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SIMPLIFIED STUDY GUIDE: NR 341 Week 7 Exam Three Study Guide (Chapters 19, 20, 6, 17, 13, 21, 18) Chapter 19 Trauma and Surgical Management
- (^) Introduction
- (^) Trauma demographics
- (^) Systems approach to trauma care o (^) Trauma system ▪ Levels of trauma care ▪ Trauma continuum ▪ Injury prevention ▪ Trauma team concept ▪ Prehospital care and transport ▪ Trauma triage ▪ Disaster and mass casualty management
- (^) Mechanism of injury o (^) Blunt trauma
o (^) Penetrating trauma o (^) Blast injuries
- (^) Emergency care phase o (^) Initial patient assessment o (^) Primary and secondary survey
- (^) Resuscitation phase o (^) Establishing airway patency o (^) Maintaining effect breathing o (^) Maintaining circulation o (^) Diagnostic testing o (^) Adequacy of resuscitation o (^) Fluid resuscitation o (^) Assessment of neurological disabilities o (^) Exposure and environmental considerations
- (^) Assessment and management of specific organ injuries o (^) Thoracic injuries
▪ Cardiac tamponade ▪ Cardiac contusion ▪ Aortic disruption ▪ Tension pneumothorax ▪ Hemothorax ▪ Open pneumothorax ▪ Pulmonary contusion ▪ Rib fractures and flail chest o (^) Abdominal injuries o (^) Musculoskeletal injuries ▪ Complications
- (^) Compartment syndrome
- (^) Rhabdomyolysis
- (^) Venous thromboembolism
- (^) Fat embolism syndrome
- (^) Critical care phase
o (^) Damage-control surgery o (^) Postoperative management
- (^) Special considerations and populations o (^) Alcohol and drug abuse o (^) Family and patient coping
- (^) Rehabilitation Chapter 20 Burns
- (^) Introduction
- (^) Review of anatomy and physiology of the skin o (^) Effects of aging
- (^) Mechanisms of injury o (^) Thermal injury o (^) Chemical injury o (^) Electrical injury o (^) Inhalation injury ▪ Carbon monoxide and cyanide poisoning
▪ Injury above the glottis ▪ Injury below the glottis
- (^) Burn classification and severity o (^) Depth of injury o (^) Extent of injury
- (^) Physiological response to burn injury o (^) Cardiovascular response o (^) Host defense mechanisms o (^) Pulmonary response o (^) Renal response o (^) Gastrointestinal response o (^) Metabolic response
- (^) Phases of burn assessment and collaborative interventions o (^) Resuscitative phase: prehospital ▪ Primary survey - (^) Stopping the burning process
- (^) Airway (with cervical spine precautions)breathing
- (^) Circulation ▪ Secondary survey o (^) Resuscitative phase: emergency department and critical care burn center ▪ Transfer to a burn center ▪ Primary survey
- (^) Airway
- (^) Breathing
- (^) Circulation o (^) Fluid resuscitation o (^) End point monitoring o (^) Peripheral circulation ▪ Secondary survey
- (^) Cardiovascular system
- (^) Neurological status
- (^) Renal status
- (^) Gastrointestinal system
- (^) Integumentary system
- (^) Blood and electrolytes o (^) Acute care phase: critical care burn center ▪ Respiratory system ▪ Cardiovascular system ▪ Neurological status ▪ Renal status ▪ Gastrointestinal system ▪ Integumentary system ▪ Blood and electrolytes
- (^) Special considerations and areas of concern o (^) Burns of the face o (^) Burns of the ears o (^) Burns of the eyes
o (^) Burns of the hands, feet, or major joints, burns of the genitalia and perineum o (^) Electrical injury o (^) Chemical injury o (^) Abuse and neglect
- (^) Pain control
- (^) Infection control
- (^) Wound management o (^) Wound care o (^) Topical agents and dressings o (^) Surgical excision and grafting
- (^) Nutritional considerations
- (^) Psychosocial considerations
- (^) Geriatric concerns
- (^) Nonburn injury o (^) Severe exfoliative disorders
▪ Toxic epidermal necrolysis, stevens-johnson syndrome, erythema multiforme ▪ Staphylococcal scalded skin syndrome o (^) Necrotizing soft tissue infections
- (^) Discharge planning
- (^) Burn prevention Chapter 6 Nutritional Support
- (^) Introduction
- (^) Gastrointestinal tract
- (^) Utilization of nutrients
- (^) Assessment of nutritional status
- (^) Overview of nutritional support o (^) Enteral nutrition o (^) Parenteral nutrition o (^) Nutritional additives
- (^) Nutritional therapy goals
- (^) Practice guidelines o (^) Enteral nutrition o (^) Parenteral nutrition o (^) Drug-nutrient interactions
- (^) Monitoring nutritional status and complications of nutritional support o (^) Monitoring and evaluating the nutrition care plan Chapter 17 Gastrointestinal Alterations
- (^) Introduction
- (^) Review of anatomy and physiology o (^) Gastrointestinal tract ▪ Gut wall
- (^) Mucosa o (^) Gastric mucosal barrier
- (^) Submucosa ▪ Oropharyngeal cavity
- (^) Mouth
- (^) Salivary glands
- (^) Pharynx ▪ Esophagus ▪ Stomach ▪ Small intestine ▪ Large intestine o (^) Accessory organs ▪ Pancreas ▪ Liver
- (^) Vascular functions o (^) Blood storage o (^) Blood filtration
- (^) Secretory functions o (^) Bile production o (^) Bilirubin metabolism
- (^) Metabolic functions
o (^) Carbohydrate metabolism o (^) Fat metabolism o (^) Protein metabolism o (^) Production and removal of blood clotting factors o (^) Detoxification o (^) Storage, synthesis, and transport of vitamins and minerals ▪ Gallbladder o (^) Neural innervation of the gastrointestinal system o (^) Hormonal control of the gastrointestinal system o (^) Blood supply of the gastrointestinal system o (^) Geriatric considerations
- (^) General assessment of the gastrointestinal system o (^) History o (^) Inspection ▪ Skin color and texture
▪ Symmetry and contour of abdomen ▪ Masses and pulsations ▪ Peristalsis and movement o (^) Auscultation o (^) Percussion o (^) Palpation
- (^) Acute gastrointestinal bleeding o (^) Pathophysiology ▪ Peptic ulcer disease ▪ Stress ulcers ▪ Mallory-Weiss Tear ▪ Esophageal varices o (^) Assessment ▪ Clinical presentation ▪ Nursing assessment ▪ Medical assessment
- (^) Laboratory studies
- (^) Endoscopy and barium study o (^) Nursing diagnoses o (^) Collaborative management: nursing and medical considerations ▪ Hemodynamic stabilization ▪ Gastric lavage ▪ Pharmacological therapy
- (^) Antibiotics ▪ Endoscopic therapy ▪ Surgical therapy ▪ Nursing diagnoses ▪ Recognition of potential complications o (^) Treatment of variceal bleeding ▪ Somatostatin or octreotide ▪ Vasopressin ▪ Endoscopic procedures
▪ Transjugular intrahepatic portosystemic shunt ▪ Esophagogastric tamponade ▪ Surgical interventions o (^) Patient outcomes
- (^) Acute pancreatitis o (^) Pathophysiology o (^) Assessment ▪ History and physical examination ▪ Diagnostic tests ▪ Predicting the severity of acute pancreatitis o (^) Nursing diagnoses o (^) Medical and nursing interventions ▪ Fluid replacement ▪ New modalities ▪ Electrolyte replacement ▪ Nutrition support
▪ Comfort management ▪ Pharmacological intervention ▪ Treatment of systemic complications ▪ Surgical therapy o (^) Patient outcomes
- (^) Hepatic failure o (^) Pathophysiology ▪ Hepatitis - (^) Assessment - (^) Nursing diagnoses - (^) Medical and nursing interventions ▪ Cirrhosis ▪ Fatty liver o (^) Assessment of hepatic failure ▪ Presenting clinical signs - (^) Portal hypertension
- (^) Impaired metabolic processes
- (^) Impaired bile formation and flow o (^) Nursing diagnoses o (^) Medical and nursing interventions ▪ Diagnostic tests ▪ Supportive therapy ▪ Support for the failing liver ▪ Treatment of complications
- (^) Ascites
- (^) Portal systemic encephalopathy
- (^) Hepatorenal syndrome
- (^) Hepatopulmonary syndrome o (^) Patient outcomes
- (^) Bariatric surgery Chapter 13: Nervous System Alterations
- (^) Introduction
- (^) Anatomy and Physiology of the Nervous System o (^) Cells of the Nervous System o (^) Cerebral Circulation o (^) Cerebral Metabolism o (^) Blood-Brain Barrier System o (^) Ventricular System and Cerebrospinal Fluid
- (^) Functional and Structural Divisions of the Central Nervous System o (^) Meninges o (^) Brain (Encephalon) o (^) Cerebrum ▪ Brainstem ▪ Cerebellum ▪ Specialized Systems Within the Central Nervous System o (^) Spinal Cord o (^) Peripheral Nervous System o (^) Effects of Aging
o (^) Assessment ▪ Mental Status ▪ Language ▪ Memory ▪ Cranial Nerve Function ▪ Motor Function ▪ Reflexes ▪ Sensory Function ▪ Respiratory Assessment ▪ Hourly Assessment
- (^) Increased Intracranial pressure o (^) Pathophysiology o (^) Causes of Increased Intracranial Pressure ▪ Increased Brain Volume ▪ Increased Cerebral Blood Volume ▪ Increased Cerebrospinal Fluid
o (^) Assessment ▪ Monitoring Techniques
- (^) Intracranial Pressure Monitoring
- (^) Cerebral Oxygenation Monitoring o (^) Diagnostic Testing o (^) Nursing Diagnoses o (^) Management ▪ Medical and Nursing Interventions (Nonsurgical)
- (^) Nursing Actions to Manage Intracranial Pressure
- (^) Medical Management
- (^) Adequate Oxygenation
- (^) Management of Carbon Dioxide
- (^) Diuretics
- (^) Optimal Fluid Administration
- (^) Blood Pressure Management
- (^) Reducing Metabolic Demands
o (^) Temperature Control o (^) Sedation o (^) Seizure prophylaxis o (^) Neuromuscular Blockade and Barbiturate Therapy ▪ Surgical Interventions ▪ Psychosocial Support
- (^) Traumatic Brain Injury (TBI) o (^) Pathophysiology ▪ Scalp Lacerations ▪ Skull Fractures - (^) Linear Skull Fracture - (^) Depressed Skull Fracture - (^) Comminuted Skull Fracture ▪ Brain injury - (^) Primary Brain Injury - (^) Concussion
- (^) Contusion
- (^) Diffuse Axonal injury
- (^) Penetrating Injury
- (^) Hematoma o (^) Epidural Hematoma o (^) Subdural Hematoma o (^) Intracerebral Hematoma
- (^) Secondary Brain Injury o (^) Assessment ▪ Nursing Diagnoses o (^) Management ▪ Medical (Nonsurgical) Interventions ▪ Surgical Interventions
- (^) Acute Stroke o (^) Pathophysiology ▪ Ischemic Stroke
- (^) Large Artery Atherosclerosis
- (^) Cardioembolic Stroke
- (^) Lacunar Stroke
- (^) Cryptogenic Stroke ▪ Hemorrhagic Stroke
- (^) Intraparenchymal Hemorrhage
- (^) Ruptured Cerebral Aneurysm with Subarachnoid Hemorrhage
- (^) Arteriovenous Malformation o (^) Assessment o (^) Diagnostic Tests o (^) Management ▪ Nursing Diagnoses ▪ Ischemic Stroke
- (^) Thrombolytic Candidates
- (^) Nonthrombolytic Candidates
▪ Other Ischemic Events
- (^) Transient Ischemic Attacks ▪ Hemorrhagic Stroke
- (^) Intraparenchymal Stroke ▪ Subarachnoid Hemorrhage ▪ Arteriovenous Malformation o (^) Postoperative Neurosurgical Care
- (^) Seizures and Status Epilepticus o (^) Pathophysiology of Status Epilepticus o (^) Assessment o (^) Diagnostic Tests o (^) Management ▪ Nursing Diagnoses ▪ Nursing and Medical Interventions
- (^) Central Nervous System Infections o (^) Bacterial Meningitis
▪ Pathophysiology ▪ Assessment ▪ Diagnostics Tests ▪ Management
- (^) Nursing Diagnoses
- (^) Nursing and Medical Management
- (^) Spinal Cord Injury o (^) Pathophysiology o (^) Assessment ▪ Airway and Respiratory Assessment ▪ Neurological Assessment ▪ Bowel and Bladder Function ▪ Skin Assessment ▪ Psychological Assessment o (^) Diagnostic Studies o (^) Management