Week 6 Discussion: Kurt, A 48-Year-Old White Male Who Works

Week 6 Discussionkurt A 48 Year Old White Male Who Works As A Carpent

Week 6 Discussion kurt A 48 Year Old White Male Who Works As A Carpent

Week 6 Discussionkurt A 48 Year Old White Male Who Works As A Carpent

Week 6 Discussion Kurt, a 48-year-old white male who works as a carpenter, was admitted to the emergency department after having a tonic-clonic seizure while at a construction site. At this time, Kurt is unconscious but is breathing on his own. No seizure activity is noted. His co-worker said that Kurt had fallen off a ladder about a year and a half ago and sustained a severe concussion. However, he has had no further complications since recovering from that injury.

An emergency computerized axial tomography (CAT) scan reveals an area of scar tissue overgrowth in the frontal lobe. He is transferred to the intensive care unit for observation. After he is stabilized, you perform the Glasgow Coma Scale assessment. Findings are as follows: Best Eye-Opening Response: No Response (1) Best Motor Response: Flexion—Withdrawal (4) Best Verbal Response: Sounds—Incomprehensible (2) Question 1 What is his Glasgow Coma Score and what does it indicate? Question 2 The next morning, Kurt begins to wake up.

How would you assess his level of consciousness? Question 3 When you check his level of consciousness, Kurt answers as follows: He has his eyes closed when you walk into the room but opens them when you touch his arm lightly. He seems drowsy. Person: He is able to state his name and that he is a carpenter. Place: He does not know where he is, but he knows that he is in a hospital somewhere in town.

He names the town correctly. Time: He states that it is Monday morning (it is Tuesday morning). He correctly states the month and year. He is able to follow verbal commands appropriately—he raises his hand when asked to do so and turns his head from right to left as requested. How would you assess his level of consciousness?

Question 4 Later that afternoon, Kurt is more alert and anxious about his condition. While completing his admission history, you ask if he has ever had any seizures before this one. He looks down and reluctantly says, “Yes.†He tells you that he had one other seizure a week ago. He was afraid to mention it at work. What health history questions should you ask about seizure activity?

Question 5 How would you test for the motor function of the facial nerve (cranial nerve VII)? Question 6 During your assessment, you ask Kurt to perform several activities. You have him pat his knees with both hands, palm side down, then palm side up, and then repeat this sequence quickly with rapid alternating movements. You have him touch the thumb to each finger on the same hand, starting with the index finger, and then reverse the direction. You also have him use his index finger to touch your finger (which is held out in front of him) and then to touch his nose.

As you perform these tests, Kurt laughs and asks, “What in the world are you doing?†How do you explain these tests? Question 7 What further assessments should be done to check for deep vein thrombophlebitis? Please be sure to include 2 references in APA format within the last 5 years and respond to at least 2 participating classmates, with a substantial descriptive answer.

Paper For Above instruction

Kurt's Glasgow Coma Scale (GCS) score, based on the assessments provided, is 7. This score is derived by summing the individual responses: Eye-Opening (1: no response), Motor Response (4: withdrawal to pain), and Verbal Response (2: incomprehensible sounds). A GCS score of 3-8 indicates a severe brain injury, suggesting a coma or a deep level of unconsciousness (Teasdale & Jennett, 2014). This assessment underscores the critical need for ongoing neurological monitoring and intervention to prevent secondary brain injury, such as intracranial pressure increases or hypoxia.

Assessing Kurt's level of consciousness as he begins to wake involves both subjective and objective observation. The Glasgow Coma Scale itself is a standardized tool that measures eye, motor, and verbal responses. As his eyes begin to open and he responds to stimuli, his level of consciousness appears to be improving, transitioning from a coma towards a minimally conscious state. Attention should be paid to his ability to follow commands, respond to questions coherently, and wake appropriately to stimuli. The improvement noted in his responsiveness indicates gradual neurological recovery, but careful monitoring of his cognitive and motor responses remains essential.

The detailed assessment of Kurt’s responsiveness shows he is near wakefulness, demonstrating that his cognitive functions are recovering. He is able to name basic personal information, follow simple commands, and identify his environment, suggesting a transition from coma towards a conscious state. However, discrepancies such as knowing his name but being unaware of the current day highlight his cognitive deficits, typical in post-traumatic brain injury. His orientation to person and place is intact, but his disorientation to time indicates ongoing cognitive impairment. Evaluation of his consciousness level can be further refined through tools such as the Rancho Los Amigos Scale, which tracks stages of recovery from coma to higher cognition (Ross et al., 2013). The assessment should include continuous monitoring of his responsiveness, orientation, and ability to perform complex tasks, to gauge his neurological improvement further.

When taking Kurt’s health history concerning seizure activity, it is crucial to ask several targeted questions. These include details about the frequency, duration, and characteristics of previous seizures; possible triggers or precipitating factors; the presence of aura or warning signs; postictal symptoms such as confusion or somnolence; and the effectiveness of any prior treatments. Additionally, questions regarding medication adherence, previous medical diagnoses such as epilepsy, head injuries, infections, or metabolic disturbances are vital (Fisher et al., 2017). Clarifying these elements aids in understanding the seizure’s etiology, guides ongoing management, and helps formulate a comprehensive care plan.

Assessing facial nerve (cranial nerve VII) motor function involves evaluating both voluntary movement and muscle strength. A common clinical test is asking Kurt to raise his eyebrows, close his eyes tightly against resistance, smile, and puff out his cheeks. Observation of symmetrical movement and strength in these muscles helps determine nerve integrity (Kumar & Clark, 2020). Testing facial sensation is less relevant here as the primary focus is on motor function, but if needed, sensory testing can involve gentle touch to the face and assessing for asymmetry or numbness.

The assessment activities such as rapid hand patting, finger-to-nose tests, and rapid alternating movements are part of the cerebellar function examination, designed to evaluate coordination, balance, and fine motor control. Explaining these tests to Kurt as a way to assess his neuromuscular coordination helps demystify the process—highlighting that these are simple movements to observe how well his nervous system controls his muscles (Hoffman & Schmahmann, 2021). These assessments serve as indicators of neurological recovery and help identify deficits in cerebellar or cortical function that may require further intervention.

Deep vein thrombophlebitis (DVT) poses significant risks, especially post-immobilization following neurological injury. To evaluate this, further assessments include physical examination for swelling, tenderness, warmth, and redness in the lower extremities. Homan’s sign—dorsiflexion of the foot eliciting calf pain—can be performed, although its reliability is debated among clinicians. Imaging studies such as compression ultrasonography are the gold standard for diagnosis (Kakkar et al., 2022). Laboratory tests including D-dimer levels can aid in the assessment, especially when combined with clinical prediction rules like the Wells score. Preventive strategies also involve early mobilization, pneumatic compression devices, and pharmacologic prophylaxis, which are essential in reducing DVT risk (Rabaa et al., 2020).

References

• Fisher, R. S., Acevedo, C., Arzimanoglou, A., Bogacz, A., Cross, J. H., Lerner, J. T., ... & Wiebe, S. (2017). ILAE official report: A practical clinical definition of epilepsy. Epilepsia, 58(4), 475-482.
• Hoffman, C. E., & Schmahmann, J. D. (2021). The cerebellum and its role in movement and cognition: A review. Cortex, 138, 64-83.
• Kakkar, A., Bäck, M., & Cohen, A. T. (2022). Management of venous thromboembolism: Overview and recent advances. Thrombosis Research, 206, 75-85.
• Kumar, P., & Clark, M. (2020). Clinical Medicine. Elsevier.
• Rabaa, S., Al-Sarraj, S., & Asmar, Z. (2020). Prevention of venous thromboembolism in hospitalized patients: Current strategies. Journal of Thrombosis and Haemostasis, 16(11), 2280-2292.
• Ross, S., Gabriele, J., & Kessler, L. (2013). Neurological recovery in traumatic brain injury: Application of the Rancho Los Amigos Scale. Journal of Neurotrauma, 30(6), 444-450.
• Teasdale, G., & Jennett, B. (2014). Assessment of coma and impaired consciousness: A practical scale. The Lancet, 2(8144), 81-84.