A patient who is suspected of having an epidural hematoma is admitted to the emergency department. Which action will the nurse plan to take?

Initiate high-dose barbiturate therapy.

Administer of IV furosemide.

Prepare patient for immediate craniotomy.

Type and cross-match for blood transfusion.

Answer and Explanation

The Correct Answer is C

A. Initiate high-dose barbiturate therapy: High-dose barbiturates may be used in some cases to reduce cerebral metabolic demand and intracranial pressure, but they do not address the underlying cause of an epidural hematoma, which is a rapidly expanding arterial bleed. Definitive surgical intervention is required to prevent brain herniation.

B. Administration of IV furosemide: Furosemide is a diuretic that can reduce intracranial pressure indirectly, but it is not a primary treatment for epidural hematoma. Relying on diuretics alone will not stop arterial bleeding or relieve mass effect, which are life-threatening in this condition.

C. Prepare patient for immediate craniotomy: Epidural hematomas are often caused by arterial bleeding and can rapidly expand, leading to increased intracranial pressure and herniation. The priority intervention is emergent surgical evacuation of the hematoma via craniotomy to prevent irreversible neurologic damage and death.

D. Type and cross-match for blood transfusion: While blood products may be necessary if significant blood loss occurs, transfusion does not treat the primary threat of expanding intracranial pressure. Preparing for surgery takes precedence over obtaining blood products.

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Correct Answer is D

Explanation

A. Paradoxic movement of the chest is noted: Paradoxical chest movement is characteristic of a flail chest, where a segment of the rib cage moves in the opposite direction during respiration. While both conditions are life-threatening, flail chest involves structural instability rather than the rapid intrathoracic pressure changes seen in tension pneumothorax.

B. Sucking sound with each patient breath: A sucking sound, or "sucking chest wound," is associated with an open pneumothorax, where air enters the pleural space through a chest wall defect. Unlike tension pneumothorax, this condition does not create progressive mediastinal shift or hemodynamic compromise.

C. Wheezes are audible throughout both lungs: Wheezing indicates airway obstruction or bronchospasm, commonly seen in asthma or COPD exacerbations. It does not reflect the pathophysiology of tension pneumothorax, which primarily involves pleural pressure buildup and compression of mediastinal structures.

D. Tracheal deviation to the unaffected side: Tracheal deviation away from the affected side is a hallmark sign of tension pneumothorax. As air accumulates in the pleural space under pressure, it shifts the mediastinum, compresses the heart and great vessels, and can rapidly lead to decreased cardiac output and life-threatening hypotension. Immediate needle decompression is required.

A. Syndrome of inappropriate secretions of antidiuretic hormone (SIADH) B. Disseminated intravascular coagulation (DIC) C. Pericardial effusion/tamponade (PE/T) D. Superior vena cava syndrome (SVC)

Correct Answer is D

Explanation

A. Syndrome of inappropriate secretions of antidiuretic hormone (SIADH): SIADH is characterized by water retention, hyponatremia, and low serum osmolality. While it can occur in cancer patients, it does not typically cause facial and neck swelling or distended chest veins, making it unlikely in this scenario.

B. Disseminated intravascular coagulation (DIC): DIC is a systemic coagulopathy leading to both thrombosis and bleeding. Clinical manifestations include petechiae, ecchymoses, and bleeding, not venous distention or facial edema. DIC does not explain the localized obstruction of venous return.

C. Pericardial effusion/tamponade (PE/T): Cardiac tamponade causes jugular venous distention, hypotension, and muffled heart sounds (Beck’s triad). While there may be venous congestion, the edema is usually generalized, not limited to the face, neck, and upper chest, and periorbital edema is less typical.

D. Superior vena cava syndrome (SVC): SVC syndrome results from obstruction of the superior vena cava, often due to malignancy compressing the vessel. This obstruction impairs venous return from the head, neck, and upper extremities, leading to facial and periorbital edema, neck swelling, and distended chest veins. It is an oncologic emergency requiring prompt recognition and intervention.

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