Download TNCC Notes for Written Exam latest 2023-2024 TEST BANK (6).pdf and more Exams Nursing in PDF only on Docsity! TNCC NURSING PROCESS 2024 | ALREADY GRADED A+ TESTBANK|100% COMPLETE A - primary survey - ANS- Across the room - Airway - Alertness (AVPU) B - primary survey - ANSBreathing and ventilation C - primary survey - ANSCirculation and bleeding (control of hemorrhage) D - primary survey - ANSDisability (neurologic status) - GCS E - primary survey - ANS- Expose - Environment control F - primary survey - ANS- Full set of vitals - Facilitate family presence G - primary survey - ANS- Get monitoring devices - Give comfort (LMNOP) GCS - part of D (disability (neurologic status) - ANSE/4 - spontaneous/4, speech/3, pain/2, none/1 V/5 - oriented/5, confused/4, inappropriate/3 incomprehensible/2, none/1 M/6 - obeys/6, localizes/5, withdraws/4, decorticate/3, decerebrate/2, none/1 H - secondary survey - ANS- Head-to-toe assessment (LACE (secondary assessment) - History: MIST (pre-hospital) and SAMPLE (pt hx) I - secondary survey - ANSInspect posterior surfaces J - secondary survey - ANSJust keep re-evaluating L - ANSLabs LACE - part of H (head-to-toe) - ANSlacerations, abrasions/avulsions, contusions, edema/ecchymosis M - ANSMonitor - obtain HR and rhythm MIST - part of (H) pre-hospital report in secondary survey - ANSM - MOI I - injuries sustained S - S/Sx in the field