Randy Adams Scenario 1

Randy Adams, age 32, is a former National Guardsman who was deployed to Iraq. He and his

wife, Joy, have twin boys, Jeff and Jarod, aged 18 months. After returning home, Randy went

back to school to complete his fourth year of college, but had difficulty with coursework. After

being placed on academic probation, he withdrew from the university and found employment at

a local computer repair shop. Joy graduated with an engineering degree while Randy was

deployed and has worked part-time since the babies were born. We meet Randy, disoriented to

time and place, in the emergency department following a car accident. We learn about his

experiences in Iraq with improvised explosive devices (IEDs) and his social isolation.

Randy is being discharged after a 24-hour observation following his motor vehicle accident. His

wife, Joy, is with him. He has referrals to see a neurologist, an appointment for an evaluation at a

behavioral health clinical, and several new discharge medications.

Questions

1. List the health risks or problems encountered by military veterans for military cohorts

based on their theater, time of service, or experiences.

2. Discuss patient teaching for recognition and response to symptoms post-concussive

syndrome.

3. List the signs and symptoms of a concussion:

Randy Adams Scenario 2

Randy Adams, age 32, is a former National Guardsman who was deployed to Iraq. He and his

wife, Joy, have twin boys, Jeff and Jarod, aged 18 months. After returning home, Randy went

back to school to complete his fourth year of college, but had difficulty with coursework. After

being placed on academic probation, he withdrew from the university and found employment at

a local computer repair shop. Joy graduated with an engineering degree while Randy was

deployed and has worked part-time since the babies were born. We meet Randy, disoriented to

time and place, in the emergency department following a car accident. We learn about his

experiences in Iraq with improvised explosive devices (IEDs) and his social isolation.

Randy does not keep his follow-up appointments with either the neurologist or the behavioral

health center. He shows up at his doctor\'s office on the day prior to his scheduled appointment.

Joy is not with him. The physician agrees to see him shortly but asks the nurse to determine how

he is recovering from his concussion, find out about his concerns and questions, and conduct a

mental status screening.

Questions

1. Complete the ACE evaluation using the CDC ACE evaluation checklist for a client with

the following symptoms (sections A-C): A client presents with a head injury that is

presumed to have occurred less than 1 hour ago. He has no previous history of ahead

injury, psychiatric conditions, or other illnesses or disabilities. He complains of \"waking

up\" on the ground with a bleeding head wound. He cannot remember the circumstances

that lead to his head injury; however, his bicycle was laying just beside him, and he was

some distance from home. He is alert and oriented to person and place, but no time. He

continually asks the same questions and can\'t seem to recall the previous answers. He is

complaining of a headache, nausea, and dizziness. He asks you to turn off the lights

because \"they hurt to look at\". When he gets up to go to the bathroom, with your help, he

bends over and grabs his head. He states, \"I\'m going to throw up the head pain just got

so much worse!\"

2. Use the Guideline for Concussion/Mild Traumatic Brain Injury & Persistent Symptoms

guide to answering the following question. Your client in is week 3 post-concussion. He is

complaining of having trouble remembering things like his parent\'s phone number and

his social security number. Is this expected in the post-concussive recovery period?

Randy Adams Scenario 3

Randy Adams, age 32, is a former National Guardsman who was deployed to Iraq. He

and his wife, Joy, has twin boys, Jeff and Jarod, aged 18 months. After returning home,

Randy went back to school to complete his fourth year of college but had difficulty with

coursework. After being placed on academic probation, he withdrew from the university

and found employment at a local computer repair shop. Joy graduated with an

engineering degree while Randy was deployed and has worked part-time since the babies

were born. We meet Randy, disoriented to time and place, in the emergency department

following a car accident. We learn about his experiences in Iraq with improvised

explosive devices (IEDs) and his social isolation.

Randy is back at his physician\'s office for follow-up. This time Joy is with him. Randy

reports that he saw a neurologist and psychiatrist and they prescribed new medications.

Questions

1. Your client, a veteran, indicates that he was in Afghanistan during Operation

Enduring Freedom. He states that hasn\'t been attending regular VA appointments

because, \"I\'m doing just fine, and I know others need the care more than I do.\" A)

What characteristic of veterans is your client displaying? and B) What is one

therapeutic response the nurse might use to encourage appropriate utilization of VA

services?

2. Your client, who has suffered a mild traumatic brain injury (TBI), continues to have

difficulty remembering and staying oriented to the date and time. What interventions

will assist the client in recalling important details of the appointment, follow up care,

medications, and help the client prepare for future appointments?

3. Your client mentions that his friend, who has recently returned from military

deployment has PTSD. The client asks you what signs or symptoms indicate that a

a person might have PTSD and how it is treated. Using non-medical terms: A) Indicate

the signs and symptoms of PTSD using and B) discuss common treatments.