An individual arrives at the emergency department with injuries sustained in a natural gas explosion. The patient is unable to respond to questions and keeps repeating "I can't hear." For what should the nurse assess this patient?
1. tympanic membrane rupture
2. air embolism
3. oxygen saturation level
4. confusion
Correct Answer: 1
After a blast injury, damage to the ear can include tympanic membrane rupture or damage to the cochlea. As the patient is expressing difficulty hearing, the tympanic membrane should be assessed. An air embolism would impact the patient's respiratory status. There is no evidence to suggest the patient's oxygen saturation level is impaired. There is no evidence of confusion.
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