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Central Community CollegeNURS 210

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J.R. is a 28-year-old man who was doing home repairs. He fell from the top of a 6-foot (1.8 metres) stepladder, striking his head on a rock. He experienced a momentary loss of consciousness. By the ti... me his neighbor got to him, he was conscious but bleeding profusely from a laceration over the right temporal area. The neighbor drove him to the emergency department of your hospital. As the nurse, you immediately apply a cervical collar, lay him on a stretcher, and take J.R. to a treatment room. 1. What steps will you take to assess J.R.? 2. List at least 6 components of a neurologic examination. 3. What types of injuries may J.R. have sustained? 4. Differentiate between primary and secondary head injury. 5. What complication common to each of these diagnoses concerns you most? Increased ICP—I’m giving you this answer to help you with question 6. 6. Why is this complication clinically important? 7. Name at least 6 findings that would indicate this complication is occurring. 8. Which one is the most sensitive indicator of neurologic change? CASE STUDY PROGRESS You complete your neurologic examination and find the following: Glasgow Coma Scale (GCS) score of 15; pupils equal, round, reactive to light; and full sensation intact. J.R. complains of a headache and is somewhat drowsy. His vital signs are 120/72, 114, 30, 98.7° F (37.1° C), and Spo2 94%. As the radiology technician performs a portable cross-table lateral cervical spine x-ray examination, J.R. begins to speak incoherently and appears to drift off to sleep. 9. What are the next actions you will take? CASE STUDY PROGRESS While waiting for the provider to arrive, J.R. becomes unresponsive to verbal stimuli. The right pupil is larger than the left and does not respond to light. J.R. responds to painful stimuli in the manner shown in the illustration. [Show More]

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