Post-Traumatic Amnesia: Screening And Management Research Paper Examples

Abstract

This study investigates the characteristics of post-traumatic amnesia (PTA), which is the recovery period that follows head injuries. It explains that memory restoration is the last stage in the process of acquiring complete consciousness. In addition, the study examines the screening method used to identify PTA. Symptoms that indicate PTA may include unreliable memory, disorientation, and fatigue. Moreover, the investigation explores the management approach used during the recovery process. The PTA management requires the presence of a consistent nursing team to create and maintain a supportive, quiet, and low-stimulating environment.

Introduction

Post-traumatic Amnesia (PTA) is the duration of recovery from the suffering of a brain trauma to the return of a dependable memory. Hence, the last stage in the process of acquiring full consciousness involves the memory restoration for daily events (Wilson, 2013). According to Queensland Health (2011), the generalized cognitive disturbance may take a duration that ranges from hours to several months. An individual with PTA appears confused about personal details, surroundings, and time. Usually, such persons have unreliable memory of different events. They may appear afraid, restless, aggressive, agitated, or disinhibited. In addition, they may seem delusional and wander around the ward (Queensland Health, 2011). A study of PTA, therefore, is crucial to understanding the challenges that patients with PTA undergo. The investigation also helps in the screening PTA, as well as the management of the recovery process.
Research Statement: The prediction of the brain injury’s severity and the identification of the patient’s emergence from PTA require effective assessment techniques.

Objective: To identify the screening and management approaches for assessing and managing PTA.

PTA Screening
Presently, there is no specified tool for predicting the PTA duration. Nevertheless, various tools for assessing PTA exist and can help to predict the extent of a brain injury. Such methods can also identify the patients’ emergence from PTA. According to Gumm et al. (2011), patients are not diagnosed with PTA until they begin their recovery from a coma. During the screening of PTA, the indicants used to identify PTA are numerous. However, the primary symptoms include the absence of day-to-day memory, reversed sleep/wake cycle, fatigue, and disorientation (Gumm et al., 2011).
Usually, head injuries cause lifelong cognitive, physical, and social dysfunction (Khan, Baguley, & Cameron, 2003). Consequently, they can place enormous financial and social burdens on societies and families. Gumm et al. (2011) explain that nearly 150 Australian patients out of about 100, 000 representative individuals are admitted with head injuries annually. Eighty percent of the cases are classified as mild with about 63% occurring in the 16 to 64-year-old patients. Significant functional deficits, which follow head injuries, may range from post-traumatic amnesia and relentless post-concussion symptoms to disabling behavioral sequelae (Ponsford et al., 2004).
In the screening process, head injuries refer to the initial presentation of a patient who has sustained a blunt physical damage to the head. A traumatic brain injury, however, describes the subsequent functional outcome after the head injury. In practice, terms such as brain injury, concussion, and closed head injury are used interchangeably (Gumm et al. 2011). Typically, a concussion diagnosis is made on self-reported symptoms. Nevertheless, the diagnosis of a Mild Brain Injury (MBI) occurs through neurological approaches such as the presence of PTA and the use of a Glasgow Coma Score (GCS). Gumm et al. (2011) explain that Closed Head Injuries (CHIs) are categorized as Mild (GCS 13 to 15), Severe (GCS 3 to 8), or Moderate (GCS 9-12).
Usually, patients with CHIs exhibit characteristics such as amnesia, focal neurological deficits, and head traumas (Gumm et al., 2011). Characteristics of MBIs may include an ephemeral loss of consciousness, head traumas, and transient lack of alertness. The long-term outcome of MBIs is often excellent with rare neurosurgical intervention. However, post-concussion symptoms often occur and may have cognitive-behavioral-social effect on patients, as well as their families. For example, they may cause relationship and work difficulties. Such post-concussion symptoms may include dizziness, reduced concentration, memory impairment, and mood swings (Gumm et al., 2011).The most appropriate methods of predicting post-concussion symptoms, as well as the functional outcomes, include the duration of PTA, initial GCS on admission, and the length of consciousness loss. For example, if the PTA fails to persist beyond twenty-four hours, significant post-concussion symptoms may not occur.
When assessing patients for MBIs, it is crucial to rule out other causes of consciousness loss such as epilepsy, drug use, metabolic disturbances, intoxication, and shock. In addition, it is important to employ the Abbreviated Westmead PTA Scale or A-WPTAS, which assists in the early recognition of cognitive impairment caused by an MBI. The scale is also a non-subjective measure of PTA (Gumm et al., 2011). It is administered every hour during the first twenty-four hours until the patient’s score reaches 18/18. The patient is then considered out of PTA. However, the A-WPTAS is only a screening tool and, hence, clinical judgment should be considered if concerns are present. Patients requiring admission may include those that fail to attain an 18/18 score within four hours of testing. Such patients should be referred for outpatient rehabilitation. The rehabilitation may include Neuropsychology, Speech Pathology, and Physiotherapy, as well as Occupational Therapy. In contrast, patients with Moderate or Severe Brain Injuries may have sustained multiple injuries and often require prolonged hospitalization. Consequently, they do not need screening and assessment can be performed using the Westmead PTA Scale. In addition, such cases require a referral to Occupational Therapists (Gumm et al., 2011).

Management of PTA

The successful management of the PTA patients requires the use of a multidisciplinary approach (Gumm, Liersch, & Carey, 2014). Such a strategy should address the patient’s behavior and the environment (Khan, Baguley, & Cameron, 2003). The nurses that spend time with PTA patients should participate actively in the management and assessment of such patients. The nurses should ensure that family members have access to adequate information regarding the admission of a patient to the ward (Khan, Baguley, & Cameron, 2003).
In addition, the management of PTA patients requires the presence of a consistent nursing team aimed at creating and maintaining a supportive, low-stimulating, and quiet environment (Gumm, Liersch, & Carey, 2014). The patients should be kept in single rooms and external stimuli such as loud noise, bright lights, and TVs should be reduced. Nurses should also encourage a consistent approach and limit the number of visitors. The patient’s environment should be kept familiar using personal objects and photos of the patient or family. Caution, however, should be taken to prevent the over stimulation of the patient. Thus, unnecessary furniture, newspapers, and oxygen outlets should be removed from the room. The nurses should close the curtains and keep the lighting at low levels. Moreover, the noise level in the patient’s room should be maintained at a minimum level. Interactions with the patients should involve simple conversations in order to keep the patient calm.
Further, the behavior of PTA patients can be managed efficiently by creating a suitable environment. For example, if patients are restless, agitated, or impulsive, they should be nursed on a low bed or the floor depending on their medical condition. In addition, the use of the Westmead Scale should not begin until the agitation period settles (Gumm, Liersch, & Carey, 2014). During PTA, the nurse should use appropriate memory enhancing techniques (Byrne, 1997-present), as well as Occupational Therapy methods such as the introduction of simple personal care activities. Finally, intensive rehabilitation programs should be avoided until the patient has fully emerged from PTA (Gumm, Liersch, & Carey, 2014).

Conclusion

The research statement argues that the prediction of the brain injury’s severity and the identification of the patient’s emergence from PTA require effective assessment techniques. Therefore, appropriate screening procedures should be employed to make early detections of the PTA symptoms. This study presents the primary approaches used in the screening and management of PTA. Therefore, the study has successfully achieved the research objective. Nurses should utilize the testing and management strategies discussed in this study in order to ensure a successful recovery of the PTA patients.

References

Byrne, J.H., (1997-present). Chapter 7: Learning and Memory. Neuroscience Online: an electronic textbook for the neurosciences. Houston: The University of Texas Health Science Center at Houston. Retrieved from http://neuroscience.uth.tmc.edu/s4/chapter07.html
Gumm, K, Liersch, K., Orbons, K., Taylor, T., Carey, L. Kavar, B., & PTA Working Party (2011). Screening for Post Traumatic Amnesia. The Royal Melbourne Hospital. Retrieved from http://clinicalguidelines.mh.org.au /brochures/TRM01.02.pdf
Gumm, K., Liersch, K., & Carey, L. (2014). Post Traumatic Amnesia Screening and Management. The Royal Melbourne Hospital. Retrieved from http://clinicalguidelines.mh.org.au/brochures/TRM01.01.pdf
Khan, F., Baguley, I. J., & Cameron, I. D. (2003). 4: Rehabilitation after traumatic brain injury. Medical Journal of Australia, 178(6), 290-295. Retrieved from https://www.mja.com.au/journal/2003/178/6/4-rehabilitation-after-traumatic-brain-injury
Ponsford J, Facem PC, Willmott C, et al. (2004). Use of the Westmead PTA scale to monitor recovery of memory after mild head injury. Brain Injury, 18(6), 603-614.
Queensland Health (2011). Health Professionals Education: Post Traumatic Amnesia. Queensland Health. Retrieved from http://www.health.qld.gov.au/pahospital/biru/education/hp_amnesia.asp
Wilson, J. F. (2013). Biological Basis of Behavior. San Diego: Bridgepoint Education, Inc.