A 2-year-old child fell and sustained a scalp laceration that will require suturing. The parents ask the nurse, "How serious an injury is this?" How should the nurse respond?
1. "There is a lot of bleeding, but it is really a rather superficial injury."
2. "From the description of the fall it doesn't appear serious, but the X-ray will tell us for sure."
3. "He'll need a few stitches and a tetanus injection, but that should do it."
4. "Children this age are really resilient, but you never know until the X-rays are read."
2
Rationale 1: Telling the parents that the wound is superficial without the benefit of radiological confirmation is inappropriate.
Rationale 2: Scalp lacerations account for a large number of emergency department visits and are usually not serious, but with any scalp laceration, the possibility of an underlying skull fracture must be addressed. An accurate history of the event surrounding the injury is very important. If there is any reason to suspect a skull fracture, a computerized tomography (CT) scan or a plain X-ray of the skull should be obtained.
Rationale 3: Stating that a few stitches and a tetanus injection are all that is needed is minimizing the potential extent of the injury.
Rationale 4: Stating that children are resilient is minimizing the parents' concern.
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