Worsening or severe headache, repeated vomiting, increasing confusion or drowsiness, unequal pupils, slurred speech, weakness, or seizures — signs of an evolving intracranial bleed; return to the ED immediately.
Before you read
Test yourself first: 2 questions
Question 1 of 2
A client is admitted with a concussion (mild traumatic brain injury). Which sign, if it develops at home, indicates a complication requiring the client to return for evaluation?
Answer: A. After a concussion, worsening or persistent vomiting, increasing or severe headache, increasing confusion or drowsiness, slurred speech, weakness, unequal pupils, or a seizure suggest a developing intracranial bleed or rising ICP and require immediate re-evaluation. Brief, mild headache that improves and normal sleep that the client can be roused from are expected.
Question 2 of 2
A client sustained a head injury and was lucid immediately after, then rapidly deteriorated into unconsciousness. The CT shows an arterial bleed between the skull and dura. Which injury does this lucid-interval pattern classically describe?
Answer: A. An epidural (extradural) hematoma classically presents with a brief lucid interval followed by rapid deterioration as arterial bleeding (often the middle meningeal artery) accumulates between the skull and dura. Subdural hematomas (venous) develop more slowly; a concussion is transient; a contusion is bruised brain tissue without this hallmark pattern.
Keep the streak going with more questions like these, each with a full rationale.
What is concussion?
Symptoms include brief loss of consciousness or feeling dazed, headache, dizziness, confusion, and amnesia surrounding the event. Most symptoms resolve over days to weeks with rest. The main nursing concern is monitoring for a worsening or evolving bleed such as an epidural or subdural hematoma.
Key points to remember
- Defined as a transient alteration in brain function from head trauma; CT and MRI are typically normal because there is no gross structural injury.
- Common symptoms: headache, dizziness, nausea, confusion, brief amnesia (retrograde or anterograde), and sometimes brief loss of consciousness.
- Cognitive and physical rest is the cornerstone of treatment, with gradual, monitored return to activity, school, and sports.
- Post-concussion syndrome (persistent headache, dizziness, irritability, poor concentration) can last weeks to months.
- Repeated concussions before full recovery raise the risk of second-impact syndrome and long-term cognitive effects.
Signs & symptoms
- Brief LOC, confusion, amnesia
- Headache, dizziness, N/V
- Photophobia, irritability, fatigue
Nursing priorities
- Perform serial neurologic assessments including level of consciousness, pupil response, and Glasgow Coma Scale.
- Educate the caregiver on warning signs that require immediate return to the emergency department.
- Promote physical and cognitive rest by limiting screen time, schoolwork, and strenuous activity.
- Manage headache with acetaminophen; avoid aspirin and NSAIDs early because they can increase bleeding risk.
- Ensure no return to sports or contact activity until cleared by a provider and symptom-free.
Patient teaching
- Wake or check on the person periodically the first night, and return to the ED for worsening headache, repeated vomiting, confusion, unequal pupils, or trouble waking.
- Rest both physically and mentally; limit screens, reading, and strenuous activity until symptoms improve.
- Use acetaminophen for headache and avoid aspirin/NSAIDs and alcohol early in recovery.
- Do not return to sports or contact activity until a provider clears you to prevent second-impact injury.
- Expect a gradual return to normal activity and report symptoms that persist or worsen.
Red flags: report now
- Worsening or severe headache, repeated vomiting, increasing confusion or drowsiness, unequal pupils, slurred speech, weakness, or seizures — signs of an evolving intracranial bleed; return to the ED immediately.
- Inability to be awakened, clear or bloody drainage from the nose or ears (CSF leak), or a fixed dilated pupil — emergency.
References
Clinical references for this topic
