An 8 yr old boy is admitted to the emergency room after being hi by a car. He ha

Question

An 8 yr old boy is admitted to the emergency room after being hi by a car. He had a short period of unconsciousness and is currently lethargic but able to be aroused. He complains of nausea nut has not vomited. He does not remember the accident or what happended 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.

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

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 subdural hematoma. What nursing assessments would the nurse monitor in this patient?

Explanation / Answer

Coup-counter coup injury is kind of a head injury where a coup injury occurs under the site of impact , and a contrecoup injury occurs on the side opposite the area that was hit. The severity of the head injury could be assesed from the symptoms presented by the patient. The outward symptoms of almost the head injuries are fairly same. Thus, a special case such as coup-couter coup injury may be mistaken as a normal concussion or epidural/subdural hematoma.

Subdural hematoma is the most common result of head injury. In such a injury blood gathers between the dura matter and the brain. The nurse would monitor symtoms such as dizziness, nausea, seizures, pain, numbness etc. A detailed CT scan and MRI report will reveal significant subdural hematoma.

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