Case Studies

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Case Study: Pain

This paper analyses the effect of head injuries on two individuals with almost similar circumstances experienced in an injury but different physiological conditions due to differences in age and gender. As such, it will primarily focus on the aspects of pain, how pain will affect the patients as well as how to manage them. The two individuals’ specifications are that of a three-year old girl and an eighty-five-year-old frail, thin looking man. Both of them have been admitted at hospital for continued observation following the incidences both of them experienced earlier. Due to the differences in age, we will look at some aspects that have changed as results of the injuries caused and how they differ from each other. These aspects will enable us to understand how age comes in to play when it comes to the response of an individual to an injury and how one recovers from the injury after treatment commences.

Molly Higgins.

Upon analysis of the assessment data collected, most of these aspects show that Molly is in good health condition and is, therefore, in no cause for alarm (Best, 2012). The heart-beat rate is at 108, which is within the normal range for the three year old girl, the temperature of 36.8 degrees Celsius is at its optimum, the respiratory rate per minute at 22 is also within the normal range. However, the GCS of 14 shows that there is still some negative effect on the brain that has been caused by the fall to the child (Thurston, 2014). The GCS shows a slight departure from the optimum which is a 15. The patient also shows a pain score of 16/10, signaling that she still feels some moderate pain as a result of the accident. The presence of nausea and vomiting, headache and drowsiness might be an evidence of a possible concussion experienced due to the accident which is a case of a mild traumatic brain injury. A further assessment might need to be carried out by the physician to ascertain the level of head injury caused to the patient (de Brito & Fernandes, 2016). The patient might need to be monitored for any changes or discomfort experienced from time to time to ensure that she is in good condition. Further analysis done through X-ray test indicate that the child is in good condition and has a high chance of recovering well from the injury.

Paul Jones

Due to his age (above 65years), this individual is considered to be in the red flag criteria and, therefore, special care and regular check-checkups are required, making it important for the patient to be put under observation. There are other several factors which seem to necessitate the special care to Paul after the injury (Rosenfeld, 2012). Conditions like hypertension, GORD and the lack of stability are indicators that further check-ups are required to ensure that the patient is in good conditions (Ching, Long, Williams, & Blackmore, 2013). Any changes recorded in blood pressure, heart beat and temperature should be closely monitored.

Further analysis done through X-ray test indicate that the child is in good condition and has a high chance of recovering well from the injury. CT scan MRI scans for the head will also be used for more in-depth tests on the state of the injury.

Considering his age and a GCS of 14, the nurse can consider commencing the Abbreviated Westmead Post Traumatic Scale (A-WPTAS) assessment.

Analysis of Current Evidence

When it comes to patients under observation with head injuries, nurse’s role is to monitor the patient and check for any changes that can be observed on the patient. The nurse should check if there are other body injuries experienced by the patient apart from the head injury. The fall by the patient from a height of 1.5 meters can cause serious head injuries to an 85-year old individual and, therefore, any changes in the bodily aspects could be an indication of serious injuries caused as a result of the fall. Likewise, to the girl, the 2meter fall can cause serious harm to the child and should therefore be closely monitored. Both patients experienced GCS of less than 15, which is also an indicator that there could have been a significant trauma experienced as a result of the fall. The fact that there was no mild agitation or altered behaviors that were experienced after the incidences happened are an indicator that the injuries were mild. Equally important, the nurse should also inquire for the possibility of any past ingestion of alcohol or drug prior to the occurrence of the incidence especially for the 85year old man. History of past injuries should also be an aspect that the nurse might consider, as it might give an indication of the harm caused by the injury. Due to the intensity of the impact, the nurse should not rule out internal injuries and should consider checking out the patient for any cases of internal bleeding.

As a matter of procedure, the nurse should continue to conduct the necessary neurological observations including Pupil response to light, limb movement, GCS, and limb strength.

Relevant Assessment Data

Pain management

A strong impact like the one experienced by the patients on the head may lead to future occurrences of pain associated with the injuries sustained. Due to this, the nurse may be need to provide the required analgesia according to the pain scale. Patient should receive hourly observations as regards to additional observation for four hours as a minimum (Helen & Turner, 2016). Any deterioration in the patient’s condition should be detected early by the nurse and the relevant medical officer immediately notified (Macintyre & Schug, 2015).  When the patient improves, he/she should be discharged to a responsible adult caregiver.

Before discharge is made, all the necessary medical information about the condition should be taken into account for further referencing when needed in the future. All the assessment findings should be documented, as well as the interventions and the outcomes.

Modification of Assessment Practice for Each Case.

Molly Higgins: In each case there are two types of pain: external and internal. For external pain, the child can easily identify and describe the feeling. Analgesics for under age children can be administered in form of syrups to minimize the pain (Linnard-Palmer, 2017). Other methods can be applied to ease external pains like applying ice pack or cold packs to the injured area for every twenty minutes in a span of three to four hours (Hockenberry, & Wilson, 2015). Internal pain normally exhibits itself in form of headaches the intensity of the headache should be monitored and thereafter manage by administration of analgesics appropriate for a three-year-old child.

Paul Jones: Certain factors need to be taken into consideration for his case. His medical case implies that extra care should be administered to prevent occurrence of other unprecedented conditions. Medications to be provided should not cause the blood pressure to escalate, a condition that can further worsen the headache if it is experienced (Carlson, & Bengtsson, 2014). The elderly should be first put to rest by being made to relax before any form of medication is administered. For the external pain, ice cubes in can be applied at the affected region of the head to reduce the pain.

Implementation an Evaluation of Patient Care for Each Case.

The main aim of care is to ensure that the health status is improved and there is no other occurrence of any other health condition or ailment as a result of healthcare provision at the facility. For both cases, evaluation can be done by regular monitoring of certain aspects to ensure they are at they are at their optimum. The body temperature, heart rate and blood pressure should be regularly checked for the two individuals. The elderly has a more special case as he had hypertension before visiting the facility. Signs of further discomfort should also be taken into account.

For molly Higgins, the mother can assist in understanding the condition of the child by using her experience to check on any changes that would signify any positive or negative changes. The child her age should be able to describe the feelings of pain in her body, rather vaguely. Any changes in condition should be noted and acted upon. To reduce the nausea medications to that effect can as well be administered as prescribed by the doctor.

For Paul Jones, monitoring of all aspects should be done thoroughly and regularly due to the requirements of his age. The patient should be constantly asked to describe any changes in body conditions and taken into account to understand the effect of the medication given.

The main reason for the comparison and the contrast was to check on the similarities and differences of the healthcare provided with regards to the ages of the patients. While other aspects of the healthcare are similar, others may be different due to the health conditions that come about with advancement of age. The main differences between the two is the kind of medication that was given to both of them. For the Molly Higgins, medications administered were those suitable for a child while Paul jones received adult medication that was suitable for his health conditions. The similarities included the fact that both needed special care for their ages considering that one was very young and the other was aged.(2017) study employed, there are very little room for generalizing the study’s findings.