TNCC Trauma Nursing Core Course 7th Edition Questions And Answers Graded A+ 2024., Exams of Nursing

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TNCC Trauma Nursing Core Course 7th

Edition Questions And Answers Graded

A+ 2024.

Components of SBAR and its purpose - Answer S: Situation B: Background A: Assessment R: Recommendation Purpose- to provide framework for communication amount members of the healthcare team p. 7 Components of DESC and its purpose - Answer D: 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 CUS and its purpose - Answer C: 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

Define trauma - Answer - Trauma is injury to living tissue caused by extrinsic agent

• Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Leading cause of death for ages

1. over 65
2. 5 to 24
3. 25 to 64 - Answer 1. Falls
4. MVCs
5. poisoning p. 9 Explain 3 phases of injury prevention - Answer Primary: 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 Describe the three E's of injury control - Answer Engineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury

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 How can the trauma nurse have an impact when it comes to the legislative process? - Answer By advocating for stronger laws and more consistent enforcement p. 11 Define kinematics - Answer The study of energy transfer as it applies to identifying actual or intentional injuries p. 25 Define biomechanics - Answer The general study of forces and their effects p. 25 Define mechanism of injury (MOI) - Answer How external energy forces in the environment are transferred to the body p. 25 Newton's First Law of Motion - Answer A body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - Answer Force = Mass X Acceleration

p. 26 Newton's Third Law of Motion - Answer For every action, there is an equal and opposite reaction p. 26 Law of Conservation of Energy - Answer Energy can neither be created nor destroyed, but it can change form p. 26 Describe energy forms - Answer - Mechanical (energy transfer from one object to another in the form of motion)

• Thermal (energy transfer of heat in environment to the host)
• Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants)
• Electrical (energy transfer from light socket, power lines, or lightning)
• Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 External energy forces can be exerted on the body by the following forces - Answer - 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 The degree to which tissues resist destruction under circumstances of energy transfer depends on... - Answer Their proximity to the impact and their structural characteristics p. 27 Structural strengths of tissue are described in what three ways? - Answer -Compression -Tensile -Shear p. 27 Compression strength refers to the tissue's ability to: - Answer Resist 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 Tensile strength describes the tissue's ability to: - Answer Resist pulling apart when stretched
• Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) p. 27 Shear strength describes the tissue's ability to: - Answer Resist a force applied parallel to the tissue
• Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this

p. 27 Types of injuries include - Answer - Blunt trauma

• Penetrating trauma
• Thermal trauma
• Blast trauma p. 28 Lateral impacts (T-bone) are associated with - Answer Shear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Depending on the motorcycle design and rider positioning, the lower extremities can collide with the handlebars, resulting in... - Answer Femur and pelvis fractures and hip dislocations p. 31 Cavitation refers to the... - Answer Separation 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

The U.S. Department of Defense classifies blast injuries in five levels: - Answer - 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.
• Tertiary injuries: include impacts with larger objects propelled by the blast wind resulting in blunt trauma. These cause high energy transfer and can result in pelvic or femur fractures or major thoracic injuries such as aortic and great vessel rupture.
• Quaternary injuries: result of heat, flame, gas, and smoke. These injuries include external burns and internal burns from inhaled hot gases.
• Quinary injuries are those associated with exposure to hazardous materials from radioactive, biologic, or chemical components of a blast. ch. 4, p. 33 Compression may occur from the effects of chemical substances and can cause.. - Answer Edema, 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- 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: - Answer Pre-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

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: - Answer - 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 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. - Answer A: 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 When does the approach to trauma care typically begin? - Answer With notification that a trauma patient is arriving to ED ch. 5, p. 39 What does 'safe practice' mean? - Answer Means 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 What does 'safe care' mean? - Answer Means 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 During primary survey... - Answer Life-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 What is the most major cause of preventable death after injury? - Answer Uncontrolled hemorrhage

ch. 5, p. 40 Explain the MARCH mnemonic - Answer M: 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- While in ED, alignment and protection of the cervical spine can be accomplished by which 2 ways? - Answer - Manual stabilization

• Immobilization ch. 5, p. 42 Explain the AVPU mnemonic - Answer Used 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 ABC ch. 5, p. 42

Use the jaw-thrust maneuver to open airway and assess for obstruction when the patient is... - Answer Unable to open the mouth, responds only to pain, or is unresponsive. ch. 5, p. 42 Once patient has airway in place, assess for proper placement by... - Answer - Presence of adequate rise and fall of the chest with assisted ventilation

• Absence of gurgling on auscultation over epigastrium
• Bilateral breath sounds present on auscultation
• CO2 detector device color change ch. 5, p. 43 If patient's airway is NOT patent: - Answer 1. 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 What are the late signs that may indicate a tension pneumothorax? - Answer JVD and tracheal deviation ch. 5, p. 43 If breathing is absent: - Answer - Open airway using jaw-thrust maneuver while maintaining manual cervical spinal stabilization

• Insert and oral airway adjunct
• Assist ventilations with bag-mask device
• Prepare for definitive airway ch. 5, p. 44 If breathing is present: - Answer 1. 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

The major assessment parameters that produce important information within seconds of a patient's arrival are... - Answer 1. Level of consciousness

2. Skin color
3. Pulse ch. 5, p. 44 The assessment of circulation during the primary survey includes... - Answer Early 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 A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). - Answer a. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 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... - Answer Dilutional coagulopathy which worsens metabolic acidosis and may cause hypothermia ch. 5, p. 45 _________ therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - Answer COMPONENT THERAPY ch. 5, p. 45

Assess pupils for... - Answer Equality, shape, and reactivity (PERRL) ch. 5, p. 45 Consider ABGs. A decreased level of consciousness may be an indicator of... - Answer Decreased cerebral perfusion, hypoventilation, or acid-base imbalance. ch. 5, p. 46 Hypothermia combined with ______ and ______ is a potentially lethal combination. - Answer HYPOTENSION and ACIDOSIS ch. 5, p. 46 Explain the LMNOP mnemonic - Answer Used 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) 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 ABGs provide values of oxygen, CO2 and base excess, which are... - Answer Reflective 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 When does the secondary survey (HI) begin? - Answer After the completion of the primary survey (ABCDE), after the initiation of resuscitation efforts, once vital functions have been stabilized and after consideration for resuscitation adjuncts (FG). ch. 5, p. 47 Additional history includes the following (MIST mnemonic) prehospital report: - Answer - MOI
• Injuries sustained
• Signs and Symptoms (in the field)
• Treatment (in the field) ch. 5, p. 47 SAMPLE mnemonic regarding patient's history - Answer S - Symptoms associated with injury A - Allergies and tetanus status M - Medications currently used, including anticoagulant therapy P - Past medical history (hospitalizations/surgeries)

L - Last oral intake E - Events and Environmental factors related to injury ch. 5, p. 48 What are odors you want to be sure to document? - Answer Alcohol, gasoline, other chemicals ch. 5, p. 48 Explain the B2-Transferrin test - Answer Gold standard for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 What are some circumstances that may lead to unreliable pulse ox readings? - Answer - 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 Oxyhemoglobin-dissociation curve indicates the correlation of tissue oxygneation (PaO2) as it saturates the hemoglobin molecule (SO2). P50 describes the oxygen pressure when the hemoglobin molecule is 50% saturated. Normal P50 is 26.7 mm Hg. A shift in the curve notes changes in the relationship: - Answer Shift to the RIGHT occurs in an environment of HIGH metabolic demand. Hemoglobin's affinity for oxygen decreases, making it easier to release the bound oxygen to the tissues. A shift to the right occurs in response to:

• Increased carbon dioxide (hypercapnia)
• Increased temp (hyperthermia)
• Increased 2,3-diphosphoglycerate levels (a substance in blood that helps O2 move from hemoglobin to the tissues)
• Decreased pH (acidemia) Shift to the LEFT occurs in an environment of LOW metabolic demand. Hemoglobin's affinity for oxygen increases, making it harder to release bound oxygen to the tissues. A shift to the right occurs in response to:
• Decreased carbon dioxide (hypocapnia)
• Decreased temp (hypothermia)
• Decreased 2,3-diphosphoglycerate levels
• Elevated pH (alkalosis)
• Carbon monoxide and methemoglobinemia ch. 6, p. 65 Trauma nurse should be attempting to maintain NORMOTHERMIA and NORMOCARBIA, which... - Answer Decreases risk of.. HYPOTHERMIA ACIDOSIS COAGULOPATHY ch. 6, p. 65 Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - Answer D - Displaced tube O - Obstructed or kinked tube P - Pneumothorax E - Equipment failure, such as patient becoming detached from equipment or loss of capnography waveform

ch. 6, p. 66 Maintain PaO2 between - Answer 100-200 mm Hg for ABGs ch. 6, p. 66 RSI pretreatment medications Cough reflex can be blocked using IV... - Answer LIDOCAINE 1.5 mg/kg ch. 6, p. 67 What are two examples of obstructive shock that may result from trauma? - Answer TENSION PNEUMOTHORAX and CARDIAC TAMPONADE ch. 7, p. 73 __________, which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - Answer HYPERVENTILATION ch. 7, p. 74 Describe DISTRIBUTIVE SHOCK - Answer Occurs as result of maldistribution of an adequate circulating blood volume with loss of vascular tone or increased permeability. ch. 7, p. 75

Describe ANAPHYLACTIC SHOCK - Answer Results from release of inflammatory mediators (e.g. histamine) which contracts bronchial smooth muscles and increases vascular permeability and vasodilation. ch. 7, p. 75 Describe SEPTIC SHOCK - Answer Caused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe NEUROGENIC SHOCK - Answer Occurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 Early treatment for septic shock includes... - Answer Early administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. ch. 7, p. 75 The increase of the diastolic blood pressure with a narrowing pulse pressure... - Answer May be one of the first CONCRETE measurements signaling that the patient's circulatory status is compromised. ch. 7, p. 76 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - Answer - 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 One of the earliest responses to inadequately pefused tissue is... - Answer TACHYPNEA ch. 7, p. 78 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... - Answer cerebral 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 Resuscitation-associated coagulopathy is associated with the trauma triad of death. It includes... - Answer HYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78 Stage I: Compensated Shock - Answer - Anxiety, lethargy, confusion, restlessness from oxygen being shunted to brainstem
• Systolic BP usually within normal range
• Rising diastolic BP, results in narrowed pulse pressure, which is a reflection of peripheral constriction

• A bounding and/or slightly tachycardic pulse
• Increased RR
• Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock - Answer - LOC deteriorates patient becomes obtunded or unconscious as cell switch to anaerobic metabolism with increasing levels of lactic and pyruvic acids
• Normal or slightly decreased systolic BP
• Narrowing pulse pressure that continues until peripheral vascular vasoconstriction fails to provide cardiovascular support
• HR > 100 beats/min
• Weak, thready pulses
• Rapid, shallow respirations
• Cool, clammy, cyanotic skin
• Base excess not within normal range of -2 to +2
• Serum lactate levsl > 2 to 4 ch. 7, p. 79 Stage III: Irreversible Shock - Answer - Obtunded, stuporous, comatose
• Marked hypotension and HF
• Bradycardia with possible dysrhythmias
• Decreased and shallow RR
• Pale, cool, clammy skin
• Kidney, liver, and other organ failure
• Severe acidosis, elevated lactic acid levels, and worsening base excess on ABGs
• Coagulopathies with petechiae, purpura, or bleeding

ch. 7, p. 79 Replacement with packed cells and saline without also transfusing with _______ and _______ further dilutes the patient's ability to clot blood. - Answer PLATELETS and PLASMA ch. 7, p. 79 Because calcium is a vital part of the clotting casade, hypocalcemia, as a result of a massive transfusion, can actually worsen hypovolemic shock by... - Answer Permitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 Disadvantages of auto-transfusion include: - Answer - 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 Explain what Tranexamic acid (TXA) is - Answer A 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 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... - Answer Indicative of Shock ch. 7, p. 82

What lab studies are used to guide resuscitative efforts in shock? - Answer - Platelet count, clotting studies

• Serum lactate, anion gap, base deficit, and ABGs to assess acidosis
• Toxicology screen to help assess mental status and differentiate from head injury
• Calcium level when rapidly infusing large volumes of blood products ch. 7, p. 83 Following the primary survey, FAST examination may be used to rapidly assess for bleeding from damage to the... - Answer Heart, liver, kidneys, and spleen. FAST also increasingly used to detect pneumothorax, especially tension pneumothorax. ch. 7, p. 84 Output less than 0.5 mL/kg per hour for two consecutive hours indicates... - Answer OLIGURIA ch. 7, p. 84 Pain Theories include... - Answer GATE CONTROL THEORY- proposes pain may be modulated by interneurons within spinal cord. Stimulation of the large A-beta cutaneous fibers was thought to close gate pain impulses from A-delta or C fibers. A-beta fibers carry impulses from touch, vibration, rubbing a painful area. Supports non-pharmacologic therapies for pain control such as ice, heat, massage. NEUROMATRIX THEORY- proposes that each person's brain produces a unique pattern of nerve impulses from a complex neural network with multidimensional inputs. This theory explains phantom limb pain and why people with similar injuries report differing levels and responses to pain. NEUROPLASTIC THEORY- suggests that neurons can be permanently affected and reshaped by the experience of pain. This theory attempts to explain chronic pain, pain syndromes, and phantom pain. ch. 8. p. 93

Classifications of acute pain are based on the source and origin and include... - Answer SOMATIC pain originates from skin and muscloskeletal structures VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Explain oligoanalgesia - Answer the concept of undertreatment of pain ch. 8, p. 94 Physiologic effects of pain by system: Cardiovascular - Answer HYPERCOAGULATION INCREASED CARDIAC WORKLOAD INCREASED OXYGEN DEMAND ch. 8, p. 97 Physiologic effects of pain by system: Respiratory - Answer SPLINTING HYPOVENTILATION HYPERCARBIA RESPIRATORY ACIDOSIS INCREASED RISK OF ATELECTASIS & PNEUMONIA ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - Answer IMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE

MUSCLE SPASM

ch. 8, p. 97 Physiologic effects of pain by system: Gastrointestinal - Answer DECREASED MOTILITY ch. 8, p. 97 Physiologic effects of pain by system: Genitourinary - Answer DECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Endocrine - Answer INCREASED RELEASE OF HORMONES AND MEDIATORS ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - Answer GLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Immune - Answer DECREASED RESPONSE