An elderly patient comes into the emergency department with confusion and mental status changes. Which of the following would suggest to the nurse that this patient has a head injury?
1. hand grasps stronger on right than left
2. takes Coumadin every evening and bumped head when getting into car earlier in the day
3. left sided weakness
4. right facial droop and slurred speech
2
Rationale: Subdural hematomas occur more frequently in the older adult following a head injury. The age-related loss of brain volume and increased intracranial space between the brain and the dura, permit a large amount of bleeding before the appearance of symptoms of intracranial bleeding. Additionally, the classic signs of headache and vomiting due to increased intracranial hypertension may be absent due to cerebral atrophy. Since the patient is taking Coumadin, a blood thinner, and bumped his head while getting into a car earlier in the day, the nurse should suspect that the patient has a head injury. Unilaterally weak hand grasps, one sided weakness, facial droop, and slurred speech would be seen more often in a patient who has experienced a stroke.
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