NCLEX Review Guide: Child Health - Neurologic & Cognitive - Submersion Injury

Submersion Injury Overview

• Submersion injury occurs when a child's airway is below the surface of liquid, leading to respiratory impairment and potential hypoxic brain injury.
• Peak incidence occurs in children ages 1-4 years and adolescents, with drowning being the second leading cause of unintentional injury death in children.
• Fresh water causes hemolysis and hyponatremia, while salt water leads to fluid shifts and hypernatremia.

Neurologic Assessment Priority

• Immediate assessment focuses on airway, breathing, circulation, and neurologic status using Glasgow Coma Scale.
• Signs of increased intracranial pressure include altered level of consciousness, vomiting, headache, and changes in pupil response.

Immediate Care Priorities

1. Maintain patent airway and provide oxygen support - may require intubation and mechanical ventilation
2. Monitor vital signs continuously, especially oxygen saturation and neurologic status
3. Position child with head of bed elevated 30 degrees to reduce intracranial pressure
4. Maintain normothermia - avoid hyperthermia which increases metabolic demands

Neurologic Complications

• Cerebral edema typically peaks 24-72 hours post-injury and is the leading cause of death in submersion victims.
• Long-term neurologic deficits may include cognitive impairment, seizure disorders, and developmental delays requiring ongoing rehabilitation.

Safety Measures

• Constant adult supervision within arm's reach when children are near water, including bathtubs, pools, and natural bodies of water.
• Install proper barriers around pools including four-sided fencing with self-closing, self-latching gates.
• Teach children basic water safety and swimming skills appropriate for developmental level.