TNCC Trauma Nursing Core Course 12th Edition ENA Test Bank: Practice Questions and Answers, Exams of Nursing

Download TNCC Trauma Nursing Core Course 12th Edition ENA Test Bank: Practice Questions and Answers and more Exams Nursing in PDF only on Docsity! TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ 1. Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ansQuestion 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient. 1. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) D. Subdermal (fourth degree) - ansQuestion 1: B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn. 1. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ansQuestion 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients. 1. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. You note gurgling respirations. Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient? A. It's an easy technique that always works to open the airway. B. It allows you to open the airway with little or no movement of the head and cervical spine. TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ C. Other techniques and interventions don't work as well. D. It can relieve a variety of anatomic airway obstructions in patients who are breathing spontaneously. - ansQuestion 1: B Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway maneuver you should make when treating a trauma patient. In patients with suspected head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line position.The trauma jaw thrust maneuver allows you to open the airway with little or no movement of the head and cervical spine. 1. You are responding to a call for 25-year-old, fit and healthy female who fell off a mountain bike. Upon arrival, you find the patient walking around. She is alert but complaining of pain in her clavicle and on her right side when she inhales. You notice that her helmet is split in two. What is the first thing you need to do? A. Complete a review of the ABCs. B. Check motor and sensory function. C. Perform manual in-line stabilization. D. Place her on a backboard. - ansQuestion 1: C Because there's a possibility of spinal injury, you should bring the patient's head into a neutral in-line position. 1. You have been performing ongoing management on a 35-year-old female patient who sustained thoracic trauma when a car hit her as she crossed the street. Originally, your electronic monitoring devices all produce results consistent with your patient's clinical condition. However, en route the trauma center, the monitors start to differ from your patient's current clinical condition each time you reassess. How should you handle this situation? A. Treat the patient's condition, not the monitor results. B. Continue to reassess the patient and record the results for the trauma center. C. Treat your patient based on the test results. D. Stop testing and wait until you arrive at the trauma center for them to perform an assessment. - ansQuestion 1: A If there are inconsistent data from electronic monitoring devices, reassess to be sure the monitor matches the patient's current clinical condition. However, it is most important to treat the patient, not the monitor, so use other signs and symptoms of potential patient deterioration. 1. You're called out to an assisted living facility for a 72-year-old woman complaining of a severe headache and experiencing increased confusion. Staff reports she fell out of her wheelchair earlier in the week but didn't appear to be hurt; however, she's become increasingly disoriented over the last day or so. Vital signs show: BP 110/90; heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored; SpO2 93% on room air. She is taking warfarin for a clotting issue. Which of the following should you suspect? A. Cerebral contusion B. Epidural hematoma C. Subarachnoid hemorrhage TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ 2. Upon examination, you find the patient responsive to your presence, although she is clearly confused. Motor response shows reduced pain response but normal flexion. What's her GCS score? A. 15 B. 12 C. 10 D. 8 - ansQuestion 2: B Eye opening: 4; verbal response: 4; motor response: 4 = 12 2. When using the XABCDE assessment, which of the following takes precedence over all other actions? A. Controlling severe bleeding from a limb or other compressible site B. Airway stabilization and assessing circulatory status C. Exposing the body to allow a thorough evaluation D. Ensuring adequate breathing - ansQuestion 2: A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time. 2. You are responding to a call to an MVC involving one patient. When you perform your primary survey, you find a patent airway, but abnormalities with breathing and circulation. You suspect hypovolemic shock, but cannot determine the source. What does this finding most likely indicate? A. Hemothorax B. Intra-abdominal bleed C. Blunt cardiac injury D. Diaphragmatic rupture - ansQuestion 2: B The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic shock from an unexplained source. 2. You have determined that you are going to need to perform orotracheal intubation on a 50-year-old male motor vehicle crash (MVC) critically injured trauma patient due to prolonged transport time. What do you need to do first? A. Preoxygenate to maximize oxygen saturation. B. Place the patient in a "sniffing"position. C. Clear the mouth of any obstructions. D. Prepare the patient for immediate transport. - ansQuestion 2: A Before insertion of any invasive airway, the patient is preoxygenated with a high concentration of oxygen using a simple airway adjunct or manual airway procedure. 3. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ A. Lance the blisters to drain the fluidand relieve the pressure. B. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. C. Use a topical antibiotic ointment and firmly wrap the burn injury. D. Establish an IV for fluid resuscitation. - ansQuestion 3: B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing. 3. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ansQuestion 3: B A total GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI. 3. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart C. Tourniquet D. Occlusive dressing - ansQuestion 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow. 3. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ansQuestion 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis. 3. Which of the following is the basis on which a patient's chance of survival is maximized? A. Preferences B. Phases C. Principles D. Transport - ansQuestion 3: C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome. 3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still confused, and you still have no radial pulse. Your next move is to: A. give 1-L fluid bolus. TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ B. give one 250-mL fluid bolus, and then stop. C. give fluid until you get a radial pulse. D. administer TXA. - ansQuestion 3: C Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids. 3. Why might it be more difficult to deal with an airway obstruction in a child? A. Children have longer tracheas. B. Children have larger heads and tongues so there is a greater potential for airway obstruction. C. Children have smaller heads, so there is less room to clear the obstruction. D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway. 3. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2 (ETCO2) monitoring aiming to maintain what level? A. Between 40 and 45 mm Hg B. Between 30 and 35 mm Hg C. Between 35 and 40 mm Hg D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C The proper level to maintain is between 35 and 40 mm Hg. 3. You are transporting a 37-year-old male patient with a suspected intraabdominal bleed. His blood pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid resuscitation for this patient? A. Aggressively administer IV fluids to compensate for internal blood loss. B. Do not administer IV fluids to patients with intra-abdominal bleeding. C. Obtain the patient's medical records and resuscitate to his normal blood pressure reading. D. Carefully administer IV fluids to raise the patient's systolic blood pressure to between 80 and 90 mm Hg. - ansQuestion 3: D Abdominal trauma represents one of the key situations in which a balanced resuscitation is indicated. Aggressive administration of IV fluid may elevate the patient's blood pressure to levels that will disrupt any clot that has formed and result in recurrence of bleeding that had ceased because of blood clotting and hypotension. Prehospital care practitioners must achieve a delicate balance: maintain a blood pressure that provides perfusion to vital organs without restoring blood pressure to elevated or even normal ranges, which may reinitiate bleeding sites in the abdomen or pelvis. In the absence of TBI, the target systolic blood pressure is 80 to 90 mm Hg (mean arterial pressure of 60 to 65 mmHg). TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues. 5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital. C. Yes, he will need platelets and a heart surgeon ASAP. D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent platelet transfusion. 6. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated state after a TBI? A. CSF, ICP, heart rate, and blood pressure are still within normal range. B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases. C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range. D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ansQuestion 6: C In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY ch. 5, p. 45 , which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - ansHYPERVENTILATION ch. 7, p. 74 55% of spinal injuries occur to which part of spine? - anscervical ch. 13, p. 179 A rapid, thready pulse may indicate (a. ), and an irregular pulse may warn of potential (b. ). - ansa. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the resuscitation. An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation of hydrogen ions and metabolic acidosis. ch. 5, p. 46 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use) - NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores. ch. 7, p. 77 Additional history includes the following (MIST mnemonic) prehospital report: - ans- MOI - Injuries sustained - Signs and Symptoms (in the field) - Treatment (in the field) ch. 5, p. 47 All open fractures are considered contaminated due to exposure to the environment and are at risk for infection. These sites of injury have poor wound healing with a risk of.... - ansOSTEOMYELITIS and SEPSIS ch. 14, p. 197 Anterior cord syndrome - ansloss of pain and temperature sensation with weakness, paresthesia, and urinary retention ch. 13, p. 182 AORTIC DISRUPTION - ansAssessment findings - Fractures of sternum, first or second rib or scapula - CARDIAC MURMURS - BACK, CHEST PAIN TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - UNEQUAL EXTREMITY PULSE STRENGTH or BLOOD PRESSURE (Significantly greater in upper extremities) - HYPOTENSION - TACHYCARDIA - SKIN CHANGES: diaphoresis, pallor, cyanosis - PHARAPLEGIA (due to disruption of spinal perfusion from aortic injury) - Radiograph findings include- left hemothorax, right-sided tracheal deviation, widened mediastinum Interventions - Prepare for surgery or angiography - Consider massive transfusion protocol ch. 11, p. 146 Are the lumen contents of the small bowel considered sterile? What is the pH? - ansneutral pH, and sterile ch. 12, p. 164 As ICP rises, CPP , resulting in cerebral ischemia, hypoxemia, and lethal secondary insult. - ansDECREASES Ch. 9, p. 109 As shock progresses, primary goal of the body is to maintain perfusion to vital organs. Sympathetic stimulation has little effect on the cerebral and coronary vessels since they are capable of autoregulation. Cerebral autoregulation maintains a constant... - anscerebral vascular blood flow as long as the MAP is maintained between 50-150... when autoregulation in the brain fails, perfusion becomes dependent solely on pressure. ch. 7, p. 78 Assess pupils for... - ansEquality, shape, and reactivity (PERRL) ch. 5, p. 45 Assessment findings for MILD, MODERATE, and SEVERE TRAUMATIC BRAIN INJURY INCLUDE: - ansMILD - GCS 13-15 - Brief (<30 min) LOC - POST-TRAUMATIC AMNESIA < 24 hours - No change on neuron aging studies MODERATE - GCS score 9-12 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - CONTRALATERAL HEMIPARESIS Ch. 9, p. 114 Assessment findings of DIFFUSE AXONAL INJURY - ans- UNCONSCIOUSNESS Mild DAI lasts 6-24 hrs Severe DAI lasts weeks to months - INCREASED ICP - ABNORMAL POSTURING - HTN (systolic BP between 140-160) - HYPERTHERMIA (104-105 F) - EXCESSIVE SWEATING - MILD TO SEVERE MEMORY LOSS; COGNITIVE, BEHAVIORAL, and INTELLECTUAL DEFICITS Ch. 9, p. 116 AXIAL LOADING - ansetiology/cause- direct force transmitted along the length of vertebral column rest of injury- deformity of vertebral column, secondary edema of spinal cord resulting in neurologic effects example- diver striking head on bottom of pool ch. 13, p. 179 Because calcium is a vital part of the clotting casade, hypocalcemia, as a result of a massive transfusion, can actually worsen hypovolemic shock by... - ansPermitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 BLUNT ESOPHAGEAL INJURY - ansInjury to esophagus, rare, results form blunt trauma Assessment findings include - AIR in MEDIASTINUM with possible widening - CONCURRENT LEFT PNEUMOTHORAX or HEMOTHORAX - ESOPHAGEAL MATTER IN CHEST TUBE - SUBCUTANEOUS EMPHYSEMA Interventions - Prepare for surgery TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Ch. 11, p. 143 Brown-squared syndrome - ansContralateral loss of pain and temperature sensation and ipsilateral paralysis with reduced touch sensation ch. 13, p. 182 CARDIAC TAMPONADE - ansAssessment findings Beck's Triad- HYPOTENSION, MUFFLED HEART SOUNDS, DISTENDED NECK VEINS - CHEST PAIN - TACHYCARDIA - DYSPNEA - CYANOSIS - Pulsus paradoxus greater than 10 mm Hg Interventions - Prepare for pericardial decompression - 3 to 4 cm incision made just left of xiphoid process - Needle percardiocentesis may also be used to relieve symptoms of cardiac tamponade but its only temporary solution ch. 11, p. 146 Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include: - Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high- velocity cavitation relatively well compared to other tissues - Solid organs such as the liver, have a greater propensity to shear or tear under the same forces - If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 Central cord syndrome - ansloss of motor function in upper extremities that is greater than that of lower extremities. often sacral sparing. bladder function may be affected ch. 13, p. 182 Classifications of acute pain are based on the source and origin and include... - ansSOMATIC pain originates from skin and muscloskeletal structures TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Components of CUS and its purpose - ansC: I am Concerned U: I am Uncomfortable S: This is a Safety issue/ I am Stressed Purpose- used to "stop the line" if a team member senses or discovers an essential safety breach p. 7 Components of DESC and its purpose - ansD: Describe the specific situation or behavior E: Express your concerns or how the situation makes you feel S: Suggest alternatives and seek agreement C: State consequences in terms of impact on performance goals Purpose- used in conflict management; paraphrasing the other person's comments is an important technique that should be done throughout the DESC script. Following discussion of consequences, team members should work towards consensus. p. 7 Components of SBAR and its purpose - ansS: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Compression may occur from the effects of chemical substances and can cause.. - ansEdema, restricting or obstructing the airways, oxygenation, and ventilation. This can result from aspiration of liquids or inhalation of powder or noxious gas. ch. 4, p. 33-34 Compression strength refers to the tissue's ability to: - ansResist crush force - Compression injuries to organs occur when the organs are crushed from surrounding internal organs or structures such as a seatbelt worn up across the abdomen causing compression of the small bowel or a fracture to the lumbar spine p. 27 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use p. 11 Disadvantages of auto-transfusion include: - ans- Risk of contamination - RBCs might become hemolyzed during hemorrhage - Coagulation factors, including platelets and cryoprecipitate may be destroyed, increasing d-dimer in collected blood ch. 7, p. 81 During primary survey... - ansLife-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 During the secondary survey in patient with thoracic or neck trauma, what questions do you want to ask? - ansIf patient is complaining of: - DYSPNEA - DYSPHAGIA - DYSPHONIA Was there a cardiac event prior to injury? If CPR is being performed, when was it started? - Important information in determining the indications for performing an emergency thoracotomy or when to consider withdrawal of support Ch. 11, p. 143 Early assessment findings of increased ICP include: - ans- HEADACHE - NAUSEA/VOMITING - AMNESIA - BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS) - ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109 Early treatment for septic shock includes... - ansEarly administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ ch. 7, p. 75 Examples of referred pain include... - ans- radiating to left shoulder (Kehr sign) - referred to testicle may be indicative of duodenal injury - always begin palpation away from inital site of pain by assessing the painful area last ch. 12, p. 158 Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury p. 10 Explain definitive care on pancreatic trauma - ans- Non-op management including complete bowel rest, nutritional support, serial CT scanning with observation - Pseudocyst formations may be managed with percutaneous drainage - Pancreatic ductal injuries may need distal pancreatectomy - complications from pancreatic injury include, secondary hemorrhage, pancreatic fistula, abdominal abscess - s/s of infection occur often 7-10 days after injury and usually include fever, elevated WBC, nausea, vomiting ch. 12, p. 164 Explain emergency thoracotomy - ansDone when patient arrives with unstable vital signs or impending arrest... Indications for performing this include: - PERICARDIAL TAMPONADE needed to be evacuated - IMMEDIATE CONTROL OF MASSIVE INTRATHROATIC BLEEDING - PENETRATING TRAUMA with witnessed CARDIAC ARREST permitting open cardiac massage, or with massive hemorrhage in peritoneal cavity needing cross-clamping of aorta - It is rarely successful in patients with blunt chest trauma Ch. 11, p. 142-143 Explain eye irrigation when used for the removal of chemicals, foreign bodies, and debris from eye - ansCONTRAINDICATED in patients who may have RUPTURED GLOBE - Prior to procedure, check eye pH then instill anesthetic drops unless contraindicated. - Use warmed NS or LR, warmed to body temp 37 C to limit risk of thermal injury - Morgan lens or intravenous tubing may be used to direct flow, remember the shorter the tubing, the greater the flow and pressure - Direct stream across eye from inner to outer eye - Irrigation continued until eye pH reaches neutral (7.0-7.3) TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Ch. 10, p. 133 Explain GLOBE RUPTURE - ans- Considered a genuine EMERGENCY - Occurs when full thickness injury occurs to cornea or sclera or both -Once Dx is confirmed, it is important to protect eye from further injury Assessment findings include: - ANTERIOR CHAMBER APPEARING FLAT/SHALLOW - IRREGULAR or TEARDROP-SHAPED PUPILS or PRESENCE of what looks like a secondary pupil due to a tear in the ciliary body (traumatic iridodialysis) - PERIORBIAL ECCHYMOSIS - DECREASED VISUAL ACUITY and EOM - SEVERE SUBCONJUNCTIVAL HEMORRHAGE - NAUSEA - PAIN Treatment includes: - AVOID ANY TYPE OF PRESSURE TO GLOBE - DO NOT PERFORM TONOMETRY - APPLICATION OF RIGID SHIELD to protect affected eye - Administration of antiemetics - AVOID USE OF OPHTHALMIC DROPS or MEDICATIONS - CONSULTS * Pain not always present in globe penetration Ch. 10, p. 131 Ch. Ch. 10, p. 131-132 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - ansAuscultation for: - MUFFLED HEART SOUNDS or MURMURS Palate for: - CENTRAL PULSES compare quality between left and right and lower and upper extremities - EXTERNAL JUGULAR VEIN DISTENTION - EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - Emergency decompression via LATERAL CANTHOTOMY indicated with IOP > 40 mm Hg Ch. 10, p. 131 Explain stable and unstable pelvic fractures - ansStable- does not involve pelvic ring or there is minial displacement of pelvic ring Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational displacement ch. 12, p. 166 Explain the AVPU mnemonic - ansUsed to quickly assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to <C>ABC ch. 5, p. 42 Explain the B2-Transferrin test - ansGold standard for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 Explain the Cushing response - ansLoss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central nervous system response known as Cushing response. It is characterized by a triad of assessment findings: - widening pulse pressure - reflex bradycardia - diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch) - Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm - Dysrhythmias (PVCs, a fib, or ST segment changes) TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ may indicate blunt cardiac trauma - PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment - Pulse ox may only be accurate if there is adequate peripheral perfusion - ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41-42 Explain TRACHEOBRONCHIAL INJURY and what are the assessment findings and interventions - ansUsually caused by penetrating mechanisms, occurring in proximal trachea. Direct blows to neck or clothesline-type injuries common mechanisms for blunt trauma. Dx based on assessment findings and confirmed with BRONCHOSCOPY or CT. Assessment findings include: - DYSPNEA, TACHYPNEA - HOARSENESS - SUBCUTANEOUS EMPHYSEMA in neck, face, upper thorax - PNEUMOTHORAX, tension pneumothorax - HEMOPTYSIS - DECREASED OR ABSENT BREATH SOUNDS - SIGNS and SYMPTOMS of AIRWAY OBSTRUCTION Interventions include: - Attempts at ET placement may cause further damage, anesthesiology if available may reduce risk of intubation injury - Other approaches include flexible endoscopy, or smaller ET tube Ch. 11, p. 143 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Explain what second impact syndrome is - ansRefers to a condition that occurs when patient suffers a mild second TBI before recovery from the first. Rare but usually fatal. The second impact causes LOSS OF AUTO REGULATION LEADING TO CEREBRAL EDEMA Ch. 9, p. 115 Explain what Tranexamic acid (TXA) is - ansA synthetic version of the amino acid lysine. It is an antifibrinolytic that inhibits activation of plasminogen, a substance responsible for dissolving clots. ch. 7, p. 81 Explain why antipyretics are not effective in treating hyperthermia in acute brain injury. - ansFever is result of a change in thermoregulatory set point. A cooling blanket or ice packs may be used. Avoid causing shivering, it increases cerebral metabolic rate and may cause ICP to rise Ch. 9, p. 118 External energy forces can be exerted on the body by the following forces - ans- Deceleration forces: include those applied in falls and collisions where injuries are caused by sudden stop of the body's motion - Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed) - Compression force is an external force applied at times of impact, explains include: + Stationary objects such as dashboards or steering wheels, that collide with or push up into a person + Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects + Blast forces p. 27 FLAIL CHEST - ansClassified as 2 or more fractures of 3 or more adjacent ribs and/or sternal fractures, creating free-floating segment Assessment findings include - PARADOXICAL CHEST MOVEMENT drawing in with chest expansion and pushing out with exhalation - DYSPNEA - CHEST WALL PAIN, CONTUSIONS Interventions - prepare for intubation TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ ch. 5, p. 44 If breathing is present: - ans1. Administer O2 at 15L/min via nonrebreather mask -- inability to maintain adequate oxygenation, causes hypoxemia resulting in anaerobic metabolism and acidosis -- Titrate oxygen delivery for stabilized trauma patients to avoid the detrimental physiologic effects of hyperoxia 2. Determine if ventilation is effective -- ETCO2 (end-tidal carbon dioxide) measurement between 35-45 shows effective ventilation. Level above 50 signifies depressed ventilation -- SpO2 of 94% of higher is associated with effective ventilation ch. 5, p. 44 If injury causes the CPP to fall outside the range between mm Hg, the brain loses its ability to autoregulate and CBF becomes directly dependent on MAP for perfusion. - ans50 and 160 mm Hg Ch. 9, p. 108 If patient's airway is NOT patent: - ans1. Suction airway - Avoid stimulating gag reflex - Use rigid suction device if obstructed by blood, vomitus, or secretions - Remove any foreign bodies carefully with forceps 2. If suctioning does not relieve airway obstruction, tongue may be cause. Insert airway adjunct. - Use jaw-thrust maneuver to open airway while maintaining manual stabilization - A nasopharyngeal airway can be used in patients who are conscious or unconscious - An oropharyngeal airway can be used in patients without gag reflex 3. Consider a definitive airway (ET tube securely placed in trachea with cuff inflated) - The following conditions or situations require a definitively secured airway --apnea -- GCS score < 8 -- severe maxillofacial fractures -- evidence of inhalation injury/facial burns -- laryngeal or tracheal injury or neck hematoma -- high risk of aspiration and patient's inability to protect airway -- compromised or ineffective ventilation -- anticipated of deterioration of neurological status ch. 5, p. 43 Imaging studies for bladder and urethral injuries include - ans- CT cystogram used to dx intraperitoneal or extraperitoneal bladder rupture TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - Urethrogram usually performed prior to insertion of urinary catheter when injury is suspected; contrast instilled at meatus. Detection of contrast media within bladder indicates adequate instillation, leakage demonstrates urethral disruption ch. 12, p. 168 Increased or bounding central pulses may indicate increased cardiac output. Peripheral pulses do not demonstrate a similar effect in the presence of hypovolemia due to vasocontriction. Thus, strong central pulses combined with weak peripheral pulses may be... - ansIndicative of Shock ch. 7, p. 82 Initial assessment - approach to trauma patient care that requires a process to identify and treat or stabilize life-threatening injuries in an efficient and timely manner. It is divided into the following process points: - ans- Preparation and triage - Primary survey (ABCDE) with resuscitation adjuncts (FG) - Reevaluation (consideration of transfer) - Secondary survey (HI) with reevaluation adjuncts - Reevaluation and post resuscitation care - Definitive care of transfer to an appropriate trauma center ch. 5, p. 39 Interventions for INTRAOCULAR FOREIGN BODY include - ans- Elevating HOB - CONSULT - IMMOBILIZE FOREIGN BODY IF LARGE WITH POTENTIAL to become unstable - PATCH UNAFFECTED EYE to LIMIT concomitant eye movement - PEFORM GLOBE CLOSURE ASAP - ADMINISTER SYSTEMIC and TOPICAL ANTIBIOTICS - SYSTEMIC ANALGESICS Ch. 10, p. 130 Late assessment findings of increased ICP include: - ans- DILATED, NON-REACTIVE PUPILS - UNRESPONSIVENESS to verbal/painful stimuli - ABNORMAL POSTURING - CUSHING RESPONSE Widening pulse pressure Reflex bradycardia Decreased respiratory effort Ch. 9, p. 109 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can change form p. 26 Leading cause of death for ages 1. over 65 2. 5 to 24 3. 25 to 64 - ans1. Falls 2. MVCs 3. poisoning p. 9 Maintain PaO2 between - ans100-200 mm Hg for ABGs ch. 6, p. 66 Mastoid process ecchymooses - ansBattles sign, indicates middle fossa fracture Ch. 9, p. 113 Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - ansForce = Mass X Acceleration p. 26 Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction p. 26 Non-invasive near-infrared spectroscopy is used to... - ansmeasure decreased tissue blood flow, useful to diagnose compartment syndrome ch. 14, p. 202 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ Physiologic effects of pain by system: Gastrointestinal - ansDECREASED MOTILITY ch. 8, p. 97 Physiologic effects of pain by system: Genitourinary - ansDECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Immune - ansDECREASED RESPONSE ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - ansGLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - ansIMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE MUSCLE SPASM ch. 8, p. 97 Physiologic effects of pain by system: Respiratory - ansSPLINTING HYPOVENTILATION HYPERCARBIA RESPIRATORY ACIDOSIS INCREASED RISK OF ATELECTASIS & PNEUMONIA ch. 8, p. 97 POSTCONCUSSIVE SYNDROME assessment findings include: - ans- NAUSEA - DIZZINESS, PERSISTENT HEADACHE - MEMORY and JUDGEMENT IMPAIRMENT as well as ATTENTION DEFICITS - INSOMNIA and SLEEP DISTURBANCES - LOSS OF LIBIDO TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - ANXIETY, IRRITABILITY, DEPRESSION, EMOTIONAL LIABILITY - Noise and light over sensitivity - ATTENTION or CONCENTRATION PROBLEMS Ch. 9, p. 115-116 Prophylactic administration of what can reduce the risk of contrast-induced nephropathy when patients serum creatinine is above 1.2mg? - ansN-acetylcysteine along with hydration ch. 12, p. 170 PULMONARY CONTUSION - anscommonly occur from rapid deceleration or direct blunt impact such as MVCs or falls - it develops when capillary blood leaks into lung parenchyma with edema and inflammation, it may be localized or diffuse The subtle assessment findings associated with pulmonary contusions usually develop over time rather than immediately after injury. Assessment findings - DYSPNEA - INEFFECTIVE COUGH - INCREASED WORK OF BREATHING - HYPOXIA - CHEST PAIN - CHEST WALL CONTUSIONS or ABRASIONS Interventions - Maintain SpO2 between 94-98% - Minimize or use IV fluids judiciously - Prepare for possible intubation ch. 11, p. 146 Replacement with packed cells and saline without also transfusing with and further dilutes the patient's ability to clot blood. - ansPLATELETS and PLASMA ch. 7, p. 79 Resuscitation-associated coagulopathy is associated with the trauma triad of death. It includes... - ansHYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78 RHABDOMYOLYSIS - ansSignficant muscle damage and cellular destruction releases MYOGLOBIN, a muscle protein, into bloodstream. Since myoglobin is excreted in the kidneys, risk of acute renal failure is high in patients with crush injury. Classic triad of assessment findings include: - MUSCLE PAIN, NUMBNESS, CHANGES in SENSATION - MUSCLE WEAKNESS or PARLYSIS - DARK RED OR BROWN URINE other assessment findings include: - extensive soft tissue EDEMA and BRUISING - general WEAKNESS or MALAISE - evidence of hypovolemic shock - elevated creatinine kinase levels Treatment - aggressive fluid resuscitation to flush out myoglobin to prevent renal failure (>100 mL/hr until resolved is goal) ch. 14, p. 198 ROTATIONAL - ansetiology/cause- combination of forceful forward flexion with lateral displacement of cervical spine rest of injury- posterior ligament rupture and/or anterior fracture, dislocation of vertebral body example- MVC to front or near lateral area of vehicle results in conversion of forward motion to a spinning-type motion ch. 13, p. 179 RSI pretreatment medications Cough reflex can be blocked using IV... - ansLIDOCAINE 1.5 mg/kg ch. 6, p. 67 RUPTURED DIAPHRAGM - ansAssessment findings - DYSPNEA or ORTHOPNEA - DYSPHAGIA TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - Severe acidosis, elevated lactic acid levels, and worsening base excess on ABGs - Coagulopathies with petechiae, purpura, or bleeding ch. 7, p. 79 Structural strengths of tissue are described in what three ways? - ans-Compression -Tensile -Shear p. 27 Sudden vision changes may indicate in the cerebral vascular - ansA POSSIBLE FAT EMBOLISM ch. 14, p. 199 Tears or lacerations of the tracheobronchial tree disrupt the... - ansIntegrity of the upper and lower airways... Patients initially present with dramatic symptoms, such as... - SIGNS OF AIRWAY OBSTRUCTION - HEMOPTYSIS - CYANOSIS - SUBCUTANEOUS EMPHYSEMA from massive air leaks into tissues of face, chest, and neck Ch. 11, p. 141 Tensile strength describes the tissue's ability to: - ansResist pulling apart when stretched - Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) p. 27 TENSION PNEUMOTHORAX - ansOccurs when air enters INTRAPLEURAL space but cannot escape on expiration, increasing pressure causes lung on injuries side to collapse. If pressure not relieved, mediastinum can shift toward the uninjured side compressing heart, great vessels, and ultimately the opposite lung. As pressure rises, venous return is hampered, cardiac output decreases, and hypotension occurs. Assessment findings include: - ANXIETY, SEVERE RESTLESSNESS - SEVERE RESPIRATORY DISTRESS - SIGNIFICANTLY DIMINISHED OR ABSENT BREATH SOUNDS on injured side - HYPOTENSION TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ - DISTENDED NECK, HEAD, UPPER EXTREMITY VEINS (may not be evident if patient has experienced significant blood loss) - TRACHEAL DEVIATION or shift toward injured side - CYANOSIS (late sign) Interventions - Immediate chest X-RAY if pt somewhat stable - prepare for immediate needle thoracentesis 14 g needle inserted into 2nd intercostal space in mid clavicular line on affected side over the top of the rib to avoid neurovascular bundle that runs under rib - prepare for chest tube placement, which is the definitive treatment ch. 11, p. 145 The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life- threatening injuries and identify all injuries in a systematic manner. - ansA: airway and alertness with simultaneous cervical spinal stabilization B: breathing and ventilation C: circulation and control of hemorrhage D: disability (neurological status) E: exposure and environmental control F: full set of vital signs and family presence G: get resuscitation adjuncts: L - lab studies (ABGs) and obtain specimen for blood type and cross match M - monitor for continuous cardiac rhythm and rate assessment N - naso or orogastric tube consideration O - oxygenation and ventilation analysis: pulse oximetry and end-tidal carbon dioxide (ETCO2) monitoring and capnography P - pain assessment and management H: history and head-to-toe assessment I: inspect posterior surfaces ch. 5, p. 39 The assessment of circulation during the primary survey includes... - ansEarly evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ The degree to which tissues resist destruction under circumstances of energy transfer depends on... - ansTheir proximity to the impact and their structural characteristics p. 27 The Haddon Matrix broadened the approach and placed emphasis on countermeasures, such were more effective than changing human behavior. Haddon describes three phases of the injury event: - ansPre-event, Event, Post-event For each phase of the event, countermeasures for prevention can be applied. They include: The host (human) The agent (motor vehicle) The physical environment (socioeconomic environment) ch. 4, p. 34 The increase of the diastolic blood pressure with a narrowing pulse pressure... - ansMay be one of the first CONCRETE measurements signaling that the patient's circulatory status is compromised. ch. 7, p. 76 The major assessment parameters that produce important information within seconds of a patient's arrival are... - ans1. Level of consciousness 2. Skin color 3. Pulse ch. 5, p. 44 The standard approach to treating hypotension in trauma patients has been to infuse large volumes of IV fluids. Recent studies now recommend a different approach and note that an elevated BP may dislodge the body's formation of clots and promote further bleeding. In addition, large volumes of fluid lead to... - ansDilutional coagulopathy which worsens metabolic acidosis and may cause hypothermia ch. 5, p. 45 The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary blast injuries: found in those closest to the detonation, with enclosed space detonation resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are most susceptible to rupture with primary blast injuries. - Secondary injuries: include fragment injuries and generally cause the greatest volume of casualties. They include injuries such as puncture wounds, lacerations, and impaled objects. TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ What are some assessment findings for patients who sustain a pancreatic injury? - ans- Serial serum amylase levels increasing over time may indicate but this does not constitute a definitive diagnosis - Serial abdominal exams are preformed in conjunction with serial serum amylase levels to appropriately confirm pancreatic injury - slight abdominal pain and tenderness becoming more significant within 48 hours of injury - epigastric pain radiating to back - abdominal pain tenderness on deep palpation - increasing or worsening abdominal wall muscle rigidity, spasm, or involuntary guarding ch. 12, p. 16 What are some circumstances that may lead to unreliable pulse ox readings? - ans- Poor peripheral perfusion - BP cuff inflated above sensor - CO poisoning (carboxyhemoglobin) - Methemoglobinemia - Severe dehydration Pulse ox provides evidence of SaO2 but not PaO2. The non-liner relationship between the two measurements is reflected in the oxyhemoglobin-dissociation curve. ch. 6, p. 65 What are the late signs that may indicate a tension pneumothorax? - ansJVD and tracheal deviation ch. 5, p. 43 What are the rules concerning standard imaging in relation to eye injury - ans- If wood or a vegetative foreign body is suspected, MRI most appropriate imaging method to use, however, it is minimally useful in acute setting - CT scans not helpful if vegetative foreign bodies are suspected - the GOLD STANDARD for evaluation of mid-face and orbit trauma is a CT scan - Plain films are used to assess foreign bodies and fractures of facial structures, excluding orbits Ch. 10, p. 133-134 What are the two priorities in treating patients with TBI? - ansFacilitating OXYGENATION and VENTILATION Ch. 9, p. 120 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ What are two examples of obstructive shock that may result from trauma? - ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE ch. 7, p. 73 What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI In presence of facial fractures, the inability to perform EOMs may indicate a trapped nerve Ch. 9, p. 113 What can you do to easily see eyes that have abrasions? - ansStain them with fluorescein Ch. 10, 129 What diagnostic exam is helpful to inspect abdominal spaces for spillage and to examine loops of bowel? - ansLaparoscopy ch. 12, p. 164 What do you do with open wounds? - ansCover in saline-soaked dressings ch. 14, p. 201 What does 'safe care' mean? - ansMeans assuring the patient is getting to the right hospital in the right amount of time for the right care. American College of Surgeons Committee on Trauma (ACS-COT) developed trauma triage criteria that serves at the international standard to identify the trauma patient who would benefit from resuscitation and care at the right trauma facility with the appropriate resources. ch. 5, p. 40 What does 'safe practice' mean? - ansMeans taking into consideration the protection of the team, including: - observing universal precautions - donning PPE (gown, gloves, mask) prior to patient's arrival ch. 5, p. 39 TNCC TRAUMA NURSING CORE COURSE 12TH EDITION ENA TEST BANK VERIFIED PASS|ALREADY GRADED A+ What is one unique post-operative risk following a splenectomy? Explain. - ansPNEUMOCOCCAL SEPSIS - Asplenic compromised immune system has difficulty destroying encapsulated bacteria (Streptococcus pneumonia, Nesisseria meningitides, and Haemophilus influenza) therefore vaccinations against these bacteria are required. - Following splenectomy, patients encouraged to receive annual flu, meningitis, and pneumonia vaccines every five years. ch. 12, p. 163 What is the difference between penetrating and perforating in regards to ocular injuries? - ansPenetrating - having ENTRANCE WOUND, an INTRAOCULAR FOREIGN BODY when they are present Perforating - having ENTRANCE and EXIT WOUND Ch. 10, p. 125 What is the most common cause of thoracic trauma? - ansMVC's Others include: Falls, crush injury, assaults, gunshot and stabbing wounds, ped vs. vehicle collisions Ch. 11, p. 140 What is the most major cause of preventable death after injury? - ansUncontrolled hemorrhage ch. 5, p. 40 What is the standard of care in the hemodynamically STABLE patient who sustained blunt liver injury? - ansNon-operative management - For patients with penetrating liver injuries or blunt abdominal trauma with signs of hypodynamic instability, surgery is indicated. Appropriate fluid resuscitation and interventions to promote hemostasis are essential in surgery prep ch. 12, p. 162 What is used to diagnosis renal injuries? What are the cons? How are rectal injuries often managed? - ansSigmoidoscopy Cons- unprepared bowel may not detect injury Often managed with colostomy and distal rectal washout ch. 12, p. 165