Prioritizing Care for Patients with Subdural Hemorrhage: What Nurses Need to Know

A nurse receives shift report and is told to prioritize the care of a client with a subdural hemorrhage who is requesting food. What is the most important consideration in this situation?

• A. Assess the client's ability to swallow
• B. Determine if the client is still on NPO status
• C. Request a dietary consult for the client
• D. Verify the order for the client's diet

Answer: (A)

The most important consideration in this situation is to assess the client's ability to swallow. A subdural hemorrhage can lead to neurological changes that may affect the client’s ability to swallow safely. Assessing this ability is crucial because if the client has dysphagia, eating could lead to aspiration pneumonia or choking. Ensuring that the client can safely ingest food is a fundamental nursing responsibility when a patient expresses hunger or a desire to eat, particularly after sustaining a head injury. While determining if the client is still on NPO status, requesting a dietary consult, and verifying diet orders are important steps in the care process, they become less relevant without first confirming the client's capacity to swallow. If the client is unable to swallow effectively, the other considerations may become moot as the priority is ensuring the client's immediate safety.

When caring for a client with a subdural hemorrhage, you might wonder, “What’s the first thing I need to focus on?” You could be juggling various responsibilities, but there's one clear priority here: assessing the client’s ability to swallow. This isn’t just about food; it’s about ensuring the client’s safety and well-being after such a serious condition.

Imagine being in that situation—hungry, maybe a little confused, and someone telling you it’s time for lunch. But here’s the catch: if you’ve just had a head injury, your body may not necessarily cooperate the way you want it to. Subdural hemorrhaging can lead to significant neurological changes, which might leave a person struggling with something as fundamental as swallowing. You know what I mean? Eating shouldn’t put you at risk, but without the right checks, it could.

So, what should a nurse do first? You might think about confirming the client's NPO status, maybe jotting down a note to request a dietary consult or checking what’s on the menu. All of that is important, but let’s not put the cart before the horse. Before considering a client’s dietary needs, it’s critical to assess whether they can swallow safely.

Think about it: if the client has dysphagia—a difficulty in swallowing—any attempt to eat could lead to complications like aspiration pneumonia. Choking isn’t just an embarrassing situation; it can escalate into a medical emergency in seconds. So, the golden rule here is to ensure that the person can safely ingest food first, before offering up anything on a plate.

While you assess their swallowing ability, remember that the other steps do come into play eventually. Checking if the client is still on NPO status, verifying doctor’s diet orders, and even broaching the idea of a dietary consult are all part of the overall care plan. But get this—if the client can’t swallow, discussing food options isn’t just moot; it’s treating a symptom without addressing the root cause. It's like putting a band-aid on a gaping wound—it just doesn’t make sense!

Here’s the thing: when it comes to nursing, communication is key. If you realize a client might have trouble swallowing, what do you think you should do next? Inform your team immediately. Collaborate with speech therapists or dietitians who can provide further insight into managing the client’s dietary needs safely. Keeping everyone on the same page ensures comprehensive care, reducing the risks tied to swallowing difficulties.

Always remember—every client is unique, and their care should reflect that reality. Assessing swallowing ability isn’t just a checkbox on a task list; it’s a vital piece of the puzzle in ensuring holistic and compassionate care. By prioritizing this assessment, you're not only safeguarding the client’s health but also reinforcing the trust they place in you as their nurse.

So, when you're knee-deep in the hustle and bustle of a nursing shift, keep this guiding principle in mind: safety first. Your aim isn’t merely to fulfill tasks at hand but to create an environment where clients feel nurtured and cared for. It’s all about making informed choices and advocating for your patients. And sometimes, those choices boil down to the simplest of assessments—the ability to swallow. Who knew that could hold so much weight in the world of nursing?