fluid. The bonny structure and the liquid saves the brain from the exterior injury. A hit on the body effects on the brain and causes the traumatic injury in the brain, which is considered a concussion.
The human brain has several nerves, including axon, neuron and concussion in the brain mainly happens with the projection of neuron, which transmits the messages to each other. While the disruption caused in the brain nerves concussion can happen (Arias-Buría et al, 2019). A concussion is also dependent on the portion of the brain, which is affecting.
The protective tools can be used as the assessment tools such as helmets that have to wear properly. The persons irrespective of old age or young age need to wear a helmet in head specifically while playing a ride in motorbike and motorcycle (Longmuir et al, 2018).
Ageing in concussion leads to cognitive impairment
The concussion depends on the different components such asage, sex and prior record of concussion which leads the risk and recovery from the concussion of the patient. John here suffers from headache, dizziness, nausea and confusion and several other cognitive functions. From the different studies, the concussion has been stated in an adult person to stay approximately 24 hours, whereas, the children take many times about a week to recover from the concussion. But for the older person without proper care, a concussion cannot be removed even if the person is active (Petersen, 2016).
There are many theories which are related to the age differences. Decreased myelination and space in the subarachnoid in the cranium and lean cranium bones in the older people reflects more concussion.
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Place Your OrderHematoma- subdural and subarachnoid concussion
There are two mechanisms in the injury of the brain, and this pertains to the movement of the brain in the skull, which causes traumatic brain injury. A subdural hematoma is severe, which affects 12 – 29 per cent of traumatic brain injury(Bohl et al, 2018). The acute subdural hematoma acts between the brain surface and skull, which are related to the superior sagittal sinus. The skull is attached to the vessels of the brain, and increased movement can cause the effect of the vessels (Arias-Buría et al, 2019). Acute Subdural hematoma (ASD) can cause head trauma. This hematoma forms the blood clot between dura and arachnoid both are the membranes.
On the other hand, the subarachnoid concussion is the traumatic brain function. It arises from the corticomeningeal vessels and from the brain hemorrhagic. Blood in the brain gets melted by the CSF fluid in the brain, which is different and does not pressure oriented. The arachnoid membrane and subarachnoid space may impair the circulation of CSF in the brain it leads to the patient concussion (Belval et al, 2018).
Vital signs including AUPU GCS concussion
An older person like John has the chance of concussion from fall ina hard surface of the ground and receives an injury in the brain. Vital signs for the brain is the function which is considered to be a promise to improve brain health (Bohl et al, 2018). The vital signs have an impact on improving the heart and health. The blood pumping of the heart relates to the brain, which is same as the blood pressure that moves towards the brain (Smith et al, 2017). The GCS is the vital signs that include the respiratory rate, pulse rate, heart rate, pressure of blood, body temperature record such as John wells. These are recorded and held by the physicians to avoid any abnormality that is related to the patient physiology. In the AUPU signs, the physician obtained a family history from the patient and controlled the disability and environment (Caygill et al, 2017).
Cranial nerves screening in concussion
The concussion elements relate to the cranial nerves and muscle testing. It relates to relaxes of the tendon, which is deep in nature. It also inspects head and neck trauma and cervical range. In this screening, the immediate mental status has been observed under which certain major examinations comes such as memory power, concentration, mood, clinical suspicion and examination of upper motor nerves (Ferreira et al, 2019).
Evaluation Assumption and consideration
The evaluation of Vital signs shows that John has a body temperature of 36.7-degree centigrade it is within the normal range. The Blood pressure of John is 148/84, whereas the normal ranges between 110/70. The respiratory rate of John is 17 bpm, whereas the normal rate is 18 (Gentsch et al, 2015). Therefore based on this assessment it can be assumed that as the vitals are normal except the risk of hypertension for the increased blood pressure which needs not to have under medication thus, it onlyneeds to carry out a thorough neurological assessment.
Neurological Assessment that can be carried out on a patient with sports concussion
In order to make an accurate diagnosis of concussion, it is important to carry out a neurological assessment. The complete neurological assessment includes assessment of mental status, cranial nerves, pupillary responses, reflexes, vital signs, motor and sensory function. The most prominent tests that can be carried out on John Wells in order to determine concussion include Cranial Computerized Tomography (CT) scan and Magnetic Resonance Imaging (MRI) scan (Costerus et al`, 2018). As John has complained about headache after injury CT scan is the most standard that had to be carried out. In addition, it is suggested that MRI should also be conducted for diagnosing any complication that can arise out of concussion.
Conclusion
The screening examination, anatomy of the brain and several other measurements have been illustrated in this paper based on the case study of John Wells. This report has provided all the requirements of the concussion, which is including the information and cue collection, process information. An older concussion is complicated to treatand relates to several confusing injuries. Every older person must need treatment because of the quality of life of the older person can collapse without medication. The risk of concussion and injury should be considered for the diagnosis. The disciplinary team and best practice must be managed the concussed older.
Reference List
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Arias-Buría, J.L., Cleland, J.A., El Bachiri, Y.R., Plaza-Manzano, G. and Fernández-de-las-Peñas, C., 2019. Ultrasound-Guided Percutaneous Electrical Nerve Stimulation of the Radial Nerve for a Patient With Lateral Elbow Pain: A Case Report With a 2-Year Follow-up. journal of orthopaedic & sports physical therapy, 49(5), pp.347-354.
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Belval, L.N., Casa, D.J., Adams, W.M., Chiampas, G.T., Holschen, J.C., Hosokawa, Y., Jardine, J., Kane, S.F., Labotz, M., Lemieux, R.S. and McClaine, K.B., 2018. Consensus statement-prehospital care of exertional heat stroke. Prehospital Emergency Care, 22(3), pp.392-397.
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Bohl, M.A., Martirosyan, N.L., Killeen, Z.W., Belykh, E., Zabramski, J.M., Spetzler, R.F. and Preul, M.C., 2018. The history of therapeutic hypothermia and its use in neurosurgery. Journal of neurosurgery, 130(3), pp.1006-1020.
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Caygill, R., Peardon, M., Waite, C. and Wright, J., 2017. Comparing a longitudinal integrated clerkship with traditional hospital-based rotations in a rural setting. Medical teacher, 39(5), pp.520-526.
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Costerus, J.M., Brouwer, M.C., Sprengers, M.E., Roosendaal, S.D., van der Ende, A. and van de Beek, D., 2018. Cranial computed tomography, lumbar puncture, and clinical deterioration in bacterial meningitis: a nationwide cohort study. Clinical Infectious Diseases, 67(6), pp.920-926.
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Ferreira, M.A., Gamazon, E.R., Al-Ejeh, F., Aittomäki, K., Andrulis, I.L., Anton-Culver, H., Arason, A., Arndt, V., Aronson, K.J., Arun, B.K. and Asseryanis, E., 2019. Genome-wide association and transcriptome studies identify target genes and risk loci for breast cancer. Nature communications, 10(1), p.1741.
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Gentsch, A., Storm, C., Leithner, C., Schroeder, T., Ploner, C.J., Hamm, B., Wiener, E. and Scheel, M., 2015. Outcome prediction in patients after cardiac arrest: a simplified method for determination of gray–white matter ratio in cranial computed tomography. Clinical neuroradiology, 25(1), pp.49-54.
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Longmuir, P.E., Sampson, M., Ham, J., Weekes, M., Patel, B.J. and Gow, R.M., 2018. The mental health of adolescents and pre-adolescents living with inherited arrhythmia syndromes: a systematic review of the literature. Cardiology in the Young, 28(5), pp.621-631.
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Petersen, R.C., 2016. Mild cognitive impairment. CONTINUUM: Lifelong Learning in Neurology, 22(2 Dementia), p.404.
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Prins, N.D. and Scheltens, P., 2015. White matter hyperintensities, cognitive impairment and dementia: an update. Nature Reviews Neurology, 11(3), p.157.
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Rosenfeldt, A.B., Pilkey, L.M. and Butler, R.S., 2017. Physical therapy intervention during a red blood cell transfusion in an oncologic population: a preliminary study. Journal of Acute Care Physical Therapy, 8(1), pp.20-27.
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Scheffers, M., Van Busschbach, J.T., Bosscher, R.J., Aerts, L.C., Wiersma, D. and Schoevers, R.A., 2017. Body image in patients with mental disorders: Characteristics, associations with diagnosis and treatment outcome. Comprehensive psychiatry, 74, pp.53-60.
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Smith, M.J., Ahn, S., Lee, J.I., Bulman, M., Plessis, D.D. and Suh, Y.L., 2017. SMARCE 1 mutation screening in classification of clear cell meningiomas. Histopathology, 70(5), pp.814-820.
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Stevens, B., Hyde, J., Knight, R., Shires, A. and Alexander, R., 2017. Competency?based training and assessment in Australian postgraduate clinical psychology education. Clinical Psychologist, 21(3), pp.174-185.
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Zori, S., 2016. Teaching critical thinking using reflective journaling in a nursing fellowship program. The Journal of Continuing Education in Nursing, 47(7), pp.321-329.
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