Chapter 13, Problem 1CCS

44-Year-Old Male with Skull Fracture

William Hancock, 44, fell from the scaffolding at a construction site. When emergency personnel arrived, they found him unconscious but with stable vital signs. As paramedics placed him on a backboard to stabilize his head, neck, and back, they noted watery blood leaking from his right ear. In the hospital, Mr. Hancock regained consciousness and was treated for deep lacerations on his scalp and face. Head CT scans revealed both longitudinal and transverse fractures of the right petrous temporal and sphenoid bones that extended through the foramen rotundum and foramen ovale.

The following observations were recorded on Mr. Hancock’s chart on admission:

•Complete loss of hearing in the right ear.

•Paresthesia (sensation of “pins and needles’) at the right corner of the mouth, extending to the lower lip and chin.

•Numbness of the right upper lip, lower eyelid, and cheek.

•Right eye turned slightly inward when looking straight ahead. Diplopia (double vision), particularly when looking to the right.

1. NCLEX-STYLE Which of the following choices best describes the fluid leaking from Mr. Hancock's ear and the cause of that leakage?

a. Blood and mucus are leaking because the sphenoid bone is fractured.

b. Blood and mucus are leaking because the petrous part of the temporal bone is fractured.

c. Blood and cerebrospinal fluid are leaking because the petrous part of the temporal bone is fractured.

d. Blood and sweat are leaking because the sphenoid bone is fractured and because his temperature was elevated.