Trauma Nursing Core Course (TNCC) Exam Preparation, Exams of Nursing

Download Trauma Nursing Core Course (TNCC) Exam Preparation and more Exams Nursing in PDF only on Docsity! 1 / 47 TNCC 8th Edition FINAL EXAM Question and Answers Latest Updates 2024 GRADE A+ 1. Expedite transfer to the closest trauma center: A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? 2. a pertinent medical hx is crucial: Which of the following considerations is the most important when caring for a geriatric trauma pt? 3. Mitigation: Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster . Which phase of the disaster life cycle does this describe? 4. Multiple requests for water: EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? 5. hemoglobin does not readily release O2 for use by the tissues: What is the effect of hypothermia on the oxyhemoglobin dissociation curve? 6. acidosis: Which of the following is a component of the trauma triad of death? 7. Complete: EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? 8. flucuation in the water seal chamber: Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? 9. insert an oropharyngeal airway if there is no gag reflex: During the primary survey of an unconscious pt with multi-system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? 10. globe rupture: A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? 11. compensated: A trauma pt is restless and repeatedly asking "where am i?" VS upon arrival: BP 110/60, HR96, RR 24. Her skin is cool and dry. Current VS are BP 2 / 47 104/84, HR 108, RR 28. The pt is demonstrating s/sx of which stage of shock? 12. ventilate with a bag mask device: An unresponsive trauma pt has an oropharygeal airway in place, shallow and labor d respirations, nd du ky skin. The tr uma te m has administered medications for drug-assi ted intubation a d att mpted intubation but was unsuccessful. What is the mo t appropriate immedi- te next st p? 13. within 24 hrs of trauma: When is the tertiary survey completed fora trauma pt? 14. pressure: An intubated and sedated pt in the ED has multiple extremity injuries with the potential for causing compartment syndrome. What is the most reliable indication of compartment syndrome in a patient who is unconscious? 15. worsening pneumothorax: Which of the following is possible complication of positive-pressure ventilation? 16. pelvic stability: the most reassuring finding for a male pt with hip pain after a fall is which of the following? 17. narrowed: Which of the following pulse pressures indicate early hypovolemic shock? 18. dysrhythmias: Patients with a crush injury should be monitored for which of the following conditions? 19. subdural hematoma: Tearing of the bridging veins is most frequently associ- ated with which brain injury? 20. straight cath for urine sample: A 20 y/o M presents to the ED complaining of severe lower abd pain after landing hard on the bicycle cross bars while preforming an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the RN question? 21. placental abruption: You are caring for a pt who was involved in a MVC and is 32 weeks pregnant. Findings of your secondary survey include abd pain on palpation, fundal ht at the costal margin, and some dark bloody show. Varying accelerations and decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? 22. it can worsen cord damage from an unstable spinal injury: Which of the following is true about the log-roll? 23. defusings: All of these are considered a critical communication point in trauma care EXCEPT which of the following? 24. pulse oximetry and capnography: What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? 25. padding the upper back while stabilizing the cervical spine: Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? 5 / 47 50. What is kinematics?: A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. 51. What is Newton's First Law?: A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. 52. What is the Law of Conservation of Energy?: Energy can neither be created nor destroyed. It is only changed from one form to another. 53. What is Newton's Second Law?: Force equals mass multiplied by accelera- tion of deceleration. 54. What is kinetic energy (KE)?: KE equals 1/2 the mass (M) multiplied by the velocity squared. 55. What is the Mnemonic for the Initial Assessment?: A = Airway with simul- taneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) 56. What is the Mnemonic for the Secondary Assessment?: F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces 57. Where do you listen to auscultate breath sounds?: Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth inter- costal space at the anterior axillary line. 58. What are the late signs of breathing compromise?: - Tracheal deviation - JVD 59. What are signs of ineffective breathing?: - AMS - Cyanosis, especially around the mouth - Asymmetric expansion of chest wall - Paradoxical movement of the chest wall during inspiration and expiration - Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing - Sucking chest wounds 6 / 47 - Absent or diminished breath sounds - Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated - Anticipate definitive airway management to support ventilation. 60. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively?: A tight-fitting nonrebreather mask at 12-15 lpm. 61. What intervention should be done if a pt presents with effective circula- tion?: - Insert 2 large caliber IV's - Administer warmed isotonic crystalloid solution at an appropriate rate 62. What are signs of ineffective circulation?: - Tachycardia - AMS - Uncontrolled external bleeding - Pale, cool, moist skin - Distended or abnormally flattened external jugular veins - Distant heart sounds 63. What are the interventions for Effective/Ineffective Circulation?: - Control any uncontrolled external bleeding by: - Applying direct pressure over bleeding site - Elevating bleeding extremity - Applying pressure over arterial pressure points - Using tourniquet (last resort). - Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution - Use warmed solution - Use pressure bags to increase speed of IVF infusion - Use blood administration tubing for possible administration of blood - Use rapid infusion device based on protocol - Use NS 0.9% in same tubing as blood product - IV = surgical cut-down, central line, or both. - Blood sample to determine ABO and Rh group - IO in sternum, legs, arms or pelvis - Administer blood products - PASG (without interfering with fluid resuscitation) 64. How do you assess Mnemonic "D"?: DISABILITY A = Alert V = Verbal P = Pain U = Unresponsive 7 / 47 - GCS - PERRL? - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain 65. What are the interventions for Disability?: - If assessment indicates a decreased LOC, conduct further investigation during secondary focused assess- ments - If pt is not alert or verbal, continue to monitor for any compromise to ABC's - If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation. 66. What is assessed and intervened for Expose/Environmental Controls?: - Remove clothing - Ensure appropriate decontamination if exposed to hazardous material - Keep pt warm - Keep clothing for evidence 67. What is the first thing assessed under the Secondary Assessment?: - FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE - ABCDE should be completed - Labs, X-rays, CT, Foley, - Family Presence 68. What is the second thing assessed under the Secondary Assessment?- : GIVE COMFORT MEASURES - Talking to pt - Pharmacologic/Nonpharmacologic pain management - Observe for physical signs of pain 69. What is assessed under the Mnemonic "H"?: HISTORY / HEAD-TO-TOE ASSESSMENT - MIVT - M = Mechanism of injury - I = Injuries sustained - V = Vital Signs - T = Treatment - Pt generated information - PMH - Head-to-toe assessment 10 / 47 - Hemorrhage or hematoma formation or both - Lac to trachea or esophagus - Creation of a false passage - Laryngeal stenosis 79. How do you confirm ET Tube/Alternative Airway Placement?: - Visualiza- tion of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray 80. How do you inspect the chest for adequate ventilation?: Observe: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) 81. What are you looking for when auscultating lung sounds?: Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain 82. What are you looking for when percussing the chest?: Dullness: - hemothorax Hyperresonance - Pneumothorax 83. What are you looking for when palpating the chest wall, clavicles and neck?: - Tenderness - Swelling - subcutaneous emphysema - step-off deformities = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. 11 / 47 84. What is the DOPE mnemonic?: D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing 85. Explain Hypovolemic Shock.: Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. 86. Explain Cardiogenic Shock.: Syndrome that results from ineffective perfu- sion caused by ineffective perfusion caused by inadequate contractility of cardiac muscle. Some causes: - MI - Blunt cardiac injury - Mitral valve insufficiency - dysrhythmias - Cardiac Failure 87. Explain Obstructive Shock.: Results from inadequate circulating blood vol- ume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock 12 / 47 88. Explain Distributive Shock.: Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involve- ment in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflam- matory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. 89. What is vascular response?: As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of barore- ceptors. Arterioles constrict to increase TPR and BP. 90. What is renal response?: Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes: - Vasoconstriction of arterioles and some veins - Stimulation of sympathetic nervous system - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. 91. Explain adrenal gland response.: When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. 15 / 47 hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. 97. What are the early signs and symptoms of increased ICP?: - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement 98. What are the late observable signs of symptoms of increased ICP?: - Dilated, nonreactive pupil - Unresponsiveness to verbal or painful stimuli - Abnormal motor posturing patterns - Widening pulse pressure - Increased systolic blood pressure - Changes in RR and pattern - Bradycardia 99. What is Cushing's phenomenon or Cushing's Reflex?: Triad of progressive HTN, bradycardia and diminished respiratory effort. 100. What are the two types of herniation that occurs with ICP?: 1. Uncal herniation 2. Central or transtentorial herniation 101. Why does herniation occur? What are the symptoms?: Because of un- controlled increases in ICP. S/E's - Unilateral or bilateral pupillary dilation - AsyDimmetric pupillary reactivity - Abnormal motor posturing - Other evidence of neurologic deterioration 102. Define uncal herniation.: The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. 16 / 47 103. Define central or transtentorial herniation.: A downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. 104. Disruptions of the bony structures of the skull can result in what?: Dis- placed or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential en- trance for invading bacteria. Also: meningitis or encephalitis or brain abscess 105. Define Minor Head Trauma.: GCS 13-15 106. Define Moderate Head Trauma: Postresuscitative state with GCS 9-13. 107. Define Severe Head Trauma.: Postresuscitative state with GCS score of 8 or less. 108. What is a concussion and its signs and symptoms?: A temporary change in neurologic function that may occur as a result of minor head trauma. S/S: - Transient LOC - H/A - Confusion and disorientation - Dizziness - N/V - Loss of memory - Difficulty with concentration - Irritability - Fatigue 109. What are the signs and symptoms of postconcussive syndrome?: - Persistent H/A - Dizziness - Nausea - Memory impairment - Attention deficit - Irritability - Insomnia - Impaired judgement - Loss of libido 17 / 47 - Anxiety - Depression 110. What is diffuse axonal injury and its signs and symptoms?: (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S: - Immediate unconsciousness - mild DAI, coma = 6-24 hrs - severe DAI, coma = weeks/months or persistent vegetative state - Elevated ICP - Abnormal posturing - HTN - Hyperthermia - Excessive sweating because of autonomic dysfunction - Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits 111. What is a cerebral contusion and its S/S?: A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S: - Alteration in LOC - Behavior, motor or speech deficits - Abnormal motor posturing - Signs of increased ICP 112. What is an epidural hematoma and its S/S?: Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly: - Compression of underlying brain - rapid increase in ICP - Decreased CBF - Secondary brain injury * Usually requires surgical intervention S/S: - Transient LOC - Lucid period lasting a few minutes to several hours - Rapid deterioration in neurologic status - Severe H/A 20 / 47 - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 mm Hg may cause increased cerebral vasodilation, increased CBF, increased ICP. - Prolonged hyperventilation NOT RECOMMENDED. - Hypocarbia occurs as result of hyperventilation causes cerebral vasoconstriction, decreased CBF, decreased ICP. And ischemia secondary to severe vasoconstric- tion. - Hyperoxygenate pt with 100% O2 via bag-mask - Apply direct pressure to bleeding sites except depressed skull fractures - Cannulate 2 large IV's - Hypotension doubles pt's death rate (w/severe head trauma) - Vasopressors used to maintain CPP. - Insert OG or NGT. OG should be used with severe facial trauma. - Position pt, elevate head to decrease ICP (but may also reduce CPP). - Position head midline to facilitate venous drng. Rotate head to compress veins in neck and result in both venous engorgement and decreased drng from brain - Prepare for ICP monitoring device - Administer mannitol as prescribed. - Mannitol, hyperosmolar, volume-depleting diuretic, decreases cerebral edema + ICP by pulling interstitial fluid into intravascular space for eventual excretion by kidneys. - Administer anticonvulsant - Sx should be avoided b/c increases cerebral metabolic rate + ICP. Indications for sz prophylaxis: - Depressed skull fx - Sz at time of injury 21 / 47 - Sz on arrival to ED - Hx of sz's - Penetrating brain injury - Acute subdural/epidural hematoma - Administer antipyretic med/Cooling blanket - Hyperthermia may increase cerebral metabolic rate + ICP. Avoid causing shiv- ering during cooling process; increases cerebral metabolic rate + may precipitate rise in ICP - Do not pack ears/nose if CSF leak suspected - Admin tetanus prophylaxis - Wound repair for facial/scalp Lac's - Admin other meds - Analgesics, sedatives, narcan, romazicon, etc. - Admin antibiotics - Pt's w/basilar skull fx need prophylaxis against meningitis - Prepare pt for OR, hospital admin or transfer. 119. What are signs of a serious eye injury?: - Visual disturbances - Pain - Redness and ecchymosis of the eye - Periorbital ecchymosis - Increased intraocular pressure 120. What is hyphema and its S/S?: Accumulation of blood, mainly RBC's that disperse and layer within the anterior chamber. A severe hymphema obscures entire anterior chamber + will diminish visual acuity severely or completely. Injuries are graded on amount of blood in chamber (Grades I-IV). S/S: - Blood in anterior chamber - Deep, aching pain - Mild to severe diminished visual acuity - Increased intraocular pressure 121. What are s/s of chemical burns to the eye?: Chemical injuries require immediate intervention if it is to be preserved. S/S: - Pain - Corneal Opacification - Coexisting chemical burn and swelling of lids 22 / 47 122. What are S/S of penetrating trauma/open or ruptured globe?: - Marked visual impairments - Extrusion of intraocular contents - Flattened or shallow anterior chamber - Subconjunctival hemorrhage, hyphema - Decreased intraocular pressure - Restriction of extraocular movements 123. What are the S/S of orbital fracture (orbital blowout fracture)?: - Diplopia (double vision) - Loss of vision - Altered extraocular eye movements - Enophthalmos (displacement of the eye backward into the socket) - Subconjunctival hemorrhage or ecchymosis of the eyelid - Infraorbital pain or loss of sensation - Orbital bony deformity 124. What is LeFort I fracture and its S/S?: Transverse maxillary fx that occurs above level of teeth and results in separation of teeth from rest of maxilla. S/S: - Slight swelling of maxillary area - Possible lip lac's or fractured teeth - Independent movement of the maxilla from rest of face - Malocclusion 125. What is LeFort II fracture and its S/S?: Pyramidal maxillary fx=middle facial area. Apex of fx transverses bridge of nose. Two lateral fx's of pyramid extend through the lacrimal bone of the face and ethmoid bone of skull into the median portion of both orbits. Base of the fx extends above level of the upper teeth into maxilla. CSF leak is possible. S/S: - Massive facial edema - Nasal swelling w/obvious fx of nasal bones - Malocclusion - CSF rhinorrhea 126. What is LeFort III fracture and its S/S?: Complete craniofacial separation involving maxilla, zygoma and bones of cranial base. This fx is frequently associ- ated w/leakage of CSF and fx mandible. S/S: - Massive facial edema 25 / 47 - Facial fx's can impinge on infraorbital nerve, causing numbness of inferior eyelid, lateral nose, cheek, or upper lip on affected side. - Check position of trachea DIAGNOSTIC STUDIES: - Xrays, CT scans, MRI's - Fluorescein staining - Slit-lamp exam - tonometry (measures intraocular pressure) - Bronchoscopy or esophagoscopy 130. What are the nursing interventions for a pt with an ocular injury?: - Assess visual acuity & reassess - Elevate HOB to minimize intraocular pressure - Instruct pt not to bend forward, cough or perform Valsalva maneuver b/c these actions may raise intraocular pressure - Assist w/removal of foreign bodies as indicated; stabilize impaled objects - Apply cool packs to decrease pain + periorbital swelling - Admin medications - Instill prescribed topical anesthetic drops for pain - Instill NS drops or artificial tears to keep corneas moist. Cover eyelids w/sterile, moist saline dsg to prevent drying and ulceration - Antibiotics topically or systemically - Admin tetanus prophylactically - Use an eye patch to affected eye - Patch or shield both eyes to reduce movement + photophobia in pt's w/retinal injuries - Patch, shield or cover w/cool pack - Do NOT patch injured eye of pt w/suspected open or ruptured globe or impaled object, patch unaffected eye. Use metal or plastic and do not put pressure on the globe. - Provide psychosocial support - Obtain an ophthalmology consultation - Provide d/c instructions: - Importance of protective eyewear - No driving w/eye patch on - Wear sunglasses to prevent tearing, aid photophobia - Prepare for admission, OR or transfer 131. What are the nursing interventions for a patient with a maxillofacial or neck injury?: - Administer oxygen 26 / 47 - For facial trauma, place pt in high-fowler's position if no spinal injury is present. - Insert OG or NGT. OGT should be used if basilar skull fx or severe midface fx's are suspected - Monitor for progressive airway assessment - Prepare for intubation, PRN. - Cannulate 2 large IV's, initiate isotonic crystalloid IV solution - Control external bleeding w/direct pressure - Monitor for continued bleeding + expanding hematomas - Apply cold compresses to face to minimize edema - Assist w/repair of oral lac's, PRN - Admin antibiotics - Stabilize impaled objects - Admin analgesic meds 132. With any eye injury, what should the evaluation and ongoing assess- ments be?: - Reassessing visual acuity at reasonable intervals - Reassessing pain, including response to nonpharmacologic + pharmacologic interventions - Monitoring appearance, position, movements of globe and pupillary responses - Monitoring airway patency, respiratory effort and ABG's 133. What are the most common type of injury associated with chest trau- ma?: blunt; MVC's. Penetrating; firarm injuries or stabbings 134. What are S/S of a rib fracture?: - Dyspnea - Localized pain on movement, palpation, or inspiration - Pt assumes position intended to splint chest wall to reduce pain - Chest wall ecchymosis or sternal contusion - Bony crepitus or deformity 135. What is a flail chest?: A fracture of two or more sites on two or more adjacent ribs, or when rib fractures produce a free-floating sternum. Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases. 136. What could a flail chest be associated with?: - Ineffective ventilation - Pulmonary contusion - Lacerated lung parenchyma 137. What are the S/S of flail chest?: - Dyspnea - Chest wall pain 27 / 47 - Paradoxical chest wall movement - the flail segment moves in during inspiration and out during expiration. 138. Define Pneumothorax.: Results when an injury to lung leads to accumula- tion of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. 139. What are the S/S of a pneumothorax?: - Dyspnea, tachypnea - Tachycardia - Hyerresonance (increased echo produced by percussion over the lung field) on the injured side - Decreased or absent breath sounds on the injured side - Chest pain - Open, sucking wound on inspiration (open pneumothorax) 140. Define tension pneumothorax.: Life-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compress- es the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. 141. What are the S/S of a tension pneumothorax?: - Severe respiratory dis- tress - Markedly diminished or absent breath sounds on affected side - hypotension - Distended neck, head and upper extremity veins-may not be clinically appreci- ated if significant blood loss present - Tracheal deviation - shift toward uninjured side (LATE sign) - Cyanosis (LATE sign) 142. Define Hemothorax.: Accumulation of blood in the pleural space. 143. What are the S/S of Hemothorax?: - Dyspnea, tachypnea - Chest pain - Signs of shock - Decreased breath sounds on injured side - Dullness to percussion on the injured side 30 / 47 - Note presence of bony crepitus - Palpate central and peripheral pulses and compare quality between: - Right and left extremities - Upper and lower extremities - Palpate the trachea (above suprasternal notch. Trach shift may indicate late sign of tension pneumothorax or massive hemothorax) - Palpate extremities for motor and sensory function (lower extremitiy paresis or paralysis may indicate aortic injury). Auscultation: - Auscultate compare BP in both UE's and LE's - Auscultate breath sounds (decreased or absent breath = pneumo or hemothorax. Diminshed BS = splinting. Shallow = b/c of pain). - Auscultate chest for presence of BS (diaphragmatic rupture) - Auscultate Heart sounds (muffled = pericardial tamponade) - Auscultate neck vessels for bruits (vascular injury) Diagnostic Procedures: - Xrays - Arteriography - Bronchoscopy and laryngoscopy - CT's - FAST - Labs (cardiac enzymes) - ECG, CVP 153. What is the planning and implementation for thoracic injury?: p. 142 154. Kinematics: Is the study of energy transfer as it applies to identifying actual or potential injuries. 155. Biomechanics: Is the general study of forces and their effects. 156. Mechanism of Injury: Is how external forces are transferred to the body, resulting in injury 157. Newton's First Law of Motion: an object in motion will remain in motion unless acted upon by another force 158. Newton's Second Law of Motion: The acceleration of an object depends on the mass of the object and the amount of force applied. 159. Newton's Third Law of Motion: For every action there is an equal and opposite reaction 31 / 47 160. Law of Conservation of Energy: Matter is neither created nor destroyed (but may change form) 161. What are the five forms in which energy exist?: 1. Mechanical 2. Thermal 3. Chemical 4. Electrical 5. Radiant 162. Describe the 3 types of Internal forces of energy transfer in the context of trauma.: Compression: The ability of the tissue to resist crush injury or force Tension: The ability to resist being pulled apart when stretched Shear: The ability to resist a force applied parallel to the tissue 163. Describe the 3 types of external forces of energy transfer in the context of trauma.: Deceleration: Force from a sudden stop in the body's motion Acceleration: Force from a sudden onset in the body's motion Compression: Force from being crushed between objects 164. List the four main types of traumatic injury and give an example of each: Blunt: The result of a broad energy impact across a large surface area. Penetrating: The 165. What 4 environmental and pathophysiologic factors are considered when the mechanism of injury is a fall?: 166. Describe the three impacts in the motor vehicle impact sequence: 1. First Impact: Vehicle hits another object 2. Second Impact: Occupant hits the interior of the vehicle 3. Third Impact: Organcs hit other internal structures 167. Define the five mechanisms of injury in blast trauma.: 1. Primary: Found in patients who were closest to the blast. Injuries are most commonly associated with air-filled organs 2. Secondary: Include fragment injuries, puncture wounds, lacerations, and im- paled objects. Generally, these cause the most casualties 3. Tertiary: Result from the patient being blown into a large object. Injuries include pelvic or femur fractures an thoracic injuries. 4. Quaternary: Result from heat, flame, gas, and smoke and cause burn injuries. 5. Quinary: Injuries associated with radioactive, biological or chemical elements that may be present in the explosion. 32 / 47 168. Describe the usefulness of the Haddon Matrix in prevention and reduc- tion of injury: Looks at 3 phases of the event: Pre-event, event, and post-event. Looks at 4 factors involved in the event: The host (patient), the agent (cause), the physical evironment, and the socioeconomic environment. Countermeasures can be applied at each phase to help reduce injury. 169. What assessment findings differentiate a placental abruption from a uterine rupture?: 170. What intervention is used to treat hypotension from aortocaval com- pression?: 171. Describe the activities and associated factors related to low-energy trauma in the older adult.: 172. List common injuries from falls in the older adult population.: 173. What condition is associated with a fall from which the older adult cannot rise? What complications result from this condition?: 174. Review the age-related anatomic and physiologic change of the older adult in relation to the components of the initial assessment.: 175. Describe the fluid resuscitation of an older adult patient related to fluid overload, when to administer red blood cells, and the use of anticoagulant medication.: 176. Describe effects of common medications in relation to the older adult trauma patient.: 177. Describe common patterns and severity of injuries in the bariatric trau- ma patient.: 178. Which comorbid conditions factor into the risks of the bariatric trauma patient? And how?: 179. Describe the pathophysiologic changes of the systems of the bariatric patient and the effects on trauma resuscitation efforts.: 180. Describe techniques to improve the intubation process for the bariatric trauma patient.: 181. Discuss the use and insertion of nasogastric tubes in the bariatric patient.: 35 / 47 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor: If the pt has a definitive airway in what should you do? 200. 1. Suction the airway 2, Use care to avoid stimulating the gag reflex 3. If the airway is obstructed by blood or vomitus secretions, use a rigid suction device If foreign body is noted, remove it carefully with forceps or another appro- priate method: If Airway is not patent 201. 1. Apnea 2. GCS 8 or less 3. Maxillary fractures 4. Evidence of inhalation injury (facial burns) 5. Laryngeal or tracheal injury or neck hematoma 6. High risk of aspiration and patients inability to protect the airway 7. Compromised or ineffective ventilation: Following conditions might require a definitive airway 202. Breathing: To assess breathing expose the chest: 1. Inspect for a. spontaneous breathing b. symmetrical rise and fall c. depth, pattern, and rate of respiration d. signs of difficulty breathing such as accessory muscle use e. skin color (normal, pale, flushed, cyanotic) f. contusions, abrasions, deformities (flail chest) g. open pneumothoraces (sucking chest wounds) h. JVD i. signs of inhalation injury (singed nasal hairs, carbonaceous sputum): B 203. tracheal deviation and jvd: Late signs of tension pneumo: 204. 1. equal breath sounds bilaterally at the second intercostal space mid- clavicular line and the bases for fifth intercostal space at the axillary line: - Auscultate the chest for: 205. 1. bony fractures and possible rib fractures, which may impact ventila- tion 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax 4. soft tissue injury: Palpate the chest for 36 / 47 206. 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway: If breathing is absent.. 207. trauma its need early supplemental oxygen, start with 15 mL O2 and titrate oxygen delivery.: Oxygen on trauma patients 208. Circulation and Control of Hemorrhage Inspect first for any uncontrolled bleeding Skin color palpate for central pulses - carotid and femoral - rate, rhythm, and strength Skin temp: cool, diaphoretic, or warm and dry: C 209. apply direct pressure to bleeding elevate extremity apply pressure over arterial sites Consider a pelvic binder for pelvic fractures consider a tourniquet cannulate two veins with large caliber IV - if unable to gain assess consider IO a. obtain labs, type and cross b. infuse warm isotonic fluids c. consider balanced resuscitation d. use rapid infusion device: C Interventions: 210. Disability - Neurologic Status 1. Assess pupils for equality, shape, and reactivity (PERRL) 2. Assess GCS (eye opening, verbal response, and motor response): D 211. 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check: D Interventions 37 / 47 212. Exposure and Environmental Control Remove all clothes and assess for any obvious injuries and uncontrolled bleeding: E 213. IF clothing is needed for evidence preserve in paper bag. Maintain body temp - cover the pt, turn up heat in room, administer warm fluids: E Interventions: 214. Full set of vitals and family presence: F 215. Get Resuscitation Adjuncts L - Labs (maybe a lactic acid), a b g 's, blood type M - monitors N - naso or oro gastric tubes O Oxygen and ETC02 monitors P - pain assessment and management: G 216. Reevaluation and Consider the need to Transfer: Final step in primary survey 217. H,I: Secondary Survery 218. History and Head to toe MIST - prehospital report MOI Injuries sustained S s/s in the field T treatment in the field if patients family present get a better hx on them: H 219. Sample is part of history S symptoms associated with injury A allergies and tetanus status M meds currently on including anticoagulant therapy P past medical hx L last oral intake E Events and environment factors related to the injury: SAMPLE 220. inspect for lacs, abrasions, asymmetry of facial expressions palate for depressions and tenderness TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 40 / 47 to a decrease in myocardial contractility and/or valvular insufficiency. Ex: MI's or dysrhythmia are common causes: Cariogenic Shock 236. occurs as a result of maldistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Ex: Anaphylactic - release of antihistamines Septic Shock - systemic release of bacterial endotoxins, resulting in in- creased vascular permeability and vasodilation. Neurogenic shock - spinal cord injury results of loss in sympathetic nervous system control of vascular tone. Goal: Volume replacement and vasoconstriction: Distributive Shock 237. A breath every 5 to 6 seconds: 10-12 ventilations per minute: Bag mask ventilation 238. Stroke Volume X HR: Cardiac Output = 239. .. activation: .... are found in the carotid sinus and along the aortic arch, are sensitive to the degree of stretch in the arterial wall. When the receptors sense a decrease in stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constric- tion of blood vessels, which causes a rise in heart rate and diastolic blood pressure: Baroreceptors: 240. activation: consist of carotid and aortic bodies. ... detect changes in blood oxygen and Co2 and pH. When Co2 rises or oxygen level of pH falls these receptors are activated and information is relayed to the CNS and the cardiorespiratory centers in the medulla , which increases respiratory rage and depth and BP: Chemoreceptors: 241. 50 to 150: MAP Range 242. the decrease coagulopathy .. you will you bleed more: The colder you are the more acidic you are.. 243. in massive transfusion protocol... responsible for dissolving clots: TXA 244. stabilized vital signs, improved mental status, improved urine output: - What are indicators of increased perfusion? 245. : Prehospital shock index pg. 85 246. Flail chest: Paradoxical chest wall movement TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 41 / 47 247. can be caused by blunt trauma. air escapes from injured lung to pleural space and negative intrapleural pressure is lost causing partial or collapsed lung: Simple Pneumothorax 248. 1. Dyspnea 2. Tachycardia 3. Decreased or absent breath sounds on the injured side 4. CP: Simple Pneumo assessment: 249. Tx is based on size, presence of sx, and stability. For those are aysmpo- matic and stable. Observation with or without oxygen. Larger pneumo who are unstable or likely to deteriorate a chest tube is placed.: Simple pneumo interventions: 250. can result from penetrating wound through chest wall causing air to be trapped in to the intrapleural place. Might hear "sucking" Tx: nonporous dressing tapes on 3 sided, then Chest tube and would closure surgical repair.: Open Pneumo: 251. Air cannot escape intrapleural space.. can begin to compress heart. pt will have sever resp distress, hypotension, JVD.: Tension pneumo 252. A 14 gauge needle that is inserted into the 2nd intercostal space in the midclavicular line on the affected side over the top of the rib to avoid neuromuscular bundle that runs under the rib. Prepare for chest tube placement.: Tension pneumo intervention 253. Caused by blood in the intrapleural space/ May also occur from lac to live or spleen combined with injury to the diaphragm. Ensure two large bore IVS are placed. Prepare for thoracentesis and chest tube insertion. If open thoracotomy is done chest tube is deferred.: Hemothorax: 254. 1. Hypotension 2. JVD 3. Muffled heart sounds: Becks Triad: 255. Needle pericardiocentesis, but it is a temp solution. Requires surgical evaluation. TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 42 / 47 (Ultrasound guided): Cardiac Tamponade Intervention: 256. Aortic Dissection: Unequal extremity pulse strength possibility of.. 257. 1. pain - hallmark sign, early sign 2. pressure - early sign 3. pallor, pules, paresthesia, paralysis - late sign: Six P's of compartment syndrome: 258. Pediatric Assessment Triangle 1. General appearance - muscle tone, interactiveness, consoloability, poor or gaze, speech or cry 2. Work of breathing - inadequate or excessive, accessory muscle use, re- tractions, tripod position, abnormal upper airway sounds 3. Circulation of the skin - color, mottling or central or peripheral cyanosis, diaphoresis: PAT 259. brachial pulse: Under age of 1 where do you find a pulse 260. What are the greatest risks for transport?: Loss of airway patency, dis- placed obstructive tubes lines or catheters, dislodge splinting devices, need to replace or reinforce dressings, deterioration in patient status change in vital signs or level of consciousness, injury to the patient and/or team members 261. According to newtons law which of these two force is greater: size or force?: Neither. For each force there is an equal and opposite reaction. 262. What is the relationship between mass and velocity to kinetic energy?: - Kinetic energy is equal to 1/2 the mass multiplied the square of its velocity therefore when mass is doubled so is the net energy, however, when velocity is doubled energy is quadrupled. 263. What is tension?: stretching force by pulling at opposite ends 264. What is compression?: Crushing by squeezing together 265. What is bending?: Loading about an axis. Bending causes compression on the side the person is bending toward intention to the opposite side 266. What is shearing?: Damage by tearing or bending by exerting faucet differ- ent parts in opposite directions at the same time. 267. What is torsion?: Torsion forces twist ends in opposite directions. 268. What is combined loading?: Any combination of tension compression tor- sion bending and/or shear. TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 45 / 47 increases yet systolic remains unchanged, tachycardia with bounding pulses, and decreased urinary output 289. What are the signs and symptoms of decompensated shock?: De- creased level of consciousness, hypertension, narrow pulse pressure, tachycardia with weak pulses, tachypnea, skin that is cool clammy and cyanotic, base access outside the normal range, and serum lactate levels greater than two to 4MMOL/L. 290. What are the signs and symptoms of irreversible shock?: Obtunded stuporous or comatose state, marked hypertension and heart failure, bradycardia with possible dysrhythmias, decreased and shallow respiratory rate, pale cool and clammy skin, kidney liver and other organ failure, severe acidosis, elevated lactic acid levels, worsening base access on ABGs, coagulopathies with petechiae purpura or bleeding. 291. What are the four types of shock?: Hypovolemic, Cardiogenic, Obstructive, & Distributive 292. What is the trauma triad of death?: hypothermia, acidosis, coagulopathy 293. Describe the characteristics of obstructive shock: Obstructive shock is it mechanical problem that results from hypoperfusion of the tissue due to an obstruction in either the vasculature or the heart resulting in decreased cardiac output. Some causes include a tension pneumothorax, cardiac tamponade, or venous air embolism on the right side of the heart during systole in the pulmonary artery.Signs include anxiety, muffled heart sounds, JVD, hypertension, chest pain, difficulty breathing, or pulses paradoxes. 294. Describe the characteristics of cardiogenic shock: Cardiogenic shock results from pump failure in the presence of adequate intravascular volume. Lack of cardiac output and an organ perfusion occurs secondary to a decrease in myocardial contractility and or valvular insufficiency. This can happen with blunt cardiac trauma or an MI. Symptoms can include low blood pressure increase heart rate and respiratory rate chest pain shortness of breath dysrhythmias increase troponin and pale cool moist skin 295. Describe the characteristics of distributive shock.: Distributive shock oc- curs as a result of Mel distribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. This can occur with spinal cord injuries, sepsis, or anaphylaxis. Symptoms include low blood pressure heart rate respiratory rate preload and afterload, spinal tenderness, difficulty breathing, warm pink and dry skin with a cool core temperature. TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 46 / 47 296. Describe the characteristics of hypovolemic shock: Hypovolemia is caused by a decrease in the amount of circulating volume usually caused by massive bleeding, but also can be from vomiting and diarrhea. Characteristics include low blood pressure and preload, increase heart rate respiratory rate and afterload, with contractility unchanged. Signs include obvious bleeding, weak peripheral pulses, pale cool and moist skin, distended abdomen, pelvic fracture, or bruise swollen and deformed extremities especially long bones. 297. What is the recommended fluid bolus for a trauma?: 500 ML's of warmed isotonic crystalloid. Ongoing fluid boluses of 500 ML's should be given judiciously with constant reassessments after administration. 298. What is the minimum permissive hypertension and a trauma patient?: A systolic of greater than or equal to 90 MMHG 299. What is the minimum permissive oxygenation level of a trauma patient?- : Greater than or equal to 94% 300. What is Cullen's sign and its significance?: Cullens sign is periumbilical bruising and is indicative of intraperitoneal bleeding 301. Define Cushing's triad: Bradycardia, progressive hypertension (widening pulse pressure), and decreased respiratory effort 302. What are the early signs of increased Intracranial pressure: headache, vomiting, behavioral changes that begin with restlessness and may progress to confusion, drowsiness, or impaired judgment 303. What are the late signs of Increased intracranial pressure: dilated, non-reactive pupil(s); abnormal motor posturing (flexion, extension, flaccidity); Cushing's triad, Unresponsive to per verbal and painful stimuli, bradycardia and decreased respiratory effort 304. What are the symptoms of a subdural hematoma?: Decreased LOC, nausea vomiting headache and ipsilateral pupillary changes 305. What is a trademark symptom of an epidural hematoma: Loss of con- sciousness then awake and alert then loss of consciousness 306. Define the characteristics of neurogenic shock: Distributive shock with a T6 or higher injury results and vasodilation, bradycardia, flushed warm dry skin. Risk for temperature instability. Nursing interventions include maintaining warmth and spinal stabilization. TNCC test prepA, TNCC Notes for Written Exam, TNCC Notes for Written Exam, TNCC Prep, TNCC EXAM, TNCC 8th Edition Study online at https://quizlet.com/_8zdlk7 47 / 47 307. Define the characteristics of spinal shock: Transient loss of function can include loss of reflexes and muscle tone below the level of industry with possible vascular response. 308. Describe the four types of spinal cord injury: Central cord injury results in greater weakness distally, anterior injury includes motor loss or weakness below the cord level of injury yet sensory is intact, Brown-Sequard (hemicord) is weak on one side with sensory deficit on opposite side, posterior cord syndrome although rare is when the patient is unable to use sense vibration in proprioception 309. Describe one fat embolism syndrome is most likely to occur in its characteristics: With longform fractures. Tachycardia, Thrombocytopenia, and petechiae rash. 310. What is the Munro-Kellie doctrine?: Within the skull 80% his brain, 10% is blood, and 10% is CSF. Any increase of any of the products results in increased intracranial pressure. 311. What are the treatment goals for a TBI?: O2 saturation > or equal to 95%, systolic blood pressure > or equal to 100 MMHG, ICP < 15 MMHG, CPP > or equal to 60 MMHG, normal glycemia, hemoglobin > or equal to 7 g/DL, sodium 135-145, osmotic diuretics, anti-emetics, sedatives, anticonvulsants, head of bed at 30°, and neck at midline