A male adolescent is brought into the ED via stretcher who was recently involved in a physical altercation with a fellow classmate. The paramedic reports off to the nurse that the adolescent had recently lost consciousness but is currently responsive, reports BP to be 154/98, Pulse 58, Respirations 8 and O2 Stat 83%. What is the priority assessment for the nurse to make?
A.Ask the patient how long he was unconscious for
B.Obtain current B/P
C.Asses for pupillary changes
D.Determine current respiratory status
Answer:D
A male adolescent is brought into the ED via stretcher who was recently involved in a physical altercation with a fellow classmate. The paramedic reports off to the nurse that the adolescent had recently lost consciousness but is currently responsive, reports BP to be 154/98, Pulse 58, Respirations 8 and O2 Stat 83%. What is the priority assessment for the nurse to make?
A.Ask the patient how long he was unconscious for B.Obtain current B/P C.Asses for pupillary changes D.Determine current respiratory status