TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDI, Exams of Nursing

Download TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDI and more Exams Nursing in PDF only on Docsity! TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Expedite transfer to the closest trauma center - CORRECT ANSWERS A 56 y/o M pt involved in a motor vehicle crash is brought to the ED of a rural critical access facility. He complains of neck pain, SOB, and diffuse abd pain. His GCS is 15. His VS: BP 98/71, HR 125, RR 26, SpO2 94% on high-flow O2 via NRB mask. Which of the following is the priority intervention for this patient? a pertinent medical hx is crucial - CORRECT ANSWERS Which of the following considerations is the most important when caring for a geriatric trauma pt? Mitigation - CORRECT ANSWERS Following a review of recent drills and a real disaster event, a hospital has identified deficiencies and is taking steps to minimize the impact of a future disaster . Which phase of the disaster life cycle does this describe? Multiple requests for water - CORRECT ANSWERS EMS brings a pt who fell while riding his bicycle. Using the American College of Surgeobs screening guidelines, which assessment finding would prompt the RN to prepare the pt for a radiologic spine clearance? hemoglobin does not readily release O2 for use by the tissues - CORRECT ANSWERS What is the effect of hypothermia on the oxyhemoglobin dissociation curve? TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ acidosis - CORRECT ANSWERS Which of the following is a component of the trauma triad of death? Complete - CORRECT ANSWERS EMS brings a pt from MVC. VS: BP 90/49, HR 48, RR 12, temp 97.2F (36.2 C). The pt exhibits urinary incontinence and priapism. These assessment findings are most consistent with which of the following types of spinal cord injury? flucuation in the water seal chamber - CORRECT ANSWERS Which of the following is an expected finding in a pt with a tube thoracstomy connected to a chest drainage system? insert an oropharyngeal airway if there is no gag reflex - CORRECT ANSWERS During the primary survey of an unconscious pt with multi- system trauma, the nurse notes snoring respirations. What priority nursing interventions should be preformed next? globe rupture - CORRECT ANSWERS A 35 y/o M presents with facial trauma after being struck in the face with a baseball. A teardrop-shaped left pupil is noted on exam. What type of injury is suspected? TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ decelerations are noted on cariocgraphy. These findings are most consistent with which of the following? it can worsen cord damage from an unstable spinal injury - CORRECT ANSWERS Which of the following is true about the log-roll? defusings - CORRECT ANSWERS All of these are considered a critical communication point in trauma care EXCEPT which of the following? pulse oximetry and capnography - CORRECT ANSWERS What bedside monitoring parameters are used to assess for adequacy of O2 and effectiveness of ventilation? padding the upper back while stabilizing the cervical spine - CORRECT ANSWERS Caregivers carry in a 2 y/o into the ED who fell out of a second-story window. The pt is awake and crying with increased work of breathing and pale skin. Which of the following interventions has the highest priority? bowel - CORRECT ANSWERS Which of the following injuries is LEAST likely to be promptly identified? TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Initiate transfer to a trauma center - CORRECT ANSWERS A pt is brought to the ED of a rural hospital following a high-speed MVC. When significant abd and pelvic injuries are noted in the primary survey, which of the following is the priority interventions? bardycardia and absent motor function below the level of injury - CORRECT ANSWERS A pt with a complete spinal cord injury in neurogenic shock will demonstrate hypotension and which other clinical signs? apply splint and elevate above the level of the heart - CORRECT ANSWERS a 37 y/o F has a deformity of the L wrist after a fall. She is reluctant to move her hand due to pain. Which of the following is the most appropriate intervention? the aorta is torn at its attachment with the ligamentum arteriosum - CORRECT ANSWERS which of the following occurs during the third impact of a motor vehicle crash? Report your suspicion of maltreatment in accordance with local regulations - CORRECT ANSWERS a 5 y/o child presents to the ED with bruises to the upper arm and buttocks in various stages of healing and multiple small, clean, round burns to the back. There are no abnormalities found based on the pediatric assessment triangle or TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ primary survey. Which of the following is the priority survey. Which of the following is the priority nursing intervention? to guage end-organ perfusion and tissue hypoxia - CORRECT ANSWERS Why is a measure of serum lactate obtained in the initial assessment of a trauma patient? elevating the extremity to the level of the heart - CORRECT ANSWERS A pt with a lower extremity fracture complains of severe pain and tightness in his calf, minimally by pain medications. Which of the following is the priority nursing intervention? velocity - CORRECT ANSWERS What factor contributes most to the kinetic energy of a body in motion? subdural hematoma - CORRECT ANSWERS An elderly patient with a history of anticoagulant use presents after a fall at home today. She denies any loss of consciousness. She has a hematoma to her forehead and complains of headache, dizziness, and nausea. What is the most likely cause of her symptoms? fat embolism - CORRECT ANSWERS a pt has been in the ED for several hrs waiting to be admitted. He sustained multiple rib fractures and a femur fracture after a fall. He has been awake, alert, and complaining of TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ providers placed a nonporous dressing over the chest wound and taped it on three sides. he is now showing signs of anxiety, restlessness, severe respiratory distress, cyanosis and decreasing blood pressure. Which of the following is the MOST appropriate immediate intervention? after a physical examination if the pt has no radiologic abnormalities on CT - CORRECT ANSWERS EMS arrives with the intoxicated driver of a car involved in a MVC. EMS reports significant damage to the drivers side of the car. The pt is asking to have the cervical collar removed. When it is appropriate to remove the cervical collar? MARCH - CORRECT ANSWERS Which of the following mnemonics can help the nurse prioritize care for a trauma patient with massive uncontrolled hemorrhage? What is kinematics? - CORRECT ANSWERS A branch of mechanics (energy transfer) that refers to motion and does not consider the concepts of force and mass of the object or body. What is Newton's First Law? - CORRECT ANSWERS A body at rest will remain at rest. A body in motion will remain in motion until acted on by an outside force. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is the Law of Conservation of Energy? - CORRECT ANSWERS Energy can neither be created nor destroyed. It is only changed from one form to another. What is Newton's Second Law? - CORRECT ANSWERS Force equals mass multiplied by acceleration of deceleration. What is kinetic energy (KE)? - CORRECT ANSWERS KE equals 1/2 the mass (M) multiplied by the velocity squared. What is the Mnemonic for the Initial Assessment? - CORRECT ANSWERS A = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) What is the Mnemonic for the Secondary Assessment? - CORRECT ANSWERS F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ H = Hx and Head-to-toe assessment I = Inspect posterior surfaces Where do you listen to auscultate breath sounds? - CORRECT ANSWERS Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line. What are the late signs of breathing compromise? - CORRECT ANSWERS - Tracheal deviation - JVD What are signs of ineffective breathing? - CORRECT ANSWERS - AMS - Cyanosis, especially around the mouth - Asymmetric expansion of chest wall - Paradoxical movement of the chest wall during inspiration and expiration - Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing - Sucking chest wounds - Absent or diminished breath sounds TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ P = Pain U = Unresponsive - GCS - PERRL? - Determine presence of lateralizing signs including: - Unilateral deterioration in motor movements or unequal pupils - Symptoms that help to locate area of injury in brain What are the interventions for Disability? - CORRECT ANSWERS - If assessment indicates a decreased LOC, conduct further investigation during secondary focused assessments - If pt is not alert or verbal, continue to monitor for any compromise to ABC's - If pt demonstrates signs of herniation or neurologic deterioration, consider hyperventilation. What is assessed and intervened for Expose/Environmental Controls? - CORRECT ANSWERS - Remove clothing - Ensure appropriate decontamination if exposed to hazardous material - Keep pt warm - Keep clothing for evidence TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is the first thing assessed under the Secondary Assessment? - CORRECT ANSWERS FULL SET VS / FOCUSED ADJUNCTS / FAMILY PRESENCE - ABCDE should be completed - Labs, X-rays, CT, Foley, - Family Presence What is the second thing assessed under the Secondary Assessment? - CORRECT ANSWERS GIVE COMFORT MEASURES - Talking to pt - Pharmacologic/Nonpharmacologic pain management - Observe for physical signs of pain What is assessed under the Mnemonic "H"? - CORRECT ANSWERS HISTORY / HEAD-TO-TOE ASSESSMENT - MIVT - M = Mechanism of injury - I = Injuries sustained - V = Vital Signs - T = Treatment TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Pt generated information - PMH - Head-to-toe assessment What is assessed under the Mnemonic "I"? - CORRECT ANSWERS INSPECT POSTERIOR SURFACES - While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks and posterior thighs. - Palpate vertebral column for deformity and areas of tenderness - Assess rectum for presence/absence of tone, presence of blood What she be done after the Secondary Assessment? - CORRECT ANSWERS Reassess: - Primary survey, - VS - Pain - Any injuries What are factors that contribute to ineffective ventilation? - CORRECT ANSWERS - AMS - LOC TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. What is a Laryngeal Mask Airway? - CORRECT ANSWERS Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area. ILMA, does not require laryngoscopy and visualization of the chords. What is Needle Cricothyrotomy - CORRECT ANSWERS Percutaneous transtracheal ventilation. (temporary) Complications include: - inadequate ventilation causing hypoxia - hematoma formation - esophageal perforation - aspiration - thyroid perforation - subcutaneous emphysema TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is Surgical Cricothyrotomy? - CORRECT ANSWERS Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated. Complications include: - Aspiration - Hemorrhage or hematoma formation or both - Lac to trachea or esophagus - Creation of a false passage - Laryngeal stenosis How do you confirm ET Tube/Alternative Airway Placement? - CORRECT ANSWERS - Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ How do you inspect the chest for adequate ventilation? - CORRECT ANSWERS Observe: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when auscultating lung sounds? - CORRECT ANSWERS Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain What are you looking for when percussing the chest? - CORRECT ANSWERS Dullness: - hemothorax Hyperresonance TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Some causes: - Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume). - Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium. - Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Distributive Shock. - CORRECT ANSWERS Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. What is vascular response? - CORRECT ANSWERS As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP. What is renal response? - CORRECT ANSWERS Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes: - Vasoconstriction of arterioles and some veins TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Stimulation of sympathetic nervous system - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. Explain adrenal gland response. - CORRECT ANSWERS When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Heart sounds - Bowel sounds Percuss: - Chest and abdomen Palpate: - Central pulse (carotid or femoral) - Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse - Palpate peripheral pulses - Palpate skin temp and moisture Diagnostic Procedures: - Xrays and other studies - Labs Planning and Implementation - Oxygen - IV's with warmed replacement fluids - Control external bleeding with direct pressure - Elevate LE's - NGT - Foley TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Monitor and pulse oximeter - Monitor for development of coagulopathies - Surgery? ICP is a reflection of what three volumes? What happens when one increases? - CORRECT ANSWERS 1. Brain 2. CSF 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are the early signs and symptoms of increased ICP? - CORRECT ANSWERS - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement What are the late observable signs of symptoms of increased ICP? - CORRECT ANSWERS - Dilated, nonreactive pupil - Unresponsiveness to verbal or painful stimuli - Abnormal motor posturing patterns - Widening pulse pressure - Increased systolic blood pressure - Changes in RR and pattern - Bradycardia What is Cushing's phenomenon or Cushing's Reflex? - CORRECT ANSWERS Triad of progressive HTN, bradycardia and diminished respiratory effort. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - H/A - Confusion and disorientation - Dizziness - N/V - Loss of memory - Difficulty with concentration - Irritability - Fatigue What are the signs and symptoms of postconcussive syndrome? - CORRECT ANSWERS - Persistent H/A - Dizziness - Nausea - Memory impairment - Attention deficit - Irritability - Insomnia - Impaired judgement - Loss of libido - Anxiety TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Depression What is diffuse axonal injury and its signs and symptoms? - CORRECT ANSWERS (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S: - Immediate unconsciousness - mild DAI, coma = 6-24 hrs - severe DAI, coma = weeks/months or persistent vegetative state - Elevated ICP - Abnormal posturing - HTN - Hyperthermia - Excessive sweating because of autonomic dysfunction - Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits What is a cerebral contusion and its S/S? - CORRECT ANSWERS A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S: - Alteration in LOC - Behavior, motor or speech deficits - Abnormal motor posturing - Signs of increased ICP What is an epidural hematoma and its S/S? - CORRECT ANSWERS Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly: - Compression of underlying brain - rapid increase in ICP - Decreased CBF - Secondary brain injury * Usually requires surgical intervention S/S: - Transient LOC - Lucid period lasting a few minutes to several hours - Rapid deterioration in neurologic status - Severe H/A TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Possible open fx - Palpable depression of skull over the fx site What are the S/S of a basilar skull fx? - CORRECT ANSWERS - H/A - Altered LOC - Periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), or blood behind tympanic membrane (hemotympanum) - Facial nerve (VII) palsy - CSF rhinorrhea or otorrhea How would you assess a pt with a cranial injury? - CORRECT ANSWERS (Initial assessment) INSPECTION: - Assess airway - RR, pattern and effort - Assess pupil size and response to light - Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome - Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Determine if pt uses eye meds - Abnormal posturing? - Inspect craniofacial area for ecchymosis/contusions - Periorbital ecchymosis - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 mm Hg may cause increased cerebral vasodilation, increased CBF, increased ICP. - Prolonged hyperventilation NOT RECOMMENDED. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are signs of a serious eye injury? - CORRECT ANSWERS - Visual disturbances - Pain - Redness and ecchymosis of the eye - Periorbital ecchymosis - Increased intraocular pressure What is hyphema and its S/S? - CORRECT ANSWERS Accumulation of blood, mainly RBC's that disperse and layer within the anterior chamber. A severe hymphema obscures entire anterior chamber + will diminish visual acuity severely or completely. Injuries are graded on amount of blood in chamber (Grades I-IV). S/S: - Blood in anterior chamber - Deep, aching pain - Mild to severe diminished visual acuity - Increased intraocular pressure What are s/s of chemical burns to the eye? - CORRECT ANSWERS Chemical injuries require immediate intervention if it is to be preserved. S/S: - Pain TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Corneal Opacification - Coexisting chemical burn and swelling of lids What are S/S of penetrating trauma/open or ruptured globe? - CORRECT ANSWERS - Marked visual impairments - Extrusion of intraocular contents - Flattened or shallow anterior chamber - Subconjunctival hemorrhage, hyphema - Decreased intraocular pressure - Restriction of extraocular movements What are the S/S of orbital fracture (orbital blowout fracture)? - CORRECT ANSWERS - Diplopia (double vision) - Loss of vision - Altered extraocular eye movements - Enophthalmos (displacement of the eye backward into the socket) - Subconjunctival hemorrhage or ecchymosis of the eyelid - Infraorbital pain or loss of sensation - Orbital bony deformity TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is LeFort I fracture and its S/S? - CORRECT ANSWERS Transverse maxillary fx that occurs above level of teeth and results in separation of teeth from rest of maxilla. S/S: - Slight swelling of maxillary area - Possible lip lac's or fractured teeth - Independent movement of the maxilla from rest of face - Malocclusion What is LeFort II fracture and its S/S? - CORRECT ANSWERS Pyramidal maxillary fx=middle facial area. Apex of fx transverses bridge of nose. Two lateral fx's of pyramid extend through the lacrimal bone of the face and ethmoid bone of skull into the median portion of both orbits. Base of the fx extends above level of the upper teeth into maxilla. CSF leak is possible. S/S: - Massive facial edema - Nasal swelling w/obvious fx of nasal bones - Malocclusion - CSF rhinorrhea TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - What was it caused by? - Pt restrained? Airbags deployed? Etc. - What are the pt's complaints? - Pt normally wear glasses or contacts? - Pt have hx of eye problems? - Pt ever have eye surgery? - Pt have visual or ocular changes associated with chronic illness? PHYSICAL INSPECTION: - Inspect eye, orbits, face and neck - Check for symmetry, edema, ecchymosis, ptosis, lacerations and hematomas - Inspect globe for lacerations, large corneal abrasions, hyphema, and extrusion or prolapse of intraocular contents - Determine whether lid lac's - Assess pupil's (PERRL) - Unilateral fixed and dilated pupil may indicate oculomotor nerve compression as a result of ICP + herniation syndrome - Bilateral fixed and pinpoint pupils = pontine lesion or drugs - Mildly dilated pupil w/sluggish response may early sign of herniation syndrome TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Widely dilated pupil occasionally occurs w/direct trauma to globe of eye - Assess for consensual response - Assess redness, eye watering, blepharospasm - Assess extraocular movement, except when an open globe injury is known or suspected. - Limitation range of ocular motion may indicate orbital rim fx w/entrapment or paralysis of cranial nerve or ocular muscle - Perform visual acuity exam - Use Snellen or handheld chart. Check uninjured eye first - Assess for blurred or double vision with injured eye and then with both eyes open - Inspect for rhinorrhea or otorrhea - If drng present, may indicate CSF leak - Observe for impaled objects - Assess occlusion of mandible and maxilla - Malocclusion or inability to open + close mouth is highly indicative of maxillary or mandibular fx - Observe for uncontrolled bleeding PALPATION - Palpate periorbital area, face and neck for: TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Tenderness - Edema - Step-off defects or depressions - Subcutaneous emphysema (esophageal or tracheal tear) - Palpate trachea above suprasternal notch - Trach deviation = late indication of tension pneumothorax or massive hemothorax - Assess sensory fx of perioribital areas, face and neck - Facial fx's can impinge on infraorbital nerve, causing numbness of inferior eyelid, lateral nose, cheek, or upper lip on affected side. - Check position of trachea DIAGNOSTIC STUDIES: - Xrays, CT scans, MRI's - Fluorescein staining - Slit-lamp exam - tonometry (measures intraocular pressure) - Bronchoscopy or esophagoscopy What are the nursing interventions for a pt with an ocular injury? - CORRECT ANSWERS - Assess visual acuity & reassess - Elevate HOB to minimize intraocular pressure TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ With any eye injury, what should the evaluation and ongoing assessments be? - CORRECT ANSWERS - Reassessing visual acuity at reasonable intervals - Reassessing pain, including response to nonpharmacologic + pharmacologic interventions - Monitoring appearance, position, movements of globe and pupillary responses - Monitoring airway patency, respiratory effort and ABG's What are the most common type of injury associated with chest trauma? - CORRECT ANSWERS blunt; MVC's. Penetrating; firarm injuries or stabbings What are S/S of a rib fracture? - CORRECT ANSWERS - Dyspnea - Localized pain on movement, palpation, or inspiration - Pt assumes position intended to splint chest wall to reduce pain - Chest wall ecchymosis or sternal contusion - Bony crepitus or deformity What is a flail chest? - CORRECT ANSWERS A fracture of two or more sites on two or more adjacent ribs, or when rib fractures produce a free-floating sternum. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Flail segments may not be clinically evident in the first several hours after injury b/c of muscle spasms that cause splinting. After positive pressure intiated, paradoxical chest wall movement ceases. What could a flail chest be associated with? - CORRECT ANSWERS - Ineffective ventilation - Pulmonary contusion - Lacerated lung parenchyma What are the S/S of flail chest? - CORRECT ANSWERS - Dyspnea - Chest wall pain - Paradoxical chest wall movement - the flail segment moves in during inspiration and out during expiration. Define Pneumothorax. - CORRECT ANSWERS Results when an injury to lung leads to accumulation of air in pleural space w/subsequent loss of negative intrapleural pressure. Partial or total collapse of lung may ensue. An open pneumothorax results from wound through chest wall. Air enters pleural space both through the wound and trachea. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are the S/S of a pneumothorax? - CORRECT ANSWERS - Dyspnea, tachypnea - Tachycardia - Hyerresonance (increased echo produced by percussion over the lung field) on the injured side - Decreased or absent breath sounds on the injured side - Chest pain - Open, sucking wound on inspiration (open pneumothorax) Define tension pneumothorax. - CORRECT ANSWERS Life-threatening injury. Air enters pleural space on inspiration, but air cannot escape on expiration. Rising intrathoracic pressure collapses lung on side of injury causing a mediastinal shift that compresses the heart, great vessels, trachea and uninjured lung. Venous return impeded, cardiac output falls, hypotension results. Immediate decompression should be performed. Treatment should not be delayed. What are the S/S of a tension pneumothorax? - CORRECT ANSWERS - Severe respiratory distress - Markedly diminished or absent breath sounds on affected side TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Abdominal pain - Sharp epigastric or chest pain radiating to left shoulder (Kehr's sign) - Bowel sounds heard in lower middle chest - Decreased breath sounds on injured side What are S/S with tracheobronchial injury? - CORRECT ANSWERS Blunt trauma. "Clothesline-type" injuries. - Dyspnea, tachypnea - Hoarseness - Hemoptysis - Subcutaneous emphysema in neck, face, or suprasternal area - Decreased or absent breath sounds - S/S of airway obstruction What are S/S with blunt cardiac injury? - CORRECT ANSWERS "Cardiac contusion" or "concussion." Common with MVC or falls from heights. - ECG (sinus tach, PVC's, AV blocks) - Chest pain - Chest wall ecchymosis TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are the S/S of pericardial tamponade? - CORRECT ANSWERS A collection of blood in pericardial sac. As blood accumulates, it exerts pressure on the heart, inhibiting or compromising ventricular filling. - Hyotension - Tachycardia or PEA - Dyspnea - Cyanosis - Beck's Triad (hypotension, distended neck veins + muffled heart sounds) - Progressive decreased voltage of conduction complexes on ECG What are aortic injuries S/S? - CORRECT ANSWERS - Hypotension - Decreased LOC - Hypertension in UE's - Decreased quality (amplitude) of femoral pulses compared to UE pulses - Loud systolic murmur in parascapular region - Chest pain - Chest wall ecchymosis - Widened mediastinum on chest xray - Paraplegia TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ How would you assess a pt with a thoracic injury? - CORRECT ANSWERS (Initial assessment) Obtain Hx. PHYSICAL: Inspection: - Observe chest wall - Assess breathing effort and RR - Symmetry - Inspect jugular veins (Distended = increased intrathoracic pressure as result of tension pneumothorax or pericardial tamponade. Flat = external jugular veins may reflect hypovolemia) - Inspect upper abdominal region for injury Percussion: - Percuss the chest (Dullness = hemothorax, Hyperresonance = pneumothorax) Palpation: - Palpate chest wall, clavicles and neck for: - Tenderness - Swelling or hematoma - Subcutaneous emphysema TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is the Mnemonic for the Initial Assessment? - CORRECT ANSWERS A = Airway with simultaneous cervical spine protection B = Breathing C = Circulation D = Disability (neurologic status) E = Expose/Environmental controls (remove clothing and keep the patient warm) What is the Mnemonic for the Secondary Assessment? - CORRECT ANSWERS F = Full set of VS/Focused adjuncts (includes cardiac monitor, urinary catheter, and gastric tube)/Family presence G = Give comfort measures (verbal reassurance, touch, and pharmacologic and nonpharmacologic management of pain). H = Hx and Head-to-toe assessment I = Inspect posterior surfaces Where do you listen to auscultate breath sounds? - CORRECT ANSWERS Auscultate the lungs bilaterally at the second intercostal space midclavicular line and at the fifth intercostal space at the anterior axillary line. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are the late signs of breathing compromise? - CORRECT ANSWERS - Tracheal deviation - JVD What are signs of ineffective breathing? - CORRECT ANSWERS - AMS - Cyanosis, especially around the mouth - Asymmetric expansion of chest wall - Paradoxical movement of the chest wall during inspiration and expiration - Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing - Sucking chest wounds - Absent or diminished breath sounds - Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated - Anticipate definitive airway management to support ventilation. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - CORRECT ANSWERS A tight-fitting nonrebreather mask at 12-15 lpm. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What intervention should be done if a pt presents with effective circulation? - CORRECT ANSWERS - Insert 2 large caliber IV's - Administer warmed isotonic crystalloid solution at an appropriate rate What are signs of ineffective circulation? - CORRECT ANSWERS - Tachycardia - AMS - Uncontrolled external bleeding - Pale, cool, moist skin - Distended or abnormally flattened external jugular veins - Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - CORRECT ANSWERS - Control any uncontrolled external bleeding by: - Applying direct pressure over bleeding site - Elevating bleeding extremity - Applying pressure over arterial pressure points - Using tourniquet (last resort). - Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution - Use warmed solution TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is the second thing assessed under the Secondary Assessment? - CORRECT ANSWERS GIVE COMFORT MEASURES - Talking to pt - Pharmacologic/Nonpharmacologic pain management - Observe for physical signs of pain What is assessed under the Mnemonic "H"? - CORRECT ANSWERS HISTORY / HEAD-TO-TOE ASSESSMENT - MIVT - M = Mechanism of injury - I = Injuries sustained - V = Vital Signs - T = Treatment - Pt generated information - PMH - Head-to-toe assessment What is assessed under the Mnemonic "I"? - CORRECT ANSWERS INSPECT POSTERIOR SURFACES - While maintaining C-spine, logroll pt with assistance to inspect back, flanks, buttocks and posterior thighs. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Palpate vertebral column for deformity and areas of tenderness - Assess rectum for presence/absence of tone, presence of blood What she be done after the Secondary Assessment? - CORRECT ANSWERS Reassess: - Primary survey, - VS - Pain - Any injuries What are factors that contribute to ineffective ventilation? - CORRECT ANSWERS - AMS - LOC - Neurologic injury - Spinal Cord Injury - Intracranial Injury - Blunt trauma - Pain caused by rib fractures - Penetrating Trauma - Preexisting hx of respiratory diseases - Increased age TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What medications are used during intubation? - CORRECT ANSWERS LOAD Mnemonic: L = Lidocaine O = Opioids A = Atropine D = Defasiculating agents What are the Rapid Sequence Intubation Steps? - CORRECT ANSWERS PREPARATION: - gather equipment, staffing, etc. PREOXYGENATION: - Use 100% O2 (prevent risk of aspiration). PRETREATMENT: - Decrease S/E's of intubation PARALYSIS WITH INDUCTION: - Pt has LOC, then administer neuromuscular blocking agent PROTECTION AND POSITIONING: - Apply pressure over cricoid cartilage (minimizes likelihood of vomiting and aspiration PLACEMENT WITH PROOF TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Lac to trachea or esophagus - Creation of a false passage - Laryngeal stenosis How do you confirm ET Tube/Alternative Airway Placement? - CORRECT ANSWERS - Visualization of the chords - Using bronchoscope to confirm placement - Listening to breath sounds over the epigastrum and chest walls while ventilating the pt - CO2 detector - Esophageal detection device - Chest x-ray How do you inspect the chest for adequate ventilation? - CORRECT ANSWERS Observe: - mental status - RR and pattern - chest wall symmetry - any injuries - patient's skin color (cyanosis?) - JVD or tracheal deviation? (Tension pneumothorax) TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are you looking for when auscultating lung sounds? - CORRECT ANSWERS Absence of BS: - Pneumothorax - Hemothorax - Airway Obstruction Diminished BS: - Splinting or shallow BS may be a result of pain What are you looking for when percussing the chest? - CORRECT ANSWERS Dullness: - hemothorax Hyperresonance - Pneumothorax What are you looking for when palpating the chest wall, clavicles and neck? - CORRECT ANSWERS - Tenderness - Swelling - subcutaneous emphysema - step-off deformities TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ = These may indicate: esophageal, pleural, tracheal or bronchial injuries. Palpate trachea above suprasternal notch. Tracheal deviation may indicate a tension pneumothorax or massive hemothorax. What is the DOPE mnemonic? - CORRECT ANSWERS D - Displaced tube O - Obstruction: Check secretions or pt biting tube P - Pneumothorax: Condition may occur from original trauma or barotrauma from ventilator E - Equipment failure: pt may have become detached from equipment or there's a kink in the tubing Explain Hypovolemic Shock. - CORRECT ANSWERS Most common to affect a trauma pt cause by hypovolemia.. Hypovolemia, a decrease in amount of circulating blood volume, may result from significant loss of whole blood because of hemorrhage or from loss of semipermeable integrity of cellular membrane leading to leakage of plasma and protein from intravascular space to the interstitial space (as in a burn). Some causes: - Blood loss - Burns, etc. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is renal response? - CORRECT ANSWERS Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes: - Vasoconstriction of arterioles and some veins - Stimulation of sympathetic nervous system - Retention of water by kidneys - Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ Explain adrenal gland response. - CORRECT ANSWERS When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol. Effect of cortisol release is elevation in blood sugar and increased insulin resistance and gluconeogenesis, hepatic process to produce more sugar. Cortisol also causes renal retention of water and sodium, a compensatory mechanism to conserve body water. Explain Hepatic Response. - CORRECT ANSWERS Liver can store excess glucose as glycogen. TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ As shock progresses, glycogenolysis is activated by epi to break down glycogen into glucose. In a compensatory response to shock, hepatic vessels constrict to redirect blood flow to other vital areas. Explain Pulmonary Response. - CORRECT ANSWERS Tachypnea happens for 2 reasons: 1. Maintain acid-base balance 2. Maintain increased supply of oxygen * Metabolic acidosis from anaerobic metabolism will be a stimulus for the lungs to increase rate of ventilation. Increased RR is an attempt to correct acidosis + augments oxygen supply to maximize oxygen delivery to alveoli. Explain Irreversible Shock. - CORRECT ANSWERS Shock uncompensated or irreversible stages will cause compromises to most body systems. - Inadequate venous return - inadequate cardiac filling - decreased coronary artery perfusion TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ 3. Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. What are the early signs and symptoms of increased ICP? - CORRECT ANSWERS - Headache - N/V - Amnesia regarding events around the injury - Altered LOC - Restlessness, drowsiness, changes in speech, or loss of judgement TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What are the late observable signs of symptoms of increased ICP? - CORRECT ANSWERS - Dilated, nonreactive pupil - Unresponsiveness to verbal or painful stimuli - Abnormal motor posturing patterns - Widening pulse pressure - Increased systolic blood pressure - Changes in RR and pattern - Bradycardia What is Cushing's phenomenon or Cushing's Reflex? - CORRECT ANSWERS Triad of progressive HTN, bradycardia and diminished respiratory effort. What are the two types of herniation that occurs with ICP? - CORRECT ANSWERS 1. Uncal herniation 2. Central or transtentorial herniation Why does herniation occur? What are the symptoms? - CORRECT ANSWERS Because of uncontrolled increases in ICP. S/E's TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Unilateral or bilateral pupillary dilation - AsyDimmetric pupillary reactivity - Abnormal motor posturing - Other evidence of neurologic deterioration Define uncal herniation. - CORRECT ANSWERS The uncus (medial aspect of the temporal lobe) is displaced over the tentorium into the posterior fossa. This herniation is the more common of the two types of herniation syndromes. Define central or transtentorial herniation. - CORRECT ANSWERS A downward movement of the cerebral hemispheres with herniation of the diencephalon and midbrain through the elongated gap of the tentorium. Disruptions of the bony structures of the skull can result in what? - CORRECT ANSWERS Displaced or nondisplaced fx's causing CSF leakage b/c of lac to the dura mater, creating a passage for CSF. CSF leaks through the nose (rhinorrhea) or the ears (otorrhea). A potential entrance for invading bacteria. Also: meningitis or encephalitis or brain abscess TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - mild DAI, coma = 6-24 hrs - severe DAI, coma = weeks/months or persistent vegetative state - Elevated ICP - Abnormal posturing - HTN - Hyperthermia - Excessive sweating because of autonomic dysfunction - Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits What is a cerebral contusion and its S/S? - CORRECT ANSWERS A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S: - Alteration in LOC - Behavior, motor or speech deficits - Abnormal motor posturing - Signs of increased ICP TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ What is an epidural hematoma and its S/S? - CORRECT ANSWERS Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly: - Compression of underlying brain - rapid increase in ICP - Decreased CBF - Secondary brain injury * Usually requires surgical intervention S/S: - Transient LOC - Lucid period lasting a few minutes to several hours - Rapid deterioration in neurologic status - Severe H/A - Sleepiness - Dizziness - N/V - Hemiparesis or hemiplegia on opposite side of hematoma - Unilateral fixed and dilated pupil on same side of hematoma What is a subdural hematoma and its S/S? - CORRECT ANSWERS A focal brain injury beneath the dura mater that results from TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ acceleration/deceleration. Usually venous, and not necessarily from a fx. Formation may be acute or chronic. Acute pt's hematoma manifest 48 hrs post injury S/S: - Altered LOC or steady decline in LOC - S/S of increased ICP - Hemiparesis or hemiplegia on opposite side of hematoma - Unilateral fixed and dilated pupil on same side of hematoma Chronic pt's " " up to 2 wks post injury - H/A - Progressive decrease in LOC - Ataxia - Incontinence - Sz's What are intracerebral hematoma's and its S/S? - CORRECT ANSWERS Occur deep within brain tissue, may be single or multiple and commonly associated with contusions (frontal & temporal lobes). They TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Mastoid's process ecchymosis - Blood behind tympanic membrane - Inspect nose and ears for drainage - Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF - If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF - Assess extraocular eye movement (Tests cranial nerves, III, IV, VI) - Performing extraocular eye movements indicates functioning brainstem - Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle - Determine LOC with GCS PALPATION - Palpate cranial area for: - Point tenderness - Depressions or deformities - Hematomas - Assess all 4 extremities for: - Motor function, muscle strength and abnormal motor posturing TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Sensory function DIAGNOSTIC PROCEDURES - Lab Studies PLANNING AND IMPLEMENTATION - (Initial assessment) - Clear airway (stimulation of gag reflex can produce transient increase in ICP or vomiting with subsequent aspiration. - Administer O2 via NRB - Assist with early ET intubation - Administer sedative/neuromuscular blocking agent - Consider hyperventilation - PaCO2 above 45 mm Hg may cause increased cerebral vasodilation, increased CBF, increased ICP. - Prolonged hyperventilation NOT RECOMMENDED. - Hypocarbia occurs as result of hyperventilation causes cerebral vasoconstriction, decreased CBF, decreased ICP. And ischemia secondary to severe vasoconstriction. - Hyperoxygenate pt with 100% O2 via bag-mask - Apply direct pressure to bleeding sites except depressed skull fractures - Cannulate 2 large IV's TNCC TEST PREPA, TNCC NOTES FOR WRITTEN EXAM, 415Q & AS TNCC PREP, TNCC EXAM, TNCC 8TH EDITION2023/2024 GRADED A+ - Hypotension doubles pt's death rate (w/severe head trauma) - Vasopressors used to maintain CPP. - Insert OG or NGT. OG should be used with severe facial trauma. - Position pt, elevate head to decrease ICP (but may also reduce CPP). - Position head midline to facilitate venous drng. Rotate head to compress veins in neck and result in both venous engorgement and decreased drng from brain - Prepare for ICP monitoring device - Administer mannitol as prescribed. - Mannitol, hyperosmolar, volume-depleting diuretic, decreases cerebral edema + ICP by pulling interstitial fluid into intravascular space for eventual excretion by kidneys. - Administer anticonvulsant - Sx should be avoided b/c increases cerebral metabolic rate + ICP. Indications for sz prophylaxis: - Depressed skull fx - Sz at time of injury - Sz on arrival to ED - Hx of sz's - Penetrating brain injury - Acute subdural/epidural hematoma