An 8-year-old boy is admitted to the emergency room after being hit by a car. He

Question

An 8-year-old boy is admitted to the emergency room after being hit by a car. He had a short period of unconsciousness and is currently lethargic but arouseable. He complains of nausea but has not vomited. He does not remember the accident or what happened immediately before.

On the initial nursing assessment he is oriented X3, slightly lethargic but responds to name. BP 130/80, P 88, R 16. Pupils are equal and reactive to light.

The admitting diagnosis is concussion.

1. On the admission assessment, the nurse notes the physician described the child had a coup-contrecoup injury. Describe what this means and why this could impact the nursing assessment of this patient.

2. On the CT scan, the child is found to have a subdural hematoma. The child was taken to surgery. Describe physiologically what is meant by a subdural hematoma. What nursing assessments would the nurse monitor in this patient?

Explanation / Answer

1. A coup injury occurs under the site of impact with an object and a contrecoup injury occurs on the side opposite the area that was hit. It is associated with cerebral contusions. this will affect the nursing assessment because the patient can have symptoms associated with either side of the brain. A patient can have opposite side more prominent.

2. The Subdural hematoma is the bleeding occur in sub dural space post injury. As this expands in the sub dural space, it raises the intra cranial pressure and deforms the brain and can even cause midline shift compressing the brain. This is evident by neurological deficient symptoms.

The nurse would have to monitor the vital sign carefully. The patient can develop respiratory distress and can even have seizures. Emergency medicine should be arranged. the level of consciousness of the patient should be monitored along with pupil size. The worsening of symptoms can indicate increase in bleed hence and emergency surgical evacuation should be planned .

symptoms then the side of actual injury.

Related Questions

Navigate

• Browse (All)
• Browse A
• Subjects

Integrity-first tutoring: explanations and feedback only — we do not complete graded work. Learn more.