Neurological Disorders Q 132

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Emergency medical technicians transport a 27-year-old ironworker to the emergency department. They tell the nurse, “He fell from a two-story building. He has a large contusion on his left chest and a hematoma in the left parietal area. He has a compound fracture of his left femur and he’s comatose. We intubated him and he’s maintaining an arterial oxygen saturation of 92% by pulse oximeter with a manual resuscitation bag.” Which intervention by the nurse has the highest priority?

  

     A. Assessing the left leg.

     B. Assessing the pupils.

     C. Placing the client in Trendelenburg’s position.

     D. Assessing level of consciousness.

    

    

Correct Answer: A. Assessing the left leg.

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In the scenario, airway and breathing are established so the nurse’s next priority should be circulation. With a compound fracture of the femur, there is a high risk of profuse bleeding; therefore, the nurse should assess the site. Monitor vital signs. Note signs of general pallor, cyanosis, cool skin, changes in mentation. Inadequate circulating volume compromises systemic tissue perfusion.

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Option B: Test sensation of peroneal nerve by pinch or pinprick in the dorsal web between the first and second toe, and assess the ability to dorsiflex toes if indicated. Length and position of peroneal nerve increase risk of its injury in the presence of leg fracture, edema or compartment syndrome, or malposition of traction apparatus.

Option C: The nurse doesn’t have enough data to warrant putting the client in Trendelenburg’s position. Handle injured tissues and bones gently, especially during the first several days. This may prevent the development of fat emboli (usually seen in the first 12–72 hr), which are closely associated with fractures, especially of the long bones and pelvis.

Option D: Neurologic assessment is a secondary concern to airway, breathing, and circulation. Perform neurovascular assessments, noting changes in motor and sensory function. Ask the patient to localize pain and discomfort. Impaired feeling, numbness, tingling, increased or diffuse pain occurs when circulation to nerves is inadequate or nerves are damaged.

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