The nurse is caring for a client with a head injury after a fall from a hayloft. What aspect helps the nurse to detect cerebrospinal fluid(CSF) drainage when examining a client after a significant head injury?
A) Change in the level of consciousness (LOC)
B) Signs of increased intracranial pressure (IICP)
C) Halo sign
D) Swelling

Question

Quizplus · Accepted Answer

The Halo sign is a reliable indicator of CSF leakage after a head injury. It appears as a ring of fluid around a spot of blood on a dressing or bed linen, indicating that CSF is leaking from the nose or ear. A change in LOC, signs of IICP, and swelling may indicate a head injury but do not specifically detect CSF drainage.

The Nurse Is Caring for a Client with a Head