TCRN Quick Notes Exam 177 Questions with Verified Answers, Exams of Nursing

Download TCRN Quick Notes Exam 177 Questions with Verified Answers and more Exams Nursing in PDF only on Docsity! TCRN Quick Notes Exam 177 Questions with Verified Answers Trauma Assessment (A-I) - CORRECT ANSWER Rapid Assessment!! •Airway / Cervical spine (C-Spine) •Breathing - lung sounds •Circulation - IV access / blood transfusion •Disabilities - Neuro assessment /GCS/Pupil •Exposed/Environmental control •Full set of VS: Family •Give comfort measures L- labs, M- monitor, N-NG Tube, O-Oxygen, P-Pain Secondary Assessment starts now: •History & physical •Inspection Glascow Coma Scale (GCS) - CORRECT ANSWER Neurologic assessment of a patient's best verbal response, eye opening, and motor function. basilar skull fracture - CORRECT ANSWER Fracture at the base of the skull. Anterior Fossa- Raccoon eyes (periorbital ecchymosis), Rhinorrhea with CSF leakage Middle Fossa- Battle's sign (mastoid ecchymosis), Otorrhea with CSF leakage, Hemotympanum (Blood behind ear drum) Interventions to reduce ICP - CORRECT ANSWER Positioning - HOB 30-45 Avoidance of coughing, straining, and bright lights Avoid hypotension, hypoxia (keep O2 98%), hypercarbia (keep CO2 35-37) and hyponatremia. Minimizing environmental stimuli - dark, quiet, low voices/no voices Remove rigid collar, keep neck midline Maintain normothermia - tx fever aggressively Introduce nutrition and physical therapy early Provide early prophylaxis for venous thrombosis and stress ulcers Prevent hyperglycemia Beck's Triad - CORRECT ANSWER Jugular Venous distension, muffled heart sounds, decreased BP -----> Cardiac Tamponade Cushing's Triad - CORRECT ANSWER three classic signs—bradycardia, wide pulse pressure (increased SBP) and irregular slow respirations —seen with pressure on the medulla as a result of brain stem herniation compartment syndrome - CORRECT ANSWER any compartment over 20 mm Hg. Le Fort Fractures I, II, III - CORRECT ANSWER Le Fort 1 - free floating maxilla, lip laceration Le Fort II- mallocclusion, epitaxis, lengthening of face Le Fort III- commonly unresponsive, immense swelling "beach ball", severe hemorrhage epidural hematoma - CORRECT ANSWER a collection of blood in the space between the skull and dura mater char arrived by -sudden loss of consciousness or, -shirt period of unconsciousness followed by Lucid period and subsequent deterioration. -Cushing triad subdural hematoma - CORRECT ANSWER collection of blood under the dura mater characterized by - progressive or decreasing loss of consciousness from venous bleed - headache -vomiting -more coming in older and alcoholics -shaken impact syndrome - May evolve weeks after initial traumatic insult normal cerebral perfusion pressure - CORRECT ANSWER 70-90 mmHg 80-100 - must keep over 60! Cerebral Perfusion Pressure (CPP) - CORRECT ANSWER CPP = MAP - ICP MAP = (systolic + (diastolic x2))/3 Anterior Cord Syndrome - CORRECT ANSWER - caused by flexion injuries - occurs when 2/3 of the anterior cord is lost - *motor function, pain, and temperature sensation lost bilaterally below the lesion* (*flaccidity* below the lesion) the only thing intact is proprioception (position sense) and vibratory sensation worse prognosis of incomplete injuries with only 10-20% recovery of motor fnx Central Cord Syndrome - CORRECT ANSWER occurs with hyperextension of the cervical area. Symptoms include weakness or paresthesia in the upper extremities but normal strength in lower. Typical in the elderly. Brown-Sequard Syndrome - CORRECT ANSWER Hemi-section of the cord (by stab or GSW) - ipsilateral (same side) spastic paralysis and loss of position sense aka loss of motor fnx - contralateral (opposite side) loss of pain and temp sense good prognosis! 90% revovery of ambulation What masks the early signs of shock? - CORRECT ANSWER Beta Blockers (Carvedilol, Metoprolol, labetalol etc.) b/s they help to control HR and BP. What should you worry about in cheek laceration? - CORRECT ANSWER Parotid duct (you can see saliva in the blood coming out of the laceration) What areas should you use caution applying lidocaine with epinephrine? - CORRECT ANSWER Nose and ears b/c decreased circulation can lead to increased risk of infection. Orbital Fracture - CORRECT ANSWER Caused by direct trauma to the eyeball. Signs: blurred vision, diplopia, restricted eye movement/limited upward gaze, downward displacement of the eye, soft-tissue swelling and hemorrhaging, numbness. Hyphema - CORRECT ANSWER Blood in anterior chamber of the eye. Needs to be evaluated daily by optothalmologist. Keep HOB up 30 degree, do not blood nose, do not take aspirin or NSAID, do not lean forward. If increased pain go to ED. Retinal Detachement (3 things) - CORRECT ANSWER Visual Floaters, flashes of light, curtain/veil vision Globe Rupture - CORRECT ANSWER Tear drop shaped pupil, decreased IOP, aqueous or vitreous humor leakage. Secure impaled object do not use eye drops. Zygomatic Fracture - CORRECT ANSWER TIDES Trismus: reduced ability to open jaw related to mucsle spasm Infraorbital hypesthesia: loss os sentation to heat, cold, touch, pain Diplopia: double vision Epistaxis: nosebleed Symmetrical: subcutaneous emphysema of the face, flattening of the cheek on the affected side. When is mannitol contraindicated? - CORRECT ANSWER Hypovolemia/hypotension SCIWORA - CORRECT ANSWER spinal cord injury without radiographic abnormality Happens in pediatrics due to weak neck muscles typically under age of 8 must have MRI to diagnose Pediatric Burn Formula - CORRECT ANSWER 3mL x kg's x %TBSA pediatric minimum SBP - CORRECT ANSWER 70 + (2xage in years) Normal fetal heart rate - CORRECT ANSWER 110-160 beats per minute; fetal distress is tachycardia, bradycardia is severe distress. What is the approximate age of a fetus if you can feel the fundal height at the umbilicus? - CORRECT ANSWER approx 20 weeks uterine rupture - CORRECT ANSWER A tear in the wall of the uterus. Who is at risk- prior C-sections, large babies, contractions too close to each other, multiple babies, rapid labor, prior abortion/uterine manipulation with window or scarring in uterus. s+s= Sudden onset of intense abd. pain - momentarily pain w/ diffuse pain thereafter vaginal bleed: spotting-severe hemorrhage Tachycardia palpate fetal parts over the abdomen Asymmetry of the uterus placenta abruptio - CORRECT ANSWER A life-threatening emergency condition in which the placenta peels away from the wall of the uterus, causing massive bleeding., severe back pain, dark red vaginal bleeding, increased fundal height placenta previa - CORRECT ANSWER implantation of the placenta over the cervical opening or in the lower region of the uterus painless with bright red vaginal bleeding. what medication stops contractions/preterm labor? - CORRECT ANSWER Magnesium Sulfate (tocolytic) Nitrazine test - CORRECT ANSWER 1. A Nitrazine test strip is used to detect presence of amniotic fluid in vaginal secretions. 2. Vaginal secretions have a pH of 4.5 to 5.5; they do not affect yellow color of Nitrazine strip or swab 3. Amniotic fluid has a pH of 7.0 to 7.5 and turn yellow Nitrazine strip or swab a *blue color*. 4. Interventions a. Place client in dorsal lithotomy position b. Touch test tape to fluid c. Asses test tape for a blue-green, blue-gray, or deep blue color, which indicates that membranes are probably ruptured. magnesium toxicity symptoms and tx - CORRECT ANSWER diarrhea, alkalosis, dehydration, hypotension, slurred speech, difficulty breathing, hyporeflexia tx: calcium gluconate Kleihauer-Betke test - CORRECT ANSWER used to detect fetal blood in maternal circulation. Pt will possibly need Rhogam and c-section. Diaphragmatic rupture - CORRECT ANSWER Herniation of the abdominal viscera into the chest occurs (usually on L side) when there is a traumatic defect in the diaphragm produced by blunt or penetrating trauma to the upper abdomen or lower thorax. Shifts mediastinum to the right. s+s: SOB, dysphagia, bowel (peristaltic) sounds in chest, Kehr's sign, decreased breath sounds on injured side. Tx: surgery 1st and 2nd ribs fractures - CORRECT ANSWER bad news! Look out for great vessel injury. 90% of aortic injuries occur at the ligamentum of arteriosum which secures the heart to the aorta. Rapid acceleration/deceleration injuries can tear the aorta decreasing L arm BP etc Aortic Tear - CORRECT ANSWER Traumatic tearing or laceration of the aorta >90% @ aortic isthmus (where heart and aorta connect) Symptoms: Many do NOT have visual signs of chest pain. Change or altered in mental status, L arm BP decreased, new onset murmur, obscured aortic knob, widened mediastinum on xray possible 1st or 2nd rib fracture. Imaging: *CT modality of choice tx: emergency surgery. maintain pulse 60-80, SBP 100-120 with fluids and beta- blockers Tx for stable pt with pulmonary contusion? - CORRECT ANSWER Judicious use of IV fluids to decrease risk of pt going into ARDS. splenic injury grades - CORRECT ANSWER Grade 1 - hematoma <10% surface area, laceration <1cm depth Grade 11 - hematoma 10-50% surface area, laceration 1-3cm depth Grade 111 - >50% surface area, laceration >3cm depth Grade 1V- devascularization >25% of spleen Grade V - completly shattered, hilar vascular injury that devascularizes spleen. Urethral injury - CORRECT ANSWER Posterior Urethral Injury - signs of POSTERIOR urethral injury i. blood at meatus ii. inability to void iii. high riding prostate Anatomy of Posterior Urethra - includes i. prostatic urethra ii. membranous urethra - when you see additionally a PERINEAL OR SCROTAL HEMATOMA, THINK CAUSE = PELVIC FRACTURE CAUSED BOTH URETHRAL INJURY + HEMATOMA - on suspicion of POSTERIOR urethral injury - DO RETROGRADE URETHROGRAM BEFORE INSERTION FOLEY CATHETER (blind insertion can cause infection of periurethral hematoma) - Tx of Posterior Urethral injury - after retrograde urethrogram - do URINARY DIVERSION VIA SUPRAPUBIC CATHETER WHILE PRIMARY INJURY + ASSOC HEMATOMAS ARE ALLOWED TO HEAL; after healing complete, repair residual damage Anterior Urethral Injury - in case of ANTERIOR urethral injury - IMMEDIATE SURGICAL REPAIR - urethra portion that is distal to urogenital diaphragm - causes may be: i. BLUNT TRAUMA TO PERINEUM AKA STRADDLE INJURIES ii. INSTRUMENTATION TO URETHRA - Findings/Presentation i. perineal tenderness or hematoma ii. normal prostate (vs "high riding prostate) iii. bleeding from urethra (versus blood at meatus) iv. retain ability to void (versus posterior urethral injury) v. may see delayed presentation - patient may first present when there is SEPSIS DUE TO EXTRAVASATION OF URINE INTO SCROTUM, PERINEUM, OR ABD WALL lap belt injury - CORRECT ANSWER from MVA chance fracture (flexion disruption of lumbar spine T12-L2) damage to hollow organs- bowel perforation, stomach or bladder Monitoring abdominal compartment pressures through bladder pressure readings - CORRECT ANSWER 1. Pt supine 2. Tranducer leveled at symphysis pubis 3. do not add more than 50mL of sterile saline before reading pressure 4. notify MD is reading over 20 mmhg -NORMAL reading is 12-15mm Hg Abdominal compartment syndrome - CORRECT ANSWER sustained intra- abdominal pressure exceeding 20 mmHg associated with new organ dysfunction or failure. Increased peak airway pressure, low urine output, and urinary bladder >20 mmHg Abdominal Perfusion Pressure (APP) - CORRECT ANSWER = MAP - IAP Target APP is above 60 mmHg intra-abdominal pressure - CORRECT ANSWER as diaphragm contracts, pressure exerted on abdominal cavity is created in opposite direction to this movement. Normal IAP is 5- 7 mmHm. Intra-abdominal hypertenison is over 12 mmHg In blunt abdominal traumas which organ injury commonly goes undetected sue to its asymptomatic initial presentation? - CORRECT ANSWER Pancreas Rule of 9's adult - CORRECT ANSWER Parkland Burn Formula - CORRECT ANSWER V = Pt Weight (kg) x Body Surface Burned (%) x 4 First half is to be given of first 8 hours with the remaining amount given over the remaining 16 hours. American Burn Association Modified parkland Formula - CORRECT ANSWER adults with over 20% burned need fluid resuscitation: LR at 2 mL x kg x BSA for adult thermal burns, 3 for pediatrics, 4 for electrical burns. Asphalt burn tx - CORRECT ANSWER use fat emollients (like mayo or bactracin) to loosen, peel off when cool Alakline burns - CORRECT ANSWER ex: lye or ammonia use large volumes of irrigation due to saponification (destroy tissue) does deep worse than acid burns phenol (carbolic acid) burn - CORRECT ANSWER causes whitening of the exposed area; if ingested patient should drink large amounts of water and be referred for medical evaluation copious irrigation with 50% PEG (Miralax) and water Hydrofluoric acid burns - CORRECT ANSWER Irrigate for at least 30min, until pain relief, then apply 2.5% calcium gluconate gel. Dry chemical burns - CORRECT ANSWER lightly brush off the dry chemical use soap and water after To assess pelvic fractures apply pressure.. - CORRECT ANSWER gently press inward over the iliac crest and downward over the symphysis pubis. Do not apply pressure if one is suspected. Cauda Equina Syndrome - CORRECT ANSWER from hard fall on bottom -Injury at the L1 level and below (to L5) resulting in a LMN lesion S+S -saddle anesthsia -loss of bowel or bladder function -lower extremity weakness that can progress to Flaccid paralysis w/no spinal reflex activity if not caught and treated. Imaging used = CT or MRI First thing to do in pelvic fractures? - CORRECT ANSWER Apply a pelvic binder, even if on a pregnant woman, to decrease the area for blood to pool and to stabilize the pelvis. Then fluid resus, massive blood transfusion protocol, need interventional radiologist and angio-embolization (REBOA). s+s frog leg in open book fracture externally rotated hip swelling of the scrotum blood at urinary meatus blood in urine shortening of leg Lateral compression fracture of pelvis - CORRECT ANSWER Most common (60- 70%) Typically from MVA side on collision Hemorrhage not likeyl but bladder injury possible internal rotation AP compression / open book pelvis fracture - CORRECT ANSWER 15-20% frequency with 50% mortality typically from auto vs ped or motorcycle crash, direct crush injury to pelvis pelvic ring opens = hemorrhage from posterior pelvic venous complex tear of posterior osseous ligamentous complex internal iliac artery may also be involved vertical shear pelvic fracture - CORRECT ANSWER -fall off roof -land on 1 leg -through SI joint - ligaments disrupted FOOSH injury - CORRECT ANSWER fall on outstretched hand Radial fracture w/ dorsal displacement, dinner-fork deformity (colles) farmers hoe (Smiths) axial loading injuries - CORRECT ANSWER Injuries in which load is applied along the vertical or longitudinal axis of the spine, which results in load being transmitted along the entire length of the vertebral column; for example, falling from a height and landing on the feet in an upright position. May have bilateral calcaneal fracture but also spine injury and/or tibial plateau injury that are commonly associated with the injury. How long are sutures left in for? - CORRECT ANSWER Face = 3-5 days Extremity = 7 days Scalp and trunk = 7-10 days Joint = 14 days in general no suture will be left in over 14 days Boxer's fracture - CORRECT ANSWER 4th or 5th metacarpal fracture typically after punching an object. Splint the wrist in a mild extension for 3-4 weeks. Ulnar fracture - CORRECT ANSWER Defense injury Scaphoid fracture - CORRECT ANSWER injury of the snuffbox (anterior between thumb and index finger)!!! Typically not seen on xray unless specifically xraying for it Fat Emoblism - CORRECT ANSWER a type of embolism that is often caused by "physical trauma" such as fracture of (long bones, soft tissue trauma, and burns). s+s present 24-72 hr after injury/long bone fx -altered mental status -respiratory distress -*petechial rash* to head, neck, torso, anterior thoraz, conjunctiva, buccal mucousa membranes or axillae (60%) Tx: is supportive - ventilation/oxygenation When do you remove a turniquet? - CORRECT ANSWER When the surgeon says so. Turniquet rule of 2s - CORRECT ANSWER Place 2in above laceration should be 2in in width Place a second 2 in above first if 1st doesn't control it Knee dislocation - CORRECT ANSWER EMERGENT REDUCTION due to compressed popliteal injury. A vascular injury may occur in up to 40% of these patients, with half requiring amputation posterior hip dislocation - CORRECT ANSWER EMERGENT REDUCTION "dashboard knee" from MVA 1-2mL/kg/hr ped hemorrhagic shock fluid resuscitation in pediatric pt - CORRECT ANSWER 2 cyrstalloid bolus at 20 ml/kg .. no improvement? PRBCs at 10cc/kg What hgb do you transfuse? - CORRECT ANSWER < 7g/dL Which electrolyte imbalances should you watch out for after transfusions? - CORRECT ANSWER Hypocalcemia, hypomagnesmia, potassium irregularities permissive hypotension - CORRECT ANSWER SBP 80-90 to decrease blood loss in trauma pt until they reach surgery. contraindicated in head trauma why can crystalloid fluid be bad in trauma - CORRECT ANSWER it can cause/worsen hypothermia, metaolic acidosis, and coagulapathy. Mean Arterial Pressure (MAP) - CORRECT ANSWER pressure forcing blood into tissues, averaged over cardiac cycle Normal 60-100 mm Hg Cardiac Output (CO) - CORRECT ANSWER measurement of the amount of blood ejected per minute from either ventricle of the heart Normal: 4-8 L/min Cardiac Index (CI) - CORRECT ANSWER Normal range 2.5 to 4 L/min. < 2.1 inconsistent for weaning. Central Venous Pressure (CVP) - CORRECT ANSWER the pressure of blood in the thoracic vena cava, near the right atrium of the heart; reflects the amount of blood returning to the heart and the ability of the heart to pump the blood into the arterial system Normal 2-6 mm Hg Pulmonary Artery Systolic Pressure (PAS) - CORRECT ANSWER Normal: 15-30 mm Hg Pulmonary Artery Diastolic Pressure (PAD) - CORRECT ANSWER Normal: 8-15 mm Hg Pulmonary Artery Occlusive Pressure (PAOP) - CORRECT ANSWER Left pressure Normal: 6-12 mm Hg Pulmonary Vascular Resistance (PVR) - CORRECT ANSWER Opposition encountered by the right ventricle <250 dynes Systemic Vascular Resistance (SVR) - CORRECT ANSWER the pressure in the peripheral blood vessels that the heart must overcome to pump blood into the system Normal: 800-1200 dynes Stroke Volume (SV) - CORRECT ANSWER measurement of the amount of blood ejected from a ventricle in one contraction Normal: 60-100 mL Stroke volume Index (SVI) - CORRECT ANSWER 40-50 ml/m2 Mixed Venous Saturation (SvO2) - CORRECT ANSWER 60-80% Thromboelastography (TEG) - CORRECT ANSWER It predicts the need for transfusion and guides transfusion strategy. It tests clot formation and strength, platelet function, and coagulation. Haddon Matrix - CORRECT ANSWER A way of conceptualizing injury prevention strategies based on the phase and whether the strategy is targeted to the host, the vehicle, or the environment. Pre-event: posting appropriate speed limit Intra-event: using occupant safety restraints in automobiles: advocating for crash- resistant roadside barriers Post event: ensuring adequate receiving facility trauma readiness. Four E's of Injury Prevention - CORRECT ANSWER Engineering Enforcement Education Economic Incentives - CORRECT ANSWER e Blast Injuries - CORRECT ANSWER Primary = blast wind/pressure wave often lethal impact Secondary = flying debris (fragment injuries, puncture wounds, lacerations/impaled objects) Tertiary = patient displacement, blunt object impacts from winds Quarternary = collapse building inhalation or external burns Quinary = exposure to radioactive, biological or chemical compents of blast wolf model of trauma nursing - CORRECT ANSWER knowledge, critical application, and advocating/moral agency injuries associated with lateral impact - CORRECT ANSWER same side sholder, clavicle and ribs, pelivc fractures, liver, spleen injuries associated with frontal impact - CORRECT ANSWER aoritc and cardiac, rib fractures, spleen injuires, posterior hip dislocation, knee and femur. injuries associated with rear-end impact - CORRECT ANSWER neck hyperextension/hyperfelxtion injuries associated with roll over - CORRECT ANSWER DAI injuries associated with ejection - CORRECT ANSWER 4x more likely to be lethal Waddell's Triad - CORRECT ANSWER injury for pediatric pedestrian struck by MVC femur # intra thoracic/intra abd injury contralateral head injury What holds the greats potential for injury? - CORRECT ANSWER Velocity. ex: handgun is medicum velocity while shot gun is high velocity.