Traumatic Brain Injury s1

Traumatic Brain Injury Concept: Intracranial Regulation Can be done individually or in groups (best if there is no more than 4 students/group)

One morning on your way to school you are listening to the radio when you hear about an accident on a main thoroughfare in town. The news team on scene is saying that a driver of a small Honda Accord crossed the center line and hit an on-coming car head on. The only serious injury at the scene is supposedly to the driver of the Honda who is being transported to the local trauma unit.

When you arrive home later that day, you are shocked to hear that the injured driver was your neighbor’s twenty-two year old son, Doug. From the reports that you have heard from others in the neighborhood, Doug is in the ICU at the trauma hospital with a severe head injury and a fractured pelvis. He is breathing on his own but comatose at this time. The doctors have told Joyce and Bill (your neighbors) that the next 24-48 hours will give them information as to Doug’s prognosis.

A few days later you see Joyce coming home from the hospital. You are amazed as she looks 10 years older than she did last week. She tells you that Bill had to go back to work but she was able to take a leave from work and is at the hospital ‘from sun up to sun down’…she is just coming home for a few minutes to shower and catch up on a few things before heading back to the hospital. Joyce tells you that Doug is making progress but the hospital staff continues to be concerned as they are still unable to waken him…he just makes a ‘funny face’ when they pinch his fingers and then tries to pull away. Joyce remembers that you are in nursing school so wonders if you are interested that she has overheard nurses say that Doug has a “Glass Coma Number” of 7. You are about to talk to her about what the ‘glascow coma scale’ means when she says she doesn’t care what the number means…she just knows that ‘one of these days he is going to wake up and wonder what all the fuss is about and want to come home’.

Several weeks later, you see Joyce and Bill bringing Doug home. You knew that he had moved to a rehab unit a few weeks ago after waking up from a coma that he was in for 8 days. He was sent to rehab to help him gain strength and become more independent. You are actually quite surprised to see him coming home so soon. From what you had heard, you thought Doug would be in the rehab unit for at least a month or two.

However, you are happy to see the homecoming so you walk over to welcome Doug home. You are surprised that when you walk up Joyce introduces Doug to you… especially since you have known each other for several years. You wondered why but then it all became clearly evident. Doug looks at you with a blank look on his face but says “nice to meet you”.

While Bill helps Doug into the house, Joyce tells you that Doug’s memory was affected by the accident. He has trouble remembering people but is getting better and stronger Developed by Carol Thorn, RN, MS May use with permission for the purposes of nursing education If questions/comments, please contact Carol Thorn at [email protected] every day. The doctors wanted him to stay at the rehab unit longer but she felt they weren’t doing anything for him that Joyce couldn’t do for him at home. Besides, his medical insurance was running out. Since the recession hit and affected their savings, they didn’t have the money to pay for the care out of their pocket so they felt their only choice was to bring him home. Joyce is going to stay home with Doug for the rest of the month and then will go back to work after her leave is up, leaving Doug alone at home. She doesn’t want to impose but wonders if you would check in on him from time to time when you are home after she goes back to work since she doesn’t know any other resources in the area.

Over the course of the next few weeks, Doug improves but continues to have short term memory problems. You figure everything must be going okay since Joyce went back to work as planned but one day when you are over at their house for lunch, Doug gets up from the table and walks into the living room only to return less than 10 minutes later asking his mother when she was going to fix lunch because ‘he’s starving’.

At that point, Joyce breaks down crying saying she “doesn’t know how much longer she can do it”. Having Doug at home is a lot more work than she thought it would be but she can’t even imagine “putting him in a home”. She is at a loss…at her wits end and from what she says Bill doesn’t seem to be in any better shape. He comes home after a long day at work and instead of being in a position where he has to repeat himself over and over and over, he just locks himself away in the study and watches sports on TV.

Joyce begins to wonder if removing Doug from the rehab unit too early impeded his recovery and if there is anything you can think of that they can do now to help Doug.

After reading the case study –

 Identify all issues you have associated with this situation

 Are there potential biases or stigmas involved in this situation? If so, what are they?

 How would this case be different if Doug was a teenager? Elder?

 Knowing that each case is individualized, what information would you be able to provide to Joyce about traumatic brain injury?

 What else could you do for Bill and Joyce at this point?

 In your area, what community resources are available for Bill, Joyce and Doug?

Developed by Carol Thorn, RN, MS May use with permission for the purposes of nursing education If questions/comments, please contact Carol Thorn at [email protected]