Based on the information on the specified symptoms, Mary’s state can be identified as a neurocognitive disorder according to the DSM-V. Indeed, as the American Psychiatric Association declares, the phenomenon of a neurocognitive disorder may occur after a “severe head injury” (American Psychiatric Association, 2013, p. 31). The reasons for the above-mentioned conclusion are quite obvious; the fact that the patient keeps having memory and concentration issues weeks after the accident shows that the TBI can be identified as an intracerebral hemorrhage and a contusion that the patient received as she hit her head on the edge of the pool (Severity of TBI, 2015). The Glasgow Coma Scale shows that Mary’s state changed from 10 (eye-opening to verbal command, no verbal response, obeys commands (Glasgow coma score, 2015)) to 15 (eyes open spontaneously, orientated, obeys commands (Glasgow coma score, 2015)). Nevertheless, the fact that the patient still experiences difficulties in maintaining the same level of intellectual activity as the one before the accident shows that Mary may have developed a disorder. Particularly, the health issue that Mary is suffering from currently is traditionally mentioned under the umbrella term of major neurocognitive disorders (American Psychiatric Association, 2013, p. 40).
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The identification of the problem mentioned above was carried out by locating the effects of the trauma and comparing them to the standard symptoms. The loss of memory, as well as the inability of the patient to focus on particular tasks, especially those requiring an intellectual effort, falls under the category of “intellectual disability” (American Psychiatric Association, 2013, p. ), which, according to the DSM-V, is a basic symptom of a neurocognitive disorder. Additionally, the patient may experience the posttraumatic stress disorder, as she is unable to not only use her memory to recall the events that occurred to her in the course of her routine life but also displays significant mood swings, which border hysterical outbursts (American Psychiatric Association, 2013, p. 272). However, to carry out a full assessment of the patient and define not only the problem that Mary faces but also the means of addressing the current state of the patient, a more detailed series of tests need to be carried out (Lezak, 2012). Specifically, fMRI can be suggested as the key tool for defining the patient’s condition.
It should be noted, though, that Mary will have to undergo additional testing for identifying the issues that she may be having. Specifically, a comparison between Mary’s pre-morbid level of physical and intellectual activity and the current one will have to be considered. The above-mentioned comparison can be carried out with the help of the Wechsler WTAR test, which was developed to test pre-morbid intellectual capacities in general and reading abilities in particular in adults. It should be born in mind, though, that the outcomes of the above-mentioned test should be coupled with an additional study of the patient’s pre-morbid state, as the Wechsler WTAR test helps measure information acquisition and processing skills for the most part and leaves essential skills such as the use of the information in question out of the picture (Strauss, Scherman & Spreen, 2007). Additionally, the school records such as the teachers’ remarks regarding Mary’s attitude and in-class behavior as a learner, the impression that Mary made on her teachers and peers, etc., must be taken into account to define the severity of trauma that the student has received. Finally, the implications of the No Child Left Behind (Linn, Baker & Betebenner, 2008) testing will have to be considered to determine the patient’s current state. Seeing that the student belongs to an ethnic minority, it is expected that she might have had certain issues in studying before the accident, such as the ESL related problems; the related information may affect the outcomes of the diagnosing significantly.
To compare the alterations in the patient’s mental state and intellectual abilities, the measurement of her current capacities needs to be conducted as well. Therefore, the WAIS measurement is expected to be taken. The WAIS-IV Assessment will include the raw score of the patient, the scaled score, the percentile rank, and the reference group scaled score (WAIS-IV & WIAT–II scoring assistant, 2008). The aforementioned parameters will help identify the current speed of the patient’s progress, therefore, creating a set of data to be compared with the results of previous assessments. It should be born in mind, though, that the outcomes of the analysis might be considered somewhat biased, as the test tools used for assessing the scores of the patient before and after the accident are quite different from each other. However, each of the tests must help get an overview of the patient’s overall capabilities so that the current state could be compared with the previous one and the existing issues could be detected easily. The tests listed above, therefore, can be viewed as a rather reasonable choice, as they provide the opportunity to evaluate the specified areas efficiently. The WAIS measurement scale can be considered as rather important for the overall evaluation, as it provides a detailed overview of five key areas that the therapist should pay attention to, i.e., Verbal Comprehension, Perceptual Reasoning, Working Memory, Processing Speed, as well as calculates the Full Scale and identifies the General Ability (WAIS-IV & WIAT–II scoring assistant, 2008, p. 1).
Last, but not least, the Assessment of Cognitive Speed must be conducted to realize whether the patient’s state has improved and whether Mary retrieves and processes information faster than she did after the accident occurred. Moreover, the specified test can also be used after the intervention discussed above to evaluate the effects of the nursing strategies used to improve Mary’s state. According to the official description, the Assessment of Cognitive Speed test helps identify the pace, at which one acquires and digests various types of data and “the relationship between JTC and cognitive functioning, including measures of premorbid IQ, verbal learning memory, processing speed, and working memory” (Ochoa et al., 2014, p. 2). Moreover, the specified test will help locate the factors that prevent the patient from regaining her kills and integrating back into the educational environment. Particularly, the change in the efficacy of Mary’s motor functions can be assessed and explained with the help of the test in question and from the perspective of the recent accident: “Peripheral damage to the vestibular system is fairly common following head trauma” (Holdnack, Drozdick, Weiss & Iverson, 2013, p. 486).
To evaluate the cognitive speed of the patient, the Trails Marking Test will be used, as it helps locate the rate of neurological trauma severity (Tombaugh, 2004). The Digit Symbol Constitution test will be used for calculating the patient’s “orientation, registration, attention, calculation, recall, language, and visual-spatial skills” (Cognitive function, n. d.), whereas the PASAT test will allow for identifying the possible deficiencies in Mary’s audition skills (Podd, 2011). The necessity for conducting four assessments instead of one is predetermined by the fact that the severity of the trauma needs to be evaluated from the perspective of all four senses, as well as the cognitive functions of the patient. Some of the tests listed above, in their turn, only allow for an evaluation of a specific function; for instance, the PASAT test is focused on the auditory skills of the patient, for the most part, leaving a range of other important characteristics of the patient’s sensory responses out of the picture. Herein the need to incorporate several types of tests lies.
As far as recommendations for further rehabilitation are concerned, it can be suggested that the patient should be observed by a nurse regularly and should not be left alone, especially in public, to prevent possible traumas, such as an injury as a result of a fall. Also, Mary must not take part in any active games or sports for the next few weeks to avoid receiving another trauma that may exacerbate her condition. The patient should also get enough rest and avoid the situations that may cause her the slightest amount of stress. In case the above-mentioned recommendations are taken into account by both the patient and the nurses, the process of recovery is likely to occur at a faster pace.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, DC: American Psychiatric Publishing.
Cognitive function. (n. d.). Web.
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Holdnack, J. A., Drozdick, A., Weiss, L. G. & Iverson, G. L. (2013). WAIS-IV, WMS-IV, and ACS: Advanced clinical interpretation. Waltham, MA: Academic Press.
Lezak, M. (2012). Neuropsychological assessment (5th ed.). Oxford, UK: Oxford University Press.
Linn, R. L., Baker, E. L., & Betebenner, D. W. (2008). Accountability systems: Implications of requirements of the no child left behind act of 2001. Web.
Ochoa, S., Haro, J. M., Huerta-Ramos, E., Cuevas-Esteban, J., Stephan-Otto, C., Call, J.,… & Brebion, G. (2014). The relation between jumping to conclusions and cognitive functioning in people with schizophrenia in contrast with healthy participants. Schizophrenia Research, 1(1), 1–8.
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Podd, M. H. (2011). Cognitive remediation for brain injury and neurological illness: Real-life changes. New York, MY: Springer Science & Business Media.
The severity of TB. (2015). Web.
Strauss, E., Scherman, E. M. S. & Spreen, O. (2007). A compendium of neuropsychological tests: Administration, norms, and commentary. Oxford, UK: Oxford University Press.
Tombaugh, T. N. (2004). Trail Making Test A and B: Normative data stratified by age and education. Archives of Clinical Neuropsychology, 19(2), 203–214.
WAIS-IV & WIAT–II scoring assistant. (2008). Web.