Assessment & Interventions for Traumatic Brain Injury & Injuries in Trauma Nursing, Exams of Nursing

Download Assessment & Interventions for Traumatic Brain Injury & Injuries in Trauma Nursing and more Exams Nursing in PDF only on Docsity! TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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. 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. TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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. 1. You're called out to an assisted living facility for a 72-year-old woman complaining of a severe headache and experiencing increased confusion. Staff reports she fell out of her wheelchair earlier in the week but didn't appear to be hurt; however, she's become increasingly disoriented over the last day or so. Vital signs show: BP 110/90; heartrate 118 and irregularly regular; ventilation rate 20 and slightly labored; SpO2 93% on room TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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? TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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? TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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. 3. You are oxygenating a pediatric patient using a properly fitted oxygen mask and the "squeeze-release-release" timing technique. As you watch for the rise and fall of the chest, you check end-tidal CO2 (ETCO2) monitoring aiming to maintain what level? A. Between 40 and 45 mm Hg B. Between 30 and 35 mm Hg C. Between 35 and 40 mm Hg D. The level is irrelevant because capnography is inaccurate in pediatric patients. - ansQuestion 3: C The proper level to maintain is between 35 and 40 mm Hg. 3. You are transporting a 37-year-old male patient with a suspected intraabdominal bleed. His blood pressure is 70/50 mm Hg (MAP 57), and his skin is pale and diaphoretic. How will you manage fluid resuscitation for this patient? A. Aggressively administer IV fluids to compensate for internal blood loss. B. Do not administer IV fluids to patients with intra-abdominal bleeding. TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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. 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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. TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 AORTIC DISRUPTION - ansAssessment findings - Fractures of sternum, first or second rib or scapula - CARDIAC MURMURS - BACK, CHEST PAIN - UNEQUAL EXTREMITY PULSE STRENGTH or BLOOD PRESSURE (Significantly greater in upper extremities) - HYPOTENSION - TACHYCARDIA - SKIN CHANGES: diaphoresis, pallor, cyanosis - PHARAPLEGIA (due to disruption of spinal perfusion from aortic injury) - Radiograph findings include- left hemothorax, right-sided tracheal deviation, widened mediastinum Interventions - Prepare for surgery or angiography - Consider massive transfusion protocol ch. 11, p. 146 Are the lumen contents of the small bowel considered sterile? What is the pH? - ansneutral pH, and sterile ch. 12, p. 164 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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) 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 - Needle percardiocentesis may also be used to relieve symptoms of cardiac tamponade but its only temporary solution ch. 11, p. 146 Cavitation refers to the... - ansSeparation of surrounding tissue resulting from a sound and/or hydraulic wave force. This rapid motion can lead to crushing, tearing, and shearing forces on tissue. The impact of cavitation is dependent on the characterists of the affected tissue. Additional considerations include: - Air-filled organs such as lungs or stomach, are elastic, so this tissue tolerates high- velocity cavitation relatively well compared to other tissues - Solid organs such as the liver, have a greater propensity to shear or tear under the same forces - If those same forces are instead released inside the cranium, bone will resist expansion, augmenting soft tissue crushing, until the tensile strength of the bone is exceeded and an explosive release of pressure results ch. 4, p. 32 Central cord syndrome - ansloss of motor function in upper extremities that is greater than that of lower extremities. often sacral sparing. bladder function may be affected ch. 13, p. 182 Classifications of acute pain are based on the source and origin and include... - ansSOMATIC pain originates from skin and muscloskeletal structures VISCERAL PAIN originates from organs and may lead to referred pain ch. 8, p. 93 Components of CUS and its purpose - ansC: I am Concerned U: I am Uncomfortable TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - Radiant (energy transfer from blast sound waves, radioactivity such as a nuclear facility, or rays of the sun) p. 26 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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. ch. 7, p. 75 Examples of referred pain include... - ans- radiating to left shoulder (Kehr sign) - referred to testicle may be indicative of duodenal injury - always begin palpation away from inital site of pain by assessing the painful area last ch. 12, p. 158 Explain 3 phases of injury prevention - ansPrimary: prevention of the occurrence of the injury Secondary: Reduction in the severity of the injury that has occurred Tertiary: Improvement of outcomes related to the traumatic injury p. 10 Explain definitive care on pancreatic trauma - ans- Non-op management including complete bowel rest, nutritional support, serial CT scanning with observation - Pseudocyst formations may be managed with percutaneous drainage - Pancreatic ductal injuries may need distal pancreatectomy - complications from pancreatic injury include, secondary hemorrhage, pancreatic fistula, abdominal abscess - s/s of infection occur often 7-10 days after injury and usually include fever, elevated WBC, nausea, vomiting ch. 12, p. 164 Explain emergency thoracotomy - ansDone when patient arrives with unstable vital signs or impending arrest... Indications for performing this include: - PERICARDIAL TAMPONADE needed to be evacuated - IMMEDIATE CONTROL OF MASSIVE INTRATHROATIC BLEEDING - PENETRATING TRAUMA with witnessed CARDIAC ARREST permitting open cardiac massage, or with massive hemorrhage in peritoneal cavity needing cross-clamping of aorta - It is rarely successful in patients with blunt chest trauma Ch. 11, p. 142-143 Explain eye irrigation when used for the removal of chemicals, foreign bodies, and debris from eye - ansCONTRAINDICATED in patients who may have RUPTURED GLOBE TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 Ch. 11, p. 141 Explain RETROBULBAR HEMATOMA - ansTRUE OPHTHALMOLOGIC EMERGENCY TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 Explain the B2-Transferrin test - ansGold standard for identifying CSF otorrhea or rhinorrhea ch. 5, p. 48 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ Explain the Cushing response - ansLoss of auto regulation (cerebral blood flow) can result in cerebral and brainstem ischemia, initiating a central nervous system response known as Cushing response. It is characterized by a triad of assessment findings: - widening pulse pressure - reflex bradycardia - diminished respiratory effort Ch. 9, p. 107 Explain the LMNOP mnemonic - ansUsed to remember resuscitation adjuncts L - Lab studies (ABGs, blood type and crossmatch) - Lactic acid is an excellent reflection of tissue perfusion M - Monitor cardiac rate and rhythm: compare patient's pulse to the monitor's rhythm - Dysrhythmias (PVCs, a fib, or ST segment changes) may indicate blunt cardiac trauma - PEA may point to cardiac tamponade, tension pneumothorax, or profound hypovolemia N - Naso- or orogastric tube consideration: insertion provides stomach content evacuation and relief of gastric distention O - Oxygenation and ventilation assessment - Pulse ox may only be accurate if there is adequate peripheral perfusion - ETCO2 monitoring (capnography) provides instantaneous information about the ventilation, perfusion, and metabolism of carbon dioxide (35-45 is normal) ch. 5, p. 47 Explain the MARCH mnemonic - ansM: MASSIVE HEMORRHAGE A: AIRWAY R: RESPIRATION - decompress suspected pneumo, seal open chest wounds, support ventilation and oxygenation as required C: CIRCULATION - vascular access and admin fluids H: HEAD INJURY/HYPOTHERMIA - prevent or treat hypotension and hypoxia to prevent worsening of traumatic brain injury and prevent or treat hypothermia ch. 5, p. 41-42 Explain TRACHEOBRONCHIAL INJURY and what are the assessment findings and interventions - ansUsually caused by penetrating mechanisms, occurring in proximal trachea. Direct blows to neck or clothesline-type injuries common mechanisms for blunt trauma. Dx based on assessment findings and confirmed with BRONCHOSCOPY or CT. TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 -- Titrate oxygen delivery for stabilized trauma patients to avoid the detrimental physiologic effects of hyperoxia 2. Determine if ventilation is effective -- ETCO2 (end-tidal carbon dioxide) measurement between 35-45 shows effective ventilation. Level above 50 signifies depressed ventilation -- SpO2 of 94% of higher is associated with effective ventilation ch. 5, p. 44 If injury causes the CPP to fall outside the range between ___________ mm Hg, the brain loses its ability to autoregulate and CBF becomes directly dependent on MAP for perfusion. - ans50 and 160 mm Hg Ch. 9, p. 108 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ If patient's airway is NOT patent: - ans1. Suction airway - Avoid stimulating gag reflex - Use rigid suction device if obstructed by blood, vomitus, or secretions - Remove any foreign bodies carefully with forceps 2. If suctioning does not relieve airway obstruction, tongue may be cause. Insert airway adjunct. - Use jaw-thrust maneuver to open airway while maintaining manual stabilization - A nasopharyngeal airway can be used in patients who are conscious or unconscious - An oropharyngeal airway can be used in patients without gag reflex 3. Consider a definitive airway (ET tube securely placed in trachea with cuff inflated) - The following conditions or situations require a definitively secured airway --apnea -- GCS score < 8 -- severe maxillofacial fractures -- evidence of inhalation injury/facial burns -- laryngeal or tracheal injury or neck hematoma -- high risk of aspiration and patient's inability to protect airway -- compromised or ineffective ventilation -- anticipated of deterioration of neurological status ch. 5, p. 43 Imaging studies for bladder and urethral injuries include - ans- CT cystogram used to dx intraperitoneal or extraperitoneal bladder rupture - Urethrogram usually performed prior to insertion of urinary catheter when injury is suspected; contrast instilled at meatus. Detection of contrast media within bladder indicates adequate instillation, leakage demonstrates urethral disruption ch. 12, p. 168 Increased or bounding central pulses may indicate increased cardiac output. Peripheral pulses do not demonstrate a similar effect in the presence of hypovolemia due to vasocontriction. Thus, strong central pulses combined with weak peripheral pulses may be... - ansIndicative of Shock ch. 7, p. 82 Initial assessment - approach to trauma patient care that requires a process to identify and treat or stabilize life-threatening injuries in an efficient and timely manner. It is divided into the following process points: - ans- Preparation and triage - Primary survey (ABCDE) with resuscitation adjuncts (FG) - Reevaluation (consideration of transfer) - Secondary survey (HI) with reevaluation adjuncts - Reevaluation and post resuscitation care TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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) - 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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 Physiologic effects of pain by system: Cardiovascular - ansHYPERCOAGULATION INCREASED CARDIAC WORKLOAD INCREASED OXYGEN DEMAND ch. 8, p. 97 Physiologic effects of pain by system: Endocrine - ansINCREASED RELEASE OF HORMONES AND MEDIATORS ch. 8, p. 97 Physiologic effects of pain by system: Gastrointestinal - ansDECREASED MOTILITY ch. 8, p. 97 Physiologic effects of pain by system: Genitourinary - ansDECREASED URINARY OUTPUT URINARY RETENTION FLUID OVERLOAD ch. 8, p. 97 Physiologic effects of pain by system: Immune - ansDECREASED RESPONSE TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ ch. 8, p. 97 Physiologic effects of pain by system: Metabolic - ansGLUCOGENESIS HYPERFLYCEMIA GLUCOSE INTOLERANCE INSULIN RESISTANCE MUSCLE PROTEIN CATABOLISM INCREASED LIPOLYSIS ch. 8, p. 97 Physiologic effects of pain by system: Musculoskeletal - ansIMPAIRED MUSCLE FUNCTION IMMOBILITY FATIGUE MUSCLE SPASM ch. 8, p. 97 Physiologic effects of pain by system: Respiratory - ansSPLINTING HYPOVENTILATION HYPERCARBIA RESPIRATORY ACIDOSIS INCREASED RISK OF ATELECTASIS & PNEUMONIA ch. 8, p. 97 POSTCONCUSSIVE SYNDROME assessment findings include: - ans- NAUSEA - DIZZINESS, PERSISTENT HEADACHE - MEMORY and JUDGEMENT IMPAIRMENT as well as ATTENTION DEFICITS - INSOMNIA and SLEEP DISTURBANCES - LOSS OF LIBIDO - ANXIETY, IRRITABILITY, DEPRESSION, EMOTIONAL LIABILITY - Noise and light over sensitivity - ATTENTION or CONCENTRATION PROBLEMS Ch. 9, p. 115-116 Prophylactic administration of what can reduce the risk of contrast-induced nephropathy when patients serum creatinine is above 1.2mg? - ansN-acetylcysteine along with hydration ch. 12, p. 170 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ 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 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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 Stage I: Compensated Shock - ans- Anxiety, lethargy, confusion, restlessness from oxygen being shunted to brainstem - Systolic BP usually within normal range - Rising diastolic BP, results in narrowed pulse pressure, which is a reflection of peripheral constriction - A bounding and/or slightly tachycardic pulse - Increased RR - Decreased urine output ch. 7, p. 79 Stage II: Decompenstated or Progressive Shock - ans- LOC deteriorates patient becomes obtunded or unconscious as cell switch to anaerobic metabolism with increasing levels of lactic and pyruvic acids - Normal or slightly decreased systolic BP - Narrowing pulse pressure that continues until peripheral vascular vasoconstriction fails to provide cardiovascular support - HR > 100 beats/min - Weak, thready pulses - Rapid, shallow respirations - Cool, clammy, cyanotic skin - Base excess not within normal range of -2 to +2 - Serum lactate levsl > 2 to 4 ch. 7, p. 79 Stage III: Irreversible Shock - ans- Obtunded, stuporous, comatose - Marked hypotension and HF - Bradycardia with possible dysrhythmias - Decreased and shallow RR - Pale, cool, clammy skin - Kidney, liver, and other organ failure - Severe acidosis, elevated lactic acid levels, and worsening base excess on ABGs - Coagulopathies with petechiae, purpura, or bleeding ch. 7, p. 79 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ Structural strengths of tissue are described in what three ways? - ans-Compression -Tensile -Shear p. 27 Sudden vision changes may indicate________ in the cerebral vascular - ansA POSSIBLE FAT EMBOLISM ch. 14, p. 199 Tears or lacerations of the tracheobronchial tree disrupt the... - ansIntegrity of the upper and lower airways... Patients initially present with dramatic symptoms, such as... - SIGNS OF AIRWAY OBSTRUCTION - HEMOPTYSIS - CYANOSIS - SUBCUTANEOUS EMPHYSEMA from massive air leaks into tissues of face, chest, and neck Ch. 11, p. 141 Tensile strength describes the tissue's ability to: - ansResist pulling apart when stretched - Tendons, ligaments, and muscles can tear when they are overstretched (Achilles tendon) p. 27 TENSION PNEUMOTHORAX - ansOccurs when air enters INTRAPLEURAL space but cannot escape on expiration, increasing pressure causes lung on injuries side to collapse. If pressure not relieved, mediastinum can shift toward the uninjured side compressing heart, great vessels, and ultimately the opposite lung. As pressure rises, venous return is hampered, cardiac output decreases, and hypotension occurs. Assessment findings include: - ANXIETY, SEVERE RESTLESSNESS - SEVERE RESPIRATORY DISTRESS - SIGNIFICANTLY DIMINISHED OR ABSENT BREATH SOUNDS on injured side - HYPOTENSION - DISTENDED NECK, HEAD, UPPER EXTREMITY VEINS (may not be evident if patient has experienced significant blood loss) - TRACHEAL DEVIATION or shift toward injured side TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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 p. 28 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ Up to 25% of the general population have UNEQUAL PUPILS, called ANISOCORIA; this is benign and caused by... - ans- TRAUMA - INCAL HERNIATION - OCULOMOTOR NERVE (CN III) PALSY - MEDICATIONS - SOME NEBULIZERS (IPRATROPIUM) Ch. 10, p. 126 Use the DOPE mnemonic to troubleshoot ventilator or capnography alarms - ansD - Displaced tube O - Obstructed or kinked tube P - Pneumothorax E - Equipment failure, such as patient becoming detached from equipment or loss of capnography waveform ch. 6, p. 66 Use the jaw-thrust maneuver to open airway and assess for obstruction when the patient is... - ansUnable to open the mouth, responds only to pain, or is unresponsive. ch. 5, p. 42 What are causes of peritoneal membrane irritation? - ans- presence of blood - chemical peritonitis as result of gastric content leakage - possible enzyme spillage from pancreas into bowel and/or peritoneal cavity - bacterial contamination from bowel contents ch. 12, p. 158 What are complications related to crush injuries? - ansCompartment syndrome, hyperkalemia, rhabdomyolysis K levels peak 12 hours after injury ch. 14, p. 198 What are late signs of MEDIASTINAL SHIFT? - ansNECK VEIN DISTENTION from increased intrathroatic pressure and TRACHEAL DEVIATION Ch. 11, p. 141 What are odors you want to be sure to document? - ansAlcohol, gasoline, other chemicals TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ ch. 5, p. 48 What are signs of worsening hypoxia with nerve injuries? - ansIncreased pain even when pulses remain present, often the first sign of increased compartment pressures ch. 14, p. 196 What are some assessment findings for patients who sustain a pancreatic injury? - ans- Serial serum amylase levels increasing over time may indicate but this does not constitute a definitive diagnosis - Serial abdominal exams are preformed in conjunction with serial serum amylase levels to appropriately confirm pancreatic injury - slight abdominal pain and tenderness becoming more significant within 48 hours of injury - epigastric pain radiating to back - abdominal pain tenderness on deep palpation - increasing or worsening abdominal wall muscle rigidity, spasm, or involuntary guarding ch. 12, p. 16 What are some circumstances that may lead to unreliable pulse ox readings? - ans- Poor peripheral perfusion - BP cuff inflated above sensor - CO poisoning (carboxyhemoglobin) - Methemoglobinemia - Severe dehydration Pulse ox provides evidence of SaO2 but not PaO2. The non-liner relationship between the two measurements is reflected in the oxyhemoglobin-dissociation curve. ch. 6, p. 65 What are the late signs that may indicate a tension pneumothorax? - ansJVD and tracheal deviation ch. 5, p. 43 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 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ - 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 When does the approach to trauma care typically begin? - ansWith notification that a trauma patient is arriving to ED ch. 5, p. 39 When does the secondary survey (HI) begin? - ansAfter the completion of the primary survey (ABCDE), after the initiation of resuscitation efforts, once vital functions have been stabilized and after consideration for resuscitation adjuncts (FG). ch. 5, p. 47 TNCC Trauma Nursing Core Course 15th Edition ENA Test Bank |Graded A+ When patient is receiving massive blood transfusions it is important to closely monitor which electrolytes? Why? - ansHigh K, Low C Potassium : released from cellular destruction of banked blood occurs naturally when blood ages Calcium : calcium citrate used in banked blood to prevent clotting, this citrate binds with free calcium reducing serum levels ch. 12, p. 158 When someone suffers a GSW, below what part of the body is considered an abdominal injury that requires an exploratory laparotomy? - ansBelow the nipple line ch. 12, p. 155 While in ED, alignment and protection of the cervical spine can be accomplished by which 2 ways? - ans- Manual stabilization - Immobilization ch. 5, p. 42 Why do partial amputations have more severe bleeding than complete amputations? - ansThe severed arteries retract with complete amputations ch. 14, p. 197 Why is CONTINUOUS ICP MONITORING important? - ansImportant for assessing brain injury and response of patient to treatment. It can provide early detection of secondary brain injury such as cerebral hypoxia, ischemia. The device reflects oxygen delivery to cerebral tissues and monitors temperature Ch. 9, p. 119