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)


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. I also fetched some suitable toys for her from the play specialist.

While assessment of Anna's airway, breathing and circulation was completed, I explained the procedures as clearly as possible and answered any questions.

The handover from ambulance staff helped me to establish the history of the injury, and Anna's course since the injury occurred. I documented this information in Anna's notes and informed the relevant staff.

I carried out a rapid assessment of Anna's conscious level using the AVPU categories (see Appendix 2) and placed Anna in the alert category as my observations concluded she was aware of, and responding to the people, movement and noises around her appropriately.

Her vital signs including heart rate, blood pressure, respirations, pulse oximetry and temperature were stable and age appropriate.

Before examining pupil size and reactivity I enlisted the support of Anna's mother (who had seemed to have moved further away from Anna) to help facilitate her involvement. I explained what I was going to do and she seemed happy to assist me. I performed the assessment on her first so that Anna could see, and hoped this would prepare her and gain her cooperation. Her pupil size was 4 and responded quickly and positively.

I began frequent 1/2 hourly assessments of neurological function and level of consciousness using an adapted paediatric version of the Glasgow Coma Scale (see Appendix 3), the first of which I carried out alongside another nurse, as I wanted to be sure I was using the assessment tool properly. Anna consistently scored 14/14, her vital signs remained stable, and she had experienced no nausea or vomiting.

Following a full head to toe examination no other injuries were located and it was decided Anna had experienced only an isolated, minor head injury with no cervical spine abnormality. Therefore, the protective measures were removed and after brief observation Anna was discharged home with verbal and written advice on what Anna's mother should observe for and what action to take if she had any concerns.

I was asked if I wanted to take on the responsibility of caring for and assessing Anna about two minutes before her arrival. All I new at that point was that she was a two - year - old head trauma victim with a possible cervical spine injury. In that brief time before her arrival I experienced feelings of excitement, enthusiasm, motivation to learn as much as possible from this new opportunity, and proud that the nursing staff had faith in my capabilities. Amidst the mass of nursing, ambulance and medical staff that gathered upon Anna's arrival, the noise and seeming panic and confusion which ensued my initial feelings where taken over by my own panic and anxiety. This caused me to question my capabilities, prompting frustration in my lack of confidence, and my feelings that to ask for support and encouragement from staff would some how lessen my achievements and affect how dependable I was viewed by staff.
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I then recognised that if the atmosphere and unfamiliarity of A & E had evoked such fear in me, then the psychological impact it would have on Anna would be massive. Considering it was her first experience of the hospital environment in addition to the impact of her accident, Anna was probably deeply frightened and traumatised by the whole experience and I did not wish to exacerbate her fear and distress. I would have to swallow my pride and ask for help in order to act in Anna's best interests and cause her no further psychological harm. In ...

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