A nurse is caring for a patient in the intensive care unit who was admitted with severe head trauma and cerebral edema. The patient opens their eyes spontaneously, is oriented, and obeys commands.Which of the following findings indicate the patient is experiencing a decline in their condition?

Choice A rationale
A contrecoup injury is indeed a “true” injury. It occurs on the side of the brain opposite to the point of impact and can have severe consequences, including brain damage. Therefore, this statement is incorrect.
Choice B rationale
The severity and healing time of contrecoup injuries can vary greatly depending on the force and location of the impact, as well as individual health factors. It’s not accurate to say that contrecoup injuries are generally less severe and heal more quickly over time.
Choice C rationale
This statement is correct. A coup injury refers to the brain damage that occurs directly under the point of impact, while a contrecoup injury occurs on the opposite side of the brain from

where the head is struck. These injuries can occur separately or together, but if the blow is strong enough, they usually appear together.
Choice D rationale
The sequence of coup and contrecoup injuries is not as this choice describes. The coup injury happens at the point of impact, and the contrecoup injury happens when the brain rebounds and hits the opposite side of the skull. Both types of injuries can impact the brain’s blood supply.

Choice A rationale
Osmotic cerebral edema is a condition where water moves from the blood vessels into the brain due to changes in the concentration of particles in the blood. However, this is not the primary cause of cerebral edema in meningitis.
Choice B rationale

While inflammation can contribute to cerebral edema, it is not specific to the brain and does not affect the brain the most. In meningitis, the inflammation is primarily in the meninges, the membranes that cover the brain, and not the whole body.
Choice C rationale
Cerebrospinal fluid (CSF) does flow from the intraventricular space to the interstitial area of the brain, but this is a normal process and does not cause cerebral edema. In meningitis, the inflammation of the meninges can disrupt the normal flow and absorption of CSF, leading to an accumulation of fluid and increased intracranial pressure.
Choice D rationale
In meningitis, the inflammation and immune response to the infection can lead to an increase in the permeability of the blood-brain barrier. This allows fluid and immune cells to enter the brain tissue, leading to cerebral edema. Additionally, the by-products of the pathogen that causes meningitis can directly damage the brain tissue and contribute to the edema.