| Course | N420 Adult Health IV |
|---|---|
| Module | Module 5 |
| Paper type | Nursing priorities paper |
| Length | About 1,051 words, 6 pages |
| Format | APA 7 student paper |
| School | Aspen University |
| Program | Pre-licensure BSN |
| Updated | September 2026 |
Free sample paper for N420 Module 5
She Was Talking When She Arrived: Nursing Priorities in the First 24 Hours After a Fall and Brain Injury on Apixaban
Student Name
Pre-licensure BSN Program, Aspen University
N420: Adult Health IV
Instructor Name
Month Day, Year
She Was Talking When She Arrived: Nursing Priorities in the First 24 Hours After a Fall and Brain Injury on Apixaban
Older adults on anticoagulants can look well after a head injury and then deteriorate hours later as blood collects under the skull. Mrs. K., a composite 74-year-old retired teacher who takes apixaban for atrial fibrillation, fell down four basement stairs at 3 p.m. She arrived in the emergency department at 4:10 p.m. with a scalp laceration, a headache and a Glasgow Coma Scale score of 14. This paper sets out the nursing priorities for her first 24 hours, from the first neurological baseline to reversal of her anticoagulant, preventing secondary brain injury, preparing for surgery and supporting her family. Mrs. K. is an illustrative composite.
Why This Patient Is at High Risk
Age shrinks the brain and stretches the bridging veins between the brain and the dura, so a modest fall can tear them. An anticoagulant allows the bleeding to continue. The result is often a subdural hematoma that grows over hours, so the patient's first examination may be the best of the day. For nurses, this means that the first normal-looking assessment is a baseline to be compared, not a reassurance (Harding et al., 2023).
The First Hour: Baseline and Imaging
The nurse records a full neurological baseline: the score for eyes, verbal and motor responses separately, pupil size and reaction, limb strength on each side and speech. Mrs. K. opened her eyes to voice, was oriented but slow, and moved all limbs. The nurse also records the time of her last apixaban dose, taken at 8 a.m., because it guides reversal. A computed tomography scan at 4:40 p.m. showed an acute left subdural hematoma 9 millimeters thick with slight midline shift.
Reversal Is the Time-Critical Step
Guidance for antithrombotic-associated intracranial hemorrhage recommends reversing factor Xa inhibitors such as apixaban when the bleed is serious, using a prothrombin complex concentrate when a specific antidote is not available, and giving activated charcoal if the drug was taken within about two hours (Frontera et al., 2016). Hospitals now also stock a specific antidote, andexanet alfa, and choose between agents by protocol. For the nurse, the priority is speed: confirming the order, obtaining the product from pharmacy, giving it as soon as it arrives and documenting the time. Mrs. K. received reversal at 5:05 p.m., 25 minutes after the scan.
Preventing Secondary Brain Injury
Much of the harm after brain injury comes later, from low oxygen, low blood pressure, fever, high or low glucose and swelling. Guidelines for severe injury recommend keeping systolic pressure at or above 110 in patients older than 70 and at or above 100 in those 50 to 69, avoiding prolonged hyperventilation, and treating intracranial pressure above 22 where it is monitored (Carney et al., 2017). Although Mrs. K.'s injury was not yet severe, the same principles guide her nursing care: head of bed at 30 degrees with the head midline, oxygen saturation kept above 94%, no tight collar, glucose checks, normal temperature and pain control that does not over-sedate.
Monitoring Plan
Frequent, consistent checks by the same method are the core of nursing in the first 24 hours.
| Measure | Frequency | Report immediately if |
|---|---|---|
| Coma score, pupils, limb strength | Every 15 minutes for 2 hours, then hourly | Score falls by 2 or more; new pupil change or weakness |
| Blood pressure, pulse | Every 15 minutes at first, then each hour | Systolic below the ordered floor; rising pressure with slowing pulse |
| Oxygen saturation and breathing pattern | Continuous | Below 94%, irregular breathing |
| Glucose and sodium | Every 6 hours or as ordered | Glucose above 180 or below 80; sodium falling |
| Headache, vomiting, speech | Each assessment | New vomiting, worsening headache, new confusion |
When She Changed
At 9:15 p.m., Mrs. K. became drowsy and opened her eyes only to pain. Her score fell from 14 to 10, and her right pupil was a little slower than her left. The nurse called the neurosurgeon with a report that led with the change in score and pupils and the time of the previous normal check. A repeat scan showed the hematoma had grown to 14 millimeters. She went to the operating room for evacuation at 10:40 p.m. Before transfer, the nurse confirmed consent from her son, removed dentures and jewelry and handed over the timeline of scores, reversal and scans.
The Handoff to Intensive Care
After surgery, Mrs. K. went to the neurological intensive care unit. The handoff the nurse gave followed the timeline rather than the systems: the fall at 3 p.m., the first score of 14, the last apixaban dose at 8 a.m., reversal at 5:05 p.m., the drop to 10 with a sluggish right pupil at 9:15 p.m., the repeat scan and the operation. It then listed her usual function, her son's contact details and the fact that she wears hearing aids, which affects how her responses should be judged. A clear timeline lets the receiving nurse recognize whether the next change is new or part of a known trend.
Seizures, Glucose and Sodium
After evacuation, Mrs. K. received an antiseizure medicine as ordered, since prophylaxis during the first week reduces early seizures after brain injury (Carney et al., 2017). The nurse kept seizure precautions, checked glucose, and watched sodium, because both high and low values worsen brain swelling. Any seizure, even brief, was to be reported at once.
Supporting the Family
Mrs. K.'s son had found her at the bottom of the stairs and blamed himself for not fixing the railing. The nurse gave him clear updates, explained why his mother had seemed fine at first, prepared him for how she would look after surgery, and asked about her wishes and her usual function, information the team would need later. She also asked him whether his mother had ever said what she would want if she could not recover fully, a question that is easier to raise early, gently and before any crisis forces it.
Conclusion
Mrs. K. arrived talking and deteriorated six hours later, which is the pattern that makes older anticoagulated patients with head injuries dangerous. The nursing priorities in her first 24 hours were a careful baseline, fast reversal, prevention of secondary injury, frequent checks with clear thresholds, rapid escalation when she changed, and steady support for her son.
References
Carney, N., Totten, A. M., O'Reilly, C., Ullman, J. S., Hawryluk, G. W. J., Bell, M. J., Bratton, S. L., Chesnut, R., Harris, O. A., Kissoon, N., Rubiano, A. M., Shutter, L., Tasker, R. C., Vavilala, M. S., Wilberger, J., Wright, D. W., & Ghajar, J. (2017). Guidelines for the management of severe traumatic brain injury, fourth edition. Neurosurgery, 80(1), 6-15. https://doi.org/10.1227/NEU.0000000000001432
Frontera, J. A., Lewin, J. J., III, Rabinstein, A. A., Aisiku, I. P., Alexandrov, A. W., Cook, A. M., del Zoppo, G. J., Kumar, M. A., Peerschke, E. I. B., Stiefel, M. F., Teitelbaum, J. S., Wartenberg, K. E., & Zerfoss, C. L. (2016). Guideline for reversal of antithrombotics in intracranial hemorrhage: A statement for healthcare professionals from the Neurocritical Care Society and Society of Critical Care Medicine. Neurocritical Care, 24(1), 6-46. https://doi.org/10.1007/s12028-015-0222-x
Harding, M. M., Kwong, J., Hagler, D., & Reinisch, C. (2023). Lewis's medical-surgical nursing: Assessment and management of clinical problems (12th ed.). Elsevier.
What the N420 Module 5 instructions ask for
Trauma appears in Aspen's N420 course description, and this sample builds on that listing because the module prompt is reserved for students logged into the class. A brain injury assignment usually asks you to set nursing priorities for a defined period, explain neurological assessment, describe prevention of secondary injury and show how the nurse escalates changes. Some instructors assign a young trauma patient; others allow an older adult or a specific injury type. Check whether the Glasgow Coma Scale must be scored by component, whether anticoagulant reversal should be discussed or left to the medical team, and how many sources are required. Confirm the time frame the paper must cover.
Inside the N420 Module 5 example
The paper holds around 1,020 words in eleven sections with one monitoring table. The introduction presents the fall and the first score. A section explains why age and anticoagulation make late deterioration likely. The first hour covers the baseline, dose timing and scan. Reversal is presented as the time-critical step. Prevention of secondary injury gives guideline targets. The monitoring table lists measures, frequency and reporting thresholds. A section follows her deterioration and transfer to surgery, then the timeline handoff to intensive care. Seizures, glucose and sodium, family support and a conclusion that restates the priorities complete the paper. Times are given throughout, so the reader can follow the six hours between arrival and surgery.
N420 Module 5 rubric: what earns full marks
Priority papers in this course are commonly marked on the order of actions, the accuracy of assessment, prevention of complications and communication. Order earns marks because reversal and repeated checks come first, with times recorded. Assessment is precise, with the score recorded by component, a choice the first margin note defends. Prevention draws on the severe brain injury guidelines with specific targets. Communication is shown twice, in the escalation call and in a handoff built on a timeline, which a second margin note explains. Family care adds depth. Remaining marks go to the table's clear thresholds and correct APA references for three sources. The paper also names the reversal time, which shows speed as well as knowledge.
N420 Module 5 help: mistakes that cost marks
A frequent error is treating a good first assessment as reassurance in an older anticoagulated patient. Treat it as a baseline. Students also report the coma score as one number when its parts tell more; record eyes, verbal and motor separately. Another common gap is leaving out the time of the last anticoagulant dose, which guides reversal. Some papers list neuro checks without saying what change should be reported. Set thresholds. Others forget secondary injury prevention, the part of care nurses control most. Finally, write handoffs as timelines. A receiving nurse cannot recognize a new change without knowing what came before. Keep the family informed as the plan changes.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Aspen University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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N420 Module 5 questions, answered
What does N420 Module 5 usually ask for?
Aspen's N420 description includes trauma, so a paper on nursing priorities after traumatic brain injury is a typical assignment. Check your classroom for the prompt and the time frame required.
Why are older adults on anticoagulants at special risk after a fall?
Their bridging veins tear more easily and anticoagulants let bleeding continue, so a subdural hematoma can grow for hours after a patient first seems well.
What is secondary brain injury?
Damage that develops after the initial trauma from low oxygen, low blood pressure, swelling, fever, abnormal glucose or seizures. Nursing care aims to prevent it.
Where can I find a free N420 Module 5 sample paper?
Scroll up for the whole brain injury priorities paper; its monitoring table and every margin note are open to read without payment. It is the fifth of the eight N420 samples.
How often are neuro checks done in N420 Module 5?
Often every 15 minutes for the first two hours, then hourly, following your facility's orders. The key is using the same method each time and reporting a fall of two or more points or a new pupil change.