A client sustained a concussion after falling off a ladder. What are essential instructions for the nurse to provide when the client is discharged from the hospital? Select all that apply.

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An essential aspect of discharging a client with a head injury is ensuring that a responsible adult will check on the client as the level of consciousness can change (Option E). Brain edema or increased intracranial pressure (IICP) may not be evident immediately. The client should return to the emergency department or notify the primary care provider if any of the following signs/symptoms are present in the next 2-3 days: Change in level of consciousness (eg, increased drowsiness, difficulty arousing, confusion) Worsening headache or stiff neck, especially if unrelieved by over-the-counter analgesics Visual changes (eg, blurring) Motor problems (eg, difficulty walking, slurred speech) (Option C) Sensory disturbances Seizures Nausea/vomiting or bradycardia (indicates IICP) The client is also to abstain from alcohol, check before taking medications that can affect level of consciousness (eg, muscle relaxants, opioids), and avoid driving or operating heavy machinery (Option A). (Option B) It is not necessary to cause sleep deprivation by keeping the client awake. It is most important that the client can be easily aroused to an awake state. (Option D) A neurological examination includes evaluation with the Glasgow Coma Scale, testing of pupils, and assessment of all 4 extremities for movement, strength, and sensation; this examination should be performed by a clinician. The responsible adult is taught the general indicative symptoms in the list above. Educational objective: A client sent home with a head injury requires the presence of a responsible adult. This person should observe for the signs/symptoms of increased intracranial pressure including change in level of consciousness, projectile vomiting, motor alteration (eg, ataxia), ipsilateral pupil dilation, and seizures.

A Client Sustained a Concussion After Falling Off a Ladder