TNCC - Trauma Nursing Core Course Questions And Answers Most Lastest Reviewed Version 100%, Quizzes of Nursing

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Initial Assessment - ans1. Preparation and Triage

2. Primary Survey
3. Reevaluation
4. Secondary Survey
5. Reevaluation Adjuncts
6. Reevaluation and Post Resuscitation Care
7. Definitive Care or Transport A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Alertness Assessment - ansA-Alert V-Verbal P-Painful U-Unresponsive 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

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A (AVPU) - ansAlert. Will be able to maintain airway once clear. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) P (AVPU) - ansPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) U (AVPU) - ansUnresponsive. Does not respond to any stimuli. 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, prepare for definitive airway

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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 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy.

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Assess pupils for equality, shape and reactivity (PERRL) Disability interventions - ansEvaluate for need for CT. Assume AMS to be the result of CNS injury until proven otherwise. Consider ABGs - AMS may be indicator of decreased cerebral perfusion, hypoventilation or acid-base imbalance. Consider bedside glucose. GCS - ansGCS EYES 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
6. Makes no movements

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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 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 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.

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Consider need for transfer. 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 BONY DEFORMITIES:

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Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness shock - ansInadequate tissue perfusion. Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. In trauma typically results from hemorrhage, but can result in a precipitous loss of volume, ie vomiting or diarrhea. Burn trauma can result in hypovolemic shock from damage to the cell membranes leading to plasma and protein leakage. of body water, results in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart.

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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. 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. 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.

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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. lid injury - ans Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein. Findings: photophobia, tearing, pain, injected conjunctiva (redness), lid swelling, irritation Treatment: Ophthalmic ABX, Cycloplegic agent to decrease spasms and pain, ophthalmic NSAIDS to decrease swelling, oral analgesics, Ophthalmic f/u in 24 hours. (Do NOT patch - increases infection) Cycloplegic agent - ansCycloplegia is paralysis of the ciliary muscle of the eye, resulting in a loss of accommodation. Because of the paralysis of the ciliary muscle, the curvature of the lens can no longer be adjusted to focus on nearby objects. Corneal Laceration - ansInvolves one or more layers of the cornea. Visualized with a slit lamp. Findings: similar to abrasion, pain out of proportion to findings, decreased vision

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Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery Corneal Foreign Body - ansRoutinely metal, plastic or wood. Findings: photophobia, pain, injected conjunctiva (redness), lid swelling Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia 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. 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.

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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). Hepatic Injuries - ansIn blunt trauma the liver may lacerate from increased abdominal pressure. Hematoma - bleeding contained within the capsule Laceration - the capsule is disrupted Findings: Cullen sign (ecchymosis around the umbilicus or RUQ), tenderness, guarding or rigidity RUQ, 9-12 rib FXs, elevated LFT Graded I-VI, I = minor trauma Nonoperative management is standard of care in hemodynamically stable patient. Observed with serial abdominal exams. Findings of contrast extravasation may be embolized by IR. For surgical patients - fluid resuscitation is essential. Risks of surgery include disruption of the natural tamponade process due to the evacuation of large amounts of blood resulting in hypovolemia. 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

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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.