Assignment Task

Relevance

Nurses need to demonstrate effective and appropriate clinical decision-making to provide high-quality patient-centered care. This assessment provides the opportunity to demonstrate your understanding of clinical care related to a closed head injury and a deteriorating patient.

Task

This assessment is in three parts. After reading the clinical case scenario, write paragraphs answering parts A, B & C.

Part A) Identify, discuss, and rationalize each component of the systematic A-H assessment and highlight specific considerations when assessing a patient with a closed head injury.

Part B) Identify 1-2 patient problems related to the closed head injury from the case study. For each problem, outline and rationalize the interventions you could have taken as the bedside nurse.

Part C) As a soon-to-be new graduate nurse, reflect on this case scenario and discuss how this will affect your practice in the future. You can be guided by a reflective cycle of your choice e.g Driscoll`s What Model.

Case Study

Vanessa, a 16-year-old girl, was participating in a golf tournament when she was hit by a golf ball on the right side of her head. A CT scan revealed a depressed right parietal fracture with dural laceration and underlying brain contusion.

Upon admission to the Royal North Shore Trauma Centre, Vanessa was conscious but disoriented and vomiting. As she was a child admitted to an adult neurosurgical ward, she was placed in a single room. This was away from the nurse`s station. At the time, Vanessa had a headache, and her head injury was considered mild.

Vanessa had an increasing headache, and the doctor changed her medication from Tramadol to codeine phosphate. The doctor (new to the neurosurgical specialty) did not discuss the patient with anyone more senior. If an A-H assessment was conducted by the nurses, it was not documented in the notes.

Due to staffing issues, Vanessa was on the ward for nearly 24 hours before the senior consultant was involved in her care. He reviewed her second CT scan and visited her in the presence of her mother. He felt that Vanessa had bone fragments in the brain itself requiring surgical intervention and discussed the need for phenytoin and directed the junior doctor to prescribe it. He also indicated that they were constrained in how much analgesia could be used in head injury. The consultant`s instructions were to consult him or the neurosurgical registrar for analgesia decisions, but no notes were recorded. Later, when Vanessa`s mother mentioned her brother`s past reaction to phenytoin, the junior doctor opted not to prescribe it as the senior consultants were unavailable as they were in surgery. Vanessa had an increasingly severe headache. The junior doctor changed the medication regime to two Panadeine Forte (500 mg paracetamol and 30 mg codeine per tablet) 4 times a day and 5 mg immediate-release oxycodone every 4 hours as needed. She did not discuss the increasing pain or the medication change with a more senior doctor. She did not consider the risks of opioid medication in closed-head injury. Identify, discuss, and rationalize each component of the systematic A-H assessment and highlight specific considerations when assessing a patient with a closed.