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In this assignment I will reflect upon a neurological assessment I carried out of a child admitted to paediatric Accident and Emergency department following a head trauma.

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Assessment -Theory-3000 word essay The theoretical assessment is in two parts; Students are expected to carry out an assessment of a child in an ambulatory setting of their choice, giving a clear rationale, supported by evidence and using appropriate assessment tools. Reflection on the assessment and communication skills required assessing the child and families health care needs using a cyclical approach. Student information: Name: Kim Chappelle-Hedges Student Number: 10277631 Intake: October 2001 Module: 6 Diploma of Higher Education Nursing (Child branch) APPENDIX 1 In this assignment I will reflect upon a neurological assessment I carried out of a child admitted to paediatric Accident and Emergency department following a head trauma. I have chosen to reflect upon this particular assessment due to the immense learning achieved and my excitement at the future learning it will bring. Only a brief profile of the child in question will be presented reflecting the amount of information known to me at the time of her arrival. For the purpose of patient confidentiality and respect any information that could lead to the identification of this patient and her family have been either changed or omitted. The patient therefore has been named Anna. Following a profile of Anna to set the scene my reflection will begin based upon Johns (1995) model of structured reflection. Anna, a 2 1/2 year old female, was playing at home one morning when a 28 inch television fell on top of her, falling from the top of a chest of drawers and hitting the right side of her head, screamed out alerting her mother in the next room who called for an ambulance. I was asked to carry out Anna's neurological assessment following the primary survey. Upon arrival at the paediatric Accident and Emergency Department, c - spine immobilisation was in place and Anna was highly distressed so I encouraged Anna's mother to continually talk to her and try to remain in sight, explaining that this may help to reassure her. ...read more.


Since Anna pushed a nurses hand away whist she was trying to administer pain relief and since she reached out to take a toy from her mother a 5 for motor response was given. My confidence had grown and I was happy to continue my assessments alone and refer to her when necessary. The AVPU (Alert, Verbal, Painful, Unresponsive) system I used in my rapid assessment can provide a rough guide to whether patients need airway protection, but full assessment will still be required (Mackway-Jones and Maurice, 1999; Gentleman,1999). Then I assessed Anna further using the following assessment tools: the Glasgow Coma Scale and the Glasgow Coma Score. The Glasgow Coma Scale provides a standardised framework for assessing cerebral function and describing the level of consciousness of a patient in terms of three aspects of responsiveness: eye opening, verbal response, and best motor response. The Glasgow Coma score is an artificial index; obtained by adding scores for the three responses. This score can provide a useful single figure summary and a basis for systems of classification, but contains less information than a description separately of the three responses. The three responses of the original) scale, not the total score, should therefore, be of use in describing, monitoring and exchanging information. Examination of the cranial nerves, in particular pupil reactivity, and neurological examination of the limbs, in particular the pattern and power of movement, provide supplementary information about the site and severity of local brain damage. Measuring Anna's vital signs were also of great importance as the centres for their vital signs are located within the brain stem and normal brain stem function is affected by pressure upon the brain stem from cerebral lesions, edema, or herniation, and direct invasion of the brain stem by tumours and trauma. This can often cause changes in vital signs. These assessment tools are used widely to assessing patients both before and after arrival at hospital( Gentleman and Teasdale,1981;Ingersoll and Leydon,1987; Winkler et al,1984). ...read more.


believe that my from them about their child and new ways of interacting with them that could increased confidence, and the skills and understanding I would bring if a similar situation should arise, would mean vast improvements from the care I was able to deliver in this particular situation. However due to the tremendous scope of paediatric trauma, the age range involved and the different skills required for injuries causing different and more severe neurological problems, this experience has only fuelled my curiosity. From this experience my views regarding parental participation have been altered, and in my future practice I would like to work on my confidence and assertiveness so as not to be embarrassed by their presence when I am caring for patients so that I can both assist them in providing nursing care for their children, and listen and learn from them about child and family needs. This personal development in myself will also assist with my interactions with fellow nursing staff and members of the multi- disciplinary team. With regards to my interest in developing my knowledge of paediatric neurosurgeon and observed a paediatric craniosynostosis following his care from preparation to surgery to his admission onto a general paediatric ward from a high dependency unit. I intend to arrange visits with a paediatric trauma care team in the near future also. From my reflection and discussion upon this experience I can conclude that neurological assessment in children requires a complex mix of skills, nurses must have a detailed knowledge of child development from a physiological and psychological perspective, in addition to the ability to assess each child individually. The skills to communicate will both the child and family, and to collaborate and coordinate care as part of multi-disciplinary team. Experience and knowledge is essential to gain an accurate assessment of any potential or existing neurological problems, and regardless of the tool used, the nurse should be familiar with the tool and it's short comings in order take steps to counteract these. ...read more.

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