Week 6 Closed Head Injury Case Study Answers
Name Class/Group Date
Scenario
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 time 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.?
Using the ABCD (Airway, Breathing, Circulation, Disability) system, the first action is to
ensure that the cervical spine is immobilized, his airway is patent, begin as-needed
oxygen therapy, and start ECG monitoring. Then perform the neurologic examination
and determine the extent of disability. Evaluate the scalp laceration.
2. List at least 6 components of a neurologic examination.
Glasgow Coma Scale, including eye opening, best motor response, best verbal response;
level of consciousness (LOC); pupil size, shape, and reaction to light; extraocular eye
movements; sensation (superficial—light touch, pain, temperature; deep—vibration,
deep pain, proprioception); behavior status (e.g., combative, cooperative, calm); motor
tone and strength (hand grips, pronator drift, leg movement, motor strength of
extremities); cranial nerve assessment; VS (Cushing’s response with increased systolic
BP, widened pulse pressure, bradycardia, and altered respiratory patterns); cerebellar
functioning (rapid alternating movements, heel to shin, Romberg sign, nystagmus); other
reflexes (deep tendon, Babinski reflex)
3. What types of injuries may J.R. have sustained?
J.R. may have a skull fracture, cervical spine injury, brain contusion, concussion,
epidural or subdural hematoma, or intracranial hemorrhage
4. Differentiate between primary and secondary head injury.
A primary head injury is the initial tissue damage resulting from the traumatic impact.
It can include the scalp, skull, or brain tissue itself. A secondary head injury
complicates the primary injury and causes further damage, resulting in a worse
outcome or increased risk for death. Secondary injuries include intracranial
hemorrhage, cerebral edema, increased ICP, hypoxic (ischemic) brain damage, and
infection.
5. What complication common to each of these diagnoses concerns
you most? Increased ICP because it could lead to brain herniation
and death.
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 02:26:03 GMT -05:00
https://www.coursehero.com/file/77419979/Week-6-Closed-Head-Injury-Case-Study-Answersdocx/
, Week 6 Closed Head Injury Case Study Answers
6. Why is this complication clinically important?
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 02:26:03 GMT -05:00
https://www.coursehero.com/file/77419979/Week-6-Closed-Head-Injury-Case-Study-Answersdocx/
Name Class/Group Date
Scenario
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 time 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.?
Using the ABCD (Airway, Breathing, Circulation, Disability) system, the first action is to
ensure that the cervical spine is immobilized, his airway is patent, begin as-needed
oxygen therapy, and start ECG monitoring. Then perform the neurologic examination
and determine the extent of disability. Evaluate the scalp laceration.
2. List at least 6 components of a neurologic examination.
Glasgow Coma Scale, including eye opening, best motor response, best verbal response;
level of consciousness (LOC); pupil size, shape, and reaction to light; extraocular eye
movements; sensation (superficial—light touch, pain, temperature; deep—vibration,
deep pain, proprioception); behavior status (e.g., combative, cooperative, calm); motor
tone and strength (hand grips, pronator drift, leg movement, motor strength of
extremities); cranial nerve assessment; VS (Cushing’s response with increased systolic
BP, widened pulse pressure, bradycardia, and altered respiratory patterns); cerebellar
functioning (rapid alternating movements, heel to shin, Romberg sign, nystagmus); other
reflexes (deep tendon, Babinski reflex)
3. What types of injuries may J.R. have sustained?
J.R. may have a skull fracture, cervical spine injury, brain contusion, concussion,
epidural or subdural hematoma, or intracranial hemorrhage
4. Differentiate between primary and secondary head injury.
A primary head injury is the initial tissue damage resulting from the traumatic impact.
It can include the scalp, skull, or brain tissue itself. A secondary head injury
complicates the primary injury and causes further damage, resulting in a worse
outcome or increased risk for death. Secondary injuries include intracranial
hemorrhage, cerebral edema, increased ICP, hypoxic (ischemic) brain damage, and
infection.
5. What complication common to each of these diagnoses concerns
you most? Increased ICP because it could lead to brain herniation
and death.
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 02:26:03 GMT -05:00
https://www.coursehero.com/file/77419979/Week-6-Closed-Head-Injury-Case-Study-Answersdocx/
, Week 6 Closed Head Injury Case Study Answers
6. Why is this complication clinically important?
This study source was downloaded by 100000832558064 from CourseHero.com on 05-23-2022 02:26:03 GMT -05:00
https://www.coursehero.com/file/77419979/Week-6-Closed-Head-Injury-Case-Study-Answersdocx/
