Health Assessment Nursing Mike -

Health Assessment Nursing Mike - Head Injury Car Accident This case study involves an 8-year-old with obvious trauma to the face and head. There is no apparent fractures of the extremities, and while the patient is awake, he is only semi-alert. The following eight questions will be crucial in evaluating this case. The questions are simple, given the patients age and the likelihood the boy may suffer from some form of shock following the injury.

Each question focuses on assessing the extent to which neurological impairment exists, with some questions assessing the potential for cervical spinal damage, and others assessing whether the boy suffers from a concussion or related injury. Immobilization of the cervical spine will help prevent additional injury to the patient during questioning (NICE, 2003).

What is your name? Do you know what happened? Do you have a headache? Can you tell me where you feel pain? Are you able to wiggle your fingers and toes? Do you know where you are now? Can you tell me what happened? How old are you? These preliminary questions, asked within the first five minutes of arrival, will help the emergency response team assess whether the patient is alert and cognizant of his or her surroundings, and whether risk exists for severe injury.

Such injury may be noted by the patient's loss of memory, inability to remember the event, his name or other common details. Assessment of parasthesia to the extremities is ascertained by asking the patient whether mobilization of the extremities, even if they do not appear injured, is evident (NICE, 2003, p. 248).

Much assessment to the patient following the head injury will include assessment of neck and head pain or tenderness, nausea or vomiting, swelling, visual disturbances, loss of motor skills or consciousness suggesting brain injury, and "parasthesia in the extremities" which may suggest the boy suffered an injury to the cervical spine, warranting computer tomography and other radiological procedures (NICE, 2003). Movement of the patient and of the head and surrounding areas should be limited before cervical injury is ruled out. Focusing problems may suggest neurological injuries as well.

The body systems included in this assessment includes recommendation for computed tomography or an MRI to provide imaging of the head and spine, especially the cervical area surrounding the spine, to identify any fractures or disc injury in this area. MRI assessment will also help reveal swelling in the brain. The use of the Glasgow Coma Scale, the child's version, will provide important information to assess whether the patient is at risk for a coma or may suffer a coma.

Use of local pain relief and analgesia may help relieve the patient's pain, but due to the severity of a head injury, it is more important the patient stay alert. A systematic review using CT imaging and MRI are critical for select patients including this boy to rule out severe brain injury and other trauma, including skull fracture, the existence of disorders including a brain or cranial haematoma (blood pooling or clot) or other neurological impairment.

MRI however, should be avoided in patients that may have implants in the brain or cranium (NGI, 2006). While unlikely in a pediatric patient, if evidence that such a device cannot be confirmed through conversation with relatives, CT imaging and X-Ray imaging may be the best tools to assess damage to the brain and surrounding regions. Radio imaging will also provide assessment and evaluation of cervical spine fractures should they exist.

The risk factors in this patient's condition include possible concussion and internal bleeding, in and around the head, but also of internal organs that may have experienced damage on impact during the car accident. For example, the patient may start vomiting due to excitement or abdominal injury (NICE, 2003). Assessment should include diagnoses of irrational behavior. While fear and distress are likely to be present, other emotions that seem out of the ordinary should be noted during assessment when evaluating further risk factors for these patients.

If the patient's parents or relatives are available, they can serve as calming agents and help medical assessment teams evaluate whether certain behaviors are within the "norm" for the patient or not. Any patient sustaining a head injury is at risk for swelling of the brain, internal bleeding, neurological impairment, and paralysis. Paralysis and other injuries may occur resulting from damage to the cervical spine during injury.

Damage to the cervical spine may depend on the nature of the head injury, the force of impact, and how much or little the child is moved in the time from the accident to delivery by medical support professionals to a healthcare setting.