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Reflection on patient assessment
Medical patient assessment
The importance of patient assessment
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Paramedics are frequently presented with neurological emergencies in the pre-hospital environment. Neurological emergencies include conditions such as, strokes, head or spinal injuries. To ensure the effective management of neurological emergencies an appropriate and timely neurological assessment is essential. Several factors are associated with the effectiveness and appropriateness of neurological assessments within the pre-hospital setting. Some examples include, variable clinical presentations, difficulty undertaking investigations, and the requirement for rapid management and transportation decisions (Lima & Maranhão-Filho, 2012; Middleton et al., 2012; Minardi & Crocco, 2009; Stocchetti et al., 2004; Yanagawa & Miyawaki, 2012). Through a review of current literature, the applicability and transferability of a neurological assessment within the pre-hospital clinical environment is critiqued. Blumenfeld (2010) describes the neurological assessment as an important analytical tool that evaluates the functionality of an individual’s nervous system. Blumenfeld (2010) dissected and evaluated the neurological assessment into six functional components, mental status, cranial nerves, motor exam, reflexes, co-ordination and gait, and a sensory examination.
The mental status exam investigates global and limbic brain functions, left and right parietal functionality and language. This is achieved through tests such as, level of consciousness, memory, and language assessment (Blumenfeld, 2010). Yanagawa and Miyawaki (2012) highlight the importance of obtaining reports from witnesses to assist with a mental status examination. They state that pre-hospital patients can deteriorate quickly into unconsciousness, limiting the ability for para...
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...R. (2006). Paramedics’ clinical judgement and mental health assessments in emergency contexts: Research, practice, and tools of the trade. Australasian Journal of Paramedicine, 4(2). Received from http://ro.ecu.edu.au/
Stocchetti, N., Pagan, F., Calappi, E., Canavesi, K., Beretta, L., Citerio, G., … Colombo, A., (2004). Inaccurate early assessment of neurological severity in head injury. Journal of Neurotrauma, 21(9), 1131-1140. doi:10.1089/neu.2004.21.1131
Sullivan, S. J., Hammond-Tooke, G. D., Schneiders, A. G., Gray, A. R., & McCrory, P. (2012). The diagnostic accuracy of selected neurological tests. Journal of Clinical Neuroscience, 19. 423-427. doi:10.1016/j.jocn.2011.09.011
Yanagawa, Y., & Miyawaki, H. (2012). Importance of checking prehospital neurological findings to reveal incidence of spinal cord concussion. Spinal Cord, 50, 278-280. doi:10.1038/sc.2011.151
However, this approach not only lacks objectivity, but it also fails to acknowledge the abnormal physiology that precedes this breakdown in self-care. For instance, it has been reported that 70% of patients preceding cardio-pulmonary arrest had a physiological decline in respiratory or mental function (Schein et al 1990). Observing deterioration in activities of daily living alone does not accurately mirror underlying physiological deterioration occurring in patients.
Two types of assessment procedures that are currently being used are the Luria-Nebraska Neuropsychological Battery (LNNB), and the Halstead Russell Neuropsychological Evaluation System (HRNES-R). The LNNB is used to diagnose cognitive deficits, while the HRNES-R indicates both the presence and degree of impairment. Both procedures involve tasks that require the patient to complete a series of functions that test abilities and/or perceptions. Such tasks would include, but are not limited to, problem solving, memory, sensorimotor functioning, and psychological/emotional status.
middle of paper ... ... While there is no neurobiological or neuropathological explanation as to why CTE occurs, the majority of researchers believe the disease is strongly related to previous head injuries. An individual suffering from CTE will most likely experience changes in their mood, behavior, and cognition. Because this is a relatively new area of research, there are still a vast amount of unknowns pertaining to the disease’s symptoms, pathology, and natural course.
A serious brain injury could lead to bleeding in or around your brain, causing symptoms that may develop right away or later.
Yates, Keith, et al. “Longitudinal Trajectories of Postconcussive Symptoms in Children With Mild Traumatic Brain Injuries and Their Relationship to Acute Clinical Status.” Pediatrics. 123.3 (2009) : 735-743. Web. 11 Apr. 2014.
Concussions can spring from practically anywhere; at home during cleaning, playing catch in the yard, or even slipping and falling. One
Adirim, Terry A. “Concussions in Sports and Recreation.” Clinical Pediatric Emergency Medicine 8.1 (2007): 2-6. Print.
Rowland, L. P., ed. Merritt’s Textbook of Neurology. 7th ed. Lea and Febiger. Philadelphia: 1984.
Kanske, P., Heissler, J., Schönfelder, S., Forneck, J., & Wessa, M. (2013). Neural correlates of
The purpose of the paper is to discuss the activities involved during the evaluation of a patient. Evaluation of a patient can be seen as the process of examining a patient critically. It comprises of gathering and analyzing data about a patient and the illness (Allan, 2012). The core reason is to make judgment about the disease one is suffering from. Such judgment will guarantee proper treatment and diagnosis. Typically, gathering of information from the patient is the role of nurses while making judgment and prescription is the doctor’s role (Jacques, 1988). In any case all practitioners are required to know how to evaluate a patient.
Based upon previous knowledge of brain function, what results from the testing were consistent with a brain injury?
The aim of this essay is a reflective account in which I will describe a newly acquired skill that I have learned and been able to implement within my role as a trainee assistant practitioner. (T.A.P.) for Foundation for Practice. I have chosen to reflect upon neurological observations on patients that will be at risk of neurological deterioration. Before I begin any care or assessments, I should have a good theoretical underpinned knowledge, of the skill that I am about to put into practice, and have a good understanding of anatomy and physiology, in order to make an accurate assessment of a patients neurological status. I will be making a correct and relevant assessment to identify any needs or concerns to establish the patient’s individualized care, and make observations to determine an appropriate clinical judgement.
My colleague and I received an emergency call to reports of a female on the ground. Once on scene an intoxicated male stated that his wife is under investigation for “passing out episodes”. She was lying supine on the kitchen floor and did not respond to A.V.P.U. I measured and inserted a nasopharyngeal airway which was initially accepted by my patient. She then regained consciousness and stated, “Oh it’s happened again has it?” I removed the airway and asked my colleague to complete base line observations and ECG which were all within the normal range. During history taking my patient stated that she did not wish to travel to hospital. However each time my patient stood up she collapsed and we would have to intervene to protect her safety and dignity, whilst also trying to ascertain what was going on. During the unresponsive episodes we returned the patient to the stretcher where she spontaneously recovered and refused hospital treatment. I completed my patient report form to reflect the patient's decision and highlighted my concerns. The patient’s intoxicated husband then carried his wife back into the house.
Most of the noninvasive imaging methods estimate brain activity by changes in blood flow, oxygen consumption, glucose utilization, etc. Discuss the potential problems with using this type of indirect measure.
The most commonly used representative of this type of test is the Halstead - Reitan Neuropsychological Battery. The second method is to use an assessment technique in which a fixed battery of tests is given but in this method there is a hierarchical each subtest so that if a function is impaired, the level at which it is impaired can be determined. The most common representative of this type of test is the Luria - Nebraska. Common to both of these tests is a long history of research studies examining the ability of the two batteries to measure dysfunction of the brain and to accurately identify why that dysfunction is occurring.