Chapter 68: Management of Patients With Neurologic Trauma 5

C5

A client with a spinal cord injury has full head and neck control when the injury is at which level?

Irrigates the wound to remove debris

A patient comes to the emergency department with a large scalp laceration after being struck in the head with a glass bottle. After assessment of the patient, what does the nurse do before the physician sutures the wound?

Because hypoxemia can create or worsen a neurologic deficit of the spinal cord

For a patient with an SCI, why is it beneficial to administer oxygen to maintain a high partial pressure of oxygen (PaO2)?

"I can apply powder under the liner to help with sweating."

The nurse is caring for a client following a spinal cord injury who has a halo device in place. The client is preparing for discharge. Which statement by the client indicates the need for further instruction?

Pulse and blood pressure

The nurse is caring for a client immediately after a spinal cord injury. Which assessment finding is essential when caring for a client in spinal shock with injury in the lower thoracic region?

Young age Alcohol use Drug abuse

Which are risk factors for spinal cord injury (SCI)? Select all that apply.

Widened pulse pressure

Which finding indicates increasing intracranial pressure (ICP) in the client who has sustained a head injury?

Spasticity

Which term refers to muscular hypertonicity in a weak muscle, with increased resistance to stretch?

Temperature increase from 98.0°F to 99.6°F

The nurse is caring for a client with traumatic brain injury (TBI). Which clinical finding, observed during the reassessment of the client, causes the nurse the most concern?

It results from inadequate delivery of nutrients and oxygen to the cells.

The nurse working on a neurological unit is mentoring a nursing student who asks about a client who has sustained primary and secondary brain injuries. The nurse correctly tells the student which of the following, related to the secondary injury?