A Concussion is a type of temporary traumatic brain injury that affects brain function. It is usually caused by a blow or jolt to the head or the upper body that causes the brain to move rapidly back and forth and bounce around in the skull. This irregular movement can disrupt brain function, affecting memory, consciousness, and motor coordination.
Concussions are most often caused by falls. Athletes, especially in contact sports like football, hockey, rugby, or soccer, are at an increased risk for concussions. Other causes include motor vehicle accidents, war combat, and physical altercations.
Symptoms usually occur immediately but may not appear for days or weeks. Concussions typically do not have lasting or permanent effects.
Symptoms of a concussion include:
- Ringing in the ears
- Headache
- Nausea and vomiting
- Confusion
- Dizziness
- Inability to recall events before or after a hit or fall
- Clumsy movement
- Loss of consciousness
- Delayed response to questions
- Disorders of taste and smell
- Personality changes
Head trauma is common among children. Since they cannot verbalize feelings like adults, it is more difficult to recognize. Signs and symptoms to monitor for in children are:
- Tiring easily
- Excessive crying
- Lack of interest in playing or favorite toys
- Seizures
- Vomiting
- Unsteady walking
- Irritability
- Behavior changes
A cranial computed tomography (CT) scan is the standard test for assessing adults after brain injuries. It can visualize severe damage such as bleeding or swelling in the skull.
Nursing Process
Nurses have multiple responsibilities in the treatment and recovery of patients with concussions, which include assessment of neurological functioning, coordination and communication of care, therapy integration, emotional support, patient advocacy, and prevention education.
Nursing Care Plans Related to Concussion
Acute Confusion
Concussions may lead to bleeding in or around the brain, causing symptoms such as prolonged drowsiness and confusion.
Nursing Diagnosis: Acute Confusion
Related to:
- Significant blow to the head
- Brain injury
- Possible bleeding in the brain
As evidenced by:
- Fluctuation in psychomotor activity
- Misperceptions
- Impaired memory
- Restlessness or agitation
- Fluctuation in the level of consciousness
- Visual or auditory hallucinations
- Erratic sleep-wake cycle
Expected outcomes:
- Patient will regain alertness with orientation within normal limits.
- Patient will demonstrate a neurological assessment within normal limits.
- Patient will demonstrate appropriate motor skills and reflexes.
Assessment:
1. Assess the patient’s level of consciousness frequently.
A change in mental status may be indicative of an increase in cerebral pressure.
2. Assess the patient’s behavior and cognition continually.
Almost half of the patients with head injuries may develop delirium, which invokes acute changes in mental status. Knowledge of the patient’s baseline mental status is key in assessing delirium.
3. Review imaging results.
Imaging may not always be necessary, but if symptoms worsen into severe headaches, seizures, or vomiting, advocate for a CT scan or MRI.
Interventions:
1. Reorient the patient to person, time, situation, and place frequently.
In concussions, memory might be affected, requiring frequent repetition of important information. Informing the patient about their situation may reduce anxiety levels and improve their awareness.
2. Allow for rest and reduce stimuli.
The most important intervention after a concussion is rest. Complete darkness and quiet aren’t necessary, but brain rest is encouraged.
3. Promote safety.
When in a confused state, safety is vital. Ensure frequent supervision, keep items within reach, and the bed alarm on.
4. Encourage family support.
Seeing familiar faces and recognizing familiar voices stimulate memory and help with reorientation. If the patient is cleared for discharge, a family member may need to stay with them to monitor for symptoms and ensure they are recovering.
Impaired Physical Mobility
Mobility, including coordination and balance, can be affected following a concussion.
Nursing Diagnosis: Impaired Physical Mobility
Related to:
- Neurological impairment
As evidenced by:
- Weakness
- Reports of pain or discomfort in movement
- Impaired coordination
- Loss of balance
- Dizziness
- Impaired reflexes
Expected outcomes:
- Patient will safely participate in desired physical activities.
- Patient will display improvement in balance, coordination, and reflexes.
- Patient will perform ADLs with the least amount of assistance.
Assessment:
1. Assess the patient’s ability and tolerance to engage in activities.
This will help provide baseline data which will aid in determining a proper direction for treatment. Physical and occupational therapy may be consulted.
2. Assess the patient’s need for special equipment.
Mechanical lifts, canes, wheelchairs, and assistive devices may be required when performing tasks.
3. Perform neurological assessments.
The nurse should perform neuro checks as ordered and assess the pupils, coordination, sensations, reflexes, gait, and more for improvement or changes.
Interventions:
1. Provide equipment as needed.
Concussion symptoms usually aren’t severe or permanent, but the patient may need a walker or equipment temporarily to support balance and weakness.
2. Allow the patient to perform tasks at their own pace.
Excessive assistance may slow their physical recovery. Take your time with the patient and encourage independent activity as allowed.
3. Encourage progressive activity as tolerated.
A gradual increase in the patient’s movement will help increase their tolerance to activity. As symptoms improve, the patient should resume light exercise.
4. Refer to therapy as required.
Specialized therapies such as physiotherapy and occupational therapy will provide treatment to safely improve their balance and coordination.
Risk for Injury
Patients who perform contact or high-risk sports are at an increased risk for a concussion. Children are also at increased risk for head injuries. After sustaining a concussion, preventing further injury is a priority.
Nursing Diagnosis: Risk for Injury
Related to:
- Impaired psychomotor performance
- Changes in cognitive function
- High-risk activities
- Brain injury
- Young age
As evidenced by:
A risk diagnosis is not evidenced by signs and symptoms as the problem has not yet occurred and the goal of nursing interventions is aimed at prevention.
Expected outcomes:
- Patient will demonstrate behaviors to help in avoiding injury.
- Patient will remain free of injuries.
- Patient will modify their environment as indicated to enhance safety.
Assessment:
1. Assess for changes in cognitive awareness.
Confusion or disorientation puts the patient at risk for falls or injuries.
2. Assess the patient’s ability to ambulate and identify the risk for falls.
Alterations in mobility increase the risk of falls. The Morse Fall Scale (MFS) is a simple fall risk assessment tool commonly used among healthcare facilities. It uses a point scale system that assesses six variables. An MFS score of 0-24 means no risk, 25-50 indicates low risk, and >51 is a high risk for falls.
3. Check on the home environment to identify the presence of safety risks.
Patients experiencing impaired mobility and deficits are at risk for injury from common hazards. Throw rugs, clutter, dim lighting, and stairs may increase the risk.
Interventions:
1. Encourage safety with sports.
Safety equipment such as helmets, headgear, and padding should always be worn correctly.
2. Educate parents on child safety.
Remind parents always to ensure their kids are strapped into car seats correctly and using their seat belts. In homes with stairs, use safety gaits to prevent falls.
3. Prevent second injuries.
Encourage the patient to return to activities slowly. A return to sports before symptoms have resolved and a second concussion may result in life-threatening brain swelling.
4. Promote strength training.
Older adults at risk for falls will benefit from strength and balance training to prevent falls and head injuries.
References
- Doenges, M. E., Moorhouse, M. F. (1993). Nurses’s Pocket Guide: Nursing Diagnoses with Interventions (4th Ed.). F.A. Davis Company.
- What Is A Concussion?. Centers for Disease Control and Prevention. https://www.cdc.gov/headsup/basics/concussion_whatis.html. Accessed on Dec. 22, 2022
- Concussion. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/concussion/symptoms-causes/syc-20355594. Accessed on Dec. 22, 2022
- What is a concussion? Concussion Legacy Foundation. https://concussionfoundation.org/concussion-resources/what-is-concussion. Accessed on Dec. 22, 2022
- Concussion. Cleveland Clinic. https://my.clevelandclinic.org/health/diseases/15038-concussion. Accessed on Dec. 22, 2022
