Which of the following signs or symptoms would be cause for concern? A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma.
A. Bulging anterior fontanel. B. Repeated vomiting. C. Signs of sleepiness at 10 PM. D. Inability to read short words from a distance of 18 inches.
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. The anterior fontanel is closed in a 4-year-old child. Evidence of sleepiness at 10 PM is normal for a four year old. The average 4-year-old child cannot read yet, so this too is normal.