ATCN EXAM REVIEW-WITH 100% VERIFIED SOLUTIONS 2024/2025, Exams of Nursing

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ATCN EXAM REVIEW-WITH 100% VERIFIED SOLUTIONS 2024/2025 The approach to trauma care typically begins with what? notification that a trauma patient is arriving When preparing to receive a trauma patient, what should you keep in mind? safe practice, safe care What does "Safe practice" mean when receiving trauma patients? take into consideration the protection of the team (universal precautions/PPE/preparing equipment prior to patient arrival) What does "Safe care" mean when receiving trauma patients? that the patient is going to the right hospital, in the right time, for the right care Trauma primary survey for "A"? airway and alertness with simultaneous cervical spinal stabilization Trauma primary survey for "B"? breathing and ventilation Trauma primary survey for "C"? circulation and hemorrhage control Trauma primary survey for "D"? disability (neurological status: AVPU/GCS) Trauma primary survey for "E"? exposure and environmental control Trauma primary survey for "F"? full set of vital signs and family presence Trauma primary survey for "G"? get resuscitation adjuncts (LMNOP) Which resuscitation adjunct under the "G" primary assessment is this? -"L" laboratory studies (ABG's/Type and cross) Which resuscitation adjunct under the "G" primary assessment is this? -"M" monitor for continuous cardiac rhythm and rate assessment Which resuscitation adjunct under the "G" primary assessment is this? -"N" naso/orogastric tube consideration Which resuscitation adjunct under the "G" primary assessment is this? -"O" oxygenation and ventilation analysis (pulse oximetry/ETCO2/capnography) Anterior/Posterior Head - 9% Each Anterior/Posterior Torson - 18% Each Anterior/Posterior Arms - 4.5% Each Anterior/Posterior Legs - 7% Each Rule of 9's - Pediatric Early signs and sx 1. increased pain, greater than expected and out of proportion to the injury 2. Palpable tenseness of the compartment 3. asymmetry of the muscle compartment 4. pain on passive stretch 5.altered sensation Note: Absent distal pulses and poor cap refill are not reliable in dx compartment syndrome. May be a very late sign of C.S. possibility of proximal vascular injury should be considered signs and symptoms of compartment syndrome thoracotomy is indicated when output exceeds 1500 mL within 24 hours, THE INDICATIONS for thoracotomy after traumatic injury typically include shock, arrest at presentation, diagnosis of specific injuries (such as blunt aortic injury), or ongoing thoracic hemorrhage. Indications for thoracotomy sx can be slow and gradual and silent. hypotension, tachycardia, arrhythmias and dysrhythmias, visible trauma, distended neck veins, muffled heart sounds, and other signs of shock. Note: rapid deceleration blunt cardiac injury s and sx 1. Metabolic acidosis is corrected by control of hemorrhage and admin of fluids and blood 2. The degree of metabolic acidosis is measured by the base deficit from the abg's. The base deficit helps estimate level of perfusion and pt's response to resuscitation Acid base balance, base deficit and shock 1. Normal -2 to 2 2. Mild -5 to -3 3. Moderate -9 to -6*** (-6 or more indicates severe injury and significant mortality) 4. Severe -10 or more Base deficit chart 1. normal 2. mild 3. moderate 4. severe Lactate levels help determine organ perfusion. Obtain lactate levels and correct to less than 2 Lactate levels and shock an abnormality of the circulatory system that results in inadequate organ perfusion and tissue oxygenation. Reduced tissue perfusion causes cellular hypoxia-> cellular conversion from aerobic to anaerobic metabolism ->leads to accumulation of lactic acid -> metabolic acidosis define shock Urine output measures organ perfusion and adequate resuscitation Adults- 0.5 ml/kg/hr Peds- 1 ml/kg/hr baby- 2 ml/kg/hr Urine output and hypovolemic shock epidural hematoma the airway with cervical spine control When multiple victims are present at the scene of a major motor vehicle crash, the highest priority is given to spine radiographs including cervical, thoracic, lumbar, and sacral vertebra A young conctruction worker falls 2 stories from a building and sustains bilateral calcaneal fractures. After a primary survery the stable patient should receive goggles gloves face mask water-impervious gown What is considered a standard precaution: secure a patent airway with C-spine immobilization place an occlusive dressing over the wound (taped on three sides) For an open bubbling chest wound tearing of a bridging vein between the cerebral cortex and a draining venous sinus Most common underlying cause of a subdural hematoma? 1. Respiratory distress 2. Asymmetry of breath sounds 3. Deviation of trachea to the opposite side of the defect 4. Marked decreased in cardiac output 5. Hypotension 6. Muffled heart sounds signs of tension pneumothorax the neck muscles are strong What is NOT an anatomical difference of children? burns that destroy the entire thickness of the skin -dark leathery appearance -mottled, or wax like appearance -painless -dry surface third degree burns muffled heart sounds distended neck veins hypotension S/S of cardiac tamponade (Beck's triad) retrograde urethrogram Radiographic procedure to r/o urethral injury Patient with RR of 10 blood or vomit in the oral cavity cervical spine injury Potential indications for nasal intubation infusion of IV crystalloid fluids judicious use of vasopressors close monitoring of the patient's BP and pulse anticipate invasive hemodynamic monitoring Treatment of neurological shock -remove damp clothing -warm fluids orally if pt can drink -placing the injured extremity in warm circulating water at 40 C Management of Frostbite - Administer IV fluids -Administer Sodium Bicarb -Close monitoring of renal perfusion/health (rhabdo) -Close monitoring of compartment syndrome The management of a crush injury infusion of warm fluids peripheral IV access short, large caliber IV catheters infusion rates of 20 ml/kg Initial fluid resuscitation may include: pain with passive stretch of the muscle swelling of the affected extremity paresthesias and loss of function pain out of proportion to the injury S/S of compartment syndrome -assess pulses, color, temperature, and sensation o the extremity distal to the injury before and after splinting -stabilize the joint proximal and distal to the fracture site Trauma Resuscitation Room alcohol seizures drugs chronic resp. conditions Patient condiitons which will alter the base deficit value CPP= MAP-ICP Central Perfusion Pressure (CPP) 70-100 mmHg Normal CPP for adults 0-10 mmHg Normal ICP at rest late sign of ICP, systolic will go up diastolic will go down, pulse drops, resp drop, temp goes up Cushings triad mild: 13-15 moderate: 9-12 severe disability: 3-8 vegatative state: <3 GCS scores anticipate the need for volume replacement due ti osmotic diuresis When using Mannitol for ICP elevation remember to >20 sustained What ICP warrants physician notification? 0- total paralysis 1- palpable of visible contraction 2- active movement with full ROM against gravity 3- active movement with full ROM against gravity AND some resistance 4-active movement, full ROM against gravity and Moderate resistance 5-normal active movement, full ROM against gravity and resistance muscle function test results measured from bottom of chin to top of shoulder Appropriate C-collar size absent distal pulses and poor capillary refill Not reliable in diagnosing compartment syndrome increasing HR Children only have one compensatory mechanism 30% A child can lose what percent of their blood before SBP decreases? hypoxia In Ped's bradycardia is often sign of bradycardia and cardiac arrest Hypoxia is the most common cause of in childred