Anatomy and Injuries: Neck, Skull, Bones, and Trauma Scoring, Exams of Nursing

Download Anatomy and Injuries: Neck, Skull, Bones, and Trauma Scoring and more Exams Nursing in PDF only on Docsity! CSTR EXAM LATEST 2023-2024 REAL EXAM 150+ |A-GRADE QUESTIONS AND VERIFIED ANSWERS (VERIFIED ANSWERS) What are types of graphic presentation? - ANSWER- Bar graphs, pie charts, line graphs, control charts, dashboards, spreadsheets, scatter grams, pareto chart, radar chart, tree chart What does a bar graph show? - ANSWER- Horizontal or vertical bars proportional to the values of the data. These are used for quick comparison of information. What does a pie chart show? - ANSWER- Show proportions of a whole or percentage of a whole. What does a line graph show? - ANSWER- Line connecting data points in a sequential order to show a trend over time. What does a control chart show? - ANSWER- Used to observe performance by studying variation over time and monitors if a process is within control or out of control limits using upper and lower control lines calculated using standard deviation or sigma values with the center line representing the overall average. What does a dashboard show? - ANSWER- A compact visual presentation of critical data, usually at a higher level, to be easily understood at a glance. What do spreadsheets show? - ANSWER- A collection of data in columns and rows that hold the data detail -- usually produced in an "Excel" type of document.12 What does a scatter gram show? - ANSWER- Displays values for two variables showing the distribution of the values. 12 What does a pareto chart show? - ANSWER- A chart showing data from most to least frequently occurring information from left to right. These are used to clearly identify higher valued items (e.g., The highest frequency or priority for resolution). What does a radar chart show? - ANSWER- Radar Chart - (same as spider gram) shows the relationship between multiple variables with one or more axis. What does a tree chart show? - ANSWER- (Fishbone diagram) - used to identify all of the various issues/tasks that go into development of a single outcome. How would you present volume? - ANSWER- Visualized by a bar chart (similar to a histogram) showing different heights depicting variance from comparative items or periods of time. How would you present a trend? - ANSWER- A trend is a series of consecutive information/data that is all moving upward or downward as time progresses. A trend line can be overlaid onto the chart information/ data for the reader to more easily visualize if there is a trend over time. What is the process of PIPS? - ANSWER- recognition, assessment, and correction Who originated the National Trauma Data Bank? - ANSWER- ACS What is the Joint Commission? - ANSWER- It is a national organization that provides standards so that hospitals may obtain accreditation for licensure and gain the right to receive payment from Medicaid and Medicare. What created the Joint Commission? - ANSWER- Created by merging the Hospital Standardization Program with similar programs run by the American College of Physicians, the American Hospital Association, the American Medical Association, and the Canadian Medical Association. What is benchmarking? - ANSWER- A benchmark is a standard by which something can be measured or judged, comparing like data over time with different organizations, providers, or with a recommended or desired outcome/standard. Name the anatomy of the lower extremities - ANSWER- Pelvic girdle Pelvis: Ilium, iliac crest, acetabulum, ischium, pubis, sacrum and sacroiliac joints. Legs: femur, patella (knee cap), tibia, fibula. Joints: Hip, knee, and ankle. Ankle Bones: Lateral malleolus, medial malleolus Foot: Tarsal bones (7), calcaneus (heel bone), talus, cuboid, navicular, first, second and third cuneiform), metatarsals, phalanges Name the bones of the skull - ANSWER- Parietal x 2, Frontal, Sphenoid, ethmoid, Occipital, temporal x 2 What injury would cause Racoon eyes? - ANSWER- Basal skull fx, Frontal fx What are signs of a basal skull fx? - ANSWER- Frontal - racoon eyes, Middle Fossa - CSF leak, Posterior - battle signs What are diffuse intracranial Injuries? - ANSWER- Concussion, shear injury, DAI, Anoxic brain injury What are focal intracranial Injuries - ANSWER- Contusion, Epidural, Subdural, Intraparenchymal - Focal meaning in one place. What symptoms should you look for in head injuries? - ANSWER- Confusion, combative, altered cons, obtunded, posturing Define decoritate - ANSWER- Posturing arms folded into chest Define decerebrate - ANSWER- Posturing with limbs extended Where can definition of trauma patient be found? - ANSWER- The Orange Book or American College of Surgeons: "Resources for Optimal Care of the Injured Patient" ACS inclusion criteria begins with injury codes and these three criteria? - ANSWER- 1. Hospital admission; 2. Patient transfer via emergency medical services transport from one hospital to another hospital; or, 3. Death resulting from the traumatic injury What is the trauma registry log? - ANSWER- The Registry Log contains a listing of each change, or update to the Registry software. It is to include the specific changes, software upgrades, and any changes that are made to the user defined fields, additions and deletions, along with the date of each event. What is data presentation format? - ANSWER- The way that the viewer wishes to view the result of the data compiled. The format identifies how the data is to be displayed such as paper, website, dashboard, PowerPoint presentation, etc. What are types of presentation formats? - ANSWER- Tables and graphics Name the layers of the skin - ANSWER- epidermis, dermis, hypodermis What is a FAST used to determine? - ANSWER- Focused Assessment with Sonography for Trauma is used as an initial diagnostic tool to identify intraperitoneal or pericardial free fluid. What are CT scans used to determine? - ANSWER- Best diagnostic tool for hemodynamically stable patients. CT Scans are used to identify free air, free fluid, identify solid organ injuries and bone/cervical abnormalities not visible on a plain film.7 What are MRI's used to determine? - ANSWER- used to visualize detailed internal structures. It is especially useful in brain, spinal cord, muscles, and heart Define toxicology - ANSWER- Toxicology can involve either a blood or urine sample. Toxicology labs tests look for levels of alcohol (BAC) or drugs that may have been used. Define chemistry - ANSWER- Chemistry labs typically include electrolyte levels Some of the tests included in a chemistry are: sodium, potassium chloride, calcium, creatinine (blood), glucose(blood sugar), magnesium, phosphorus, etc. Define hematology - ANSWER- Involves testing on the blood itself to determine the patient blood volumes in relation to the normal values What do blood gases measure? - ANSWER- Arterial blood gases measure the amount of oxygen, carbon dioxide, sodium bicarbonate, base excess, etc., in the arterial blood Blood loss >20% - ANSWER- 220 lb wt. = 1500 ml. 165 lb wt. = 1125 ml. approx 5 liters of blood in body at 75 kg Who developed the Abbreviated Injury Scale? - ANSWER- AAAM What is the format of an AIS code - ANSWER- 7 digits How many digits in pre dot? - ANSWER- 6 digits The pre-dot code represents the body area of injury, the anatomical structure(s) involved, the level of injury. What are the AIS 6 main body regions? - ANSWER- 1. AIS region 1 = Head/Neck 2. AIS region 2 = Face 3. AIS region 3 = Chest /Thorax 4. AIS region 4 = Abdomen - Lumbar spine 5. AIS region 5 = Extremities, shoulder and pelvic girdles 6. AIS region 6 = External including burn, hypothermia, asphyxiation, drowning, electrocution, explosion full body What are the post dot severity numbers? - ANSWER- .1 -- Minor .2 - Moderate .3 - Serious How manyu digits in post dot? - ANSWER- 1 digit The single digit after the dot is called the post-dot digit or severity number. died than were predicted. If z exceeds +1.96, significantly more patients survived than predicted What is the w score? - ANSWER- The w score measures the clinical significance of the outcome. The w score represents the difference between the number of patients actually surviving and the number of survivors expected per 100 patients treated. Thus, a w value of +4 indicates that 4 more patients survived per 100 patients than would have been predicted. What is OIS - ANSWER- Organ Injury Scoring - The scale is graded 1 through 6 for each organ, 1 being least severe and 5 the most severe injury from which the patient may survive. Grade 6 injuries are by definition not salvageable. Name the 4 stages of Eye GCS pediatric - ANSWER- 1 No eye opening. 2 Eye opening to pain. 3 Eye opening to verbal command. 4 Eyes open spontaneously. Name the 5 stages of Verbal GCS pediatric - ANSWER- 1 No vocal response 2 Inconsolable, agitated 3 Inconsistently consolable, moaning. 4 Cries but is consolable, inappropriate interactions. 5 Smiles, oriented to sounds, follows objects, interacts. Name the 6 stages of Motor GCS pediatric - ANSWER- 1 No motor response. 2 Extension to pain. 3 Flexion to pain. 4 Withdrawal from pain. 5 Localising pain. 6 Obeys Commands. What goes into RTS - ANSWER- GCS+SBP+RR (first vitals in ED) What is PTS - ANSWER- Weight, airway, sob, cans, opp pen wound, skeletal ( range -6 to +12) What are AIS components - ANSWER- body region, type of anatomic structure, type of anatomic structure,level, level,ais score Na me AIS body regions - ANSWER - Hea d Fac e Neck Thor ax Abdomen & pelvi s Spin e Upper extremity Lower e xtremity Externa l Name the 7 AIS severity levels - ANSWER- Mino r Moder at e Seriou s Sever e Critica l Maximal (currently untreatable) What is NISS - ANSWER- New (revised) injury severity score What is TRISS - ANSWER- Trauma score injury severity score What are components of TRISS - ANSWER- Age Mechanism of injury (blunt/penetrating) RTS ISS What is M score - ANSWER- Finding different from the norm Characterizes case mix Based on ISS What is Z score - ANSWER- How your hospital does against others Demonstrates performance National comparison American College of Surgeon: Resources for Optimal Care of the Injured Patient - ANSWER- Definition of a "Trauma Patient" can be found here: Any patient that has an injury in the code range between 800 and 959.9, but not one of the exclusion codes, for late effects of injury (905-909.9), superficial injuries, including blisters, contusions, abrasions, insect bites (910-924.9), and foreign bodies (930-939.9). and meets one of the three event criteria: Hospital admission; Patient transfer via emergency medical services transport from one hospital to another hospital; or, Death resulting from the traumatic injury. - ANSWER- ACS inclusion criteria Three Types of Data Abstraction - ANSWER- Concurrent, Retrospective & Hybrid Concurrent Abstraction - ANSWER- Daily abstraction while the patient is in house Retrospective Abstraction - ANSWER- Abstraction after patient discharge. Hybrid Abstraction - ANSWER- Data entry is begun during the patient encounter but the record is closed after patient discharge. The American College of Surgeons registry staffing recommendation for manual data entry: - ANSWER- 1 full-time equivalent employee dedicated to the registry to process the data for approximately 750 to 1,000 patients annually In order to run data for reporting the registrar needs to know several basic details: - ANSWER- What information is needed to identify the correct data fields, the time frame that is of interest, any related filters, and what format for display grouping, such as year, month, ISS range, age range, etc. Format - ANSWER- Presentation Concept of the way that the viewer wishes to view the result of the data compiled. The format identifies how the data is to be displayed such as paper, website, dashboard, PowerPoint presentation, etc. Tables - ANSWER- Show the actual data elements arranged in rows and columns. Graphics - ANSWER- A picture showing the result of data calculations. Graphic displays of information generally work better than tables for faster interpretation of changes, trends, and outliers. Bar Graphs - ANSWER- Horizontal or vertical bars proportional to the values of the data. These are used for quick comparison of information. Pie Charts - ANSWER- Show proportions of a whole or percentage of a whole. Line Graphs - ANSWER- Line connecting data points in a sequential order to show a trend over time. PI and Loop Closure Result Evaluation - ANSWER- Demonstration that a corrective action has the desired effect determined by on-going or repeat evaluation. Population Demographics - ANSWER- The demographics of a population involves analysis of differing grouping of items such as the population age, gender, residence, nationality, etc. Sampling - ANSWER- The process of taking a small portion of a larger set of data to study in order to obtain a picture of the probable larger total population. This can save time and money. Frequencies - ANSWER- Frequency is the number of occurrences of a repeating similar event that is identified within a defined set of reference. Two Types of Statistics - ANSWER- Population Demographics and Sampling Averages - ANSWER- Average or mean is the sum of the value of all integers divided by the total number of integers. The average or mean is the total all of the values, divided by the count of numbers in the listing of values, e.g., 9+8+7+6+5+5+5+3+2= 50/ 9 = 4.5. Percentages - ANSWER- Parts of an identified measured whole, typically obtained by taking the total of one group and = dividing it by the total of the entire group. For example: The total number of pediatric patients in a group is 20. The total number of patients including pediatrics is 200. To find the percent of pediatric patients: 20/200 = 10% of all patients are pediatric patients. Ranges - ANSWER- The difference between the largest and the smallest number in a series. Ratios - ANSWER- One value as compared to another, i.e., frequency of occurrence as in one in 240, e.g., 1:240. Mean - ANSWER- The same as average. Median - ANSWER- The integer holding the middle position in a sequential listing of numbers. The median when arranged : 9 8 7 6 5 5 5 3 2 Mode - ANSWER- The integer that occurs most often (i.e., 5 7 5 9 3 5 2 6 8) in this cluster is 5. Therefore, the mode would be 5. Standard Deviation - ANSWER- A measure to quantify the difference between the values in the data set. Types of Calculations - ANSWER- Frequencies, Averages, Percentages, Ranges, Ratios, Mean, Median, Mode & Standard Deviation Bones in the Head - ANSWER- Ethmoid bone, frontal bone, occipital bone, parietal bones x 2, sphenoid bone, temporal bone x 2. Brain - ANSWER- Adult average brain weighs approximately 3 pounds with 500 milliliters of cerebral spinal fluid (CSF). Neck - ANSWER- Cervical vertebrae x 7, trachea, esophagus, larynx, pharynx, hyoid bone. Facial Bones - ANSWER- 14 stationary bones and a lower jaw bone. Inferior nasal conchae x 2, lacrimal bones x 2, mandible, maxilla x 2, nasal bones and septum, palatine bones x 2, vomer, zygomatic bones x 2, eye, ear. Chest - ANSWER- Thoracic spine, ribs 1-12, sternum, heart, bronchi and lungs, thoracic aorta, diaphragm, thoracic esophagus. Abdomen - ANSWER- Liver, spleen, colon, rectum, small bowel, pancreas, kidneys, pelvis, uterus, bladder, stomach, gallbladder, retroperitoneum, abdominal aorta and other vessels. Spinal Column - ANSWER- Cervical--7, thoracic--12, lumbar--5, sacrum—5 (fused), coccyx (tailbone)—2, 3, or 4. Note: C1 = Atlas, C2 = Axis and has a "dens" (spikelike projection) that projects upward on which the atlas 14 rotates. Vertebrae Parts - ANSWER- Vertebral body, spinous process, transverse process, pedicle, foramen, lamina, superior and inferior articular processes. Note: The 5 separate bones of the sacrum begin to fuse during the late teen years and are usually completely fused by 25 or 26 years of age. Coccygeal vertebrae are also fused. Upper Extremities - ANSWER- Shoulder girdle, humerus, ulna, radius, hand Shoulder Girdle - ANSWER- Scapula and Clavicle Humerus - ANSWER- Median and lateral epicondyle (end of humerus), capitulum, trochlea, coronoid fossa, deltoid tuberosity, greater & lesser tubercle, head & neck. Ulna - ANSWER- Olecranon process (elbow), coronoid process, ulnar tuberosity, styloid process (projection at the distal end of the ulna). Radius - ANSWER- Has a styloid process at the distal end Hand - ANSWER- Carpal bones x 8 (scaphoid, locate, triquetrum, pisiform, trapezium, trapezoid, capitate, hamate), metacarpals x 5, and phalanges (proximal x 5, middle x 5, distal x 5). Upper Extremity Joints - ANSWER- Acromioclavicular, carpal bones (wrist), elbow, sternoclavicular, glenohumeral, metacarpophalangeal, interphalangeal. Lower Extremities - ANSWER- Pelvic girdle, pelvis, legs, joints, ankle bones foot Pelvis - ANSWER- Ilium, iliac crest, acetabulum, ischium, pubis, sacrum and sacroiliac joints. Legs - ANSWER- Femur, patella (knee cap), tibia, fibula. Lower Extremity Joints - ANSWER- Hip, knee, and ankle. Ankle Bones - ANSWER- Lateral malleolus, medial malleolus Foot - ANSWER- Tarsal bones (7), calcaneus (heel bone), talus, cuboid, navicular, first, second and third cuneiform), metatarsals, phalanges. Skin - ANSWER- The largest organ, approximately 8 pounds for adult. Three layers: epidermis, dermis, hypodermis. Number of Bones in Body - ANSWER- There are typically 206 bones in the body, though there may be up to about 226. (Laryngeal Mask Airway), EOA (Esophageal Obturator Airway), Combitube Airway, King Airway (Brand of Combitube) Airways Typically Used for Short-Term Events - ANSWER- LMA, EOA, King/Combitube Example of Crystalloid Fluids - ANSWER- Normal Saline, Lactated Ringers Post Trauma Conditions - ANSWER- Sequelae, Complications Sequelae - ANSWER- A pathological condition that can be considered "commonly resulting" from the actual disease process, injury, or trauma. Complication - ANSWER- A complication is an undesired, unintended injury or disease process that occurs to the patient that is not part of the expected result of the injury or disease process. Abbreviated Injury Scale - ANSWER- Originally developed by the AAAM, the Association for the Advancement of Automotive Medicine.2 AIS is an anatomically based international injury scaling system. There is a strong correlation between AIS severity and survival (and mortality). AIS Scoring - ANSWER- An AIS code follows a seven digit format for example, _ _ _ _ _ _ . _ as in 752401.2 The first 6 digits are called the pre-dot code. The single digit after the dot is called the post-dot digit or severity number. The pre-dot code represents the body area of injury, the anatomical structure(s) involved, the level of injury. 6 Main Body Regions of AIS Codes - ANSWER- Region 1: Head/Neck, Region 2: Face, Region 3: Chest/Thorax, Region 4: Abdomen - Lumbar Spine, Region 5: Extremities, Shoulder & Pelvic Girdles, Region 6: External Including Burn, hypothermia, Asphyxiation, Drowning, Electrocution and Full Body Explosion AIS Post-Dot Code - ANSWER- A numerical value that is assigned according to the severity of the injury: .1 -- Minor .2 - Moderate .3 - Serious .4 - Severe .5 - Critical .6 - Maximum (not fatal, currently untreatable) A .6 is automatically an ISS = 75, code other injuries but don't add to this highest ISS total (.9 -- indicates injury present but no severity value) E Codes - ANSWER- Classify the environmental events, circumstances, and conditions as the cause of injury, poisoning or other adverse event related to the external cause of the injury. Injury Severity Scoring - ANSWER- The Injury Severity Score (ISS) provides a score for patients with multiple injuries. The ISS score can be correlated with the mortality and morbidity of the injuries. Each injury is assigned an Abbreviated Injury Scale (AIS) score and is allocated to one of six body regions (Head/Neck, Face, Chest, Abdomen, Extremities (including Pelvis), and External. Only 23 the highest AIS score in each body region is used. The 3 most severe injuries in different body regions have their score squared and added together to produce the ISS score. ISS Range - ANSWER- 1-75 ISS Range Values - ANSWER- 9-15 - Mild, 16-25 - Moderate, >25 - Severe AIS of .6 - ANSWER- If an injury is assigned an AIS of .6 (Maximal) the ISS score is automatically assigned to 75.4 Revised Trauma Score - ANSWER- The Revised Trauma Score (RTS) is a physiological scoring system, with high inter-rater reliability and demonstrated accuracy in predicting death. It is scored from the first set of data obtained on the patient, and consists of Glasgow Coma Scale, Systolic Blood Pressure and Respiratory Rate.4 Glasgow Coma Scale - ANSWER- Glasgow Coma Scale (GCS) represents an indication of brain function/impairment (Eye/Verbal/Motor). It is important to understand the descriptors of each numerical value, i.e., "1" for verbal means no verbal response; "1" for motor means decorticate posturing. A patient cannot have a score less than 3: Eye - 1 + Verbal - 1, + Motor - 1 = total of 3. The range is 3 - 15. Normal is 15. Trauma Score - ANSWER- Score for multiple traumatic injuries with a range of 1- 16. There are 5 components that go into calculating this score: : GCS, Systolic BP, Respiratory Rate, Capillary Refill, and Respiratory Effort. Probability of Survival (TRISS) - ANSWER- The TRISS determines the probability of survival from the ISS, RTS and patient's age. 4 TRISS Probability: TRISS > 0.50 = Probability of Survival TRISS < 0.50 = Probability of Death W Scores - ANSWER- The w score measures the clinical significance. The w score represents the difference between the number of patients actually surviving and the number of survivors expected per 100 patients treated. Z Scores - ANSWER- The z score the statistical significance of outcome. Data Validation - ANSWER- The data that is entered into the database should be validated at least monthly. Not all data elements need to be validated each time although the entire medical record should be re-abstracted. (5-10% of records ACS). HIPAA - ANSWER- Health Information Portability and Accountability Act passed 1996, enacted in 2003. Definition of a Current Registry - ANSWER- = 80% of records are abstracted and closed within 60 days of patient discharge.