Docsity
Docsity

Prepare for your exams
Prepare for your exams

Study with the several resources on Docsity


Earn points to download
Earn points to download

Earn points by helping other students or get them with a premium plan


Guidelines and tips
Guidelines and tips

Trauma Nursing Core Course (TNCC) Exam Preparation, Exams of Nursing

A study guide or test bank for the trauma nursing core course (tncc) exam. It covers key topics related to the primary survey of a trauma patient, including assessment of the airway, breathing, and circulation. Detailed information on how to inspect, auscultate, and palpate the chest and lungs to identify life-threatening pulmonary injuries. It also includes a list of 400 practice questions and answers that have been verified and graded. This comprehensive resource would be highly valuable for nursing students or professionals preparing to take the tncc exam or refresh their knowledge on trauma assessment and management.

Typology: Exams

2023/2024

Available from 07/26/2024

edith-kinuthia
edith-kinuthia 🇺🇸

17 documents

1 / 513

Toggle sidebar

Related documents


Partial preview of the text

Download Trauma Nursing Core Course (TNCC) Exam Preparation and more Exams Nursing in PDF only on Docsity! TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS A adult patient with a knife injury to the neck has an intact airway and is hemodynamically stable. They complain of difficulty swallowing and speaking. In the primary survey, further assessment is indicated next for which of the following conditions? a. Damage to the cervical spine b. An expanding pneumothorax c. Laceration of the carotid artery d. Injury to the thyroid gland - ansa. Damage to the cervical spine A patient arrives at the emergency department by private vehicle after sustain ing an injury to the right lower extremity while using a saw. There is a large gaping wound to the right thigh area with significant bleeding. What is the priority intervention? a. Elevate the extremity to the level of the heart b. Initiate direct pressure c. Apply a tourniquet d. Cover the open wound with sterile saline dressings - ansb. Initiate direct pressure A patient fell two weeks ago, striking their head. Today, the patient presented with a persistent headache and nausea and was diagnosed with a small subdural hematoma. The patient has been in the ED for 24 hours awaiting an inpatient bed. The night shift nurse reports the patient has been anxious, restless, shaky, and vomited twice during the night. The patient states they couldn't sleep because a young child kept coming into the room. What is the most likely cause for these signs and symptoms? a. increase intracranial pressure b. alcohol withdrawal c. rhabdomyolysis d. pulmonary embolus - ansb. alcohol withdrawal A patient involved in a MVC has sustained a fracture to the second rib of the anterior left chest. Which concurrent injury is most commonly associated with this fracture? a. Blunt cardiac injury b. Brachial plexus injury c. Pneumothorax d. Hemothorax - ansb. Brachial plexus injury A patient with a spinal cord injury at C5 is being cared for in the emergency department while awaiting transport to a trauma center. Which of the TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS following represents the highest priority for ongoing assessment and management for this patient? a. maintain adequate respiratory status. b. administer balanced resuscitation fluid TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS The vital signs of a pregnant trauma patient at 30 weeks include a blood pressure of 94/62 mm Hg and a heart rate of 108 beats/minute. Fetal heart tones are 124 beats/minute. The emergency nurse interprets the patient's hemodynamic findings as an indication of which of the following? a. Decompensated shock b. Normal vital signs in pregnancy c. Compensated shock d. Supine hypotension syndrome - ansb. Normal vital signs in pregnancy Treatment for frostbite can include which of the following interventions? a. warm the affected part over 30-60 minutes b. use gentle friction to improve circulation c. administer tissue plasminogen activator d. leave all of the blisters intact - ansc. administer tissue plasminogen activator Understanding the kinematic concepts associated with the mechanism of injury and energy transfer can initially assist the trauma care provider in which of the following? a. Anticipating the types of injuries that may be present b. Deciding whether law enforcement should be notified c. Determining needed laboratory tests d. Predicting the need for a surgical procedure - ansa. Anticipating the types of injuries that may be present What is the appropriate technique for palpating the pelvis for stability? a. Apply gentle pressure over the iliac crests, downward and laterally. b. Apply gentle pressure over the iliac crests, downward and medially. c. Apply firm pressure over the iliac crests, downward and laterally. d. Apply firm pressure over the iliac crests, downward and medially. - ansb. Apply gentle pressure over the iliac crests, downward and medially. What is the best measure of the adequacy of cellular perfusion and can help to predict the outcome of resuscitation? a. End-tidal carbon dioxide b. Hematocrit level c. Base deficit d. Oxygen saturation - ansc. Base deficit What is the best position for maintaining an open airway in the obese TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS patient? a. Prone b. Supine TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS c. Reverse Trendelenburg d. Right lateral recumbent - ansc. Reverse Trendelenburg What is the leading cause of preventable death for the trauma patient in the prehospital environment? a. Airway compromise b. Ineffective ventilation c. Secondary head injury d. Uncontrolled external hemorrhage - ansd. Uncontrolled external hemorrhage Which of the following accurately describes ventilation principles associated with use of a bag-mask device for an adult? a. Compress the bag-mask device at a rate of one breath every 6 seconds. b. Delivers 100% oxygen. c. Squeeze the bag-mask device completely for each breath. d. Maintain the oxygen saturation levels between 92% and 94%. - ansa. Compress the bag-mask device at a rate of one breath every 6 seconds. Which of the following is considered a cornerstone of a high -performance trauma team? a. Individual goals b. Use of TeamSTEPPS c. Identification of a single decision maker d. Effective communication - ansd. Effective communication While performing an assessment on a 13-month-old involved in a motor vehicle collision, the nurse identifies which of the following findings from the patient as a sign of possible altered mental status? a. Sunken fontanel b. Crying, but consolable c. Spontaneous movement of arms and legs d. Cooperation with the assessment - ansd. Cooperation with the assessment A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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. Classifications of Shock - ansHypovolemic - decrease in the amount of circulating blood volume Obstructive - obstruction in either the vasculature or heart TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Cardiogenic - pump failure in the presence of adequate intravascular volume Distributive - maldistribution of an adequate circulating blood volume (septic, anaphylactic, neurogenic) 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) 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 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. Assess pupils for equality, shape and reactivity (PERRL) TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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. 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. 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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 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. lid injury - ans 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue. 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). Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. 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. P (AVPU) - ansPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) 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. Consider need for transfer. shock - ansInadequate tissue perfusion. 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 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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. 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) TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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) 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 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Consider bedside glucose. 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. 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. 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness 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. Hypovolemic Shock - ansCaused by a decrease in the amount of circulating blood volume. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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 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. lid injury - ans 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 th e hepatic veins. Hepatocyte cells are capable of regeneration allowing the liver to repair its own tissue. Functions: Store and metabolize lipids, transport nutrients, produce glucose and bilirubin, convert ammonia to urea, secrete electrolytes, lipids, lecithin, TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS cholesterol and TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Consider definitive airway Alertness Assessment - ansA- Alert V-Verbal P-Painful U-Unresponsive 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 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 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Blunt cardiac injury may present similar to MI. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Excess of volume administration or increased after load can result in pulmonary edema and increased myocardial ischemia. Inotropic support to improve contractility. 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. 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) Corneal Abrasion - ansDamage to the corneal epithelium. Easy to evaluate with fluorescein. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 1. Makes no movements 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 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS H: Head and Face Head to Toe Assessment (secondary survey) - ansSOFT TISSUE: TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Inspect: lacerations, puncture wounds, abrasions, contusions, edema, ecchymosis, impaled objects. Palpate: areas of tenderness, step-offs, crepitus BONY DEFORMITIES: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness 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. 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS extravasation TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS - 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. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. 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, gurgl ing, 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 Alertness Assessment - ansA-Alert TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS V- Verbal P- Painful U-Unresponsive 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 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 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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) 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 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. 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. Distributive Shock - ansOccurs as a result of maldistribution of an adequate circulating volume with a loss of vascular tone or increased permeability. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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. 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 GCS - ansGCS EYES TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 1. Makes no movements 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 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: TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. 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 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. lid injury - ans 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. 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). Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. P (AVPU) - ansPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) 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. Consider need for transfer. shock - ansInadequate tissue perfusion. 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 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. 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 Alertness Assessment - ansA- Alert V-Verbal P-Painful U-Unresponsive TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. 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. 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Anaphylactic: release of inflammatory mediators, such as histamine, which contracts bronchial smooth muscle and increases vascular permeability and vasodilation. 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. 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 GCS - ansGCS EYES 1: Does not open eyes 2: Opens eyes in response to pain 3: Opens eyes in response to voice 4: Opens TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS eyes spontaneously TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness 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. 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. Initial Assessment - ans1. Preparation and Triage 2. Primary Survey TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 3. Reevaluation 4. Secondary Survey 5. Reevaluation Adjuncts 6. Reevaluation and Post Resuscitation Care 7. Definitive Care or Transport 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. lid injury - ans 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. 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). Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS end organ perfusion. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 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 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. Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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) 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) Corneal Foreign Body - ansRoutinely metal, plastic or wood. Findings: photophobia, pain, injected conjunctiva (redness), lid swelling TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Treatment: topical anesthetic, removal of foreign body, ophthalmic ABX, cycloplegics, oral analgesia 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. 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. 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. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS matter TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Palpate: depressions, angulations, tenderness 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. 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, resu lts in inadequate perfusion. Hyperventilation can cause increased intrathoracic pressure resulting in compression of the heart and decreased cardiac output. Initial Assessment - ans1. Preparation and Triage 2. Primary Survey 3. Reevaluation 4. Secondary Survey 5. Reevaluation Adjuncts TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 6. Reevaluation and Post Resuscitation Care 7. Definitive Care or Transport 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 complication s. lid injury - ans 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. 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). Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. 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. P (AVPU) - ansPainful. Responds only to painful stimuli. TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. Airway Assessment - ansInspect: tongue obstruction, loose/missing teeth, foreign objects, blood, vomitus, secretions, edema, burns or evidence of inh alation 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 Alertness Assessment - ansA- Alert V-Verbal P-Painful U-Unresponsive 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), TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 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 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. Circulation and Control of Hemorrhage Assessment - ansInspect: Uncontrolled external bleeding, skin color Auscultate: Muffled heart sounds - may indicate pericardial tamponade TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS Palpate: carotid and/or femoral pulses for rate, rhythm, strength TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 4. Confused, disoriented TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 5. Oriented, converses normally MOTOR 1. Makes no movements 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 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: Inspect: asymmetry of facial expressions, exposed tissue or bone for brain matter Palpate: depressions, angulations, tenderness TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. Consider need for transfer. shock - ansInadequate tissue perfusion. 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 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS influenza. At risk for TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS pneumococcal sepsis. Need annual flu shot and q5yr meningococcal and pneumococcal vaccines. U (AVPU) - ansUnresponsive. Does not respond to any stimuli. V (AVPU) - ansVerbal. Needs verbal stimuli to respond. (Airway adjunct may be needed to prevent tongue obstruction) A (AVPU) - ansAlert. Will be able to maintain airway once clear. A (Primary Survey) - ansAirway and alertness with simultaneous cervical spinal stabilization. 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 Alertness Assessment - ansA- Alert V-Verbal P-Painful U-Unresponsive 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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 Treatment: treat small lacerations similar to an abrasion, larger lacerations need ophthalmology referral and possible surgery 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. D (Primary Survey) - ansDisability (Neurologic Status) Disability Assessment - ansAssess GCS on arrival and repeat per policy. 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. 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. Septic Shock: systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. 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 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 4. Confused, disoriented TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. lid injury - ans 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. 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). Obstructive Shock - ansResults from hypo perfusion of the tissue due to an obstruction in either the vasculature or heart. 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. P (AVPU) - ansPainful. Responds only to painful stimuli. (Airway adjunct may be needed while determining need for intubation) TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS 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. Consider need for transfer. shock - ansInadequate tissue perfusion. 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 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 TNCC TEST ACTUAL FINAL EXAM TEST BANK 400 QUESTIONS AND CORRET DETAILED ANSWERS WITH RATIONALES (VERIFIED ANSWERS) |ALREADY GRADED A+|100% COMPLETE VERIFIED PASS influenza. At risk for