A 20-year-old male client was brought to the emergency department with a gunshot wound to the chest. In obtaining a history of the incident to determine possible injuries, the nurse should ask which of the following?
A. "How long ago did the incident occur?"
B. "What was the initial first aid done?"
C. "Where did the incident happen?"
D. "What direction did the bullet enter into the body?"
Correct Answer: D. “What direction did the bullet enter into the body?”
The entry point and direction of the bullet will predict the injuries of the client. In gunshot wounds, due to the high-intensity kinetic energy of the bullet, the pathway is often unpredictable in nature as well as the internal organs that may be affected. The most common organs injured are the small and large bowel at 50% and 40%, respectively.
Option A: Personnel such as paramedics, police officers, or fire rescue who may have arrived at the scene of the injury may be utilized as sources of essential history regarding the etiology of the injury. This is especially important if the patient has altered mental status and is unable to relay the history of the incident.
Option B: In penetrating abdominal injury due to a gunshot wound, initial treatment can be paramount for the prognosis and survival of the victim. The most important task for the initial assessment is to assess the airway, breathing, and circulation of the patient and stop the bleeding.
Option C: The other information is not as useful in determining which diagnostic studies and care are needed immediately. It is beneficial to gather information regarding the events surrounding the injury, including the environment, people involved, allergies, medications, and past medical history of the patient. Information about the caliber of the weapon, the number of shots heard, and any other extenuating circumstances may provide additional valuable information.
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