Trauma Nursing Core Course: Assessment and Interventions for Various Injuries, Exams of Nursing

Download Trauma Nursing Core Course: Assessment and Interventions for Various Injuries and more Exams Nursing in PDF only on Docsity! TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified 1. Which of the following requires you to develop a plan of action, initiate the plan, reassess the plan as care for the patient moves forward, and adjust the plan as the patient's condition or circumstances change? A. Principles of PHTLS B. The Golden Period C. The XABCDE assessment D. Critical thinking process - ansQuestion 1: D To help achieve the PHTLS goals, you will apply your critical thinking skills in the field. Critical thinking in medicine is a process in which the healthcare practitioner assesses the situation, the patient, and the resources available and uses the information to decide on and provide the best care for the patient. 1. You and your partner are responding to a call for a 2-year-old patient with a burn injury to the hand. He has a visible burn to the left hand, ending at the level above the wrist, red color, and wet in appearance. What type of burn do you suspect the patient has sustained? A. Superficial (first degree) B. Partial thickness (second degree) C. Full thickness (third degree) D. Subdermal (fourth degree) - ansQuestion 1: B Scald burns are the most common burns seen in the pediatric population ages 1 to 5 years. Scalds are partial thickness burns. The dermal layer is damaged, and blisters are present or popped. It is also the most painful type of burn. 1. You are called to the scene of a possible mass casualty motor vehicle collision on the highway. Once you arrive on scene, what is your first priority? A. Immediately begin triaging patients. B. Treat the patient with the most visible blood loss. C. Determine the need for additional resources. D. Assess the scene and ensure it is safe. - ansQuestion 1: D Ensure safety for responders, bystanders, and patient(s). The first consideration when approaching any scene is the safety of all emergency responders. When EMS personnel become victims, they not only can no longer assist others, but also add to the number of patients. 1. You are called to the scene of an explosion and fire at a chemical plant where you find multiple casualties.Triage has begun. Your first patient is a 40-year-old man who was near the source of the explosion. He is unconscious and has extensive injuries. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified You note gurgling respirations. Why should you use the trauma jaw thrust maneuver first when dealing with a trauma patient? A. It's an easy technique that always works to open the airway. B. It allows you to open the airway with little or no movement of the head and cervical spine. C. Other techniques and interventions don't work as well. D. It can relieve a variety of anatomic airway obstructions in patients who are breathing spontaneously. - ansQuestion 1: B Manual maneuvers like the trauma jaw thrust or chin lift are always the first airway maneuver you should make when treating a trauma patient. In patients with suspected head, neck, orfacial trauma, the cervical spine is maintained in a neutral in-line position.The trauma jaw thrust maneuver allows you to open the airway with little or no movement of the head and cervical spine. 1. You are responding to a call for 25-year-old, fit and healthy female who fell off a mountain bike. Upon arrival, you find the patient walking around. She is alert but complaining of pain in her clavicle and on her right side when she inhales. You notice that her helmet is split in two. What is the first thing you need to do? A. Complete a review of the ABCs. B. Check motor and sensory function. C. Perform manual in-line stabilization. D. Place her on a backboard. - ansQuestion 1: C Because there's a possibility of spinal injury, you should bring the patient's head into a neutral in-line position. 1. You have been performing ongoing management on a 35-year-old female patient who sustained thoracic trauma when a car hit her as she crossed the street. Originally, your electronic monitoring devices all produce results consistent with your patient's clinical condition. However, en route the trauma center, the monitors start to differ from your patient's current clinical condition each time you reassess. How should you handle this situation? A. Treat the patient's condition, not the monitor results. B. Continue to reassess the patient and record the results for the trauma center. C. Treat your patient based on the test results. D. Stop testing and wait until you arrive at the trauma center for them to perform an assessment. - ansQuestion 1: A If there are inconsistent data from electronic monitoring devices, reassess to be sure the monitor matches the patient's current clinical condition. However, it is most important to treat the patient, not the monitor, so use other signs and symptoms of potential patient deterioration. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified C. Start IV for fluid resuscitation. D. Stop the burning process and remove the ice pack. - ansQuestion 2: D A common error that results in damage to the zone of stasis is the application of ice by a bystander or prehospital care practitioner. When ice is applied to a burn, the patient will experience some reduction in pain; however, the pain relief will be at the expense of additional tissue destruction. 2. The patient's respiration improves markedly, but he remains confused. He has an absent radial pulse, and his carotid pulse is fast and thready. Your partner asks if he can let the compression go to put in an IV. How should you respond? A. "Oh yes, that's a great idea!" B. "Yes, but we have to immobilize him first" C. "Take a blood pressure first to see if he needs an IV." D. "No, keep the pressure and let's get out of here!" - ansQuestion 2: D This patient is likely in decompensated shock with internal bleeding, so rapid transport is the next priority. You should maintain pressure on the wound, because having massive external bleeding start up again is the last thing you want in this situation. 2. Upon examination, you find the patient responsive to your presence, although she is clearly confused. Motor response shows reduced pain response but normal flexion. What's her GCS score? A. 15 B. 12 C. 10 D. 8 - ansQuestion 2: B Eye opening: 4; verbal response: 4; motor response: 4 = 12 2. When using the XABCDE assessment, which of the following takes precedence over all other actions? A. Controlling severe bleeding from a limb or other compressible site B. Airway stabilization and assessing circulatory status C. Exposing the body to allow a thorough evaluation D. Ensuring adequate breathing - ansQuestion 2: A The "X" placed before "ABCDE" in the primary survey refers to the need to address exsanguinating hemorrhage immediately after establishing scene safety and before addressing airway. Severe exsanguinating hemorrhage, particularly arterial bleeding, has the potential to lead to loss of total or near total blood volume in a relatively short period of time. 2. You are responding to a call to an MVC involving one patient. When you perform your primary survey, you find a patent airway, but abnormalities with breathing and TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified circulation. You suspect hypovolemic shock, but cannot determine the source. What does this finding most likely indicate? A. Hemothorax B. Intra-abdominal bleed C. Blunt cardiac injury D. Diaphragmatic rupture - ansQuestion 2: B The most reliable indicator of an intraabdominal bleed is the presence of hypovolemic shock from an unexplained source. 2. You have determined that you are going to need to perform orotracheal intubation on a 50-year-old male motor vehicle crash (MVC) critically injured trauma patient due to prolonged transport time. What do you need to do first? A. Preoxygenate to maximize oxygen saturation. B. Place the patient in a "sniffing"position. C. Clear the mouth of any obstructions. D. Prepare the patient for immediate transport. - ansQuestion 2: A Before insertion of any invasive airway, the patient is preoxygenated with a high concentration of oxygen using a simple airway adjunct or manual airway procedure. 3. After exposing the patient, no other burn injuries were found, but blisters have started to form on the hand and the child is crying from pain. How should you manage the blisters? A. Lance the blisters to drain the fluidand relieve the pressure. B. Cover the injury with a dry, loose, sterile dressing, being sure to leave the blisters intact. C. Use a topical antibiotic ointment and firmly wrap the burn injury. D. Establish an IV for fluid resuscitation. - ansQuestion 3: B In the prehospital setting, blisters are generally best left alone during the relatively short transport time. Blisters that have already ruptured should be covered with a clean, dry dressing. 3. What does the GCS score indicate? A. Mild TBI B. Moderate TBI C. Severe TBI D. No TBI - ansQuestion 3: B A total GCS score of 13 to 15 likely indicates a mild TBI whereas a score of 9 to 12 is indicative of moderate TBI. A GCS score of 3 to 8 suggests severe TBI. 3. What is the best way to control the bleeding? A. Direct pressure B. Elevation of the arm above the heart TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified C. Tourniquet D. Occlusive dressing - ansQuestion 3: A With venous bleeds, direct pressure isusually sufficient to stop the flow. 3. When securing a patient to a backboard, which body part should you secure first? A. Head B. Torso C. Legs D. Pelvis - ansQuestion 3: B When immobilizing a patient, you should secure the torso first, then the head, the legs, and the pelvis. 3. Which of the following is the basis on which a patient's chance of survival is maximized? A. Preferences B. Phases C. Principles D. Transport - ansQuestion 3: C The science of medicine provides the principles of medical care. Simply stated, principles define the duties required of the prehospital care practitioner in optimizing patient survival and outcome. 3. While en route to the hospital, you manage to put an 18-gauge IV in the right arm. Your patient is still confused, and you still have no radial pulse. Your next move is to: A. give 1-L fluid bolus. B. give one 250-mL fluid bolus, and then stop. C. give fluid until you get a radial pulse. D. administer TXA. - ansQuestion 3: C Now is the time to titrate IV fluids to restore tissue perfusion. Giving 1 liter blindly could overshoot your target pressure and reinforce internal bleeding. TXA is not a priority, although it can run parallel to fluids. 3. Why might it be more difficult to deal with an airway obstruction in a child? A. Children have longer tracheas. B. Children have larger heads and tongues so there is a greater potential for airway obstruction. C. Children have smaller heads, so there is less room to clear the obstruction. D. A child's epiglottis is smaller and stiffer than an adult's. - ansQuestion 3: B Children have larger heads and tongues as compared to an adult so there is a greater potential for airway obstruction in a pediatric patient. You must pay special attention to the proper positioning of a pediatric patient to maintain a patent airway. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified 4. Which of the following is a goal of the Golden Period? A. Provide written documentation from field care to receiving hospital. B. Expedite the field care and transport of the patient. C. Use a team approach for optimal patient care. D. Use the XABCDE approach to patient assessment. - ansQuestion 4: B One of your most importantresponsibilities as a prehospital carepractitioner is to spend as little time onthe scene as possible and expedite yourfield care and transport of the patient.Studies show that the time from injuryto arrival at the appropriate site fordefinitive care is critical to survival. 4. Why might you consider early mechanical ventilation via bag-mask device in a geriatric patient? A. Shorter tracheas in geriatric patients create the need for ventilation assistance. B. Laxity of the rib cage makes hyperventilation more likely. C. Geriatric patients have greatly limited physiologic reserve. D. Geriatric patients have a greater alveolar surface area of the lungs. - ansQuestion 4: C Early mechanical ventilation via bag mask device or advanced airway measures should be considered in geriatric trauma patients because of their greatly limited physiologic reserve. 5. Which of the following signs would be most concerning at this point? A. A drop in systolic blood pressure to 88 mm Hg B. SpO₂ of 93% C. A field GCS motor score of 4 D. Hemiplegia on the left side - ansQuestion 5: A A systolic blood pressure of less than 90 mm Hg indicates secondary brain injury. Her SpO2 is > 90%, and a motor score of 4 is not as concerning. 5. While attempting to lay the patient supine for spinal motion restriction she becomes increasingly distressed and complains of shortness of breath and difficulty breathing. The fractured clavicle appears to move distally and increases the difficulty of breathing as the patient lies back. What should you do? A. Tip the backboard to a left lateral position. B. Raise the back of the stretcher. C. Let her sit up in a position of comfort. D. Administer morphine. - ansQuestion 5: B Because laying the patient supine increases the risk of airway/ventilation problems, raising the back of the stretchers slightly fundamentally maintains spinal alignment while reducing the ventilation issues. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified 5. You now perform a secondary survey. You notice a sternotomy scar. Your patient tells you he is on oral clopidogrel since he had a coronary artery bypass graft 2 years ago. Is this information useful? A. No, he should stop talking and breathe. B. Yes, he should see a cardiologist once in the local hospital. C. Yes, he will need platelets and a heart surgeon ASAP. D. Yes, you should raise his blood pressure up to 130 mm Hg systolic. - ansQuestion 5: C Because he is on clopidogrel, his platelets are out of order for at least 5 days, so he will require urgent platelet transfusion. 6. According to the Monro-Kellie doctrine, what happens to the brain when it is still in a compensated state after a TBI? A. CSF, ICP, heart rate, and blood pressure are still within normal range. B. CSF increases, ICP decreases, heart rate increases, and blood pressure decreases. C. CSF and blood volume decrease, while heart rate and blood pressure are still within normál range. D. CSF decreases, ICP increases, heart rate decreases, and blood pressure increases. - ansQuestion 6: C In a compensated state, CSF and blood volume decrease, while heart rate and blood pressure are still within normal range. _________ therapy is now suggested for fluid resuscitation to replace patient losses, including administering PRBCs, plasma, and platelets. - ansCOMPONENT THERAPY ch. 5, p. 45 __________, which can occur in resuscitation, is a common IATROGENIC cause of INCREASED intrathoracic pressure resulting in COMPRESSION of the heart and DECREASED cardiac output. - ansHYPERVENTILATION ch. 7, p. 74 55% of spinal injuries occur to which part of spine? - anscervical ch. 13, p. 179 A rapid, thready pulse may indicate (a. _______), and an irregular pulse may warn of potential (b. _______). - ansa. HYPOVOLEMIA b. CARDIAC DYSFUNCTION ch. 5, p. 45 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified ABGs provide values of oxygen, CO2 and base excess, which are... - ansReflective endpoint measurements of the effectiveness of cellular perfusion, adequacy of ventilation, and the success of the resuscitation. An abnormal base deficit may indicate poor perfusion and tissue hypoxia, which results in the generation of hydrogen ions and metabolic acidosis. ch. 5, p. 46 Activation of the SYMPATHETIC NERVOUS SYSTEM causes the ADRENAL glands to release TWO catecholamines - EPINEPHRINE and NOREPINEPHRINE. These cause... - ans- HIGH levels of EPINEPHRINE cause smooth muscle relaxation in the airways and causes arteriole smooth muscle contractility (potentiating inotrophic effect). EPI also INCREASES heart rate (positive chronotrophic effect), peripheral vasocontriction, and glycogenolysis (breakdown of glycogen stores in liver into glucose for cellular use) - NOREPINEPHRINE increases heart rate, vascular tone through alpha-adrenergic receptor activation, and blood flow to skeletal muscle and triggers the release of glucose from energy stores. ch. 7, p. 77 Additional history includes the following (MIST mnemonic) prehospital report: - ans- MOI - Injuries sustained - Signs and Symptoms (in the field) - Treatment (in the field) ch. 5, p. 47 All open fractures are considered contaminated due to exposure to the environment and are at risk for infection. These sites of injury have poor wound healing with a risk of.... - ansOSTEOMYELITIS and SEPSIS ch. 14, p. 197 Anterior cord syndrome - ansloss of pain and temperature sensation with weakness, paresthesia, and urinary retention ch. 13, p. 182 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified - APHASIA - IPSILATERAL UNILATERAL FIXED and DILATED PUPIL - INCONTINENCE - SEIZURES Ch. 9, p. 114 Assessment findings of a DIFFUSE INJURY - ansInjuries that occur over a wide spread area, not always identifiable on CT because damage involves contusions or hearing and stretching of micro vascular, not a localized hematoma. These injuries commonly follow a direct blow to the head and are often sports-related. Patients can have varying degrees of symptoms that last minutes to hours. Assessment findings include: - TRANSIENT LOC - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONFUSION, DISORIENTATION - MEMORY LOSS and CONCENTRATION DIFFICULTY - IRRITABILITY and FATIGUE Ch. 9, p. 115 Assessment findings of a EPIDURAL HEMATOMA - ans- TRANSIENT LOC followed by lucid period lasting minutes to hours - HEADACHE, DIZZINESS - NAUSEA, VOMITING - CONTRALATERAL HEMIPARESIS - HEMIPLEGIA - ABNORMAL MOTOR POSTURING (FLEXION/EXTENSION) Extension is associated with brainstem HERNIATION and poor outcomes - IPSILATERAL UNILATERAL FIXED, DILATED PUPIL - RAPID DETERIORATION IN NEURO STATUS Ch. 9, p. 114 Assessment findings of a HERNIATION SYNDROME - ans- ASYMMETRIC PUPILLARY REACTIVITY - UNILATERAL or BILATERAL PUPILLARY DILATION - ABNORMAL MOTOR POSTURING - other evidence of neurologic deterioration (loss of normal, reflexes, paralysis, or change in LOC) TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Ch. 9, p. 115 Assessment findings of a INTRACEREBRAL HEMATOMA - ans- PROGRESSIVE, RAPID DECLINE IN LOC - HEADACHE - SIGNS OF INCREASING ICP - PUPIL ABNORMALITIES - CONTRALATERAL HEMIPARESIS - HEMIPLEGIA - ABNORMAL POSTURING Ch. 9, p. 114 Assessment findings of an ACUTE SUBDURAL HEMATOMA - ans- SEVERE HEADACHE - CHANGES IN LOC - IPSILATERAL DILATED or NONREACTIVE PUPIL - CONTRALATERAL HEMIPARESIS Ch. 9, p. 114 Assessment findings of DIFFUSE AXONAL INJURY - ans- UNCONSCIOUSNESS Mild DAI lasts 6-24 hrs Severe DAI lasts weeks to months - INCREASED ICP - ABNORMAL POSTURING - HTN (systolic BP between 140-160) - HYPERTHERMIA (104-105 F) - EXCESSIVE SWEATING - MILD TO SEVERE MEMORY LOSS; COGNITIVE, BEHAVIORAL, and INTELLECTUAL DEFICITS Ch. 9, p. 116 AXIAL LOADING - ansetiology/cause- direct force transmitted along the length of vertebral column rest of injury- deformity of vertebral column, secondary edema of spinal cord resulting in neurologic effects example- diver striking head on bottom of pool TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified ch. 13, p. 179 Because calcium is a vital part of the clotting casade, hypocalcemia, as a result of a massive transfusion, can actually worsen hypovolemic shock by... - ansPermitting continued bleeding Signs of hypocalemia include- dysrhythmias, muscle tremors, and seizures ch. 7, p. 81 BLUNT ESOPHAGEAL INJURY - ansInjury to esophagus, rare, results form blunt trauma Assessment findings include - AIR in MEDIASTINUM with possible widening - CONCURRENT LEFT PNEUMOTHORAX or HEMOTHORAX - ESOPHAGEAL MATTER IN CHEST TUBE - SUBCUTANEOUS EMPHYSEMA Interventions - Prepare for surgery Ch. 11, p. 143 Brown-squared syndrome - ansContralateral loss of pain and temperature sensation and ipsilateral paralysis with reduced touch sensation ch. 13, p. 182 CARDIAC TAMPONADE - ansAssessment findings Beck's Triad- HYPOTENSION, MUFFLED HEART SOUNDS, DISTENDED NECK VEINS - CHEST PAIN - TACHYCARDIA - DYSPNEA - CYANOSIS - Pulsus paradoxus greater than 10 mm Hg Interventions - Prepare for pericardial decompression - 3 to 4 cm incision made just left of xiphoid process TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified p. 25 Define mechanism of injury (MOI) - ansHow external energy forces in the environment are transferred to the body p. 25 Define trauma - ans- Trauma is injury to living tissue caused by extrinsic agent - Regardless of MOI, trauma creates stressors that exceed the tissue's or organ's ability to compensate p. 9 Depending on the motorcycle design and rider positioning, the lower extremities can collide with the handlebars, resulting in... - ansFemur and pelvis fractures and hip dislocations p. 31 Describe ANAPHYLACTIC SHOCK - ansResults from release of inflammatory mediators (e.g. histamine) which contracts bronchial smooth muscles and increases vascular permeability and vasodilation. ch. 7, p. 75 Describe DISTRIBUTIVE SHOCK - ansOccurs as result of maldistribution of an adequate circulating blood volume with loss of vascular tone or increased permeability. ch. 7, p. 75 Describe energy forms - ans- Mechanical (energy transfer from one object to another in the form of motion) - Thermal (energy transfer of heat in environment to the host) - Chemical (heat energy transfer from active chemical substances such as chlorine, drain cleaner, acids, or plants) - Electrical (energy transfer from light socket, power lines, or lightning) - Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Describe FOCAL BRAIN INJURIES - ansOccur in localized area with grossly observable and identifiable brain lesions. They include... - CEREBRAL CONTUSION - INTRACEREBRAL HEMATOMA - EPIDURAL HEMATOMA - SUBDURAL HEMATOMA - HERNIATION SYNDROMES Ch. 9, p. 113 Describe NEUROGENIC SHOCK - ansOccurs with SCI results in the loss of SNS control of vascular tone, which produces venous and arterial vasodilation. ch. 7, p. 75 Describe SEPTIC SHOCK - ansCaused by systemic release of bacterial endotoxins, resulting in an increased vascular permeability and vasodilation. ch. 7, p. 75 Describe the MOI associated with brain, cranial, and maxillofacial trauma - ansBLUNT injury - falls, MVCs, sports-related injuries, recreation PENETRATING injury - firearms or exploding objects or projectiles Ch. 9, p. 108 Describe the three E's of injury control - ansEngineering: technological interventions such as side impact airbags, automated blind spot alarms, ignition lock devices for those with DUIs. In playgrounds and sports, this involves surface material under playground equipment and athletic safety gear. Another intervention is improved use of smoke alarms in fire prevention Enforcement and legislation: include laws at all jurisdictional levels regarding driving while intoxicated, booster seats, primary seatbelt use, and distracted driving. For sports this includes rules regarding illegal hits, examination after impact, and return-to-play requirements after a head injury Education: these can be community-based initiatives such as public service announcements for improved seatbelt use, education regarding risks of distracted driving, programs to commit to no texting while driving, and promotions for bicycle helmet giveaways with instructions for proper use TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified p. 11 Disadvantages of auto-transfusion include: - ans- Risk of contamination - RBCs might become hemolyzed during hemorrhage - Coagulation factors, including platelets and cryoprecipitate may be destroyed, increasing d-dimer in collected blood ch. 7, p. 81 During primary survey... - ansLife-threatening conditions are identified and immediately corrected, beginning immediately upon the patient's arrival to the trauma room. ch. 5, p. 40 During the secondary survey in patient with thoracic or neck trauma, what questions do you want to ask? - ansIf patient is complaining of: - DYSPNEA - DYSPHAGIA - DYSPHONIA Was there a cardiac event prior to injury? If CPR is being performed, when was it started? - Important information in determining the indications for performing an emergency thoracotomy or when to consider withdrawal of support Ch. 11, p. 143 Early assessment findings of increased ICP include: - ans- HEADACHE - NAUSEA/VOMITING - AMNESIA - BEHAVIOR CHANGES (IMPAIRED JUDGEMENT, RESTLESSNESS, DROWSINESS) - ALTERED LEVEL OF CONSCIOUSNESS ( HYPO/HYPERAROUSABILITY) Ch. 9, p. 109 Early treatment for septic shock includes... - ansEarly administration of antibiotics and potential need for norepinephrine to vasoconstrict the peripheral vasculature, increase blood volume return to heart, and improve cardiac output. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified extremities - EXTERNAL JUGULAR VEIN DISTENTION - EXTREMITIES FOR MOTOR and SENSORY function Lower extremity paresis or paralysis may indicate an aortic injury Ch. 11, p. 142 Explain HYPHEMA - ansCollection of blood in anterior chamber of eye - classified as spontaneous or traumatic Assessment findings include: - PAIN, PHOTOPHOBIA - NOTICEABLE COLLECTION OF BLOOD IN EYE CHAMBER - BLURRY VISION due to blood in chamber - INCREASED IOP, NAUSEA, and SEVERE PAIN with grade 4 Treatment includes: - ELEVATING HOB 30 degrees - protecting eye with METAL SHIELD - TOPICAL OPHTHALMIC CYCLOPLEGICS and OPHTHALMIC STEROIDS, OPHTHALMIC BETA-BLOCKERS if IOP is ELEVATED - Avoid aspirin and NSAIDs as they increase risk of re-bleeding - Risk of re-bleeding greatest 3-5 days after injury Ch. 10, p. 131 Explain NEUROGENIC SHOCK and what are the assessment findings - ansOccurs with SC damage at T6 or higher, resulting in sympathetic regulation disruption of vagal tone leading to loss of vascular resistance and generalized vasodilation Assessment findings - BRADYCARDIA - HYPOTENSION - WARM, NORMAL COLOR SKIN - CORE TEMPERATURE INSTABILITY ch. 13, p. 181 Explain OBITAL FRACTURE - ans- NOT CONSIDERED OPHTHALMOLOGIC EMERGENCY unless there is IMPAIRED VISION or GLOBE RUPTURE - Usually result from DIRECT BLOW TO EYE TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified - Complication of this type of fracture is ENTRAPMENT OF THE INFERIOR RECTUS or INFERIOR OBLIQUE MUSCLE Assessment findings include: - PERIORBIAL ECCHYMOSIS - DIPLOPIA WITH UPWARD GAZE - ENOPHTHALMOS - INFRAORBITAL NUMBNESS - DECREASED EOM Treatment includes: - ORAL ANTIBIOTICS - COOL COMPRESSES - CONSULT with possible surgical repair if pt continues to have DIPLOPIA or ENOPHTHALMOS 1-2 weeks after swelling has decreased - Discharge instructions include: advise pt to AVOID BLOWING NOSE, SNEEZING, and/or PERFORMING A VASALVA MANEUVER BEARING DOWN Ch. 10, p. 130-131 Explain oligoanalgesia - ansthe concept of undertreatment of pain ch. 8, p. 94 Explain pancreatic injuries - ans- Penetrating pancreatic injuries often sustain concurrent duodenal injuries - Less than 10% of those with a pancreatic injury will have a single-system injury - Suspicion for spinal fractures when the pancreas is crushed between anterior abdominal wall and spinal column ch. 12, p. 164 Explain pericardial tamponade and its assessment findings - ansWhen there is a rapid accumulation of blood in pericardial sac, resulting in compression of heart making it difficult for heart to fill during diastole, causing decreased cardiac output. Assessment findings include: - HYPOTENSION - TACHYCARDIA - MUFFLED HEART SOUNDS - NECK VEIN DISTENTION TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Ch. 11, p. 141 Explain RETROBULBAR HEMATOMA - ansTRUE OPHTHALMOLOGIC EMERGENCY Hemorrhage into space behind globe; bleeding causes increased pressure behind globe causing elevation in IOP that compresses optic nerve and blood vessels. Early recognition is imperative to save vision. Assessment findings include: - SEVERE PAIN - DECREASED VISION - REDUCED EYE MOVEMENT - IOP > 40 mm Hg Treatment include: - Emergency decompression via LATERAL CANTHOTOMY indicated with IOP > 40 mm Hg Ch. 10, p. 131 Explain stable and unstable pelvic fractures - ansStable- does not involve pelvic ring or there is minial displacement of pelvic ring Unstable fractures- 2 or more fractures of pelvic ring that have outward rotational displacement ch. 12, p. 166 Explain the AVPU mnemonic - ansUsed to quickly assess patient's level of alertness A- ALERT (If any of the responses below are elicited at this point, the airway may be compromised) V- responds to VERBAL stimuli, airway adjunct may be needed to keep tongue from obstructing airway P - responds to PAIN. U- UNRESPONSIVE. If patient is unresponsive, announce loudly to the team and direct someone to check if the patient has a pulse while assessing if the cause of the problem is the airway. Consider reprioritizing the assessment priority to <C>ABC ch. 5, p. 42 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Ch. 9, p. 118 External energy forces can be exerted on the body by the following forces - ans- Deceleration forces: include those applied in falls and collisions where injuries are caused by sudden stop of the body's motion - Acceleration forces: not as common as deceleration forces and result from a sudden and rapid onset of motion (parked car being hit by a vehicle traveling at a high rate of speed) - Compression force is an external force applied at times of impact, explains include: + Stationary objects such as dashboards or steering wheels, that collide with or push up into a person + Objects in motion such as bullets and stabbing instruments, bats and balls, fists and feet, or heavy falling objects + Blast forces p. 27 FLAIL CHEST - ansClassified as 2 or more fractures of 3 or more adjacent ribs and/or sternal fractures, creating free-floating segment Assessment findings include - PARADOXICAL CHEST MOVEMENT drawing in with chest expansion and pushing out with exhalation - DYSPNEA - CHEST WALL PAIN, CONTUSIONS Interventions - prepare for intubation Ch. 11, p. 144 Following the primary survey, FAST examination may be used to rapidly assess for bleeding from damage to the... - ansHeart, liver, kidneys, and spleen. FAST also increasingly used to detect pneumothorax, especially tension pneumothorax. ch. 7, p. 84 For skin, the immediate goal in treating surface trauma is to... and this is accomplished by... - ansOBTAIN AND MAINTAIN HEMOSTASIS, APPLY DIRECT PRESSURE TO SITE ch. 14, p. 208 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified HEMOTHORAX - anscaused by blood accumulating in the intrapleural space. Results from injury to lung, costal blood vessels, great vessels and from laceration to liver or spleen combined with diaphragm injury. Assessment findings include - ANXIETY or RESTLESSNESS - DYSPNEA, TACHYPNEA - CHEST PAIN - SIGNS OF SHOCK- tachycardia, cyanosis, diaphoresis, hypotension - DECREASED BREATH SOUNDS ON INJURED SIDE Interventions - Prepare for needle thoracentesis and chest tube insertion - Ensure 2 large IV catheters and blood is available before thoracentesis to treat large volume blood loss if needed ch. 11, p. 146 How can the trauma nurse have an impact when it comes to the legislative process? - ansBy advocating for stronger laws and more consistent enforcement p. 11 How can you check for laxity or instability for possible pelvic fractures? - ansgentle pressure over iliac wings DOWNWARD and MEDIALLY ch. 12, p. 159 How high should you elevate limb in compartment syndrome? - ansAt level of heart, any higher can reduce circulation and tissue perfusion. Also ice is strongly contraindicated ch. 14, p. 200-201 How should you wrap an amputated part? - ansWrap it in slightly saline-moistened sterile gauze, placed in sealed plastic bag THEN place in a second bag containing ice water ch. 14, p. 201 hyperEXTENSION - ansetiology/cause- backward thrust beyond anatomic capacity of vertebral column TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified rest of injury- stretching or ligament tears, bony dislocations example- rear-end whiplash ch. 13, p. 179 hyperFLEXION - ansetiology/cause- forceful forward flexion with head striking an immovable object rest of injury- wedge fractures, facet dislocations, subluxation (due to ligament rupture), teardrop, odontoid or transverse process fractures example- head-on MVC with head hitting windshield, creating starburst effect ch. 13, p. 179 Hypothermia combined with ______ and ______ is a potentially lethal combination. - ansHYPOTENSION and ACIDOSIS ch. 5, p. 46 If a penetrating wound is found below the 4th intercostal space, penetration into the _________ is suspected until proven otherwise. - ansABDOMINAL CAVITY Ch. 11, p. 140 If autoregulation fails and MAP is elevated, _______ can result. - ansEDEMA Ch. 9, p. 109 If breathing is absent: - ans- Open airway using jaw-thrust maneuver while maintaining manual cervical spinal stabilization - Insert and oral airway adjunct - Assist ventilations with bag-mask device - Prepare for definitive airway ch. 5, p. 44 If breathing is present: - ans1. Administer O2 at 15L/min via nonrebreather mask -- inability to maintain adequate oxygenation, causes hypoxemia resulting in anaerobic metabolism and acidosis TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Lateral impacts (T-bone) are associated with - ansShear injuries to aorta and other organs, fracture of the side clavicle, lateral pelvic and abdominal injuries, and lateral head and neck injury p. 30 Law of Conservation of Energy - ansEnergy can neither be created nor destroyed, but it can change form p. 26 Leading cause of death for ages 1. over 65 2. 5 to 24 3. 25 to 64 - ans1. Falls 2. MVCs 3. poisoning p. 9 Maintain PaO2 between - ans100-200 mm Hg for ABGs ch. 6, p. 66 Mastoid process ecchymooses - ansBattles sign, indicates middle fossa fracture Ch. 9, p. 113 Newton's First Law of Motion - ansA body at rest will remain at rest, and a body in motion will stay in motion p. 26 Newton's Second Law of Motion - ansForce = Mass X Acceleration p. 26 Newton's Third Law of Motion - ansFor every action, there is an equal and opposite reaction p. 26 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Non-invasive near-infrared spectroscopy is used to... - ansmeasure decreased tissue blood flow, useful to diagnose compartment syndrome ch. 14, p. 202 Once patient has airway in place, assess for proper placement by... - ans- Presence of adequate rise and fall of the chest with assisted ventilation - Absence of gurgling on auscultation over epigastrium - Bilateral breath sounds present on auscultation - CO2 detector device color change ch. 5, p. 43 One of the earliest responses to inadequately pefused tissue is... - ansTACHYPNEA ch. 7, p. 78 Output less than 0.5 mL/kg per hour for two consecutive hours indicates... - ansOLIGURIA ch. 7, p. 84 Oxyhemoglobin-dissociation curve indicates the correlation of tissue oxygneation (PaO2) as it saturates the hemoglobin molecule (SO2). P50 describes the oxygen pressure when the hemoglobin molecule is 50% saturated. Normal P50 is 26.7 mm Hg. A shift in the curve notes changes in the relationship: - ansShift to the RIGHT occurs in an environment of HIGH metabolic demand. Hemoglobin's affinity for oxygen decreases, making it easier to release the bound oxygen to the tissues. A shift to the right occurs in response to: - Increased carbon dioxide (hypercapnia) - Increased temp (hyperthermia) - Increased 2,3-diphosphoglycerate levels (a substance in blood that helps O2 move from hemoglobin to the tissues) - Decreased pH (acidemia) Shift to the LEFT occurs in an environment of LOW metabolic demand. Hemoglobin's affinity for oxygen increases, making it harder to release bound oxygen to the tissues. A shift to the right occurs in response to: - Decreased carbon dioxide (hypocapnia) - Decreased temp (hypothermia) - Decreased 2,3-diphosphoglycerate levels - Elevated pH (alkalosis) TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified - Carbon monoxide and methemoglobinemia ch. 6, p. 65 Pain Theories include... - ansGATE CONTROL THEORY- proposes pain may be modulated by interneurons within spinal cord. Stimulation of the large A-beta cutaneous fibers was thought to close gate pain impulses from A-delta or C fibers. A-beta fibers carry impulses from touch, vibration, rubbing a painful area. Supports non- pharmacologic therapies for pain control such as ice, heat, massage. NEUROMATRIX THEORY- proposes that each person's brain produces a unique pattern of nerve impulses from a complex neural network with multidimensional inputs. This theory explains phantom limb pain and why people with similar injuries report differing levels and responses to pain. NEUROPLASTIC THEORY- suggests that neurons can be permanently affected and reshaped by the experience of pain. This theory attempts to explain chronic pain, pain syndromes, and phantom pain. ch. 8. p. 93 Pathophysiologic concepts that affect the patient with brain, cranial, or maxillofacial injuries include issues related to... - ans- HYPOTENSION and CBF - HYPOXIA and HYPERCARBIA - ICP Ch. 9, p. 108 Penetrating injury to the chest wall and lacerated lung tissue can cause the loss of ________________. Thus, the collection of air or blood in the pleural space causes ______________. - ansA. NORMAL NEGATIVE INTRAPLEURAL PRESSURE B. LUNG COLLAPSE Ch. 11, p. 141 Pertaining to abdominal trauma, What does non-operative management include? When does operative management occur? - ansNon- serial abdominal exams Op- occurs in patients who exhibit signs of peritonitis or hemodynamic instability ch. 12, p. 164 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Interventions - Maintain SpO2 between 94-98% - Minimize or use IV fluids judiciously - Prepare for possible intubation ch. 11, p. 146 Replacement with packed cells and saline without also transfusing with _______ and _______ further dilutes the patient's ability to clot blood. - ansPLATELETS and PLASMA ch. 7, p. 79 Resuscitation-associated coagulopathy is associated with the trauma triad of death. It includes... - ansHYPOTHERMIA impairs thrombin production and platelet function ACIDOSIS impairs thrombin production COAGULOPATHY results in depletion of clotting factors through hemodilution and impaired ability to produce clotting factors ch. 7, p. 78 RHABDOMYOLYSIS - ansSignficant muscle damage and cellular destruction releases MYOGLOBIN, a muscle protein, into bloodstream. Since myoglobin is excreted in the kidneys, risk of acute renal failure is high in patients with crush injury. Classic triad of assessment findings include: - MUSCLE PAIN, NUMBNESS, CHANGES in SENSATION - MUSCLE WEAKNESS or PARLYSIS - DARK RED OR BROWN URINE other assessment findings include: - extensive soft tissue EDEMA and BRUISING - general WEAKNESS or MALAISE - evidence of hypovolemic shock - elevated creatinine kinase levels Treatment - aggressive fluid resuscitation to flush out myoglobin to prevent renal failure (>100 mL/hr until resolved is goal) ch. 14, p. 198 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified ROTATIONAL - ansetiology/cause- combination of forceful forward flexion with lateral displacement of cervical spine rest of injury- posterior ligament rupture and/or anterior fracture, dislocation of vertebral body example- MVC to front or near lateral area of vehicle results in conversion of forward motion to a spinning-type motion ch. 13, p. 179 RSI pretreatment medications Cough reflex can be blocked using IV... - ansLIDOCAINE 1.5 mg/kg ch. 6, p. 67 RUPTURED DIAPHRAGM - ansAssessment findings - DYSPNEA or ORTHOPNEA - DYSPHAGIA - ABDOMINAL PAIN - SHARP EPIGASTRIC or CHEST PAIN RADIATING to left shoulder (Kehr sign) - Bowel sounds auscultated in the lungs on injured side Interventions - Prepare for surgery ch. 11, p. 146 SAMPLE mnemonic regarding patient's history - ansS - Symptoms associated with injury A - Allergies and tetanus status M - Medications currently used, including anticoagulant therapy P - Past medical history (hospitalizations/surgeries) L - Last oral intake E - Events and Environmental factors related to injury ch. 5, p. 48 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Shear strength describes the tissue's ability to: - ansResist a force applied parallel to the tissue - Coup/contrecoup injury, such as a boxer being hit in the head, is an example of this p. 27 Signs of increased work of breathing, tachypnea, SOB, tachycardia, hypotension, and unilateral decrease in breath sounds on injuries side... - ansSignifies decreased cardiac output. Caused when air or blood accumulates in thoracic cavity causing increase in INTRAPLEURAL pressure on side of injury. If this pressure is allowed to expand without intervention, it can produce a MEDIASTINAL SHIFT which compresses heart and great vessels, resulting in a DECREASE in VENOUS RETURN (PRELOAD) and SUBSUQUENT DECREASE IN CARDIAC OUTPUT. Ch. 11, p. 141 Spinal cord neurons DO NOT regenerate; therefore, severe injury with cellular death may result in... - ans- temporary or permanent loss of function - flaccidity - loss of reflexes ch. 13, p. 181 SPINAL SHOCK - ansWhen spinal cord is injured, cascade of events takes place - Blood supply to cord can be disrupted - Axons are severed or damaged - Conduction of electrical activity of neurons and axons is compromised - All of the above result in loss of function which can last from several hours to several days - A transient hypotensive period and poor venous circulation may be seen - Disruption of thermal control centers results in sweating and lack of ability to regulation body temp - Transient loss of muscle tone (flaccidity) and complete or incomplete paralysis with reflex losses - Bowel and bladder dysfunction - Return of sacral reflexes, bladder tone, and presence of hyperreflexia indicates resolution of spinal shock - Presence of rectal tone and intact perineal sensation indicates sacral sparing ch. 13, p. 181 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified - Immediate chest X-RAY if pt somewhat stable - prepare for immediate needle thoracentesis 14 g needle inserted into 2nd intercostal space in mid clavicular line on affected side over the top of the rib to avoid neurovascular bundle that runs under rib - prepare for chest tube placement, which is the definitive treatment ch. 11, p. 145 The A-I mnemonic helps the trauma nurse rapidly assess for and intervene in life- threatening injuries and identify all injuries in a systematic manner. - ansA: airway and alertness with simultaneous cervical spinal stabilization B: breathing and ventilation C: circulation and control of hemorrhage D: disability (neurological status) E: exposure and environmental control F: full set of vital signs and family presence G: get resuscitation adjuncts: L - lab studies (ABGs) and obtain specimen for blood type and cross match M - monitor for continuous cardiac rhythm and rate assessment N - naso or orogastric tube consideration O - oxygenation and ventilation analysis: pulse oximetry and end-tidal carbon dioxide (ETCO2) monitoring and capnography P - pain assessment and management H: history and head-to-toe assessment I: inspect posterior surfaces ch. 5, p. 39 The assessment of circulation during the primary survey includes... - ansEarly evaluation of the possibility of hemorrhage in the abdomen and pelvis in any patient who has sustained blunt trauma. In those cases, an emergent abdominal or pelvic assessment may be preformed to include a focused assessment with sonography for trauma (FAST) examination or a radiograph of the pelvis. ch. 5, p. 44 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified The degree to which tissues resist destruction under circumstances of energy transfer depends on... - ansTheir proximity to the impact and their structural characteristics p. 27 The Haddon Matrix broadened the approach and placed emphasis on countermeasures, such were more effective than changing human behavior. Haddon describes three phases of the injury event: - ansPre-event, Event, Post-event For each phase of the event, countermeasures for prevention can be applied. They include: The host (human) The agent (motor vehicle) The physical environment (socioeconomic environment) ch. 4, p. 34 The increase of the diastolic blood pressure with a narrowing pulse pressure... - ansMay be one of the first CONCRETE measurements signaling that the patient's circulatory status is compromised. ch. 7, p. 76 The major assessment parameters that produce important information within seconds of a patient's arrival are... - ans1. Level of consciousness 2. Skin color 3. Pulse ch. 5, p. 44 The standard approach to treating hypotension in trauma patients has been to infuse large volumes of IV fluids. Recent studies now recommend a different approach and note that an elevated BP may dislodge the body's formation of clots and promote further bleeding. In addition, large volumes of fluid lead to... - ansDilutional coagulopathy which worsens metabolic acidosis and may cause hypothermia ch. 5, p. 45 The U.S. Department of Defense classifies blast injuries in five levels: - ans- Primary blast injuries: found in those closest to the detonation, with enclosed space detonation resulting in the most lethal impacts. Air-filled organs (tympanic membranes, lungs, stomach, and bowel) are most susceptible to rupture with primary blast injuries. TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified - Secondary injuries: include fragment injuries and generally cause the greatest volume of casualties. They include injuries such as puncture wounds, lacerations, and impaled objects. - Tertiary injuries: include impacts with larger objects propelled by the blast wind resulting in blunt trauma. These cause high energy transfer and can result in pelvic or femur fractures or major thoracic injuries such as aortic and great vessel rupture. - Quaternary injuries: result of heat, flame, gas, and smoke. These injuries include external burns and internal burns from inhaled hot gases. - Quinary injuries are those associated with exposure to hazardous materials from radioactive, biologic, or chemical components of a blast. ch. 4, p. 33 Trauma nurse should be attempting to maintain NORMOTHERMIA and NORMOCARBIA, which... - ansDecreases risk of.. HYPOTHERMIA ACIDOSIS COAGULOPATHY ch. 6, p. 65 Treatment for CORNEAL ABRASIONS include: - ans- TOPICAL OPHTHALMIC ANTIBIOTICS If causes by contact lenses, treat for Pseudomonas - CYCLOPLEGIC OPHTHALMIC AGENT to decrease spasms and pain - TOPICAL OPHTHALMIC NSAIDS such as ketorolac, diclofenac to reduce swelling - ORAL ANALGESICS - NO PATCHING; evidence shows they heal faster unmatched - Follow up with OPHTHALMOLOGIST in 24 hours Ch. 10, p. 129 True or false: ALL eye injuries, even the most minor, require a visual acuity examination. - ansTRUE Ch. 10, p. 125 Types of injuries include - ans- Blunt trauma - Penetrating trauma - Thermal trauma - Blast trauma TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified What are the rules concerning standard imaging in relation to eye injury - ans- If wood or a vegetative foreign body is suspected, MRI most appropriate imaging method to use, however, it is minimally useful in acute setting - CT scans not helpful if vegetative foreign bodies are suspected - the GOLD STANDARD for evaluation of mid-face and orbit trauma is a CT scan - Plain films are used to assess foreign bodies and fractures of facial structures, excluding orbits Ch. 10, p. 133-134 What are the two priorities in treating patients with TBI? - ansFacilitating OXYGENATION and VENTILATION Ch. 9, p. 120 What are two examples of obstructive shock that may result from trauma? - ansTENSION PNEUMOTHORAX and CARDIAC TAMPONADE ch. 7, p. 73 What can you assess to ensure the brainstem is intact? - ansEXTRAOCULAR EYE MOVEMENTS (EOMs) - tests functions of CNs III, IV, and VI In presence of facial fractures, the inability to perform EOMs may indicate a trapped nerve Ch. 9, p. 113 What can you do to easily see eyes that have abrasions? - ansStain them with fluorescein Ch. 10, 129 What diagnostic exam is helpful to inspect abdominal spaces for spillage and to examine loops of bowel? - ansLaparoscopy ch. 12, p. 164 What do you do with open wounds? - ansCover in saline-soaked dressings ch. 14, p. 201 TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified What does 'safe care' mean? - ansMeans assuring the patient is getting to the right hospital in the right amount of time for the right care. American College of Surgeons Committee on Trauma (ACS-COT) developed trauma triage criteria that serves at the international standard to identify the trauma patient who would benefit from resuscitation and care at the right trauma facility with the appropriate resources. ch. 5, p. 40 What does 'safe practice' mean? - ansMeans taking into consideration the protection of the team, including: - observing universal precautions - donning PPE (gown, gloves, mask) prior to patient's arrival ch. 5, p. 39 What is one unique post-operative risk following a splenectomy? Explain. - ansPNEUMOCOCCAL SEPSIS - Asplenic compromised immune system has difficulty destroying encapsulated bacteria (Streptococcus pneumonia, Nesisseria meningitides, and Haemophilus influenza) therefore vaccinations against these bacteria are required. - Following splenectomy, patients encouraged to receive annual flu, meningitis, and pneumonia vaccines every five years. ch. 12, p. 163 What is the difference between penetrating and perforating in regards to ocular injuries? - ansPenetrating - having ENTRANCE WOUND, an INTRAOCULAR FOREIGN BODY when they are present Perforating - having ENTRANCE and EXIT WOUND Ch. 10, p. 125 What is the most common cause of thoracic trauma? - ansMVC's Others include: Falls, crush injury, assaults, gunshot and stabbing wounds, ped vs. vehicle collisions TNCC Trauma Nursing Core Course 11th 2024-2025 Edition ENA Test Bank | Graded A+ verified Ch. 11, p. 140 What is the most major cause of preventable death after injury? - ansUncontrolled hemorrhage ch. 5, p. 40 What is the standard of care in the hemodynamically STABLE patient who sustained blunt liver injury? - ansNon-operative management - For patients with penetrating liver injuries or blunt abdominal trauma with signs of hypodynamic instability, surgery is indicated. Appropriate fluid resuscitation and interventions to promote hemostasis are essential in surgery prep ch. 12, p. 162 What is used to diagnosis renal injuries? What are the cons? How are rectal injuries often managed? - ansSigmoidoscopy Cons- unprepared bowel may not detect injury Often managed with colostomy and distal rectal washout ch. 12, p. 165 What lab studies are used to guide resuscitative efforts in shock? - ans- Platelet count, clotting studies - Serum lactate, anion gap, base deficit, and ABGs to assess acidosis - Toxicology screen to help assess mental status and differentiate from head injury - Calcium level when rapidly infusing large volumes of blood products ch. 7, p. 83 What should you avoid using with fingers, toes or other areas where vasoconstriction could cause impaired distal blood circulation? - ansLIDOCAINE with EPI ch. 14, p. 211 What symptoms usually indicate an INTRAOCULAR foreign body is present? - ans- IRREGULAR PUPIL - SHALLOW ANTERIOR CHAMBER - POSITIVE SEIDEL TEST Ch. 10, p. 132