Part A) Identify, discuss, and rationalise each component of the systematic A-H assessment and highlightspecific considerations when assessing a patient with a closed head injury.Part B) Identify 1...

WRITTEN ASSIGNMENT        11
WRITTEN ASSIGNMENT
Table of contents
Part A: Systematic A-H Assessment for a Closed Head Injury Patient    3
Part B: Patient Problems and Interventions    6
Part C: Reflection and Implication for Future Practice    9
References    11
Part A: Systematic A-H Assessment for a Closed Head Injury Patient
    The A-H assessment is a structured method of evaluating the patient, especially one with possible critical illness such as closed head injury. Each component of the assessment helps identify key issues that might compromise the patient’s condition:
A: Airway
    Adequate assessment of the airway should be performed and it is most important after trauma (Zrelak et al., 2020). Vanessa vomited after the injury thus a patient with closed head injury is at risk of airway obstruction because of reduced level of consciousness. Nurse should be alert for such signs as Reference, gurgling, stridor or reduced air entry.
    Consideration: Aspiration risk elevates in patients who have impaired consciousness. It may be warranted to perform intubation for the protection of airway and particularly if the GCS score drops.
B: Breathing
    End tidal CO2, pulse oximetry, respiratory rate and depth, respiratory effort. Head injury patients on sedation or receiving opioids may develop respiratory depression. For instance, Vanessa was prescribed opioids and administered high dosage leading to respiratory depression.
    Consideration: Special attention should be paid to changes of pulse and irregular breathing such as Cheyne-Stokes pattern which may manifest increased intracranial pressure. The M-valve should be used to monitor oxygenation using pulse oximetry.
C: Circulation
    Review and compare blood pressure, pulse, and capillary refill. This study should show that hypotension should not be allowed in head injury patients because it may lead to decreased perfusion. This would mean that Vanessa has poor cerebral circulation which is evidenced by the rising headache and the subsequent deterioration.
    Consideration: Intravenous therapy could be required for the patient in order to stabilize his intravascular volume and thereby ensure adequate perfusion of the brain.
D: Disability
    This includes performing of GCS assessment, assessment for the pupil response as well as the assessment of amount of limb movement. The general social change could have been properly analyzed if a GCS was conducted; Vanessa’s neurological function continued to decline progressively (e.g., inability to lift an arm) without proper documentation.
    Consideration: A GCS score below 8 is normally an indication that the patient should be intubated and managed in the intensive care unit. Nurses can prevent missed opportunities of doing head-to-toe neuromonitoring by tracking certain changes easily, including anisocoria or new flaccid extremities weakness.
E: Exposure
    Exposing patient fully admits other area which can be used to check for other injuries (Carrier et al., 2023). However, body temperature regulation is imperative in the case of head injury, as the body temperature is most likely to rise. It is best to not let hypothermia occur and if it is already present, on damage to the brain is going to be worse.
    Consideration: Patients with head injuries should be protected from hypothermia because it raises intracranial pressure.
F: Fluids
    The patients should be encouraged to report if they are thirsty or if they experience any change in appetite and especially observation should be made on their fluid intake for it corresponds with blood glucose levels. In a patient with a head injury, the combination of sodium/fluid intake will raise the intracranial pressure.
    Consideration: Isotonic fluids should be given sparingly and should be watched for increased intracranial pressure due to fluid overload.
G: Glucose
    In this case, blood glucose should be checked because hypoglycemia can imitate neurological deterioration.
    Consideration: Force A1c levels back to normal to have no further worsening of the neurological condition.
H: Head and neck assessment
    Head and neck masses should be looked for during the physical examination to rule out fractures, swelling, or hematoma (De Goumoëns et al., 2022). She had a depressed skull fracture which means further evaluation is needed to ensure no additional brain damage.
    Consideration: It...