A toddler fell out of a second-story window. She had brief loss ...

[tfester]

A toddler fell out of a second-story window. She had brief loss of consciousness and vomited four times.
 
  Since admission, she has been alert and oriented. Her mother asks why a computed tomography (CT) scan is required when she seems fine. The nurse should explain that the toddler:
  a. May have a brain injury. c. May start having seizures.
  b. Needs this because of her age. d. Probably has a skull fracture.

Question 2

A school-age child has sustained a head injury and multiple fractures after being thrown from a horse.
 
  The child's level of consciousness is variable. The parents tell the nurse that they think their child is in pain because of periodic crying and restlessness. The most appropriate nursing action is to:
  a. Discuss with parents the child's previous experiences with pain.
  b. Discuss with practitioner what analgesia can be safely administered.
  c. Explain that analgesia is contraindicated with a head injury.
  d. Explain that analgesia is unnecessary when child is not fully awake and alert.

[frogdreck123456]

Answer to Question 1

ANS: A
The child's history of the fall, brief loss of consciousness, and vomiting four times necessitate evaluation of a potential brain injury. The severity of a head injury may not be apparent on clinical examination but will be detectable on a CT scan. The need for the CT scan is related to the injury and symptoms, not the child's age, and is necessary to determine whether a brain injury has occurred.

Answer to Question 2

ANS: B
A key nursing role is to provide sedation and analgesia for the child. Consultation with the appropriate practitioner is necessary to avoid conflict between the necessity to monitor the child's neurologic status and to promote comfort and relieve anxiety. Gathering information about the child's previous experiences with pain should be obtained as part of the assessment, but because of the severity of injury, analgesia should be provided as soon as possible. Analgesia can be used safely in individuals who have sustained head injuries and can decrease anxiety and resultant increased intracranial pressure.