Question

Case Study

Joshua Thomson is an active 13-year-old who was riding his bike with friends when he fell while attempting to jump over a ditch. His friends helped him home, and his mother has brought him to the urgent care center with complaints of a slight headache and a painful left wrist. As the triage nurse at the clinic, you interview Joshua and his mother. According to Joshua, he was attempting to jump the ditch when his bike tire caught on the curb. He flipped forward over the handlebars of his bike and landed on his back. He does not remember hitting his head on the ground but does remember putting his hands down to brace his fall. His biggest complaint at this moment is the pain he experiences when he moves his left wrist, but he is also nauseated and has a “small headache.” Joshua’s other thinks that the headache and nausea may be due to the fact that Joshua has not eaten anything since 7:00 a.m. and it is now 4:00 p.m. The attending physician prescribes an x-ray of Joshua’s wrist and acetaminophen (Tylenol) 650 mg for pain. The x-ray shows that Joshua’s left wrist is fractured. He is placed in a cast and given prescriptions for Tylenol for the pain and ondansetron (Zofran) for the nausea and sent home. As the nurse, you give Joshua’s mother some discharge instructions for caring for the cast, using both the Tylenol and Zofran, and watching Joshua for any sign of neurological damage.

Question 1

What neurological alterations would you educate Joshua’s mom to watch for?

Question 2

What should Joshua’s mother do if she makes any of these observations?

Question 3

What prevention education should be given to Joshua and his mother?

Question 4

What focused assessment should you perform?

Answer 1

1. Joshua's mom is educated to watch for signs of persistent headache and nausea, sensitivity to noise and light, irritability, confusion, lightheadedness, balance problems, changes in sleep patterns, blurred vision, ringing in ears, alteration in taste, fatigue.
2. If Joshua‘s mom makes any of these observations, she should contact the emergency health care centre.
3. The preventive measures to be given to Joshua and his mother are to wear helmets and protective gears to prevent injury even if he falls, contact the health care services immediately, follow all safety measures.
4. The focused assessment to be performed on the neurological status of the child.