Posted: February 8th, 2024

GNUR 577 Case Study Diagnostic Analysis Paper

GNUR 577 Case Study Diagnostic Analysis Paper
Case Study:

A 14 year-old boy is seen in the pediatrician’s office at the request of his high school athletic trainer to be cleared to return to play football. He is the star quarterback and the state championship game is in 6 days. During last night’s game, he was tackled from the side, sustaining a blow from the other players against his left shoulder. When he fell, he struck the right side of his head against the ground but did not lose consciousness. He remembers hitting his head and events of the game before and after the tackle. Subsequently he has had a dull, throbbing headache (described in intensity as 5 out of 10), located globally. He denies associated visual disturbance, photophobia, phonophobia, nauseam vomiting and dizziness. He described no exacerbating factor for the headache and it is relieved with ibuprophen. He reports he felt “a little woozy” after the initial hit but feels tired only this morning. His mother says he slept an extra hour today but was not difficult to awaken’ he has shown no change in his behavior. He has had no previous head injury. Examination of his head, neck, cranial nerves, strength, range of motion of all joints, sensation, gait, balance, coordination, and deep tendon reflexes is normal. He is oriented to month, date, day of week, year and time, able to recall five words immediately, but when asked to recall them 5 minutes later he can only remember three of the words.

What is the most likely diagnosis?

What is the next step in management?

Objectives:

1. Recognize symptoms of concussion.

2. Describe management of concussion.

3. List factors associated with a concussion that warrant further evaluation with imaging.

Terms

Concussion: A complex process involving a decline in neurologic or cognitive function that is induced by traumatic mechanical force to the person’s head, neck, or body.

Cognitive Rest: Limiting mental exertion during tasks such as homework, testing, video games, and even TV viewing in order to prevent worsening of concussive symptoms.

Graduate Return-To-Play Protocol: A stepwise approach for athletes to demonstrate symptom-free intervals before increasing the level of physical and cognitive exertion. The athlete must remain symptom free for 24 hours at each level without any medication before advancing.

Second Impact Syndrome: If an individual is still recovering from a concussion and receives a second concussion, increased cerebral vascular congestion and edema may occur which can lead to death.

Considerations: This boy has a sport-related concussion, an injury that accounts for almost 10% of all athletic injuries during high school. Most occur during football. Concussion is a functional injury so imaging is not routinely done nor required for diagnosis. Instead, signs and symptoms indicating a concussion will involve one or more of the following areas: somatic, cognitive, emotional, or sleep. Some of the symptoms will be immediate, such as his dizziness and the mental “fogginess”, somatic and a cognitive symptom, respectively; which may worsen, subside, or fully resolve only to be followed by new findings, He now has symptoms from each of the categories: Headache (somatic), antegrade amnesia (cognitive), fatigue (emotional), and increased sleep.

GNUR 577 Case Study Diagnostic Analysis Paper
Grading rubric
Criteria Points Feedback
Overview of case study; including:
● Pertinent positives and negatives
● Special considerations based upon race, age, gender and
co-morbidities (if applicable).
10 points
Analyze testing provided in case study and what the findings
from ordered tests will tell you (rationale).
Other testing, history, physical exam or radiology assessment
needed to make diagnosis with rationale.
15 points
Briefly Compare and contrast 2-3 likely differential diagnoses 15 points
What is your assessment (probable diagnosis)? Provide
rationale for your diagnosis
15 points
Plan of care
● Medical: tests, medications or other therapies.
Include medication action, dosing, contraindications,
more common side effects and any important
considerations.
● APRN care and education for patient, family and/or
staff
● Follow up and referrals with time frames
● Health promotion/screening applicable to patient
including immunizations.
20 points
Appendices
● Algorithm, guideline or screening tool used in
presentation briefly described
● Example of SOAP note that would be suitable for
entry into the patient’s health care record
10 points
Paper mechanics
● APA
● Organization, Grammar, Punctuation, spelling
● Scholarly references used that are current (preferred
within last 5-7 years)
15 points
8/15 NM; 8/16 NM

______________________________
Overview of Case Study (10 points)
This case involves a 14-year-old male high school football star quarterback seen for clearance to return to play after sustaining a head injury during last night’s game. During a tackle, he was struck on his left shoulder and the right side of his head hit the ground, though he did not lose consciousness. Pertinent positives from the history include a headache, feeling woozy immediately after the injury, fatigue, and difficulty recalling words after a short delay.
Testing and Findings (15 points)
The physical examination was normal, without any abnormalities found on evaluation of the head, neck, cranial nerves, strength, sensation, balance, coordination, or reflexes. Neurocognitive testing demonstrated anterograde amnesia, as the patient could only recall 3 out of 5 words after 5 minutes.
Differential Diagnoses (15 points)
The main differential diagnoses considered are concussion, contusion, and subdural hematoma. A subdural hematoma is unlikely given the normal neurological exam and the patient’s recall of events surrounding the injury.
Assessment (15 points)
Based on the mechanism of injury and symptoms exhibited, the most likely diagnosis is a mild traumatic brain injury, also known as a concussion.
Plan of Care (20 points)
Treatment will involve cognitive and physical rest, monitoring for symptom resolution, and use of ibuprofen as needed for headache pain. Education will be provided on signs of worsening and the importance of complete rest. Follow-up with the primary care doctor within 5-7 days is recommended, with gradual return to play to begin after 1 week of being asymptomatic. Counseling on concussion prevention is also warranted.
Appendices (10 points)
A summary of the CDC’s “Heads Up: Concussion in Youth Sports” guideline is included for reference.
_____________________

Overview of Case Study
This case involves a 14-year-old male high school football star quarterback seen for clearance to return to play after sustaining a head injury during last night’s game. During a tackle, he was struck on his left shoulder and the right side of his head hit the ground, though he did not lose consciousness. Pertinent positives from the history include a headache, feeling woozy immediately after the injury, fatigue, and difficulty recalling words after a short delay.
Testing and Findings
The physical examination was normal, without any abnormalities found on evaluation of the head, neck, cranial nerves, strength, sensation, balance, coordination, or reflexes. Neurocognitive testing demonstrated anterograde amnesia, as the patient could only recall 3 out of 5 words after 5 minutes.
Differential Diagnoses
The main differential diagnoses considered are concussion, contusion, and subdural hematoma. A subdural hematoma is unlikely given the normal neurological exam and the patient’s recall of events surrounding the injury.
Assessment
Based on the mechanism of injury and symptoms exhibited, the most likely diagnosis is a mild traumatic brain injury, also known as a concussion.
Plan of Care
Treatment will involve cognitive and physical rest, monitoring for symptom resolution, and use of ibuprofen as needed for headache pain. Education will be provided on signs of worsening and the importance of complete rest. Follow-up with the primary care doctor within 5-7 days is recommended, with gradual return to play to begin after 1 week of being asymptomatic. Counseling on concussion prevention is also warranted.
Appendices
A summary of the CDC’s “Heads Up: Concussion in Youth Sports” guideline is included for reference.
Paper Mechanics

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