TNCC Final Exam 4: Trauma Nursing Core Curriculum Questions and Answers, Exams of Nursing

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TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc - ANSHOB 30 degrees A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritisA a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc - ANSHOB 30 degrees TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls D An unrestrained driver is brought into the emergency department following a frontal impact MVC. she is pale, anxious, and c/o SOB. what is the potential injury - ANSLumbar fx D elevated comaprtment pressure can be the result of - ANShemorrhage from within the muscle D pt with amputation of an index finger with a knife. amputaiton is brought in with pt. it is wrapped in sterile gauze with saline and sealed in a plastic bag. the next step amputation care is - ANSplace the bag on ice D restrained driver is involved in a severe head on MVC and presnts with a seatbelt mark along the neck and upper chest area. bilateral decreased breath sounds, hemoptysis and diffuse sub q emphysemato the neck and upper chest area - ANStracheobronchial injury D which of the following diagnostic intervention is most appropriate for the unstable pt with a suspectedinternal hemorrhage - ANSfocused assessment with sonography for trauma D which physiological change in airway of an odler adult pt places the pt at risk for difficult intubation - ANScervical arthritis A 5-year old child presents to the ED with bruises to the upper arms and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or primary survey. Which of the following is the priority nursing intervention? A) report your suspicion of the maltreatment in accordance with local regulations B) apply ice to the bruises and consult wound care C) engage in therapeutic communication to determine the MOI D) provide the family with injury prevention recourses - ANSA) report your suspicion of the maltreatment in accordance with local regulations A 20-year old male presents to the ED c/o severe lower abd pain after landing hard on the bicycle cross bars which performing an aerial BMX maneuver. Secondary assessment reveals lower abd tenderness and scrotal ecchymosis. Which of the following orders would the nurse questions? A) Fast exam TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS B) CT scan C) straight cath for urine sample D) ice and elevation of the scrotum - ANSC) straight cath for urine sample A 35-year old male presents with facial trauma after bring struck in the face with a baseball. a tear-drop shaped left pupil is noted on exam. What type of injury is suspected? A) oculomotor nerve palsy B) globe rupture *** C) Uncal herniation D) retinal detachment - ANSB) globe rupture A 36-year old female has a deformity of the left wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? A) apply a sling and elevate the extremity to the level of the heart. B) apply a splint and elevate above the level of the heart C) Apply a sling and elevate the extremity above the level of the heart D) apply a splint and elevate the extremity to the level of the heart. - ANSB) apply a splint and ELEVATE ABOVE THE LEVEL OF THE HEART A 49-year old restrained driver involved in a MVC presents to the trauma center c/o abd, pelvic, and bil lower extremity pain Vitals signs are stable. The nurse can anticipate all of these negative fast exam except which of the following? A. Diagnostic peritoneal lavage B. Serial FAST exams C. Abdominal and pelvic CT scans D. Serial abdominal assessments - ANSA) diagnostic peritoneal lavage The FAST exam is done at the bedside to identify pathological fluid in the abdominal and pelvic cavities. FAST exams reduce the use of more invasive diagnostic peritoneal lavage and can be repeated if clinical changes or hemodynamic changes occur. A negative FAST study does not rule out injury and may warrant a follow-up computed tomography scan. Serial FAST exams can identify increasing abdominal fluid collections from hemorrhage. Diagnostic peritoneal lavage/diagnostic peritoneal aspiration is performed by the surgical team to rapidly identify the presence of hemorrhage in patients who are hemodynamically unstable after trauma. A 56-year- male patient involved in a MVC is brought to the ED of a rural critical access facility. He c/o neck pain, SOB, and diffuse abd pain. His GCS is 15. His vitals are as follows: BP 98/71 HR 125 TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS beats/min RR 26 breaths/min SpO2 94% on high flow O2 via NRB mask TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS C) decreased WBC D) elevated GFR - ANSA) elevated creatine kinase A patient is thrown against a car during a tornado and presents with obvious bilateral femoral fractures. The patient is pale, alert, disoriented, and has delayed cap refill. Which of the following interventions would be most appropriate for this patient based on the disaster triage principle? A) initiate two large bore intravenous lines for Ringers lactate solution administration B) Administer Dilaudid for pain control and provide comfort care C) Place the patient in an observation area for care within the next few hours D) Contact the command center for the personnel to notify next of kin. - ANSA) initiate two large bore intravenous lines for Ringers lactate solution administration A patient with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? A) Bradycardia and ipsilateral absences of motor function B) Tachycardia and respiratory depression C) Tachycardia and absent motor function below the level of injury D) Bradycardia and absent motor function below the level of the injury - ANSD) Bradycardia and absent motor function below the level of the injury A patient with lower extremity fracture complains of severe pain and tightness in his calf, minimally relieved by pain medications. Which of the following is the priority nursing intervention? A) elevating the extremity above the level of the heart B) repositioning and apply ice C) Elevating the extremity to the level of the heart D) Preparing the patient for ultrasound - ANSC) Elevating the extremity to the level of the heart A trauma patient is en route to a rural ED. Radiology notifies the charge nurse that the CT scanner will be out of service for several of hours. The team gathers to plan accordingly. Which of the following terms best describes this trauma teams communication? A) Brief B) loop C) debrief D) huddle - ANSD) huddle TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A trauma patient is restless and repeatedly asking "where am I?" vital signs upon arrival were BP 100/60 mm Hg, HR 96 beats/min, and RR 24 breaths/min. Her skin is cool and TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS dry. Current vital signs are BP 104/84mm Hg, HR 108, RR 28 breaths/min. The patient is demonstrating signs and symptoms of which stage of shock? A) compensated B) Progressive C) irreversible D) decompensated - ANSA) compensated An elderly patient with a history of anticoagulant use presents after a fall at home that day. she denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. Which is a most likely cause of her symptoms? A) epidural hematoma B) diffuse axonal injury C) post-concussive syndrome D) subdural hematoma - ANSD) subdural hematoma An intubated trauma patient is being transferred to a tertiary care center. After moving the patient to the stretcher for transport, a drop in pulse oximetry to 85% is noted. Which of the following is the priority interventions? A) call for a portable CXR stat B) chest to make sure the ventilator is plugged in C) suction the ET tube D) confirm ET tube placement - ANSD) confirm ET tube placement An unresponsive trauma patient has an oropharyngeal airway in place, shallow and labored respiratory, and dusky skin. the trauma team has administered medications for drug assisted intubation and attempted intubation but was unsuccessful. What is the most appropriate immediate next step? A) Ventilate with a BVM B) Prepare for cricothyroidotomy C) administer reversal medications D) contact anesthesia for assistance - ANSA) Ventilate with a BVM Caregivers carry a 2-year old into the ED who fell out of 2nd story window. The patient is awake and crying with increased work of breathing and pale skin. which of the following interventions has the highest priority? A) padding the upper back while stabilizing the cervical TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS If a patient has received multiple transfusions of banked blood preserved with citrate, which electrolyte is most likely to drop and require supplementation? A) potassium B) magnesium C) sodium D) calcium - ANSD) calcium Patients with a crush injury should be monitored for which of the following conditions? A) Hypernatremia B) Hypercalcemia C) Dysrhythmias D) polyuria - ANSC) Dysrhythmias Tearing of the bridging veins is most frequently associated with which brain injury? A) epidural hematoma B) subdural hematoma *** C) diffuse axonal injury D) intracerebral hematoma - ANSB) subdural hematoma The most reassuring finding for a male patient with hop pain after a fall is which of the following? A) a normal prostate exam B) absence of abdominal distension C) a normal fast exam D) pelvic stability - ANSD) pelvic stability The nurse is caring for a 120 kg male is brought in after a warehouse fire and is calculating the patient's fluid resuscitation needs. He has painful red blistering to the entire surface of both upper extremities and superficial burns to the anterior chest. Using the modified Lund and Browder chart to calculate the total BSA burned, how much IV fluids would be administered in the first 8 hours? A) 2280 mL B) 3840 mL TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS C) 4560 mL D) 7680 mL - ANSA) 2280 mL (upper arm 4+4 / lower arm 3+3 / hand 2.5+2.5) = 19% TBSA. 120 kg x (2 mL) x (19% TBSA) = 4560 mL 4560 / 2 (half of fluids given in first 8 hours) = 2280 mL TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS The trauma nurse knows that placing a bariatric patients in a "ramped position" provides better visualization during the insertion of which device? A) Intraosseous line B) orogastric tube C) ET tube *** D) urinary catheter - ANSC) ET tube What bedside monitoring parameters are used to assess for adequacy of oxygenation and effectiveness of ventilation? A) pulse oximetry and capnogaphy ** B) respiratory rate and capnography C) pulse oximetry and respiratory rate D) capnography and capnometry - ANSA) pulse oximetry and capnogaphy What factor contributes most the kinetic energy of a body in motion? A) acceleration B) mass C) velocity D) inertia - ANSC) velocity What finding raises suspicion of complete spinal cord injury? A) Weakness in the lower extremities B) Priapism C) voluntary anal sphincter tone D) intact reflexes distal to the injury - ANSB) Priapism Which is the effect of hypothermia on the oxyhemoglobin dissociation curve? A) Hemoglobin does not readily release oxygen for use by the tissues B) The amount of oxygen available to the tissues increases C) Tissue oxygenation (PaO2) increases D) Hemoglobin molecule saturation (SaO2) decreases - ANSA) Hemoglobin does not readily release oxygen for use by the tissues Which of the following assessment findings differentiates a tension pneumothorax from a simple pneumothorax? A) increased work of breathing B) unilaterally diminished breath TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A) output of 200 mL/hr B) tubing clamp closed for transport C) dependent loops in the tubing to promote drainage TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS D) fluctuations in the water serial chamber - ANSD) fluctuations in the water serial chamber Which of the following is NOT considered goal-directed therapy of cardiogenic shock? A) controlled fluid boluses B) antidysrhythmic administration C) pericardiocentesis D) cardiac cath - ANSC) pericardiocentesis Which of the following is possible complication of positive-pressure ventilation? A) worsening pneumothorax B) worsening flail chest C) reabsorption of pleural air D) negative intrapleural pressure - ANSA) worsening pneumothorax Which of the following is true about the log roll maneuver? A) it causes less spinal motion than the lift and slide maneuver B) it is recommended for patients with unstable pelvic fractures C) it can worsen cord damage from an unstable spinal injury *** D) it does not increases the risk of life threatening hemorrhage from unstable injuries - ANSC) it can worsen cord damage from an unstable spinal injury Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? A) ABC B) MARC H C) AVPU D) VIPP - ANSB) MARCH Which of the following occurs during the third impact of a motor vehicle crash? A) The driver of the vehicle collides with the steering wheel B) the vehicle collides with a tree C) the aorta is torn at its attachment with the ligamentum arteriosum D) the airbag deploys and strikes the front seat passenger - ANSC) the aorta is torn at its attachment with the ligamentum arteriosum TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Which of the following patients warrants referral to a burn center? A) a 21- year old female with a partial thickness burn to the right forearm B) a 40-year old hypertensive male with a superficial burn to the back TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS D) 125 mL/hr - ANSB) 500 mL/hr A (AVPU) - ANSAlert. Will be able to maintain airway once clear. A (Primary Survey) - ANSAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ANSInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inhalation injury Auscultate: listen for obstructive airway sounds (ie. snoring, gurgling, stridor) Palpate: palpate for possible occlusive maxillofacial bony deformity, subcutaneous emphysema Airway Interventions: - ANSSuction Remove foreign body if noted Jaw thrust maneuver (maintain cspine) Nasopharyngeal airway (can be conscious) Oropharyngeal airway (no gag) Consider definitive airway Alertness Assessment - ANSA- Alert V-Verbal P-Painful U-Unresponsive B (Primary Survey) - ANSBreathing and Ventilation Breathing and Ventilation Assessment - ANSInspect: spontaneous breathing, symmetrical rise and fall, depth/pattern/rate of respirations, accessory muscle use, diaphragmatic breathing, skin color (normal, pale, flushed, cyanotic), contusions/abrasions/deformities (signs of underlying injury), open pneumothoraces (sucking chest wound), JVD, tracheal position, signs of inhalation injury Auscultate: presence, absence and equality of breath sounds at 2nd intercostal space midclavicular line and bases at the fifth intercostal space anterior axillary line Palpate: bony structures, possible rib fractures, SQ emphysema, soft tissue injury, JV pulsations at suprasternal notch or supraclavicular area Life-threatening pulmonary injuries requiring immediate intervention: open pneumothorax, tension pneumothorax, flail chest, hemothorax. Breathing and Ventilation Intervention - ANSBreathing absent: jaw-thrust maneuver, oral airway adjunct, assist ventilation with bag-mask device, TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS prepare for definitive airway TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Breathing present: NRB. Determine if ventilation effective: etCO2 35-45, SpO2 94% or higher. If ineffective: assist with bag-mask and determine need for definitive airway C (Primary Survey) - ANSCirculation and Control of Hemorrhage Cardiogenic Shock - ANSResults from pump failure in the presence of adequate intravascular volume. There is a lack of cardiac output and end- organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Acute causes - myocardial infarction, dysrhythmias or toxicologic pathologies. Heart failure is a chronic cause. Blunt cardiac injury may present similar to MI. Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. Circulation and Control of Hemorrhage Assessment - ANSInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade Palpate: carotid and/or femoral pulses for rate, rhythm, strength Circulation and Control of Hemorrhage Interventions - ANSControl and treat external bleeding: apply direct pressure, elevate bleeding extremity, apply pressure over arterial sites, consider use of a tourniquet. 2 large bore IVs, if unable consider IO, obtain labs and crossmatch. Initiate IVF of warmed isotonic crystalloid solution. Consider blood products after 2L. **Large volumes of fluid lead to dilution coagulopathy which worsens metabolic acidosis and may cause hypothermia. Component therapy, including administering RBC, plasma and platelets is a balanced approach so that O2 delivery is optimized, acidosis corrected and coagulopathy prevented. Classifications of Shock - ANSHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Consider bedside glucose. Distributive Shock - ANSOccurs as a result of maldistribution of an adequate circulating volume with a loss of vascular tone or increased permeability. Diffuse vasodilation lowers the systemic pressure, creating a relative hypovolemia or reduction of the mean systemic volume and venous return to the heart or drop in preload, resulting in distributive shock. Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth muscle and increases vascular permeability and vasodilation. Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation Neurogenic shock: loss of sympathetic nervous system control of vascular tone, which produces venous and arterial vasodilation. With the loss of sympathetic nervous system input in spinal cord injury, unopposed vagal activity may result in decreased cardiac output through bradycardia. TREATMENT: increase systemic resistance, controlled volume replacement. Vasoconstriction and in some cases (neurogenic) Atropine to counteract bradycardia. E (Primary Survey) - ANSExposure and Environmental Control Exposure and Environmental Control - ANSCarefully and completely undress the patient. Inspect for uncontrolled bleeding and note any obvious injuries. Prevent heat loss. Hypothermia combined with hypotension and acidosis is a potentially lethal combination in the injured patient. Consider: warm blankets, keep ambient temperature warm, warm IVF, forced air warmers, radiant warming lights. F (Primary Survey) - ANSFull Set of VS & Family Presence G (Primary Survey) - ANSGet Resuscitation Adjuncts: (LMNOP) L: Labs M: Monitor cardiac rate and rhythm N: Naso or orogastric tube consideration O: Oxygenation - SpO2 and/or etCO2 monitor P: Pain assessment and management GCS - ANSGCS TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS EYES TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens eyes spontaneously VERBAL 1. Makes no sounds 2. Makes sounds 3.Words 4. Confused, disoriented 5. Oriented, converses normally MOTOR 1. Makes no movements 2. Extension to painful stimuli (decerebrate) 3. Abnormal flexion to painful stimuli (decorticate) 4. Withdrawal to painful stimuli 5. Localizes painful stimuli 6. Obeys commands H (Secondary Survey) - ANSHistory Prehospital Report (MIST) M: MOI I: Injuries sustained S: Signs and symptoms in the field T: Treatment in field Patient History (SAMPLE): S: Symptoms A: Allergies and tetanus status M: Medications P: Past medical history L: Last oral intake E: Events and Environmental factors related to injury. H: Head and Face Head to Toe Assessment (secondary survey) - ANSSOFT TISSUE: Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Intraocular Foreign Body - ANS*TRUE EMERGENCY AND EARLY INTERVENTION IS ESSENTIAL. Findings: compromised visual acuity, misshapen pupils, pain Treatment: elevate HOB, ophthalmology, immobilize foreign body, patch UNAFFECTED eye to limit concomitant eye movement, globe closure ASAP, systemic and ophthalmic ABX, analgesics. Postop infection, retinal detachment and vision loss are common complications. lid injury - ANS Liver - ANSLargest solid organ of the body. RUQ, 6th to 10th ribs. Encased by Glisson capsule with blood vessels, lymphatics and nerves. Filters 1.7L of blood per minute. The liver filters out toxins, takes the nutrients and returns the blood to the heart via the hepatic veins. Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert ammonia to urea, secrete electrolytes, lipids, lecithin, cholesterol and bile. Metabolizes vitamin K and produces thrombin and fibrinogen (all necessary for clotting). Obstructive Shock - ANSResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. Tension pneumothorax - increased thoracic pressure leads to displacement of the vena cava, obstruction to atrial filling, decreased preload and decreased cardiac output. Cardiac tamponade - impedes diastolic expansion and filling leads to decreased preload, strokes volume and cardiac output and ultimately end organ perfusion. P (AVPU) - ANSPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) Reevaluation - ANSPortable radiograph - AP chest, pelvis. Can quickly identify potentially life-threatening injuries such as pneumothorax or pelvic fracture with uncontrolled internal hemorrhage. Can also confirm placement of ET tubes, chest tubes and gastric tubes. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Consider need for transfer. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS shock - ANSInadequate tissue perfusion. Spleen - ANSEncapsulated organ LUQ level of 9th-11th ribs and curves around a portion of the stomach. Minimal elasticity and flexibility - most frequent injured organ in blunt trauma. Secondary lymph organ that filters and cleanses the blood. Removes old RBCs and holds a reserve of blood. It recycles iron. It removes antibody- coated bacteria. Supplies lymphocytes to stimulate an immune response to blood borne microorganisms. Stores 200-300ml of blood and leads to hemodynamic instability quickly if damaged. Splenic Injuries - ANSIn blunt trauma the spleen may lacerate from increased abdominal pressure. Graded I-V, I = minor trauma Assessment findings: signs of trauma LUQ, abdominal distention, asymmetry, abnormal contour, tenderness, guarding, rigidity, pain left shoulder when supine. CT: Hemoperitoneum. Hypodensity - represents parenchymal disruption, intraparenchymal hematoma or subcapsular hematoma. Contrast blush or extravasation - hyperdense area that represent traumatic disruption. Active extravasation implies ongoing bleeding. Nonoperative management is preferred if hemodynamically stable, stable H/H x 12-24 hours, minimal transfusion requirements (<2units), grade I or II without blush, age <55, alert able to assist in assessment of abdomen. Surgical options: total splenectomy for severe injury, for less severe - direct pressure packing, embolization, splenorrhaphy (suturing spleen), partial removal. Asplenic patients have difficulty destroying encapsulated bacteria - Streptococcus pneumonia, Neisseria meningitides and Haemophilus influenza. At risk for pneumococcal sepsis. Need annual flu shot and q5yr meningococcal and pneumococcal vaccines. U (AVPU) - ANSUnresponsive. Does not respond to any stimuli. V (AVPU) - ANSVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) - ANSPrehospital shock index pg. 85 Injury: shearing or tearing. Diagnosed with MRI. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS stretch, they stimulate the sympathetic nervous system to release Epi, norepi, causing stimulation of cardiac activity and constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptors: ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... describes the concept of under treatment of pain. - ANSOligoanalgesia ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a principle that confuses on prevention rather than intervention. - ANSDamage control resuscitation ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a test that requires fluid to be sent to the lab and is considered the gold standard for identifying CSF - ANSBeta2-Transferrin ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is a triad of assessment findings; widening pulse pressure, bradycardia, and diminished respiratory effort - ANSCushing ( it is an attempt to increase MAP against elevated ICP, ultimately trying to cause a rise in CPP) ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral contusion ... is damaged brain tissue usually caused by blunt trauma - ANSCerebral TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS contusion TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is defined as the pressure gradient across the brain tissue, or the difference between the pressures of the cerebral artery and venous vessels. - ANSCPP; CPP = map - icp ... is the initial post traumatic inflammatory response activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the initial post traumatic inflammatory response activates this response and ... are sent to the injury sites, activating signaling pathways that mobilize inflammatory cells. - ANSImmune response; tissue hypoxia;neutrophils ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... is the shifting of brain tissue with displacement into another compartment as the result of bleeding or edema. - ANSHerniation ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain is persistent and usually lasts longer than 3 to 6 months. - ANSChronic ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral ... pain originates from organs and may lead to referred pain. (Trauma) - ANSVisceral TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS examples. - ANSDistributive; anaphylactic, septic and neurogenic ... shock occurs as a result of maldistribution of an adequate circulation blood volume with the loss of vascular tone or increased permeability. 3 examples. - ANSDistributive; anaphylactic, septic and neurogenic TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) ... shock results from hypoperfusion of the tissue due to an obstruction in either the vasculature or heart. Two examples include.... - ANSObstructive;tension pneumothorax, cardiac tamponade. (With tension pneumo the increase in intrathoracic pressure leads to displacement of the vena cava, obstruction to arrival filling leading to decreased preload and decreased cardiac output) ( with cardiac tamponade there is an accumulation of fluid in the pericardial sac impeding diastolic expansion and filling leading to decreased preload, stroke volume,CO and end organ perfusion) .... 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 constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... 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 constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors .... activation...are found in the carotid sinus and along the aortic arch, are TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS 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 constriction of blood vessels, which causes a rise in heart rate and diastolic blood pressure - ANSBaroreceptor activation; baroreceptors TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS ...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 - ANSChemoreceptors ...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 - ANSChemoreceptors ...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 - ANSChemoreceptors #1 Early Killer - ANSHemorrhage #1 Late Killer - ANSInfection & MODS `CPP - ANSMAP-ICP + gurgling over epigastrium - ANS-in stomach, pull out, preoxygenate, try again 1 Liter of O2 = % FiO2 - ANS4% 1 Liter of O2 = % FiO2 - ANS4% 1 unit of PRBC will raise HGB and HCT by how much? - ANSOnce hemostasis is achieve it is est that 1 unit will raise hgb by 1 g/dL and hct by 3%. 1. A- airway and Alertness with simultaneous cervical spinal stabilization 2. B- breathing and Ventilation 3. circulation and control of hemorrhage 4. D - disability (neurologic status) 5. F - full set of vitals and Family presence 6. G - Get resuscitation adjuncts L- Lab results (arterial gases, blood type and crossmatch) M- monitor for continuous cardiac rhythm and rate assessment TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS N- naso or orogastric tube consideration O- oxygenation and ventilation analysis: Pulse oxygemetry and end-tidal caron dioxide (ETC02) monitoring and capnopgraphy H- History and head to toe assessment I- Inspect posterior surfaces - ANSABCDEFGHI 1. Apnea TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS 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 - ANSFollowing conditions might require a definitive airway 1. bony fractures and possible rib fractures, which may impact ventilation 2. palpate for crepitus 3. subcutaneous emphysema which may be a sign for a pneumothorax 4. soft tissue injury - ANSPalpate the chest for 1. Check the presence of adequate rise and fall of the chest with assisted ventilation 2. Absence of gurgling on auscultation over the epigastrium 3. Bilateral breath sounds present on auscultation 4. Presence of carbon dioxide (CO2) verified by a CO2 device or monitor - ANSIf the pt has a definitive airway in what should you do? 1. Dyspnea 2.Tachycardia 3. Decreased or absent breath sounds on the injured side 4. CP - ANSSimple Pneumo assessment: 1. equal breath sounds bilaterally at the second intercostal space midclavicular line and the bases for fifth intercostal space at the axillary line - ANSAuscultate the chest for: 1. Get a CT 2. Consider ABG 's if decreased LOC 3. Consider glucose check - ANSD Interventions 1. Hypotension 2. JVD 3. Muffled heart sounds - ANSBecks Triad: 1. open the airway, use jaw thrust 2. insert an oral airway 3. assist ventilations with a bag mask 4. prepare for definitive airway - ANSIf breathing is absent.. 1. pain - hallmark sign, early sign 2. pressure - early sign 3. pallor, pules, paresthesia, paralysis - late sign - ANSSix P's of compartment syndrome: TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS -reassess airway after insertion of opa (no snoring heard) A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III A ... fracture is a complete craniofacial separation - ANSLefort III 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. - ANSTension pneumo intervention A a 22 yr old was struck by a vehicle while crossing the street, sustaining multiple fx she is alert and answering qestions and crying what is the best method for initial pain assessment for this pt - ANSself report scale A a pt sustrained a penetrating injury of his upper leg. the pre hospital personnel states a large amount of blood loss before hemostasiswas achieved. he presents to the ER responding to painful stimuli with moaning. he is tachy 142 b/p 104/96 and RR 24 - ANSdecompensated A an unrestrained driver was involved in a frontal collision without airbag deployment. he is hypotensive and tachycardic with shallow respirations, distended JVD and muffled heart tones the nurse prepare for what - ANSpericardiocentesis A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A body at rest will remain at rest, a body in motion will stay in motion - ANSNewton's first law A breath every 5 to 6 seconds: 10-12 ventilations per minute - ANSBag mask ventilation A during assessment of an extremety with suspected pulses are - ANScan be normal A for a ptwho has undergone recent bariatric surgery, flouroscopy is recommended to place - ANSNG tube A identification of vulnerabilities is an example of what phase of disaster management - ANSmitigation TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A in mass casualty "doing the greatest good for the greatest number of people refers to a situation where - ANSthere may be more patients than resources A in neurogenic shock, alterations in vital signs include hypotension and which other abnormal VS - ANSbradycardia A In the primary survey AVPU is performed to determine if the patient can: - ANSProtect their aiway A moderately dilated pupil with sluggish response may be an early sign of what? - ANSherniation syndrome from increased ICP A prego trauma pt develops tachy, hypotension, a rigide board like uterus, and dark, red vaginal bleeding. she reports constant back pain which is increasing. the most likely cause of s/s is - ANSplacental abruption A several groups of people are at higher risk for maltreatment including children, elderly, prego, and ... - ANSpt's with disability A the nurse is preparing to cleanse an extensive abrasion contaminated with dirt and gravel. which of the following intervention is indicated - ANSus copious amounts of NS A The systemic inflammatory response is a normal part of the body's response to shock from traumatic injury. what best describes this response - ANSit is activated by tissue hypoxia and sends neutrophils to injury site A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) - ANSIntentional;unintentional A what is an early assessment finding to increased ICP in pt with a brain injury - ANSvomiting A when providing care for the pedicatric pt with burns the post resuscitation care, how are fluids delivered - ANSparkland formula with maintainence fluidss A which of hte following nursing interventions would be best for traumitc - ANSHOB 30 degrees TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS A which of the following structures would be hte most affected by teh concept of caviation - ANSLiver A which of the following values is within the acceptable limits for trauma pt - ANSend tidal CO2 of 40 A- Alertness, Airway, Cspine - ANS-*APVU -*Hold c-spine and use jaw thrust if not talking (2 people) -*Determine patency and protection of airway using inspection, palpation, auscultation -*States need for OPA ABCDEFG(LMNOP)HI - ANSAirway+Alertness Breathing+Ventilation Circulation/Control of Hemorrhage Disability (neuro stat) Exposure/Environmental Control Full set of vitals + family Get resuscitation adjuncts -monitor cardiac rhythm, naso/gastric tube, oxygen, ETCO2, pain History +Head to toe Inspect posterior surface Abdominal Compartment Syndrome - ANSgut swelling, inflammatory process use foley catheter to measure pressure in bladder, if bladder pressure high=high intra- abdominal pressure Across-the-room Observation - ANSassess for obvious uncontrolled hemorrhage 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 - ANSChemoreceptors: Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF Adequate perfusion of oxygen and supply of nutrients to the brain tissue is dependent on ... and ... - ANSCPP; CBF TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS anaphylactic shock - ANSDistributive shock A severe reaction that occurs when an allergen is introduced to the bloodstream of an allergic individual. Histamines are released which cause bronchoconstriction, labored breathing, widespread vasodilation, increased vascular permeability, circulatory shock, and sometimes sudden death. any deformities? bleeding? contusions, lacs? skin temp?? place splints on deformities, pulses - ANSHead to toe assessment: Extremities any lacs? deformities? blood at the urtheral meatus palpate pelvis with high pressure over the iliac wings downward and medially - ANSHead to toe assessment: pelvis and perineum Aortic Dissection - ANSUnequal extremity pulse strength possibility of.. Aortic injuries - ANSmay not have pulses in LE or one arm 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 - ANSC Interventions: As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult As ICP increases CPP decreases resulting in ... - ANSCerebral ischemia, hypoxemia and lethal secondary insult TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS ask pt to pen his or her mouth - ANSWhile assessing airway the patient is alert and responds to verbal stimuli you should.. Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Assessment findings with maxillary fractures include - ANSFacial edema, ecchymoses and diplopoa (lefort III) Avoid when administering oxygen/ventilation - ANShyperoxia Avoid when administering oxygen/ventilation - ANShyperoxia AVPU - ANSAlert, Verbal, Pain, Unresponsive AVPU - ANSID pt Need intubation B - ANS-Determine breathing effectiveness -state need for assisted ventilation with bag-valve mask device -assess ET placement -Et secure, number at teeth documented -need for manuel ventilation B a pt father arrives in teh ER and needs to be told his son was severely injured in a MVC and is in surgery, the father si agitated, yelling, and smells of alcohol. in planning to talk with the father the trauma nurse will - ANSdeliver information regarding the son;s care in a calm voice B a pt involved in an MVC develops asymmetric pupillary reactivity, bilateral pupillary dilation and abnormal motor posturing. what does the nurse suspect as the most likely cause - ANSherniation syndrome B a pt with injury to the middle meningeal artery is at risk for which of the following - ANSepidural hematoma B an occlusive dressing has been applied to a pt with a penetrating injury to the chest. upon assessment the nurse notes that the patient is in respiratory distress nad has absnet breath sounds on hte affected side. what is the priroruty intervention - ANSremove the dressing to the wound TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS B an unrestrained driver inlvolved in a MVC in which alcohol was involed. he denies any pain and numbness and tinlging. according to NEXUS critera which factors indicate need for radiological - ANSsuspected alcohol abuse B Demonstrates and describes techniques for determining breathing effectiveness using components of inspection, auscultation, and palpation. identifies at least FOUR - ANS-is there spontaneous breathing -is there symmetrical chest rise -what are the depth, pattern and rate of respirations -is there increased work of breathing -skin color -open wounds or deformities, subcutaneous emphysema -tracheal deviation or jugular venous distention -great sounds present and equal B pt to ER after being pinned to brick retaining wall. knwoing crushing injuries can result to significant damage to muslces the priority asessment for trauma nruse is for - ANSmyoglobinemia nd renal failure B the most common cause of shock in the trauma pt is - ANSloss of circ volume B the unrestrained fron seat passenger in a MVC develops echymosis around umbillicus. this assessment finding is most commonly associated with: - ANSbleeding in the peritoneal cavity B thinning skin and diminished autonomic response in older adult can have what effect on primary assessment - ANScompromised thermoregulation B when assessing a pt following a MVC the nurses asks how fsat the car was going - ANSwhen volocity is doubled speed is quadroupled B WHich may lead to unreliable pulse ox reading - ANScarboxyhemoglobin B which of hte following significant assessment findigns is frequently found in a patient with complete cransiofacial separation involving the maxilla, zygoma, orbits, and bones of the cranial base. - ANSdiplopia B which of the following hemodynamic support strategies is the prioririty intervention for a pt with traumatic pulmonary contusion - ANSjudicios use of IV fluids B-breathing and ventilation - ANS-*determine effectiveness of breathing using inspection, palpation, auscultation -*state need for BVM (10-12/min) Baby ok TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS C effective pain management in hte pt iwth rib fxwill promote what - ANScough with ability to clear secretions C properly restrained 6 wk old kid was involved in a MVC. after the assessment and stabilization the pt becomes more difficult to rouse. responding with a weak cry to painful stimuli. the pupils remain brisk and reactive. the anterior fontanel is soft and flat. what is the most likely cause and pririty interventions - ANShypoglycemia C What are the primary benefits of a team approach to trauma care - ANSit provides a systemic approach to care and organizes care C what organ might be injured in left lower rib fx - ANSspleen C which of the following would be priority intervention for a pt with multiple rib fractures and chest wall instability follwoing a mvc collision - ANSassist with endotracheal intubation C which of the follwoing is a risk factor for DVT in the trauma pt. - ANSpelvic fx C-circulation and hemorrhage - ANS-*determine adequacy of circulation using inspection, auscultation, palpation -assess medic line -*2nd large bore IV, warm crystalloid infusing at controlled rate if not shocky 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 - ANSSimple Pneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ANSPneumothorax 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 TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS closure surgical repair. - ANSOpen Pneumo: TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Capnography monitors numeric value, as well as continuous waveform, indicating real- time measurement and trending over time. - ANSQuantitative: Cardiac Tamponade - ANScompression of heart due to fluid accumulation within pericardium Cardiac tamponade - ANSPericardial window Cardiogenic - ANS-ineffective perfusion caused by inadequate contractility of heart -blunt cardiac injury -pressors, dop, epi, NO FLUIDS Cardiogenic shock - ANSAntiarrythmics Care of Amputations - ANS-Remember ABCDs -Focus on Life-Threatening Injuries -Circulation: control bleeding, elevate & apply pressure on artery -Vasoconstriction reflex: decreases bleeding Save life over limb! Cause of Spleen & Liver Injuries - ANSMVC/T-bone Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces Caused by a sudden stop of the body's motion - ANSDeceleration forces 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. - ANSHemothorax: Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces Caused from a sudden and rapid onset of motion ( a Parker car being hit by another vehicle) - ANSAcceleration forces TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS -RR over 35 - Ultimately leads to organ failure and death CO - ANS=stroke volume+HR Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Co2 ... causes dilation of cerebral arterial vasculature and increased blood flood and increased ICP causes constriction and decreased blood flow.! - ANSHypercapnia; hypocapnia Collaborative Care of Flail Chest - ANS-Adequate Oxygenation-100% mask -Monitor for Hypoxemia-ABGs, SpO2 -Pain Management-Intercostal Block, Epidural, PCA -Possible Mechanical Ventilation Collaborative Care of Tension Pneumothorax - ANS-Oxygen -Needle Thoracentesis -Heimlich Valve: one way valve, allows air out but not in -Monitor SpO2, ABGs, RR, depth, BS -Chest Tube Collaborative Care: Early Phases - ANS-Airway, Breathing, Oxygenation -Circulation, Perfusion -IV Fluids -PRBCs first -Possible Vasopressors -Positioning: Modified Trendelenberg -Pain Control -Antibiotics -Tetanus Prophylaxis Collaborative Management of Pelvic Fractures - ANS-Prevent/Control Hemorrhage & Shock -Stabilize Pelvis -Bed rest> 5 days (risk of DVT) Collaborative Management of Spleen & Liver Injuries - ANS-Medical: monitor, Serial H/H TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS -Surgical: repair vs remove organ (better not to remove) -Supportive Treatment: O2, blood, fluids, vasopressors Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - ANSCardiac Tamponade Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. - ANSCardiac Tamponade Colorimetric CO2 detectors provide info about the presence or absence of CO2. A chemically treated indicator strip changes color revealing the presence or absence of exhaled CO2 - ANSQualitative Compartment syndrome - ANSPain Pulse Pallor Pressure Paralysis Parasthesi a Compensated stage - ANS-SBP is normal, rising DBP, tachy bounding, lactate builds up Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. - ANSLeFort III Complications of Abdominal Compartment Syndrome - ANS-Decreased Venous Return b/c gut pushing on vena cava -Falsely elevates CVP -Pushes on Diaphragm Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Control bleeding with direct pressure, elevate, apply tourniquets. - ANSAmputation CPP range - ANS50-70 Crush Injuries - ANS-Skeletal muscle damage causes Myoglobin release= Rhabdomyolysis --> Myoglobinuria -Soft Tissue swelling -Pain -Compartment Syndrome -Loss of Neurovascular Integrity distal to injury -Possible Bone injury -Life-threatening if involves legs or pelvis Crush injury - ANSMyoglobinuria Renal failure CT Scan - ANS-more expensive -Diagnoses Retroperitoneal & Intraperitoneal Bleeding -need to stabilize patient first Cthe term worried well when refering to disaster preparedness planning refers to: - ANSindividuals hwo think they have been affected by the event but are asymptomatic Cthe trauma nurse would prepare for a definitive airwya for which of the following condition. - ANSGCS of 8 or ls Cullen sign - ANSbruising around umbilicus Cullen's Sign - ANSEcchymosis in Umbilical Area, Associated with Intraperitoneal Bleeding Cushing - ANSpressure on brain stem causes wide pulse pressure, brady, decreased RR Cushing response - ANSTraid of widening pulse pressure, reflex brady, diminished resp effect. Attempt to incrased MAP against an elevated ICP causing a rise in CPP Cushing's triad/response - ANSr/t loss of auto regulation due to ICP Signs of increased intracranial pressure: 1. hypertension 2. bradycardia 3. irregular respirations D - ANSdisability (neurologic status) Define Severe Head Trauma. - ANSPostresuscitative state with GCS score Define Severe Head Trauma. - ANSPostresuscitative state with GCS score Define Severe Head Trauma. - ANSPostresuscitative state with GCS score TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total An open pneumothorax results from wound through chest wall. Air enters pleural space Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total An open pneumothorax results from wound through chest wall. Air enters pleural space Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total An open pneumothorax results from wound through chest wall. Air enters pleural space Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total An open pneumothorax results from wound through chest wall. Air enters pleural space Define Pneumothorax. - ANSResults when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total An open pneumothorax results from wound through chest wall. Air enters pleural space collapse of lung may both through the wound and collapse of lung may both through the wound and collapse of lung may both through the wound and collapse of lung may both through the wound and collapse of lung may both through the wound and Immediate decompression should be performed. Treatment should not Immediate decompression should be performed. Treatment should not Immediate decompression should be performed. Treatment should not Immediate decompression should be performed. Treatment should not Immediate decompression should be performed. Treatment should not TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Intubation is recommended Define tension pneumothorax. - ANSLife-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 compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, Define tension pneumothorax. - ANSLife-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 compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, Define tension pneumothorax. - ANSLife-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 compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, Define tension pneumothorax. - ANSLife-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 compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, Define tension pneumothorax. - ANSLife-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 compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension hypotension hypotension hypotension hypotension TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more Define uncal herniation. - ANSThe uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more Definitive treatment of a Tension Pneumothorax - ANSChest Tube demonstrates and describes techniques for determining latency of airway using inspection, ausculataton, and palpation. Identifies at least FOUR - ANS-is tongue obstructing airway -are there any lose or missing teeth -are there any foreign bodies is there any blood, vomitus or other secretions -is there any edema -is there any snoring, gurgling, or stridor Depressed - ANSextends below surface of head Describe a Grade I Hyphema. - ANSBlood occupying less than one third of the anterior eye chamber. Describe a Grade II Hyphema. - ANSBlood occupying one third to half of the anterior eye chamber. Describe a Grade III Hyphema. - ANSBlood occupying half but less than total filling of the anterior eye chamber. Describe a Grade IV Hyphema. - ANSBlood occupying the entire anterior eye chamber. common of the two types of herniation common of the two types of herniation common of the two types of herniation common of the two types of herniation common of the two types of herniation Do not place in head trauma patients - Do not place in head trauma patients - TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Disruptions of the bony structures of the skull can result in what? - ANSDisplaced 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 entrance for invading bacteria. Disruptions of the bony structures of the skull can result in what? - ANSDisplaced 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 entrance for invading bacteria. Disruptions of the bony structures of the skull can result in what? - ANSDisplaced 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 entrance for invading bacteria. Disruptions of the bony structures of the skull can result in what? - ANSDisplaced 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 entrance for invading bacteria. Distributive - ANSNeurogenic Septic Anaphylactic don't forget flanks!!! inspect of lacs, puncture wounds, contusions, Also: meningitis or encephalitis or brain Also: meningitis or encephalitis or brain Also: meningitis or encephalitis or brain Also: meningitis or encephalitis or brain Also: meningitis or encephalitis or brain TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS auscultate then palpate: bowel sounds? any rigidity, guarding? begin with light palpation start to palpate with side that does not hurt maybe do a fast scan? - ANSHead to toe assessment: Abdomen DOPE - ANSDisplace, obstructed, pneumo, equipment Dry chem exposure - ANSRemove pt clothing Dx of Spleen & Liver Injuries - ANSCT, DPL, FAST E - ANSExposure and environmental control -remove all clothing and inspect for uncontrolled bleeding or obvious injury -keep pt warm (blankets, warming lights, increased room temp, warmed fluids, warmed oxygen E-exposure - ANS-*need to remove all clothing and inspect for hemorrhage, injury, deformity -warm patient- blankets, fluids, temp -forensics Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early findings of increased ICP include - ANSHeadache, nausea and vomiting, amnesia, behavior changes, altered level consciousness Early sign of Increased ICP - ANSN/V Early signs of ICP - ANSDecreased LOC - Amnesia Behavior changes- impaired judgment, restlessness, drowsiness) Pupil changes Vision abnormalities (brain swelling is putting pressure on the optic and oculomotor nerves) Headache Vomiting (pressure on the vagal nerve center of the brain that controls vomiting) Nuchal rigidity TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Early signs of ICP increase, CPP decrease - ANSNV, Ha, amnesia, AMS, LOC Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Energy can neither be created nor destroyed but rather I can change form - ANSLaw of conservation of energy Epidural hematoma - ANStemporal or parietal skull that lacerate the meningeal artery younger population, with skull fx, rapid accumulation of arterial blood in space transient LOC, rapid deterioation ETT - ANS-tube in trachea with cuff inflated -GCS<8 -inhalation injury, unable to breath due to pain, apnea, high risk for aspiration/decompensation Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Examples that can cause distributive shock - ANSAnaphylactic shock, septic shock, neurogenic shock Explain adrenal gland response. - ANSWhen 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. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Some causes: - MI - Blunt cardiac injury TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS - Mitral valve insufficiency - dysrhythmias - Cardiac Failure Explain Distributive Shock. - ANSResults 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 involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults 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 involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults 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 involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults 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. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Distributive Shock. - ANSResults 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 involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Hepatic Response. - ANSLiver can store excess glucose as glycogen. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Irreversible Shock. - ANSShock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion - Membranes of lysosomes breakdown within cells and release digestive enzymes that cause intracellular damage. Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume 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 Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume 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 Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS Some causes: TNCC FINAL EXAM 4 LATEST VERSIONS 2023-2024 CONTAINS 500 QUESTIONS AND CORRECT ANSWERS (VERIFIED ANSWERS)TEST BANK |ALREADY GRADED A+|100% COMPLETE PASS - 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 Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume 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 Explain Obstructive Shock. - ANSResults from inadequate circulating blood volume 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 Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Pulmonary Response. - ANSTachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen