A child with haemophilia is brought into the emergency department after being hit on the neck with a baseball. The nurse immediately assesses the child for?

Appeared in: DHS Staff Nurse - 2018 (Shift-2nd)

Explanation

In any trauma situation, the nursing assessment follows the ABC (Airway, Breathing, Circulation) principle, making airway the top priority.
A patient with haemophilia has impaired blood clotting, leading to a high risk of severe internal bleeding even from blunt trauma.
Trauma to the neck can cause a rapidly expanding hematoma (a collection of blood in the tissues).
A neck hematoma can compress the trachea, leading to a life-threatening airway obstruction. Therefore, assessing for airway compromise is the most immediate and critical action.

Option B: Factor VIII deficiency is the underlying disease (haemophilia A), not an acute symptom or a finding to assess in an emergency. The nurse's priority is to manage the life-threatening complications of the trauma, not to re-diagnose the known condition.
Option C: Spontaneous hematuria (blood in the urine) is a possible site of bleeding in a person with haemophilia, but it is not directly caused by neck trauma and is not the most immediate life-threatening concern compared to airway obstruction.
Option D: Headache and slurred speech are critical signs of a potential intracranial (head) bleed. However, in the ABCDE trauma assessment, Airway (A) and Breathing (B) must be secured before assessing Disability/neurological status (D). Given the direct trauma to the neck, airway is the more immediate risk.

Clinical Relevance

Nursing practice connection: Prioritize focused assessment, early escalation, and real-time monitoring when managing Prioritization of nursing assessment in a pediatric trauma patient with a bleeding disorder in acute care settings.
A nurse must always prioritize assessments based on the ABCDE framework in emergencies. A compromised airway can lead to death in minutes.
In patients with bleeding disorders like haemophilia, the nurse must have a high index of suspicion for severe internal bleeding even with seemingly minor trauma. Life-threatening bleeds commonly occur in the head, neck/throat, and abdomen.
Prompt administration of clotting factor concentrate is a key nursing responsibility and can be life-saving. The nurse should anticipate this order and prepare for it.

How to Approach the Question

First, identify the key components of the scenario: the patient (a child with haemophilia), the injury (blunt trauma to the neck), and the task (what to assess immediately).
Recall the fundamental principle of emergency nursing: the ABCs (Airway, Breathing, Circulation). This framework dictates the order of priorities.
Analyze the specific risks. Haemophilia + Neck Trauma = High risk of a bleeding into the neck.
Evaluate how a bleed in the neck would manifest as a life-threatening problem. A hematoma in the neck directly threatens the airway.
Compare the options based on the ABCs. 'Airway obstruction' is 'A'. 'Headache and slurred speech' relates to 'D' (Disability). The other options are not immediate life threats in this context.
Conclude that assessing the airway is the most critical and immediate priority.

Concept Tested & Keywords

Concept Tested: Prioritization of nursing assessment in a pediatric trauma patient with a bleeding disorder.
Stem keywords: haemophilia, child, hit on the neck, emergency department
Lead-in keywords: immediately assesses
Clinical cues: Patient has haemophilia, which significantly increases bleeding risk.
Clinical cues: Injury is to the neck, a critical area for airway patency.

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E6 Nelson Textbook of Pediatrics(2024) — Volume 2 p. 823-825

E6 Nursing Brunner Adult Health 3SA Vol 1 Part 3 p. 158-159

Practise the full DHS Staff Nurse - 2018 (Shift-2nd)

Attempt every question from this paper in a timed mock, then review the full solution for each one.