A nurse in the emergency department is evaluating a client who was brought in by a neighbor after suddenly falling while walking.
What assessments should the nurse prioritize?

Choice A rationale

Respiratory therapy is primarily concerned with the treatment and management of a patient’s breathing. While swallowing difficulties can potentially lead to respiratory issues such as aspiration pneumonia, the primary role of evaluating and treating swallowing difficulties falls outside the scope of respiratory therapy.
Choice B rationale
Nutritional therapy would be involved in managing the dietary needs of a patient with Parkinson’s disease, including modifications to food texture and liquid consistency if swallowing difficulties are present. However, the evaluation and treatment of the swallowing difficulty itself would be managed by a speech therapist.
Choice C rationale
Occupational therapy could assist with adaptations to enhance the patient’s feeding skills and independence during meals. However, the specific evaluation and treatment of swallowing function is typically within the scope of a speech therapist.
Choice D rationale
Speech therapists, or speech-language pathologists, are the professionals specifically trained to evaluate and treat individuals with speech, language, voice, and swallowing disorders. This would include a patient with Parkinson’s disease experiencing difficulty swallowing.

Choice A rationale
Swelling of the optic nerve, also known as papilledema, can be a sign of increased intracranial pressure (ICP). However, it is not a direct indicator of a worsening neurological condition.
Choice B rationale
The Glasgow Coma Scale (GCS) is a clinical tool used to assess a patient’s level of consciousness and neurological functioning. A decreasing GCS score indicates a worsening neurological condition, which could be due to increasing ICP12. Therefore, a decreasing GCS score is a direct indicator of a worsening neurological condition.
Choice C rationale
A blood pressure of 108/76 mm Hg is within the normal range and does not directly indicate a worsening neurological condition. However, drastic changes in blood pressure could potentially indicate a problem.
Choice D rationale

Changes in pupil size and shape can be a sign of increased ICP, but these changes are not specific to a worsening neurological condition. They could be due to various factors, including medication effects or damage to the cranial nerves.
Choice E rationale
A respiratory rate of 12/min is within the normal range for adults. Changes in respiratory patterns could potentially indicate a worsening neurological condition, but a rate of 12/min does not directly indicate this.