Free Essay

Nursing Trauma

In: Other Topics

Submitted By adisyah
Words 4409
Pages 18
Ackowledgement

First of all, I would like to praise ALLAH THE ALL MIGHTHY. His will, I will not be able to complete the assignment.

I would like to express my gratitute to all who gave me the possibility to complete this assignment. I want to thank the Dean of Nursing Faculty, I for giving the support, encouragement towards compliting the assignment.

I deeply indebted to my tutor who gave an idea and suggestion and encouragement, helped me at the time of writing the assignment.

My colleagues from Nursing Faculty who supported me in my assignment work. I thank them for all their support, help, interest and valuable hints.

Last but not least, I would like to thank my family especially my husband whose patient love enable me to complete this work.

Table of Content

| | |Page No. |
|1. |Introduction |1 – 2 |
|2. |Clinical Assessment |3 – 6 |
|3. |Management Related To Head Injury |7 - 8 |
|4. |Immediate Care And Management Of Patient |9 - 12 |
|5. |Conclusion |12 |
|6. |Appendixs |13 - 14 |
|6. |References |15 - 16 |

Introduction

Head injury is refers to trauma to head. Head injuries include both injuries to the brain and those to other parts of the head, such as the scalp and skull. The injuries can range from a minor injury on the skull such as bruises to serious brain injury such as hemorrhages or fracture. According to Olson D.A (2010), head injury can be defined as any alteration in mental or physical functioning related to a blow to the head. Head injury is defined by National Institutes for Health and Clinical Excellence (NICE) as any trauma to the head, other than superficial injuries to the face. According to Gravell & Johnson (2002), Head injury may be defined as any injury causing traumatic brain injury (TBI), although the two phrases are typically used synonymously.

Head injury can be classified as either closed or open (penetrating) head injury. A closed head injury happens when a person received a hard blow to the head from striking an object and there is no break in the tissue (scalp and skull). The other type is an open head injury; where there is break in tissue which separate the intracranial content from the external environment. Head injuries are also commonly referred to as brain injury, or traumatic brain injury (TBI), depending on the extent of the head trauma. Mild head injury is described as a brief period of unconsciousness, (Guerrero et al., 2000). Moderate head injury is defined as loss of consciousness for between 15 minutes and six hours’ (Headway, 2001). Severe head injury occurs where a patient has been in a coma for six hours or longer (Abelson-Mitchell, 2006).

Head injury cases may causes brain damage but it may not be apparent at the time of injury and bumps on the head may eventually cause a fatal brain hemorrhage (George S.M, 1980). The results of severe impact, however, may be immediately could cause: concussion, in which the brain is shaken, another type is contusion, which is a bruise on the brain and lacerations of the brain, skull fracture, or diffuse brain damage. The complex nature of the patient with a head injury means that they are prone to complications such as hypoxia, hypotension, raised intracranial pressure (ICP) and cerebral vasospasm (Jastremski, 1998)

Incidence

The main causes of head injury are road traffic accident, falls and assaults (Jennett, 1996). The number of persons surviving from head injury is rapidly increasing and disability is as common after apparently mild head injuries, compared with more severe ones (Thornhill et. al., 2000). Head injuries are a frequent cause of death and disability in western society with the first 72 hours being an important period for prevention of further brain damage (Johnson, 1999). Morbidity and mortality for head injury victim can be significant reduced by improve organization of care, at beginning of injury site.

The highest percentage incidence is in the age group 16–25 years (41%) in Hillier et al. (1997) and in the 21–30 year group (26%) according to Wagner et al. (2000).

CLINICAL ASSESSMENT OF THE PATIENT

Assessment of the head-injured patient begins with a protocol of ensuring patency of the airway with cervical spine control whilst maintaining good oxygenation and tissue perfusion. This aims to prevent the development of secondary brain injury. Assessments of patient in Emergency Department are divided into two parts: Initial assessment and focus assessment. Initial assessment is the primary assessment when receive patient in Emergency Department. Aim for these assessments is to identify and intervene in life-threatening injuries. Interventions may need to be undertaken if a threat to these elements is discovered (Parkinson, 2008). Following the initial assessment, the nurse can continue with a focused assessment, usually directed by presenting signs and symptoms, or the mechanism of injury (Parkinson, 2008). Mr. Kumar involved in the automobile accident, so the mechanism of injury is significant. The assessment steps for significant mechanisms of injury besides the initial assessment are: Rapid Trauma assessment, Baseline vital signs, SAMPLE history; and re-evaluate (Ho S.E, 2010) the assessment that need to be done to him is the clinical examination of a patient involves not just physical examination, but also the collection of data through diagnostic or laboratory tests.

Initial Assessment

When receiving emergency patient in the Emergency Department first thing that need to be assess is patient level of consciousness. Unconscious will not be able to maintain patency of the airway. Call the patients by name to check whether he is alert, confused or unconscious. Importance of maintaining an adequate airway is to assure of an adequate blood supply to the brain. Tongue falling backward in an unconscious will obstruct the airway. An airway obstruction may increase expiratory pressure and raise the level of carbon dioxide in the blood, which in turn may aggravate the cerebral edema (George, 1980). In Mr. Kumar condition his level of consciousness is decreased.

Next, important assessment is the airway. Assess for any obstruction of the passage that can lead to insufficient pulmonary ventilation. TALK to the patient to assess conscious level of the patient. Unconscious or semi-conscious patient are potential lost their ability to maintain their airway passage. LOOK for any object in the mouth that may obstruct airway. LISTEN for any abnormal breath sounds and FEEL for the breath to confirm that patient is breathing and airway is patent. Airway should be assessing while maintaining head position. Head should be immolize with sand-bag while waiting for proper cervical immobilization such as hard cervical collar.

If the airway is patent, assess for the breathing to make sure of adequate ventilation. By using LOOK, LISTEN and FEEL, assess patient breathing effort, rate and depth. Expose the patient to look for any injury to the lung that might compromise breathing effort. Assess for breathing and any life-threatening chest injury such as penetrating object at thoracic cavity that might cause internal bleeding and pneumothorax to patient. Look for the chest expansion whether symmetry or asymmetry. Asymmetrical chest expansion could be due to lung collapse or pneumothorax due to the mechanism of injury. Listen for the breath sound and auscultation of both lungs to listen to the air entry. Assess the breathing rate, breathing pattern, use of accessory muscle and flaring of nostril to indicate problem in adequate ventilation. Mr. Kumar respiratory rate is 12/min. He might not be able to maintain adequate pulmonary ventilation and cerebral ventilation as patient show evidence of restlessness that maybe due to cerebral hypoxia or carbon dioxide retention.

Once the airway is stabilize proceed to next assessment which is the circulation and haemorrhage control. Check for any physical bleeding and take action to control the bleeding. Assess vital sign. Observations on the blood pressure, pulse and respiratory rate are also essential, not only to ensure cardiorespiratory stability of the patient, but also to indicate possible brainstem compromise (Flannery & Buxton, 2001). Check blood pressure whether there is any decrease of blood pressure that may indicate patient is shock. Assess for pulse peripheral and central for regularity and volume. Assess perfusion by observe the color of the skin, pallor might indicate poor perfusion, patient temperature, cold and clammy might indicates patient in shock and check for the capillary refill. Normal capillary refill should be less than 3 seconds. If capillary refill more than 3 seconds indicate poor in perfusion. Once the bleeding is controlled than proceed to the next assessment.

Disability (disorder of consciousness and dysfunction). The severity of the head injury can be based on this initial GCS score (Flannery & Buxton, 2001). Assess neurological status by using Glasgow Coma Scale (GCS). Check for eye opening responses, motor response, verbal response and check pupil size and response as a baseline. Asymmetrical pupil size and reduced reaction to light may indicate brain injury from either diffuse injury or an intra-cranial heamatoma (Flannery & Buxton, 2001). Call patient by name to assess without touching the patient. Assess eye opening eye to call or spontaneously. Give pain to assess whether eye opening to pain and chart at the Glasgow Coma Scale Chart. Assess the motor response by asking the patient to elevate one limb at a time. This is to see any disability of the limb and ability of the patient to obey command. Then assess patient orientation to time and place by asking him whether he is aware of the surrounding. At the same time we are checking the verbal responses. Lastly, check both pupil for size and responses. GCS scoring system is a guide to rapid evaluation of severely injured patient whose status may change quickly (Morton et. al., 2005).

Interpretations for GCS scoring are as follow:
|Total scoring (15) |Indicator |
|3 and below |Completely unresponsive |
|3 – 8 |Severe neurological impairment associate with coma |
|9 – 12 |Moderate neurological impairment |
|13 – 15 |Mild neurological impairment |

(Lee WL, 2010)

Focused Assessment/ Rapid Trauma Survey

There are three major component of focused assessment: Medical history, Baseline vital signs and Physical examination. The objective of focused assessment is to decide on the severity of the patient’s condition.

Head to toe examination should be done to the patient. Exposure of the patient to examine for any other injuries is then made, including a thorough inspection of the patient’s scalp for lacerations, compound fractures and contusions (Flannery & Buxton, 2001). Physical examination to all body parts front and back should be done to identify other injury related to the mechanism of injury (MOI). Place patient on supine position for physical examination. Starting from the head, inspect and palpate for any deformities, contusion, abrasion, puncture, burns, tenderness, laceration and swelling (DCAP-BTLS). No evidence of any external bleeding from nose or ears seen from Mr. Kumar. Next, assess the neck. Inspect patient’s neck anterior and posteriorly. Observe the trachea for any midline shift or deviated. This may be due to present of pneumothorax causing atelactesis. Observe for any jugular veins distended or flat and presence of any signs of trauma to the neck. Apply a cervical spinal immobilization collar to prevent any injury to the cervical and spinal related to MOI. Then move down to assess the chest. Expose, inspect and palpate the chest for DCAP-BTLS. Watch the chest rise and fall with breathing. Auscultate chest bilaterally to check for air entry and compare sound from side to side. Feel for any grating bones as patient breathes to detect any fracture rib. Check heart sounds and assess the rate. Expose, inspect and palpate abdomen DCAP–BTLS. Check for any distension of abdomen may indicate internal bleeding. Expose, inspect and palpate pelvis with gentle pressure downward and inward at the pelvic bone and DCAP-BTLS. Expose, inspect and palpate all four extremities DCAP-BTLS. Check the distal pulses, motor function and sensory function of the extremities. Lastly, turn patient by log rolling to inspect the back for DCAP-BTLS and any open wound.

Once completed on the physical examination, a brief history should be taken from patient, next of kin or any person that were at the scene. History taken using mnemonic SAMPLE. “S” meaning sign and symptom from the patient. “A”, drug allergies that the patient might have. “M”, any prescribe medication or unprescribe medication taken during the incidence. “L”, last meal taken before the incidence incase patient need to go for urgent operation. “E”, event leading to incidence.

MANAGEMENT RELATED TO HEAD INJURY

Blood Investigation

All patients with head injury will have other multiple injuries and those with head injuries, should have blood samples analysed for baseline estimations - full blood count, coagulation screen, blood group (and save), electrolytes and urea, blood gases and alcohol level. Electrolyte imbalance and haemoglobin deficiencies should be corrected, if present.

Imaging

Base on assesment result doctor will order for various investigation to identify patient’s actual problem. Investigation includes skull x-ray to demonstrate fracture, computed tomography and magnetic resonance imaging (MRI) of the brain to identify cerebral contusion or laceration or intracranial hematoma.

With the greater availability of CT, more head-injured patients are being scanned. Imaging of the head injured patient relied on skull radiographs. The CT scan has become the diagnostic procedure of choice when evaluating acute head trauma (Master et. al., 1987). CT scanning is recommended for patients at high risk for intracranial injury. This includes all patients with a GCS score < 15 and patients with focal neurologic deficits or clinical signs of basilar or depressed skull fractures. Abnormalities noted on CT imaging include subdural hematomas, subarachnoid hemorrhage, intracerebral hematomas, cerebral infarcts, diffuse brain injury, and generalized cerebral edema often with shift of midline structures, effacement of cortical sulci, and ventricular compression.

Medical Management

Initial Management of patient with head injury are same as any other injury which is airway, breathing and circulation. But in head injury, patient are potentialy having cervical injury due to head injury. Therefore, head should not be mobilized to prevent futher injury to cervical and spinal cord. An immobilizer should be applied immediately either using sandbag until a cervical collar can be obtained or using a proper size of cervical collar. Lateral cervical spine xray should be obtain before any attempt to remove patient’s head or immobization device are removed.

IV (intravenous) line should be inserted with branula gauge 14-16 at peripheral for possible IV fluids and medication administration. A intravenous Mannitol 20% may be given to severely head-injured patients to reduce associated cerebral oedema (Flannery & Buxton, 2001). Replacement of Dextros 50% intravenously are given if the blood sugar level indicates reading less than 45mg/dl. Hyperglycaemia increases osmotic pressure and may cause further cerebral ischaemia, depriving cells of energy leading to secondary brain damage (Woodrow, 2000). An intracranial pressure monitoring probe may be inserted into the brain through the skull to measure the ICP pressure. If the pressure rises too high, surgical decompression of the brain may be the option. Intravenous medications may be used to control intracranial pressure as a temporizing measure until the crisis resolves or surgery is performed.

Patient with head injury possible may have changes in intracranial pressure (ICP). Management focus on maintaining cerebral perfusion and reduce intracranial pressure. Blood pressure and oxygenation is important in mantianing cerebral perfusion. IV fluids of isotonik solutions are given to stabilize the systole blood pressure to over 90mmHg. Besides that, oxygen is given to provide an adequate cerebral perfusion. Patient with GCS < 8- 9/15 should be intubated in maintaining cerebral perfusion. Beside oxygenation, in order to reduce cerebral metabolic rate, medication are prescribe such as sedatives, paralytic agent, antipyretics and barbiturates. Sedative such as Morphine is order to reduce pain and to depress respiration if patient under mechanical ventilation. Sedation will reduce ICP and will help to dampen the effect of any potential stimuli that may increase ICP. Paralytic agent for example Propofol may be used to promote adequate ventilation.

IMMEDIATE CARE AND MANAGEMENT OF THE PATIENT

Maintaing Effective Airway Clearance And Gas Exchanges With Protection of The Cervical Spine

Assess mouth for any object that might obstruct the airway patency. Position head to maintain airway patency and prevent brain damage due to lack of oxygen but at the same time prevent head hyperextension to prevent injury to the cervical spine. The cervical spine should be stabilize manually by apply sandbag at both side of the head to limit the head movement during neck examination. Open patient’s mouth by using jaw thrust to immobilize the neck while waiting for rigid cervical collar to be applied. Apply a rigid cervical collar on the patient unless during neck examination. Mr. Kumar has decrease level of consciousness this will lead to potential lost the airway patency.

The tongue commonly obstructs the airway in unconscious patients, but the airway can be opened by using the chin lift maneuver. False teeth and any solid foreign object should be removed from the oral cavity. Insert oropharyngeal airway to make sure that airway passage is not obstructed and patency is well maintain. Do suction to clear the airway. Remove any secretion or vomitus in the oral cavity by using sucker to prevent aspirations of vomitus. If patient having vomiting, turn patient in a log rolling to prevent from cervical injury. Turning the patient into the recovery position may exacerbate a cervical injury.

Airway patency will provide an adequate brain perfusion. If the airway is completely obstructed, permanent brain damage will occur within 3 to 5 minutes secondary to hypoxia (Smeltzer & Bare, 2004). As patient respiration rate was 12/min oxygen therapy may be given oxygen to improve pulmonary ventilation. Monitor oxygen saturation via using pulse oxymetry to check for oxygenation level. Check for presence of gag reflex. If there is no gag reflex intubation should be done by doctor using cuffed endotracheal tube and ventilate the patient to protect the airway. Intubation may require as patient respiration rate indicates low (12/min). Low respiration may induce hypercarbia in patient. Provide 100% of oxygen during the first hour ventilation and subsequently reducing the rate according to blood gasses result. Mechanical ventilation will improve pulmonary gas exchange and promote cerebral perfusion. Wright (1999) states that a rapid sequence intubation should be carried out on all head-injured patients, with adequate anaesthetic and neuromuscular blockade drugs, to reduce changes systemic and cerebral blood flow that may be detrimental. Head injuries with a GCS of 8 or below require intubation and mechanical ventilation, which subsequently requires admission to intensive care unit (Hillman and Bishop, 1996).

Maintaining Effective Cerebral Perfusion

Assess patient neurological parameter by using Glasgow Coma Scale (GCS) upon admission to Emergency Department to patient to check on patient neurological status . Record the initial finding serves as base for ongoing comparative assessment so that even a slight change may be readily recognized. During the initial assessment GCS was 9/15 and patient having decreased level of consciousness. GCS 9/15 is in the category of moderate neurological impairment. It is important to observe if the patient's level of consciousness is stable or improving or if is now deteriorating. This may show that patient having cerebral edema or intracranial hematoma (Poehland T, 1979). All head injury cases is nurse for possibility of having cervical @ spinal injury. As stated earlier head immobilization is to prevent injury to cervical and this is routinely for all head injury patient. Elevate head 30% to reduce intracranial pressure (ICP). Elevation of the head to a 30° angle is a common practice (Klein, 1999). For every 10° of head elevation, the ICP is thought to drop by 1mmHg (Wong, 2000). Monitor GCS repeated at half-hour to hourly interval for at least 24 hours. The interval between assessments is gradually lengthened depending on patient progress.

Observe for any sign of decreased in cerebral perfusion such as decreased level of consciousness and decreased in GCS level. Inform doctor urgently if there is any decrease of GCS level for possible surgical intervention. Give oxygen 5L/min via nasal prong to improve cerebral oxygenation and reduce cerebral congestion. Prepare for intubation and supported with menchanical ventilation. Give hyperosmolar therapy such as Mannitol 20% as order by doctor to reduce ICP with promotes osmotic diuresis. Hall (1997) explains that Mannitol decreases the blood viscosity which then increases the cerebral tissue oxygen availability. Monitor blood pressure every 15 min to detect any reduction in blood pressure due to diuresis effect.

Circulation And Haemorrhage Control

Check for any obvious bleeding. Any open wound should be covered with sterile dressing and visible bleeding should be stop or controlled by giving local pressure, elevation of the affected site to encourage blood return and reduce blood flow to the site or by using tourniquet. A tourniquet is applied only as a last resort when external hemorrhage cannot be controlled in any other way (Smeltzer & Bare, 2004). Attach cardiac monitoring and record pulse and blood pressure. Insert two intravenous lines with needle gauge 14 at peripheral for any infusion needed later. Blood specimens should be taken for group and cross-matching, and for determining full blood count and urea and electrolyte concentrations. Blood investigation is required as a baseline and to check any abnormality that might cause hazard to patient. A specimen of arterial blood should also be taken to determine asid-base balance and oxygenation level in the blood. A colloid solution for example Ringer’s Lactate is usually given in the first instance to maintain the fluid balance. If there are any signs of hypovolaemia, 2 litres of colloids should be given rapidly while the vital signs are being monitored. The need for further fluids and their rate of flow are determined by the vital signs. Blood is required after a major injury or when there has been a limited response to 4 litres of colloid. Blood should be warmed before use. Check for blood sugar level. Replacement of Dextros 50% intravenously are given if the blood sugar level indicates reading less than 45mg/dl. Hyperglycaemia increases osmotic pressure and may cause further cerebral ischaemia, depriving cells of energy leading to secondary brain damage (Woodrow, 2000).

Injury Prevention Related To Restlessness

Assess the patient to ensure that oxygenation is adequate. Hypoxia can cause restlesness. Padded side rail to prevent patient from injured himself. Wrap the patient’s hand in mitten to prevent patient from pulling all the lines and injured himself. Noise may increased patient agitation and restlessness. Minimize environmental stimuli by keeping the room quiet, limit visitor and talk calmly. Closed family member should be allowed to be with the patient to keep the patient calm and relaxs.

Wound Cleaning

Any open wound should be covered with sterile dressing. The area around wound is cleaned with normal saline solution. Wound is irrigated gently and copiously with sterile isotonic saline solutio to remove dirt.

CONCLUSION

Assessment is dynamic processes as patients improves or deteriorate while in the care at the Emergency Department (ED). Nurses in collaboration with other members of the team play an important role in the care of patients with Head Injuries. Even minor head injuries can cause long-term problems, so correct and early management in ED is crucial to patient recovery. In the acute phase, accurate assessment, monitoring and early interventions is crucial in detecting further deterioration and preventing complications.

APpENDIx

[pic]

[pic]

[pic]

RUJUKAN

|Black, J.M., & Hawks, J.H. (2005). Medical-Surgical Nursing. Clinical Management for Positive Outcome. (Volume 2). 7th Edi. |
|Elsevier. Missouri. |
|Elling, B., & Elling, K. M. (2003). Principle Of Patient Assessment In EMS. Thompson Delmar Learning. Canada. |
|Flannery, T., & Buxton, N. (2001). Modern Management Of Head Injuries. J.R.Coll.Surg.Edinb. 46, 150-153. [Online].Available: |
|http://www.rcsed.ac.uk/journal/vol46_3/4630005.htm. [2011, Feb 25] |
|George, S. M. (1980). Nursing decisions. Emergency care of a head-injury patient. : Vol. 43 retrieve from Ebscohost database |
|on [2011. Feb 12]. |
|Gravell, R. & Johnson, R. (2002). Head Injury Rehabilitation: A Community Team Perspective. Whurr Publishers, London. |
|Guerrero, J. L., Thurman, D., & Sniezek, J. E. (2000). Emergency department visits associated with traumatic brain injury: |
|United States, 1995–1996. Brain Injury , 14, 181–186. |
|Hall, C. (1997). Patient Management In Head Injury Care: A Nursing Perspective. Intensive and Critical Care Nursing; 13: |
|329–337. |
|Headway. (2001). Head Injury: The Hidden Disability. Headway, London. |
|Hillier, S.l., Hiller, J.E., & Metzer, J. (1997). Epidemiology of traumatic brain injury in South Australia. Brain Injury, |
|11, 649–659. |
|Jastremski, C. (1998). Head Injuries. RN; 12: 40–46. |
|Jennett, B. (1996). Epidemiology Of Head Injury. Journal of Neurology, Neurosurgery and Psychiatry. 60, 4, 362-369. |
|Johnson, L. (1999). Factors Known To Raise Intracranial Pressure And The Associated Implications For Nursing Management. |
|Nursing in Critical Care; 3: 117–120. |
|Klein, B. (1999). Management Strategies For Improving Outcome Following Severe Head Injury. Critical Care Clinics of |
|NorthAmerica; 2: 209–223. |
|Lee, W. L. (2010). NBNC 1307 Clinical Practice 11, Open University. |
|Masters, S. J,. et al. (1987). Skull x-ray examinations after head trauma: recommendations by a multidisciplinary panel and |
|validation study. N Engl J Med,316,84-91. |
| |
|Nadine, A. M. (2006). Epidemiology And Prevention Of Head Injuries: Literature Review. Journal of Clinical Nursing 17, 46–57.|
|Olson, D.A. (2010). Head Injury. [Online]. Available: http://emedicine.medscape.com/article/1163653-overview. [2011, Feb 7]. |
|Parkinson, S.(2008) Nursing Management: Emergency And Disaster Nursing. Lewis's Medical Surgical Nursing. (2nd ed.). Mosby. |
|United State of America. |
|Poehland, T. (1979). Acute Head Injury: A Plan For Assessment. Journal of Core Nursing, 42: 48-9 via [Online CINAHL Plus with|
|Full Text]. |
|Royle, J.A., & Walsh, M. (1992). Watson’s Medical-Surgical Nursing and related Physiology. Bailleire Tindall. London. |
|Smeltzer, S.C., & Bare, B.G. (2004). Brunner & Suddarth’s Text Book of Medical Surgical Nursing. (10th ed.). Lippincott |
|William & Wilkins. United States of America. |
|Swann, I., & Teasdale, G. (1999). Current concepts in the management of patients with so-called ‘minor’ or ‘mild’ head |
|injury. Trauma. 1, 2, 143-155. |
|Thornhill. S. et al. (2000). Disability In Young People And Adults One Year After Head Injury: A Prospective Cohort Study. |
|British Medical Journal, 320, 1631–1635. |
|Wagner, A.K. et al. (2000). Intentional Traumatic Brain Injury: Epidemiology And Risk Factor Associations With Injury |
|Severity And Mortality. Journal of Trauma. 49, 404–410. |
|Walsh, M. (2002). Watson’s Clinical Nursing And Related Sciences. Bailleire Tindall. Philadelphia. |
|Wong, F. (2000). Prevention Of Secondary Brain Injury. Critical Care Nurse, 5: 18– 27. |
|Wright M. (1999). Resuscitation of The Multitrauma Patient With A Head Injury. AACN Clinical Issues; 1: 32–45. |

Similar Documents

Premium Essay

Helping Experience

...research on the effects of patient/nurse incidents and traumas, I decided that assisting her while she recovers from her injuries would be an excellent experience for this essay. My paper will focus on post traumatic stress disorder (PTSD) as well as nurses who work with mental patients. The long-term effects on nurses caused by mental patients are a very influential part of the nurses’ lives. After assisting my aunt, a recent victim and candidate for PTSD, I hope to gain a better understanding and respect for these nurses, as well as witnessing first-hand what being a victim truly means. Depression and Anxiety contained a research article about PTSD in nurses. Their research did not include nurses who have experienced a traumatic event, as my aunt has, but, nevertheless, is related to my topic. The research suggests that nurses in general are more likely to develop degrees of PTSD just from the trials and tribulations of their jobs than people in other, lower-stress jobs. Also, several nurses experience trauma and death as an everyday aspect of their job, which can result in PTSD as easily as being a victim can. Nursing, especially in high risk positions such as my aunt’s, can result in symptoms of PTSD. My aunt is at an even higher risk to developing this disorder due to the recent trauma she experienced at the hand of a patient. The Journal of Advanced Nursing also contained articles with insights into PTSD, trauma victims, and working with mental patients. One article...

Words: 482 - Pages: 2

Free Essay

Post Traumatic Stress Disorder

...Post Traumatic Stress Disorder Aria Hospital School of Nursing Abstract Post traumatic stress disorder is a severe anxiety disorder that affects “5 million people each year,” (Valente, 2010). PTSD effects more women than, with approximately 58% of at risk individuals including combat veterans. If left untreated, PTSD leaves those affected with quality of life issues, social interactions, daily functioning, and psychological issues. Over the years, there has been an increase in the awareness of post traumatic stress, and the impact of its diagnosis, (Bastien, 2010). Treatment relies on a multidimensional approach, including supportive patient education, cognitive therapy, and psychopharmacology. This paper will review PTSD, including clinical manifestations, diagnosis, medical and nursing management and community resources available to those affected by this disease. Description of Disease “Posttraumatic stress disorder (PTSD) is an anxiety disorder with a sustained and dysfunctional emotional reaction to a traumatic event, threat of injury or death, and pain,” (Valente, 2010). A traumatic event can be military combat, natural disasters, terrorist incidents, serious accidents, or physical or sexual assault. Most people who are exposed to a traumatic event will have stress reactions for the immediate days or weeks following the incident, however with some time will be able to deal with the event and return to normal. However, some people will have stress reactions...

Words: 1571 - Pages: 7

Free Essay

Sepsis Related Ards and Ptsd

...Post-traumatic stress disorder (PTSD) develops as a person enters into later life. Re-living or even a perception, or fear of a reoccurrence of a traumatic event can manifest itself into PTSD. My PICO question asks: for sepsis related ARDS patients, does the use of counseling reduce the risk of PTSD, compared with patients without counseling? My research on this question could not be fully supported. It is suggested that biological influences and life experience play a much larger role in PTSD than counseling. Post-traumatic stress disorder is a psychological and physical response to a life-threatening trauma. The perception of the trauma is characterized as an individual perception and is different for each person. The psychological response can include re-experiencing the trauma, intrusive thoughts and memories, overwhelming fear, depression and disassociations with the trauma. The physical response can include, but are not limited to, nausea, headache, palpitations, diarrhea, vomiting and insomnia. Without treatment, psychological disabilities can manifest into substance abuse, physical abuse and mental disorders. In order for patients to recover, learning how to expand on the relationship between mental health and physical health and determining if counseling is needed in order to avoid any potential and further psychological and physical threats should be priority. PTSD usually presents in clusters within one month after a traumatic event. Cluster A-fearful response after...

Words: 1103 - Pages: 5

Free Essay

Device Related Pressure Ulcres

...MHA device related conference call Incidence The incidence of device related pressure ulcers nationwide is unknown. An analysis of Minnesota AHE reports from Oct 7 2008 to Aug 1 2009 showed an average of 25% of hospital acquired stage III, IV, and unstagable pressure ulcers were caused from medical devices. Types of devices associated with pressure ulcers • Respiratory equipment like oxygen tubing, CPAP masks, endotrachial tubes (ETT) • Nasogastric (NG) tubes • Orthotics (splints and collars) Good news This group of AHE includes zero pressure ulcers caused from antiembolism stockings as seen in previous years Risk Factors for device related pressure ulcers • Use of a medical device • Impaired sensory perception (impaired ability to respond meaningfully to pressure-related discomfort). Patients without sensory perception impairment remove or request removal of shoes, stockings, or medical devices that feel uncomfortable or too tight. Conversely, patients with sensory perception impairment may not adequately communicate discomfort such as with confusion, disorientation, over-sedation or unresponsiveness. Patients who are alert and oriented may also be unable to communicate discomfort if they are orally intubated, speak a different language than their caregivers, or cannot feel pain due to paralysis or neuropathy. • Moisture may be a cofactor for the development of device related pressure ulcers making the skin less resilient...

Words: 1330 - Pages: 6

Premium Essay

Trauma, Development, and Spirituality

...Trauma, Development, and Spirituality According to the American Association of Children’s Residential Centers (AACRC), trauma is considered to be the result of occurrences of mental or physical injury such as sexual or physical abuse sexual abuse, seeing brutality, or natural tragedy (AACRC, 2014). But trauma is not limited to events per se; alternatively, trauma can also be brought about by occurrences of daily living that are emotional in nature and not quite as obvious. Traumatic stress can be evoked by trials surrounding relationships, physical issues, severe neglect, or by circumstances that overpower a person’s ability to adjust (American Association of Children’s Residential Centers, 2014). This essay will discuss how culture can influence traumatic experiences, the impact of trauma on neurobiological development, and how spiritual development can counter the effects of trauma. Cross Cultural View of Trauma Research conducted in Western countries has typically revealed a disproportionately large percentage of accounts of abuse of children among ethnic minority groups. However, mistreatment is not primarily connected to any particular ethnic group, but has been regarded as a global issue (World Health Organization [WHO], 2002 as cited by Cyr, Michel, & Dumais, 2013). The intricacy of examining child abuse from a culturally diverse viewpoint can be made clear by a number of components impeding the progress of awareness about this issue. Specifically, despite the fact...

Words: 1026 - Pages: 5

Premium Essay

Essay

...Clin Soc Work J (2014) 42:323–335 DOI 10.1007/s10615-014-0496-z ORIGINAL PAPER Trauma Through the Life Cycle: A Review of Current Literature Shulamith Lala Ashenberg Straussner Alexandrea Josephine Calnan • Highlight every key term that refers to the following key concepts: 1) "trauma" generally a) "large T trauma" b) "micro-trauma" 2) "resilience" Published online: 31 May 2014 Ó Springer Science+Business Media New York 2014 Abstract This paper provides an overview of common traumatic events and responses, with a specific focus on the life cycle. It identifies selected ‘‘large T’’ and ‘‘micro’’ traumas encountered during childhood, adulthood and late life, and the concept of resilience. It also identifies the differences in traumatic events and reactions experienced by men compared to women, those related to the experience of immigration, and cross generational transmission of trauma. Descriptions of empirically-supported treatment approaches of traumatized individuals at the different stages of the life cycle are offered. Keywords PTSD Á Large-T and micro-traumas Á Neurobiology Á Gender differences Á Immigrants Á Treatment approaches The past is never dead. It’s not even past. William Faulkner The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. Judith Lewis Herman S. L. A. Straussner (&) Silver School of Social Work, New York University, 1 Washington...

Words: 10490 - Pages: 42

Free Essay

My Bib

... information about testing and diagnoses, different types of treatments, and support. Affairs, U.S. Department Veteran. "PTSD: National Center for PTSD." Home. National Center for PTSD, 20 Jan. 2015. Web. 08 Apr. 2015. The National Center for PTSD keeps up with the latest research in regards to PTSD. Their goal is have the latest information available to those suffering from PTSD. According to the website “The National Center for PTSD is dedicated to research and education on trauma and PTSD. We work to assure that the latest research findings help those exposed to trauma.” The website has a public section for people who have PTSD and their family and friends. There is a professional section for those who work with people with PTSD. This website has information on where to get help, PTSD awareness, treatment and coping. There is a test available for people who want to see if their symptoms are consistant with PTSD. Westgard, Elizabethe .. "LWW." Journals. American Journal of Nursing, 1 May 2009. Web. 07 Apr. 2015. The author, Elizabethe Westgard, is a professor at Temple University in Philidelphia. Her journal article, Coming Home with PTSD, discusses the statistics about PTSD and the stigma that Veterans face when they come home from combat with PTSD. According to the article, “Veterans with PTSD face special barriers in seeking care. According to the Walter Reed Army Institute of Research, the stigma associated with mental health treatment prevents many veterans...

Words: 495 - Pages: 2

Premium Essay

Things to Do

...therapeutic treatments, while many of these patients are on antipsychotic drugs which futermore produces unwanted side effects. Individuals with PTSD tend to have problems with transferring short-term to long-term memory. However, there is not a specific way patient memories are affected. PTSD affects more than 3 million people in the U.S alone. This paper will further analyze insights and reports from other experts on managing Posttraumatic stress disorder more proficiently. Introduction This topic center concerns mental and emotional problems people experience in the wake of 'trauma', where trauma is understood to refer to an event involving being a victim of or witness to atrocity, violence, true horror and/or the death of another or near death of one’s self. Examples might include rape, murder, torture, accidents, terrorism, etc. Diagnostic and Statistical Manual (DSM) describes two trauma disorders: acute stress disorder, and posttraumatic stress disorder. In a nutshell, acute stress disorder occurs in the time frame between just after exposure to a traumatic event to six months later, and posttraumatic stress beginning at the six month point and extending thereafter. This paper aim at explaining and exploring the signs, symptoms, treatments and preventions of post traumatic stress disorder. The phenomena of mental...

Words: 1813 - Pages: 8

Premium Essay

Mental Health Case Study

...The first nursing intervention for this nursing diagnosis is to give “permission” to express and deal with anger at the situation in acceptable ways. Being free to express anger appropriately allows it to be dissipated, so underlying feelings can be identified and dealt with. Thus, strengthening the patient’s coping skills (Doenges, 2016, pg. 635). The second nursing intervention for this nursing diagnosis is to discuss the use of psychotropic medication. Notably, medication may be used to decrease anxiety, lift mood, aid in the management of behavior, and ensure rest until the patient regains control of own self. Lithium may be used to reduce explosiveness; low-dose psychotropics may be used when loss of contact with reality is a problem (Doenges, 2016, pg. 636). These nursing interventions can be properly evaluated by the patient expressing his own feelings and reactions during the nurse’s shift. The patient and family should be inculcated about the potential side effects of all prescribed drugs and the importance of reporting any adverse effects. The patient should also be guided on the support groups, community resources, and counseling services that are available to the...

Words: 1139 - Pages: 5

Free Essay

Week 2 Dq1

...like rebuilding a car. It breaks things down and then figures out how all of the departments and pieces fit back together in that system. Input and output as well as feedback are all necessary for this type of organizational theory. The hospital is the main system with each department being the different pieces. Each portion of the puzzle needs the other in order for it to run smoothly and be a productive organization. The hospital I work for just became a level 3 trauma center. I work up on the med-surg floor so I am not down in the heat of the moment but we all feel the effects of when a trauma is called. This is a perfect example of a systems theory. When a trauma is called the emergency room staff obviously is there to meet the patient, however, there are many more departments that are needed. A lab tech goes to the ER and takes the necessary blood work that the physician orders. In the radiology departments the radiologists themselves stop reading whatever film they are working on and wait for the trauma films to arrive. This process means that everyone that is waiting for results is going to wait that much longer in order to take care of this critical patient. Without all of these departments working together and knowing just exactly what to do a patient’s life is in danger. There are many changes within the healthcare field, current management theories and practices may fail to deal with the...

Words: 403 - Pages: 2

Free Essay

Paramedic Case Studies

...Preparation 6 Step 2- Preoxygenation 6 Step 3- Pretreatment 7 Step 4- Rapid sequence Induction and Paralysis 7 Step 5- Protection and Positioning 7 Step 6- Placement of the Endotracheal Tube in the Trachea 8 Step 7- Post-intubation Management 8 1.4 Risks and benefits associated with RSI 9 Case 2 10 2.1 Discussion 10 2.2 Clinic plan and initial management 10 2.3 Notification of Arrival 11 Conclusion 11 Case 3 12 Introduction 12 Incident 1 12 Incident 2 13 Incident 3 13 Incident 4 14 Case 4 15 Conclusion 16 References 17 Introduction The basic concept of retrieval medicine is a combination of transfer and care of a patient from one medical institution, site of trauma, and pre-hospital management to a medical institution to provide higher and better level of care. The transfer and retrieval of severely ill and wounded patients entail high-risk activities (Ellis & Hooper, 2010). This paper looks into various case studies to determine the various control measures that might and should be put in place in various retrieval situations so as to increase patient safety and efficiency in pre-hospital care. This comprises of communication procedures, team resource management, audit and training important event analysis and the pre-hospital operating care clinical plan. Patients with severe fatalities put up poorly with transportation. Highly sensitive care is thus required to reduce the probability of occurrence...

Words: 4109 - Pages: 17

Free Essay

Nurses Impact Lives Beyond

...Nurses Impact Lives Beyond: Case Studyd Nurses Impact Lives Beyond: Case Study Nurses Impact Lives Beyond Pre-hospital Phase: It was cold and dark, when the helicopter was dispatched to a scene flight for motor vehicle crash with double entrapment one May morning at 0230. Two of the three patients, are unresponsive and in critical and unstable condition. This is the first encounter our patient would have with a registered nurse providing and directing his care. The nurse possesses both acute care and pre-hospital expertise and would work collaboratively with police, fireman, good Samaritans, EMT’s and paramedics to access the patient, provide timely triage, life -saving interventions and rapid transport to the closest trauma center. Each team member has a pre-defined and respected role; the nurse is the senior health care provider and assumes the leadership role with a calm, confident demeanor that is reassuring to the team. This patient was a 25 year old man, unrestrained driver of a vehicle that hit a brick wall head-on at a high rate of speed. Of his two passengers, one of them is a brother, all require 20 minutes of extrication time from the severely damaged vehicle. After freeing our patient, the team works together to assess and stabilize him. His initial vital signs are worrisome, with a BP of 140/80, pulse of 160 and spontaneous respiratory rate of 8. The nurse assumes his care and quickly supports his respiratory rate by bagging and suctioning...

Words: 2268 - Pages: 10

Premium Essay

Concept Analysis

...is to select a concept, which is comfort. The next step is determining the purpose of the analysis. The purpose is to define what comfort means and what comfort measures are and how they are used in nursing. The third step is to identify the uses of the concept of comfort. This includes definitions of term comfort and a literature search. The fourth step is to determine the defining attributes of comfort. This allows for insight into the concept and includes the characteristics of comfort. Comfort can mean many things to many people. Comfort can be caring words, caring touch, warm blankets, pain relief or encouragement. The fifth step is a model case or a real life example of the concept that includes the attributes of the concept and a borderline and related case. The sixth step is to identify consequences and antecedents and consequences. The final step is to define empirical referents or measurable ways to show the occurrence of comfort. Purpose The concept of comfort is used frequently in nursing practice; however, it is not always clearly defined. It is a basic value of nursing care and interventions and is frequently described as comfort measures. A basic understanding of the concept of comfort and the definitions is essential in understanding its use in bedside nursing practice. The purpose of this concept analysis is to explore and clarify the meaning of comfort. A concept analysis gives the framework and purpose and is essential in analyzing claims of knowledge...

Words: 2609 - Pages: 11

Premium Essay

Repressed and Silent Suffering: Consequences of Childhood Sexual Abuse for Women’s Health and Well-Being

...STUDIES doi: 10.1111/j.1471-6712.2012.01049.x Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well-being Sigrun Sigurdardottir RN, MS (Director) (PhD Student)1,2 and Sigridur Halldorsdottir RN, MSN, PhD (Med Dr) (Professor and Chairman)3 1 The Icelandic Research Center Against Violence, Akureyri, Iceland, 2Public Health Sciences, School of Health Sciences, University of Iceland, Reykjavik, Iceland and 3Faculty of Graduate Studies, School of Health Sciences, University of Akureyri, Akureyri, Iceland Scand J Caring Sci; 2013; 27; 422–432 Repressed and silent suffering: consequences of childhood sexual abuse for women’s health and well-being Research results indicate that psychological trauma in childhood caused by child sexual abuse can have serious and widespread consequences for health and well-being. The purpose of this study was to examine the consequences of childhood sexual abuse for women’s health and well-being. The research methodology was phenomenology. Seven women with a history of childhood sexual abuse were interviewed twice with 1–6 months interval. For all the women, the abuse started when they were between 4 and 5. All of them were repeatedly violated and traumatized ever since then and were even still being victimized at the time of the interviews. The main result of the study is that time does not heal all wounds. All the women described great repressed and silent suffering in all aspects of life, and the abuse...

Words: 9166 - Pages: 37

Free Essay

Personal Reflection Paper

...Personal Reflection Paper Personal Reflection Paper In this paper, I am going to identify a point of time in which I experienced invidious comparison and vicarious traumatization. While identifying theses to aspects, I am also going to address how to stop invidious comparison. As well as identifying strategies that I use to avoid vicarious traumatization in my own personal life. I will also go in to depth to show how to avoid vicarious traumatization as a human service worker. Lastly, I am going to address the strategies that can be considered or developed to avoid vicarious traumatization. What is invidious comparison? Invidious comparison is the comparing yourself to others. It can be through race, sexual orientation, and religion. Invidious comparison can make a person feel that their self-worth is not wanted and even take its toll on the person doing the comparison themselves. It can send you into a depressive state where you develop levels of stress. To stop invidious comparison, we must first get an understanding on others and accept the different views that other may possess. Everyone is different in their own way. There will also be an individual that may excel in different things that you may have thought you were good in. Some may be incapable of abilities that one may have. By understanding these aspects we must acknowledge the strengths that we have and do not have without dwelling on the weaknesses of others. Everywhere we go there are comparisons, it is important...

Words: 1185 - Pages: 5