Trauma Nursing Core Course (TNCC) 7th Edition, Exams of Nursing

Download Trauma Nursing Core Course (TNCC) 7th Edition and more Exams Nursing in PDF only on Docsity! TNCC Trauma Nursing Core Course 7th Edition Components of SBAR and its purpose - correct 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 - correct 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 - correct 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 TNCC Trauma Nursing Core Course 7th Edition p. 7 Define trauma - correct 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 - correct answer 1. Falls 2. MVCs 3. poisoning p. 9 Explain 3 phases of injury prevention - correct 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 - correct 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 TNCC Trauma Nursing Core Course 7th Edition - 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 - correct 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... - correct answer Their proximity to the impact and their structural characteristics p. 27 TNCC Trauma Nursing Core Course 7th Edition Structural strengths of tissue are described in what three ways? - correct answer - Compression -Tensile -Shear p. 27 Compression strength refers to the tissue's ability to: - correct 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: - correct 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: - correct 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 TNCC Trauma Nursing Core Course 7th Edition Types of injuries include - correct answer - Blunt trauma - Penetrating trauma - Thermal trauma - Blast trauma p. 28 Lateral impacts (T-bone) are associated with - correct 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... - correct answer Femur and pelvis fractures and hip dislocations p. 31 Cavitation refers to the... - correct 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 TNCC Trauma Nursing Core Course 7th Edition 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. - correct 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? - correct answer With notification that a trauma patient is arriving to ED TNCC Trauma Nursing Core Course 7th Edition ch. 5, p. 39 What does 'safe practice' mean? - correct 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? - correct 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... - correct 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? - correct answer Uncontrolled hemorrhage ch. 5, p. 40 TNCC Trauma Nursing Core Course 7th Edition Explain the MARCH mnemonic - correct 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. 41-42 While in ED, alignment and protection of the cervical spine can be accomplished by which 2 ways? - correct answer - Manual stabilization - Immobilization ch. 5, p. 42 Explain the AVPU mnemonic - correct 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 TNCC Trauma Nursing Core Course 7th Edition ch. 5, p. 44 If breathing is present: - correct 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... - correct answer 1. Level of consciousness 2. Skin color 3. Pulse ch. 5, p. 44 The assessment of circulation during the primary survey includes... - correct 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. TNCC Trauma Nursing Core Course 7th Edition ch. 5, p. 44 A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). - correct 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... - correct 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. - correct answer COMPONENT THERAPY ch. 5, p. 45 Assess pupils for... - correct answer Equality, shape, and reactivity (PERRL) ch. 5, p. 45 Consider ABGs. A decreased level of consciousness may be an indicator of... - correct answer Decreased cerebral perfusion, hypoventilation, or acid-base imbalance. TNCC Trauma Nursing Core Course 7th Edition ch. 5, p. 46 Hypothermia combined with ______ and ______ is a potentially lethal combination. - correct answer HYPOTENSION and ACIDOSIS ch. 5, p. 46 Explain the LMNOP mnemonic - correct 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) TNCC Trauma Nursing Core Course 7th Edition 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: - correct 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... - correct answer Decreases risk of.. TNCC Trauma Nursing Core Course 7th Edition HYPOTHERMIA ACIDOSIS COAGULOPATHY ch. 6, p. 65 Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - correct 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 - correct answer 100-200 mm Hg for ABGs ch. 6, p. 66 RSI pretreatment medications Cough reflex can be blocked using IV... - correct answer LIDOCAINE 1.5 mg/kg ch. 6, p. 67 What are two examples of obstructive shock that may result from trauma? - correct answer TENSION PNEUMOTHORAX and CARDIAC TAMPONADE TNCC Trauma Nursing Core Course 7th Edition 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. - correct answer HYPERVENTILATION ch. 7, p. 74 Describe DISTRIBUTIVE SHOCK - correct 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 - correct 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 - correct answer Caused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe NEUROGENIC SHOCK - correct answer Occurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 TNCC Trauma Nursing Core Course 7th Edition - Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock - correct 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 - correct 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 TNCC Trauma Nursing Core Course 7th Edition - 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. - correct 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... - correct answer Permitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 Disadvantages of auto-transfusion include: - correct 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 - correct answer A synthetic version of the amino acid lysine. It is an antifibrinolytic that inhibits activation of plasminogen, a substance responsible for dissolving clots. TNCC Trauma Nursing Core Course 7th Edition 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... - correct answer Indicative of Shock ch. 7, p. 82 What lab studies are used to guide resuscitative efforts in shock? - correct 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... - correct 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... - correct answer OLIGURIA ch. 7, p. 84 TNCC Trauma Nursing Core Course 7th Edition Physiologic effects of pain by system: Genitourinary - correct answer DECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Endocrine - correct answer INCREASED RELEASE OF HORMONES AND MEDIATORS ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - correct answer GLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Immune - correct answer DECREASED RESPONSE ch. 8, p. 97 Explain the Cushing response - correct answer Loss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central TNCC Trauma Nursing Core Course 7th Edition 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 Describe the MOI associated with brain, cranial, and maxillofacial trauma - correct answer BLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Pathophysiologic concepts that affect the patient with brain, cranial, or maxillofacial injuries include issues related to... - correct answer - HYPOTENSION and CBF - HYPOXIA and HYPERCARBIA - ICP Ch. 9, p. 108 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. - correct answer 50 and 160 mm Hg Ch. 9, p. 108 TNCC Trauma Nursing Core Course 7th Edition If autoregulation fails and MAP is elevated, _______ can result. - correct answer EDEMA Ch. 9, p. 109 As ICP rises, CPP ________, resulting in cerebral ischemia, hypoxemia, and lethal secondary insult. - correct answer DECREASES Ch. 9, p. 109 Early assessment findings of increased ICP include: - correct answer - HEADACHE - NAUSEA/VOMITING - AMNESIA - BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS) - ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109 Late assessment findings of increased ICP include: - correct answer - DILATED, NON-REACTIVE PUPILS - UNRESPONSIVENESS to verbal/painful stimuli - ABNORMAL POSTURING - CUSHING RESPONSE Widening pulse pressure Reflex bradycardia Decreased respiratory effort TNCC Trauma Nursing Core Course 7th Edition Ch. 9, p. 114 Assessment findings of a CHRONIC SUBDURAL HEMATOMA - correct answer - ALTERED or STEADY DECLINE IN LOC - HEADACHE - LOSS OF MEMORY or ALTERED REASONING - MOTOR DEFICIT: CONTRALATERAL HEMIPARESIS, HEMIPLEGIA, OR ABNORMAL MOTOR POSTURING OR ATAXIA - APHASIA - IPSILATERAL UNILATERAL FIXED and DILATED PUPIL - INCONTINENCE - SEIZURES Ch. 9, p. 114 Assessment findings of a HERNIATION SYNDROME - correct answer - ASYMMETRIC PUPILLARY REACTIVITY - UNILATERAL or BILATERAL PUPILLARY DILATION - ABNORMAL MOTOR POSTURING - other evidence of neurologic deterioration (loss of normal, reflexes, paralysis, or change in LOC) Ch. 9, p. 115 Assessment findings of a DIFFUSE INJURY - correct answer Injuries that occur over a wide spread area, not always identifiable on CT because damage involves contusions or hearing and stretching of micro vascular, not a localized hematoma. These injuries commonly follow a direct blow to the head and are often sports- TNCC Trauma Nursing Core Course 7th Edition related. Patients can have varying degrees of symptoms that last minutes to hours. Assessment findings include: - TRANSIENT LOC - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONFUSION, DISORIENTATION - MEMORY LOSS and CONCENTRATION DIFFICULTY - IRRITABILITY and FATIGUE Ch. 9, p. 115 Assessment findings for MILD, MODERATE, and SEVERE TRAUMATIC BRAIN INJURY INCLUDE: - correct answer MILD - GCS 13-15 - Brief (<30 min) LOC - POST-TRAUMATIC AMNESIA < 24 hours - No change on neuron aging studies MODERATE - GCS score 9-12 - Wide variety of symptoms, including ALTERATIONS IN CONSCIOUSNESS, CONFUSION, AMNESIA, and FOCAL NEUROLOGICAL DEFICITS - May deteriorate to severe head injury over time TNCC Trauma Nursing Core Course 7th Edition SEVERE - GCS score <8 - Significant alterations in consciousness - ABNORMAL PUPILLARY RESPONSE - ABNORMAL POSTURING Ch. 9, p. 115 Explain what second impact syndrome is - correct answer Refers 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 POSTCONCUSSIVE SYNDROME assessment findings include: - correct answer - NAUSEA - DIZZINESS, PERSISTENT HEADACHE - MEMORY and JUDGEMENT IMPAIRMENT as well as ATTENTION DEFICITS - INSOMNIA and SLEEP DISTURBANCES - LOSS OF LIBIDO - ANXIETY, IRRITABILITY, DEPRESSION, EMOTIONAL LIABILITY - Noise and light over sensitivity - ATTENTION or CONCENTRATION PROBLEMS Ch. 9, p. 115-116 TNCC Trauma Nursing Core Course 7th Edition What can you do to easily see eyes that have abrasions? - correct answer Stain them with fluorescein Ch. 10, 129 Treatment for CORNEAL ABRASIONS include: - correct answer - TOPICAL OPHTHALMIC ANTIBIOTICS If causes by contact lenses, treat for Pseudomonas - CYCLOPLEGIC OPHTHALMIC AGENT to decrease spasms and pain - TOPICAL OPHTHALMIC NSAIDS such as ketorolac, diclofenac to reduce swelling - ORAL ANALGESICS - NO PATCHING; evidence shows they heal faster unmatched - Follow up with OPHTHALMOLOGIST in 24 hours Ch. 10, p. 129 Interventions for INTRAOCULAR FOREIGN BODY include - correct answer - 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 TNCC Trauma Nursing Core Course 7th Edition Explain OBITAL FRACTURE - correct answer - NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE - Usually result from DIRECT BLOW TO EYE - Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE Assessment findings include: - PERIORBIAL ECCHYMOSIS - DIPLOPIA WITH UPWARD GAZE - ENOPHTHALMOS - INFRAORBITAL NUMBNESS - DECREASED EOM Treatment includes: - ORAL ANTIBIOTICS - COOL COMPRESSES - CONSULT with possible surgical repair if pt continues to have DIPLOPIA or ENOPHTHALMOS 1-2 weeks after swelling has decreased - Discharge instructions include: advise pt to AVOID BLOWING NOSE, SNEEZING, and/or PERFORMING A VASALVA MANEUVER BEARING DOWN Ch. 10, p. 130-131 Explain HYPHEMA - correct answer Collection of blood in anterior chamber of eye - classified as spontaneous or traumatic TNCC Trauma Nursing Core Course 7th Edition Assessment findings include: - PAIN, PHOTOPHOBIA - NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER - BLURRY VISION due to blood in chamber - INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4 Treatment includes: - ELEVATING HOB 30 degrees - protecting eye with METAL SHIELD - TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED - Avoid aspirin and NSAIDs as they increase risk of re-bleeding - Risk of re-bleeding greatest 3-5 days after injury Ch. 10, p. 131 Explain RETROBULBAR HEMATOMA - correct answer TRUE OPHTHALMOLOGIC EMERGENCY Hemorrhage into space behind globe; bleeding causes increased pressure behind globe causing elevation in IOP that compresses optic nerve and blood vessels. Early recognition is imperative to save vision. Assessment findings include: TNCC Trauma Nursing Core Course 7th Edition - 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) Ch. 10, p. 133 What are the rules concerning standard imaging in relation to eye injury - correct answer - 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 is the most common cause of thoracic trauma? - correct answer MVC's Others include: Falls, crush injury, assaults, gunshot and stabbing wounds, ped vs. vehicle collisions Ch. 11, p. 140 If a penetrating wound is found below the 4th intercostal space, penetration into the _________ is suspected until proven otherwise. - correct answer ABDOMINAL CAVITY TNCC Trauma Nursing Core Course 7th Edition Ch. 11, p. 140 Penetrating injury to the chest wall and lacerated lung tissue can cause the loss of ________________. Thus, the collection of air or blood in the pleural space causes ______________. - correct answer A. NORMAL NEGATIVE INTRAPLEURAL PRESSURE B. LUNG COLLAPSE Ch. 11, p. 141 Tears or lacerations of the tracheobronchial tree disrupt the... - correct answer Integrity 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 Signs of increased work of breathing, tachypnea, SOB, tachycardia, hypotension, and unilateral decrease in breath sounds on injuries side... - correct answer Signifies decreased cardiac output. Caused when air or blood accumulates in thoracic cavity causing increase in INTRAPLEURAL pressure on side of injury. If this pressure is allowed to expand without intervention, it can produce a MEDIASTINAL SHIFT which compresses heart and great vessels, resulting in a DECREASE in VENOUS RETURN (PRELOAD) and SUBSUQUENT DECREASE IN CARDIAC OUTPUT. TNCC Trauma Nursing Core Course 7th Edition Ch. 11, p. 141 What are late signs of MEDIASTINAL SHIFT? - correct answer NECK VEIN DISTENTION from increased intrathroatic pressure and TRACHEAL DEVIATION Ch. 11, p. 141 Explain pericardial tamponade and its assessment findings - correct answer When there is a rapid accumulation of blood in pericardial sac, resulting in compression of heart making it difficult for heart to fill during diastole, causing decreased cardiac output. Assessment findings include: - HYPOTENSION - TACHYCARDIA - MUFFLED HEART SOUNDS - NECK VEIN DISTENTION Ch. 11, p. 141 Explain how to assess circulation and control of hemorrhage in relation to thoracic trauma - correct answer Auscultation for: - MUFFLED HEART SOUNDS or MURMURS Palate for: - CENTRAL PULSES compare quality between left and right and lower and upper TNCC Trauma Nursing Core Course 7th Edition Ch. 11, p. 143 BLUNT ESOPHAGEAL INJURY - correct answer Injury 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 Ch. 11, p. 143 FLAIL CHEST - correct answer Classified 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 TNCC Trauma Nursing Core Course 7th Edition - prepare for intubation Ch. 11, p. 144 TENSION PNEUMOTHORAX - correct answer Occurs 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 - 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 TNCC Trauma Nursing Core Course 7th Edition 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 HEMOTHORAX - correct answer caused by blood accumulating in the intrapleural space. Results from injury to lung, costal blood vessels, great vessels and from laceration to liver or spleen combined with diaphragm injury. Assessment findings include - ANXIETY or RESTLESSNESS - DYSPNEA, TACHYPNEA - CHEST PAIN - SIGNS OF SHOCK- tachycardia, cyanosis, diaphoresis, hypotension - DECREASED BREATH SOUNDS ON INJURED SIDE Interventions - Prepare for needle thoracentesis and chest tube insertion - Ensure 2 large IV catheters and blood is available before thoracentesis to treat large volume blood loss if needed ch. 11, p. 146 PULMONARY CONTUSION - correct answer commonly occur from rapid deceleration or direct blunt impact such as MVCs or falls - it develops when TNCC Trauma Nursing Core Course 7th Edition Interventions - Prepare for surgery or angiography - Consider massive transfusion protocol ch. 11, p. 146 RUPTURED DIAPHRAGM - correct answer Assessment findings - DYSPNEA or ORTHOPNEA - DYSPHAGIA - ABDOMINAL PAIN - SHARP EPIGASTRIC or CHEST PAIN RADIATING to left shoulder (Kehr sign) - Bowel sounds auscultated in the lungs on injured side Interventions - Prepare for surgery ch. 11, p. 146 When someone suffers a GSW, below what part of the body is considered an abdominal injury that requires an exploratory laparotomy? - correct answer Below the nipple line ch. 12, p. 155 What are causes of peritoneal membrane irritation? - correct answer - presence of blood - chemical peritonitis as result of gastric content leakage TNCC Trauma Nursing Core Course 7th Edition - possible enzyme spillage from pancreas into bowel and/or peritoneal cavity - bacterial contamination from bowel contents ch. 12, p. 158 Examples of referred pain include... - correct answer - 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 When patient is receiving massive blood transfusions it is important to closely monitor which electrolytes? Why? - correct answer High K, Low C Potassium : released from cellular destruction of banked blood occurs naturally when blood ages Calcium : calcium citrate used in banked blood to prevent clotting, this citrate binds with free calcium reducing serum levels ch. 12, p. 158 How can you check for laxity or instability for possible pelvic fractures? - correct answer gentle pressure over iliac wings DOWNWARD and MEDIALLY ch. 12, p. 159 What is the standard of care in the hemodynamically STABLE patient who sustained blunt liver injury? - correct answer Non-operative management TNCC Trauma Nursing Core Course 7th Edition - 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 one unique post-operative risk following a splenectomy? Explain. - correct answer PNEUMOCOCCAL 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 Explain pancreatic injuries - correct answer - Penetrating pancreatic injuries often sustain concurrent duodenal injuries - Less than 10% of those with a pancreatic injury will have a single-system injury - Suspicion for spinal fractures when the pancreas is crushed between anterior abdominal wall and spinal column ch. 12, p. 164 TNCC Trauma Nursing Core Course 7th Edition Assessment findings for renal injuries include - correct answer - Turner sign (bruising by 11th and 12th ribs) - Hematuria - Frank tenderness, costovertebral angle tenderness, palpable flank mass - Structural damage or leakage of contrast on intravenous pyelogram (IVP) - If patient hemodyanmically unstable for CT, a single-infusion IVP can be performed at bedside followed by complete study once patient is stable - Positive urine dipstick for microscopic blood or leukocyte esterase - Abnormal or elevated BUN and creatinine 90% of injuries are minor. Anticipate nephrology consultation in more severe injures; surgical repair is required within 12 hours to salvage an ischemic kidney ch. 12, p. 167 Imaging studies for bladder and urethral injuries include - correct answer - CT cystogram used to dx intraperitoneal or extraperitoneal bladder rupture - 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 Prophylactic administration of what can reduce the risk of contrast-induced nephropathy when patients serum creatinine is above 1.2mg? - correct answer N- acetylcysteine along with hydration TNCC Trauma Nursing Core Course 7th Edition ch. 12, p. 170 55% of spinal injuries occur to which part of spine? - correct answer cervical ch. 13, p. 179 hyperEXTENSION - correct answer etiology/cause- backward thrust beyond anatomic capacity of vertebral column rest of injury- stretching or ligament tears, bony dislocations example- rear-end whiplash ch. 13, p. 179 hyperFLEXION - correct answer etiology/cause- forceful forward flexion with head striking an immovable object rest of injury- wedge fractures, facet dislocations, subluxation (due to ligament rupture), teardrop, odontoid or transverse process fractures example- head-on MVC with head hitting windshield, creating starburst effect ch. 13, p. 179 ROTATIONAL - correct answer etiology/cause- combination of forceful forward flexion with lateral displacement of cervical spine TNCC Trauma Nursing Core Course 7th Edition 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 AXIAL LOADING - correct answer etiology/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 Explain NEUROGENIC SHOCK and what are the assessment findings - correct answer Occurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings - BRADYCARDIA - HYPOTENSION - WARM, NORMAL COLOR SKIN TNCC Trauma Nursing Core Course 7th Edition Why do partial amputations have more severe bleeding than complete amputations? - correct answer The severed arteries retract with complete amputations ch. 14, p. 197 What are complications related to crush injuries? - correct answer Compartment syndrome, hyperkalemia, rhabdomyolysis K levels peak 12 hours after injury ch. 14, p. 198 RHABDOMYOLYSIS - correct answer Signficant 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 TNCC Trauma Nursing Core Course 7th Edition - 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 Sudden vision changes may indicate________ in the cerebral vascular - correct answer A POSSIBLE FAT EMBOLISM ch. 14, p. 199 How high should you elevate limb in compartment syndrome? - correct answer At level of heart, any higher can reduce circulation and tissue perfusion. Also ice is strongly contraindicated ch. 14, p. 200-201 What do you do with open wounds? - correct answer Cover in saline-soaked dressings ch. 14, p. 201 How should you wrap an amputated part? - correct answer Wrap it in slightly saline-moistened sterile gauze, placed in sealed plastic bag THEN place in a second bag containing ice water ch. 14, p. 201 Non-invasive near-infrared spectroscopy is used to... - correct answer measure decreased tissue blood flow, useful to diagnose compartment syndrome TNCC Trauma Nursing Core Course 7th Edition ch. 14, p. 202 For skin, the immediate goal in treating surface trauma is to... and this is accomplished by... - correct answer OBTAIN AND MAINTAIN HEMOSTASIS, APPLY DIRECT PRESSURE TO SITE ch. 14, p. 208 What should you avoid using with fingers, toes or other areas where vasoconstriction could cause impaired distal blood circulation? - correct answer LIDOCAINE with EPI ch. 14, p. 211