TCRN Exam Review - Extremity and Wound Trauma, Exams of Advanced Education

Download TCRN Exam Review - Extremity and Wound Trauma and more Exams Advanced Education in PDF only on Docsity! TCRN Exam Review - Extremity and Wound Trauma | 250 Questions with 100% Correct Answers | Updated & Verified List some special considerations for abrasions. - Correct Answer-Pain control - full thickness abrasions may be associated with nerve damage and may have less pain Evaporative heat loss - consider warming measures Evaporative fluid loss - consider need for fluid replacement Scarring - anesthetize wound and aggressively remove debris Define contusion. - Correct Answer-Rupture of subcutaneous blood vessels with extravasation of erythrocytes. Define hematoma. - Correct Answer-Rupture of artery or vein that will continue to expand until the pressure in the tissue exceeds the pressure in the ruptured vessel. Contusions and hematomas have the potential for what significant complication? - Correct Answer-Compartment Syndrome List 2 special considerations related to contusions / hematomas. - Correct Answer-Potential for enough blood loss to cause hypovolemia, especially in areas of the body with greater dispensability (like the thigh). Blood is a medium for bacterial growth, therefore wounds with contusions and hematomas may have a greater risk for infection. What are the treatments for contusions / hematomas? - Correct Answer-Elevation Application of Ice Packs Puncture wounds have a high rate of _____. - Correct Answer- Infection What treatment should be done with puncture wounds? - Correct Answer-Soaking At time of discharge, what teaching should be given to a patient who sustained a puncture wound? - Correct Answer-Soak wound 2-3 times per day for 2-4 days What type of bites tend to be deep wounds involving crushing of the tissue or avulsion? - Correct Answer-Dog Bites Are larger bites or smaller bites more susceptible to infection? - Correct Answer-Smaller. The larger size of wounds allows bacteria to exit, decreasing the incidence of infection. In gunshot wounds, the faster the projectile is moving as it passes through the tissue, the _____. - Correct Answer-Greater the size of the temporary cavity and pressure wave. The longer the barre of the firearm, the _____ the projectile will strike the patient. - Correct Answer-Faster The farther the patient is from the firearm when it is fired, the _____ the projectile will be moving as it enters the body. - Correct Answer- Slower _____ has more impact on wounding potential than the size of the projectile. - Correct Answer-Speed When dealing with projectiles, it is important to remember that _____. - Correct Answer-The path of the projectile is unpredictible. Especially if it hits bone. Does the site of projectile entry always predict the path within the body? - Correct Answer-No. This is why you mark the entry site with a paperclip. What are the 2 types of bullets? - Correct Answer-Full Metal Jacket Hollow-Point How do full metal jacket bullets usually injure tissue? - Correct Answer-Tend to stay intact and pass cleanly through tissue How do hollow point bullets usually affect tissue? - Correct Answer- Tend to deform increasing energy transfer to the tissue and increases tissue damage. It is less likely to exit the body. List some characteristics of high velocity projectiles. - Correct Answer- They may splinter bone, rupture blood vessels, and break apart, causing injury to tissue far from the initial pathway. Describe what a close range shotgun wound (birdshot) does. - Correct Answer-At close range, pellets act as one mass causing massive tissue destruction. Describe what a far range shotgun wound (birdshot) does. - Correct Answer-At farther range, pellets scatter and tissue penetration is significantly reduced to superficial skin or deep fascia. What is the priority with an amputation? - Correct Answer-Control hemorrhage What are 4 ways to control hemorrhage on an amputation? - Correct Answer-Direct pressure over stump Compress artery above the site Elevate the extremity Apply tourniquets as needed Give 2 facts about tourniquet placement. - Correct Answer-Place as close to the amputation as possible Release the tourniquet as soon as the hemorrhage is controlled Describe how to care for an amputated part. - Correct Answer- Remove dirt and debris from exposed end Wrap in slightly saline-moistened sterile gauze Place in a sealed bag Place on ice Why do you not allow water onto an amputated limb? - Correct Answer-Water is hypotonic and can cause tissue edema. Should you allow an amputated part to freeze? - Correct Answer-No Define compartment syndrome - Correct Answer-Increase in pressure inside a fascial compartment. What compartment pressure causes ischemia to the muscles and nerves? - Correct Answer->30 mmHg What are the treatments for Compartment Syndrome? - Correct Answer-Remove external pressure (casts, splints, dressings) Elevate limb TO (not above) level of the heart Anticipate fasciotomy, surgical debridement or amputation In compartment syndrome, hyperkalemia peaks _____ hours after the injury. - Correct Answer-12-36 hours after the injury then steadily decreases What is the treatment for hyperkalemia in compartment syndrome? - Correct Answer-Cardio-Protection: calcium gluconate Temporary K reduction: insulin/glucose and /or nebulized beta- adrenergic agonists (like albuterol) Permanent K reduction: diuresis, intestinal potassium binders (kayexalate) or dialysis Define Rhabdomyolysis - Correct Answer-Release of myoglobin from severe muscular or cellular destruction List 7 signs and symptoms of rhabdomyolysis. - Correct Answer- Muscle Pain Numbness Changes in Sensation Weakness / Paralysis Dark red or brown urine Generalized weakness/malaise Elevated creatinine kinase levels (ck) What are the treatments and goals of rhabdomyolysis? - Correct Answer-IV isotonic crystalloids (NS/LR) with a goal of UO 100 mL/hr Alkalinization of urine with sodium bicarbonate or osmotic diuretics with a goal of urine pH above 8.0 Hemodialysis, peritoneal dialysis, renal replacement therapy with a goal of preservation of the kidneys Why should imbedded objects be left in place? - Correct Answer-They may be tamponading underlying bleeding. Is hair removal around wounds encouraged or discouraged? - Correct Answer-Discouraged. If needed, use scissors or clippers, do not shave. What solution should be used to irrigate wounds? - Correct Answer- Copious amounts of normal saline What type of irrigation works best to remove smaller contaminants and bacteria? - Correct Answer-high-pressure irrigation What body parts should not receive lidocaine with epi? - Correct Answer-Digits Penis Ears Tip of the Nose Avulsions Grossly contaminated wounds What types of foreign bodies are not seen on x-ray? - Correct Answer- Vegetative matter such as splinters, thorns, cactus splines Plastic What diagnostics are used to find matter that does not show up on x- ray? - Correct Answer-CT, Sono or MRI List and describe the 3 types of wound closure. - Correct Answer- Primary - Immediate Wound Closure Secondary - Wounds are allowed to close on their own over time Tertiary - Wounds closure is delayed for a period of time What medications slow collagen formation in wound healing? - Correct Answer-corticosteroids, phenytoin What medical problems cause poor vascular supply in wound healing? - Correct Answer-COPD, Anemia List three types of burns. - Correct Answer-Thermal Electrical Chemical Describe airway burns. - Correct Answer-Inhalation of heat can lead to edema in the upper airway with advancing airway obstruction. What are some symptoms of heat inhalation burns? - Correct Answer- Hoarse voice Carbonaceous sputum Burns around mouth or nares Stridor What is the treatment for heat inhalation burns? - Correct Answer- Prophylactic intubation Carbon monoxide, when inhaled, crosses the alveolar membrane and has a strong affinity to hemoglobin, known as _____. - Correct Answer-Carboxyhemoglobin Symptoms of carbon monoxide poisoning are dependent upon _____. - Correct Answer-The percentage of hemoglobin that has converted to carboxyhemoglobin (COHb). What are the symptoms of a 5-10% carboxyhemoglobin conversion? - Correct Answer-Headache, Dizziness What are the symptoms of a 10-20% carboxyhemoglobin conversion? - Correct Answer-Headache, Nausea and Vomiting, Loss of coordination, Dyspnea, Flushed skin What are the symptoms of a 20-40% carboxyhemoglobin conversion? - Correct Answer-Confusion, Lethargy, Visual Disturbances, Angina What are the symptoms of a 40-60% carboxyhemoglobin conversion? - Correct Answer-Dysrhythmias, Seizures, Coma What are the symptoms of >60% carboxyhemoglobin conversion? - Correct Answer-Cherry-Red Skin, Death What is the oxygen saturation for a patient with carbon monoxide poisoning? - Correct Answer-Normal O2 sat What is the treatment for carbon monoxide poisoning? - Correct Answer-100% oxygen (until asymptomatic or COHb is less than 10%) Monitor cardiac rhythm and COHb level Hyperbaric chamber may be required for carbon monoxide poisoning resistant to oxygen or for pregnant patients Describe inhalation pulmonary injury - Correct Answer-Caused by inhalation of noxious substances such as carbon or noxious fumes. List characteristics of pulmonary injury. - Correct Answer-Damages mucosal cells or bronchioles Increases pulmonary capillary permeability (ARDS) Sloughing of damaged cells causing obstructed airways Decreased production of surfactant causing atelectasis How long can symptoms of pulmonary injury be delayed? - Correct Answer-Up to 24 hours after injury What is the treatment and goal of pulmonary injuries? - Correct Answer-Deliver oxygen with a goal of an SpO2 between 94-98%. Ideally, urinary output will be _____. If urinary output falls below this threshold, increase fluids by _____. If urinary output is above this threshold, decrease fluids by _____. - Correct Answer-0.5 ml/kg/hr 33% 33% In burn fluid resuscitation, which is preferred: NS or LR? - Correct Answer-LR - however, you should consider using dextrose containing solutions (especially in pediatric patients) _____ burns involve only the epidermis. - Correct Answer-First Degree True or False: First degree burns do not blister. - Correct Answer-True Describe the pain in first degree burns. - Correct Answer-Mildly irritating to pruritic to exquisitely painful. Describe the healing process of first degree burns. - Correct Answer- Painful for 2-3 days, begins to peel at day 4. More vulnerable to sunburn, windburn and skin irritation for months. There are 2 types of second degree burns. _____ & _____ - Correct Answer-Superficial Partial Thickness; Deep Thickness What skin layers are involved with second degree superficial partial thickness burns? - Correct Answer-Epidermis and Upper Layers of Dermis What layers of skin are involved with second degree deep thickness burns? - Correct Answer-Epidermis and deep dermis Describe the appearance of second degree superficial partial thickness burns. - Correct Answer-Blisters (may be delayed by several hours) with pink, wet skin beneath. Blanches with pressure. Describe the appearance of second degree deep thickness burns. - Correct Answer-Appears mottled white or white immediately after injury. Will either blister or appear dry with cherry red color but does not blanch. Appears white and dry by day 2. Discuss the pain associated with second degree superficial partial thickness burns. - Correct Answer-Extremely painful (especially to air currents) Discuss the pain associated with second degree deep thickness burns. - Correct Answer-Causes discomfort rather than pain, and area is less sensitive to touch than surrounding skin. Describe the healing process of second degree superficial partial thickness burns. - Correct Answer-Heals within 3 weeks without functional impairment and rarely causes scarring. Describe the healing process of second degree deep thickness burns. - Correct Answer-Takes greater than 3 weeks to heal and may require grafting. What layers of skin are involved with third degree (full thickness) burns? - Correct Answer-All layers of the skin and subcutaneous fat. Describe the appearance of third degree burns. - Correct Answer-May be "leathery" "firm" "depressed compared to adjoining unaffected sking" Describe the pain associated with third degree burns. - Correct Answer-Insensitive to light touch or pin prick (perceptive to pressure only) Describe the healing process for third degree burns. - Correct Answer- Requires surgical grafting What layers of skin are involved with 4th degree burns? - Correct Answer-Extends into underlying fat, tissue, muscle and bone Direct Current (DC) decreases contact with the electrical source and _____. - Correct Answer-May cause less severe burns. Which type of current goes in one direction? - Correct Answer-DC Direct Current After an electrical burn, what should be monitored? - Correct Answer- Monitor for Compartment Syndrome Monitor for fractures and cervical spine injuries due to violent muscular contractions during electrocution Damaged muscles may cause _____. (3) - Correct Answer- Hyperkalemia Rhabdomyolysis Elevated CK levels _____ of patients have arrhythmias after electrical burns. - Correct Answer-25% When do cardiac arrhythmias occur in association with electrical burns? - Correct Answer-Most occur right after the shock, but may occur up to 12 hours later. What type of cardiac abnormalities may occur and resolve spontaneously after electrical shock? - Correct Answer-T wave and ST abnormalities Fatal arrhythmias are more common in _____. - Correct Answer- Horizontal injuries (arm to arm) Do electrical burns require fluid replacement? - Correct Answer-Yes. But fluids are difficult to determine because the TBSA is not known. How much fluids are given to patients who experience electrical burns? - Correct Answer-Start with 20 ml/kg bolus and adjust as needed to maintain a urinary output of 1 mL/kg/hr What other treatments are necessary for patients who experience electrical burns? - Correct Answer-Continuous cardiac monitoring Osmotic diuretics (enhance urinary output) Sodium bicarbonate to alkalinize urine Monitor for Compartment Syndrome All patients potentially exposed to a chemical should be _____. - Correct Answer-Redirected from the hospital to separate area to minimize contamination of other individuals. What activity occurs in a HOT zone? - Correct Answer-Undressing (removes 75-90% of the chemical) and life-saving medical care. Which individuals are placed in a HOT or a WARM zone? - Correct Answer-Reserved for contaminated individuals and rescuers wearing appropriate protective equipment What activity occurs in a WARM zone? - Correct Answer-Rinse with warm water (soap and shampoo as available) for 5 minutes until the patient states the burning sensation has stopped. The patient should stand with arms and legs spread apart, cleansing from back to front, head to toe. Which individuals are placed in a COLD zone? - Correct Answer- Reserved for decontaminated individuals. Rescuers do not have to wear protective equipment. What activity occurs in a COLD zone? - Correct Answer-Provide all appropriate medical care (use local burn center and/or poison control as resource). How are dry chemicals contained? - Correct Answer-Remove clothing first using caution not to scatter any of the agent. Brush remaining chemical off the skin before cleansing with water. What activities occur in a Radiation WARM zone? - Correct Answer- Rinse with warm water (soap and shampoo as available). The clothing can be removed once it is soaking wet. What activities occur in a Radiation COLD zone? - Correct Answer- Provide all appropriate medical care. Precautions must be taken for any fluids emanating from the patient (urine, blood, feces, etc.) which can be contaminated. What are the indications of radiation sickness? - Correct Answer- Nausea, vomiting, diarrhea, malaise, anorexia, GI bleeding Surface burns (skin will be red and moist like a partial thickness burn, but without blistering). How do you test the radial nerve? - Correct Answer-Loss of sensation to web space between thumb and first finger and base of thumb Test for ability to move thumb ("hitchhiker sign") What injuries are associated with the radial nerve? - Correct Answer- Humerus fractures, elbow injuries How do you test the Median Nerve? - Correct Answer-Loss of sensation to the palm of the hand as well as the second and third finger Test the ability to make a fist or bring the thumb across the palm to the fifth finger. What injuries are associated with the Median Nerve? - Correct Answer-Elbow and wrist injuries How do you test the Ulnar Nerve? - Correct Answer-Loss of sensation to the Forth and Fifth fingers and the area of the hand below these fingers. Test the ability to fan the fingers. What injuries are associated with the ulnar nerve? - Correct Answer- elbow, forearm and wrist injuries How do you test the Femoral Nerve? - Correct Answer-Loss of sensation to anterior surface of the thigh and medial lower leg from the knee to the ankle. Test the ability to extend the knee against resistance or flex the hip against resistance What injuries are associated with the Femoral Nerve? - Correct Answer-Pelvic, hip and femur injuries How do you test the Tibial Nerve? - Correct Answer-Loss of sensation to the plantar aspect of the foot. Test the ability to plantar flex the ankle and toes. What injuries are associated with the Tibial Nerve? - Correct Answer- Knee and ankle injuries How do you test the Peroneal Nerve? - Correct Answer-Loss of sensation to the dorsal aspect of the foot. Test the ability to dorsiflex the ankle and toes. What injuries are associated with the Peroneal Nerve? - Correct Answer-Knee and ankle injuries What is Volkmann's Contracture? - Correct Answer-Contracture of the muscles distal to a nerve impingement or injury. Prevention of Volkmann's Contracture includes: - Correct Answer- Expedient recognition of nerve injuries/compression as well as appropriate reduction of fractures/dislocations to reduce the incidence and severity of the contracture. What is the treatment for open fractures? - Correct Answer-Cover wounds with saline soaked gauze and anticipate antibiotics and surgical repair. Describe older vs. younger patients and shoulder injuries. - Correct Answer-Older people fracture their shoulder and younger people tend to dislocate their shoulder. How are anterior shoulder dislocations typically caused? - Correct Answer-Falling on an outstretched arm. How are posterior shoulder dislocations typically caused? - Correct Answer-Rare injury caused by arm being forced while extended ( may be seen after seizure ) What is the treatment for a mid-shaft humerus fracture? - Correct Answer-Allow arm to hang so the weight of the elbow helps reduce the fracture. May require casts and slings or surgery, depending on the severity and nerve involvement. What are common complications of a mid-shaft humerus fracture? - Correct Answer-Brachial artery injury (may lose up to 750 mL of blood) Radial nerve damage Fat Emboli What are symptoms of nurse maid's elbow (dislocation of the radial head)? - Correct Answer-Refusal to use the arm with limited supination (can flex and extend the elbow) What is the treatment for nurse maid's elbow? - Correct Answer- Easily reduced with manipulation Nurse maid's elbow dislocations tend to recur until age _____. - Correct Answer-5 What are the symptoms of a complete elbow dislocation? - Correct Answer-Obvious loss of arm length and rapid swelling What is the common mechanism of a complete elbow dislocation? - Correct Answer-FOOSH Fall on outstretched hand. What are some complications of a complete elbow dislocation? - Correct Answer-Frequently has neurovascular involvement (Brachial artery laceration, median nerve impingement or damage) What is the treatment for a displaced elbow fracture with nerve involvement? - Correct Answer-Surgical intervention What is important when assessing an elbow injury? - Correct Answer- Assess for brachial artery involvement Assess for nerve involvement (median nerve is most vulnerable) What is a Monteggia's Fracture? - Correct Answer-Fracture of the proximal 1/3 of the ulna with radial head dislocation What is a Nightshift Fracture? - Correct Answer-Fracture of the mid- shaft of the ulna from a direct blow. What is the treatment for a forearm fracture? - Correct Answer-Closed reduction with cast application (cast applied with elbow flexed at 90 degrees) What important parent teaching should occur with children with forearm fractures? - Correct Answer-Prevent dependency of arm or drooping of wrist inside sling after cast application What is a Smith's Fracture? - Correct Answer-Wrist fracture that takes on the appearance of a hoe when visualized laterally What is a Colle's Fracture? - Correct Answer-Wrist fracture that takeson the appearance of a fork when visualized laterally Falling on the back of the hand causes upward displacement of the distal radius and ulna called a _____. - Correct Answer-Smith's Fracture