A concussion is a type of traumatic brain injury caused by a bump, blow, or jolt to the head that can change how the brain usually works. This nursing diagnosis is crucial for healthcare providers to recognize and manage, as concussions can have severe short-term and long-term effects on a patient’s health and well-being.
Causes (Related to)
Concussions can result from various incidents that involve sudden impact on the head or rapid movement of the head and neck. Common causes include:
- Sports-related injuries, especially in contact sports like football, hockey, or soccer
- Motor vehicle accidents
- Falls, particularly in elderly patients or young children
- Physical assaults or domestic violence
- Workplace accidents, especially in construction or industrial settings
- Military service-related incidents, such as explosions or combat injuries
Signs and Symptoms (As evidenced by)
Concussions can manifest with a variety of signs and symptoms. During a physical assessment, a patient with a concussion may present with one or more of the following:
Subjective: (Patient reports)
- Headache or pressure in the head
- Dizziness or balance problems
- Confusion or feeling “foggy”
- Difficulty concentrating or remembering
- Sensitivity to light or noise
- Nausea or vomiting
- Fatigue or drowsiness
- Changes in sleep patterns (sleeping more or less than usual)
- Irritability or emotional changes
Objective: (Nurse assesses)
- Loss of consciousness (even if brief)
- Delayed response to questions
- Dazed or stunned appearance
- Forgetfulness about recent events
- Clumsy movements
- Slurred speech
- Repeated vomiting
- Seizures
- Unequal pupil size
- Inability to recognize people or places
Expected Outcomes
The following are common nursing care planning goals and expected outcomes for concussion:
- The patient will report a reduction in headache intensity and frequency.
- The patient will demonstrate improved balance and coordination.
- The patient will exhibit normal cognitive function, including memory and concentration.
- The patient will maintain a stable neurological status with no signs of deterioration.
- The patient will adhere to the recommended rest and activity modification plan.
Nursing Assessment
The nursing assessment is critical in identifying and managing concussions. The following section covers subjective and objective data collection related to concussions.
- Perform a detailed neurological assessment.
Assess the patient’s level of consciousness, pupil reactivity, and Glasgow Coma Scale score. These assessments help determine the severity of the concussion and monitor for any neurological deterioration. - Evaluate cognitive function.
Use standardized tools, such as the Standardized Concussion Assessment Tool (SCAT), to assess memory, concentration, and orientation. This helps track cognitive recovery over time. - Assess for post-traumatic amnesia.
Determine if the patient has any memory loss surrounding the injury event. Post-traumatic amnesia can be an indicator of concussion severity. - Monitor vital signs.
Regular blood pressure, heart rate, respiratory rate, and temperature monitoring is essential to detect any physiological changes that may indicate complications. - Assess balance and coordination.
Use simple tests like the Romberg test or tandem gait to evaluate the patient’s balance and coordination, which are often affected in concussions. - Evaluate cranial nerve function.
Assess all 12 cranial nerves to detect any deficits associated with the concussion. - Assess for associated injuries.
Concussions can occur alongside other injuries, especially in cases of accidents or falls. A thorough physical examination is necessary to identify any additional injuries.
Nursing Interventions
Nursing interventions play a vital role in the management and recovery of patients with concussions. The following section outlines interventions for concussion care.
- Promote rest and sleep hygiene.
Encourage the patient to get adequate rest, both physical and cognitive. Educate on the importance of a consistent sleep schedule and creating a sleep-friendly environment. - Manage pain and discomfort.
Administer pain relief medications as prescribed, typically acetaminophen. Avoid aspirin and other NSAIDs due to the risk of bleeding. - Implement a gradual return to activities.
Guide the patient through a step-wise return to normal activities, monitoring for any symptom exacerbation. - Provide education on concussion management.
Teach the patient and family about concussion symptoms, recovery expectations, and when to seek medical attention. - Monitor for signs of intracranial pressure.
Regularly assess for signs such as worsening headache, vomiting, or changes in level of consciousness that may indicate increased intracranial pressure. - Implement fall prevention strategies.
As balance may be affected, ensure the patient’s environment is safe and provide assistance with ambulation as needed.
Nursing Care Plans
The following nursing care plans provide a structured approach to managing patients with concussions. Each plan includes a concussion nursing diagnosis statement, related factors, nursing interventions with rationales, and desired outcomes.
Nursing Care Plan 1:
Nursing Diagnosis Statement:
Risk for Ineffective Cerebral Tissue Perfusion related to cerebral edema secondary to concussion.
Related factors/causes:
- Cerebral edema
- Altered cerebral blood flow
- Increased intracranial pressure
Nursing Interventions and Rationales:
- Monitor neurological status every 2-4 hours using the Glasgow Coma Scale.
Rationale: Regular neurological checks help detect early signs of deterioration. - Elevate the head of the bed to 30 degrees.
Rationale: This position promotes venous drainage and helps reduce intracranial pressure. - Maintain a quiet, low-stimulation environment.
Rationale: Reducing sensory input helps minimize cerebral metabolic demands. - Administer oxygen as prescribed to maintain SpO2 > 95%.
Rationale: Adequate oxygenation is crucial for cerebral tissue perfusion. - Monitor for signs of increased intracranial pressure (headache, vomiting, altered consciousness).
Rationale: Early detection of increased ICP allows for prompt intervention.
Desired Outcomes:
- The patient will maintain stable neurological status with GCS 15/15.
- The patient will demonstrate no signs of increased intracranial pressure.
- The patient will maintain adequate cerebral perfusion as evidenced by normal vital signs and level of consciousness.
Nursing Care Plan 2: Acute Pain
Nursing Diagnosis Statement:
Acute Pain related to trauma to head and neck muscles secondary to concussion.
Related factors/causes:
- Head trauma
- Muscle tension
- Inflammation
Nursing Interventions and Rationales:
- Assess pain intensity using a standardized pain scale every 4 hours.
Rationale: Regular pain assessment guides appropriate pain management. - Administer analgesics as prescribed, avoiding NSAIDs.
Rationale: Pain relief promotes rest and healing while avoiding NSAIDs reduces bleeding risk. - Apply cold packs to affected areas for 20 minutes every 2 hours.
Rationale: Cold therapy helps reduce inflammation and pain. - Teach relaxation techniques such as deep breathing and progressive muscle relaxation.
Rationale: These techniques can help reduce muscle tension and associated pain. - Promote a restful environment with minimal noise and light.
Rationale: A calm environment can help reduce sensory stimulation that may exacerbate pain.
Desired Outcomes:
- The patient will report pain at a level of 3/10 or less on a pain scale.
- The patient will demonstrate the use of non-pharmacological pain management techniques.
- The patient will exhibit improved comfort and ability to rest.
Nursing Care Plan 3: Impaired Physical Mobility
Nursing Diagnosis Statement:
Impaired Physical Mobility related to balance disturbances and dizziness secondary to concussion.
Related factors/causes:
- Vestibular system disruption
- Altered proprioception
- Muscle weakness
Nursing Interventions and Rationales:
- Assess gait, balance, and coordination daily using standardized tools.
Rationale: Regular assessment helps track progress and identify areas needing intervention. - Implement fall prevention measures (bed in low position, clear walkways, non-slip footwear).
Rationale: These measures reduce the risk of falls and further injury. - Assist with gradual mobilization as tolerated, starting with sitting at the edge of the bed.
Rationale: Gradual increase in activity helps prevent symptom exacerbation and promotes recovery. - Teach compensatory techniques for maintaining balance during daily activities.
Rationale: These techniques enhance safety and independence in mobility. - Collaborate with physical therapy for tailored exercises to improve balance and coordination.
Rationale: Specialized exercises can help restore normal function and prevent long-term mobility issues.
Desired Outcomes:
- The patient will demonstrate improved balance and coordination in daily activities.
- The patient will ambulate safely with appropriate assistive devices if needed.
- The patient will report decreased episodes of dizziness during movement.
Nursing Care Plan 4: Disturbed Sleep Pattern
Nursing Diagnosis Statement:
Disturbed Sleep Pattern related to neurological changes and environmental factors secondary to concussion.
Related factors/causes:
- Altered circadian rhythm
- Pain and discomfort
- Anxiety about condition
Nursing Interventions and Rationales:
- Assess sleep patterns daily, including duration and quality of sleep.
Rationale: Understanding sleep patterns helps guide interventions for improving sleep. - Implement sleep hygiene measures (consistent sleep schedule, dark and quiet environment).
Rationale: Good sleep hygiene promotes better quality and quantity of sleep. - Limit daytime napping to 20-30 minutes.
Rationale: Excessive daytime napping can disrupt nighttime sleep patterns. - Educate on relaxation techniques to use before bedtime.
Rationale: Relaxation can help reduce anxiety and promote sleep onset. - Administer sleep medications as prescribed, monitoring for effectiveness and side effects.
Rationale: Pharmacological interventions may be necessary to establish a normal sleep pattern.
Desired Outcomes:
- The patient will report improved sleep quality and duration.
- The patient will demonstrate the use of sleep hygiene techniques.
- The patient will report feeling rested upon awakening.
Nursing Care Plan 5: Impaired Memory
Nursing Diagnosis Statement:
Impaired Memory related to neurological changes secondary to concussion.
Related factors/causes:
- Altered cerebral function
- Cognitive overload
- Fatigue
Nursing Interventions and Rationales:
- Assess memory function daily using standardized cognitive assessment tools.
Rationale: Regular assessment helps track cognitive recovery and identify areas of deficit. - Provide a structured environment with consistent routines.
Rationale: Consistency and structure can help compensate for memory deficits. - Use memory aids such as calendars, notebooks, or smartphone apps.
Rationale: External memory aids can support daily functioning and reduce cognitive load. - Teach memory strategies such as chunking information and using mnemonics.
Rationale: These strategies can improve information retention and recall. - Encourage gradual return to cognitive activities, monitoring for symptom exacerbation.
Rationale: Controlled cognitive stimulation promotes recovery while preventing overexertion.
Desired Outcomes:
- The patient will demonstrate improved short-term memory function.
- The patient will use memory aids effectively in daily activities.
- The patient will report decreased frustration related to memory difficulties.
References
- Alves, W., Macciocchi, S. N., & Barth, J. T. (2018). Postconcussive symptoms after uncomplicated mild head injury. Journal of Head Trauma Rehabilitation, 33(1), 48-55.
- Centers for Disease Control and Prevention. (2023). Concussion signs and symptoms. Retrieved from https://www.cdc.gov/headsup/basics/concussion_symptoms.html
- Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2019). Nurse’s pocket guide: Diagnoses, prioritized interventions, and rationales (15th ed.). F.A. Davis Company.
- McCrory, P., Meeuwisse, W., Dvořák, J., Aubry, M., Bailes, J., Broglio, S., … & Vos, P. E. (2017). Consensus statement on concussion in sport—the 5th international conference on concussion in sport held in Berlin, October 2016. British Journal of Sports Medicine, 51(11), 838-847.
- Scorza, K. A., Raleigh, M. F., & O’Connor, F. G. (2022). Current concepts in concussion: Evaluation and management. American Family Physician, 85(2), 123-132.
- Theadom, A., Parag, V., Dowell, T., McPherson, K., Starkey, N., Barker-Collo, S., … & Feigin, V. L. (2021). Persistent problems 1 year after mild traumatic brain injury: a longitudinal population study in New Zealand. British Journal of General Practice, 66(642), e16-e23.