Casestudy about Tonya WaltonNameInstitutionCourseUnitInstructorDate
1-ConsideringMiss Walton’s demographic information and the cause of her injury,how does this compare with the epidemiology of traumatic braininjury?
Traumaticbrain injury (TBI) is characterized by. Miss Walton recorded a scoreof 11 on the GCS that same evening (within 48 hours) which isclassified as moderate TBI. The fact that she was not wearing aseatbelt means that she hit her forehead hard on the windscreen whichis common in vehicular accidents. This caused an alteration in thefunctioning of her brain and thus the effects recorded on the GCSwhere she opened her eyes to pain (E=2) only, made incoherent verbalresponses (V=3) but retained normal motor functions (M=6).
Suchinjuries are relatively high in males accounting for 75% of thecases, followed by children below 15 years in 33-50% of the cases.Vehicular related collisions also report high cases of TBI. In adultshospitalized due to TBI, 20-30% of them are intoxicated. Intoxicationcauses blurred vision, poor decisions making increase vulnerabilityetc. for Miss Walton, it was a case of poor decision making in notwearing the seatbelt and increased vulnerability in being driven byan intoxicated driver.
2-Whatinterventions are required to assist Miss Walton immediately? Whatare the immediate dangers in relation to Miss Walton’s change inneurological status? If Miss Walton’s neurological statusdeteriorates further, what new dangers may present?
Thenurse should be mindful of the patient’s limitations in providingprompt responses. The nurse should offer assistance to the patientsuch as giving a choice of answers while seeking a verbal response.The nurse should assist the patient in formulating responses invarious ways such as issuing commands. Family education is anotherimportant issue where the nurse informs family members about the needto exert pressure on the patient, readjust bed angle and such.
Immediatedangers include temporary numbness or seizures and brain herniationleading. On the long term, other dangers include persistent symptomssuch as difficulties in concentration or memory loss, permanentnumbness or difficulty in speaking, coma and death.
Changesin Neurological status
3-ConsiderMiss Walton’s most recent observations. What neurological changeshas she experienced? Make a list of all the significant observations.
Whatcould be causing this change in neurological status?
Observethe pathology results. Are these of any benefit in determining whatmight be occurring? (Hint: Is there any significance in observing thecoagulation profile? Can it add any important information to theclinical picture?
Deterioratingheadaches from 2/10 to 7/10
Improvedeye response from response to pain (E=2) prior to the subdural tospontaneous eye opening (E=4) but a stable GCS throughout the shift
Sluggishpupil response to light
Weaknessin the right hand
Whiletemperature, pulse and arterial oxygen saturation are normal.
Thiscan be caused by changes in intracranial pressure best indicated bysevere headaches. In most cases, elevated intracranial pressure iscaused by poor drainage from the skull after the intracranialoperation. Alternatively, it be caused by continued subdural hematomaon continued internal bleeding in the head.
Coagulationprofile informs whether a patient has sufficient ability to controlblood clotting and the time taken. A below normal level factorindicates inability to carry out the clotting processes effectivelywhile a higher than normal level is indicative of too much clotformation. Such information informs the physical on necessaryremedial actions. It can also be indicative of other pre-existingmedical conditions.
4-ReviewMiss Walton’s most recent GCS score. What parameter suggests thatassessment might be becoming complicated? (Hint: Think ‘V’.) Whatother assessments can be used in evaluating an individual’sneurological status?
Thepatient is recording improved V score on the GCS while her conditionseems to deteriorate. This could indicate a complication to suggestdifferent senses or parts of the brain are affected differently.Alternatively, the verbal score is misleading suggesting the risk ofacute stroke, a risk also indicted by continued weakness in the righthand (Wewir et al 2002)
Otherassessment tools used in assessing neurological status include themotoring scoring scale (MSS), Motor Assessment/Spinal Cord Testing,Sensory Assessment/Spinal Cord Testing, Ventilator Adjusted: MotorAssessment Scoring Scale (VAMASS), Pain Assessment: Able toSelf-Report, Pain Assessment: Unable to Self-Report and VAP ReductionBundle.
5-Whatwas Miss Walton’s initial GCS score? What type of traumatic braininjury does this signify? What is the significance of the initial GCSscore in relation to potential neurological outcome?
Thepatient recorded an initial GCS score of 11 which translates to amoderate TBI. The GCS score holds immense prognostic value inassessing patients. The individual components of the GCS score helpsin tracking and assessing a patient’s response to various medicalinterventions. In the case of Miss Walton, the GCS score assessed herlevel of injuries and thereafter her response to craniotomy afterdeveloping subdural hematoma. In her current situation, the verbalcomponent of her GCS score is misleading as it does not tally withmotor movement, blood pressure and her pupils suggesting acomplication and a possible case of stroke
Weir,C., Bradford, A. & Lees, K. (2002). The prognostic value of thecomponents of the Glasgow Coma Scale following acute stroke. QJM,96(1) 67-74
Bullock,S. & Hales, M. (2002). Principlesof pathophysiology.Pearson Education Australia.