MODULE 6 TRAUMA acute and critical care fully solved questions with 100% accurate solutions(Latest Update)

What are the four major types of signs and symptoms of Critical Incident Stress (CIS)

cognitive (confusion/poor concentration/memory lapse)

physical (fatigue/pain/tension)

emotional (anxiety/depression)

behavioural (withdrawl/abuse)

what are the four stages of CISM

Pre-crisis prep

informal briefing

defusing

debriefing

when is pre crisis prep done?

all the time before the incident

when is informal breifing done?

immediatly after the event involving the people involed in care

when is defusing done?

30 minutes within 12 hours of the event

for assessment and matching resources with at risk individuals

when is debreifing done?

1-10 days post event

what components make up a primary survey

A airway

B breathing

C circulation

D disability

E exposure

what does the secondary survey consist of

A allergies

M medications currently used

P past medical history

E events related to the injury

list the major complications that can arise from a trauma

ARDS

Sepsis

Shock

MODS

what is included in the lethal triad of death?

Acidosis, Hypothermia, clinical coagulopathy

define a coup-contrecoup injury

coup: impact against object caused shearing of the subdural veins. the contrecoup injury happens when the brain impacts the back of the skull and creates more shear.

what is the nursing assessment require for a TBI

Level of consciousness

motor movements

pupillary response

respiratory function

vital signs

What are the nursing priorities for managing a TBI

stabilize vital signs

prevent further injury

reduce influxes in ICP and maintain cerebral perfusion pressure (by hemodynamic management/fluids)

Pulmonary care (prevent ARDS)

reduce environmental stimuli

what is the minimum CPP needed for adequate brain perfusion?

60mmHg

tetraplegia occures when a spinal injury is between ___ and ___ vertebrae

C1 - T1

paraplegia occurs when spinal injury is between ___ and ___ vertebrae

T2-L1

what is spinal shock

occurs shortly after traumatic injury. Complete loss of muscle tone and normal reflex activity below injury

what is neurogenic shock

injury to decending sympathetic pathaways

Signs and symptoms of autonomic dysreflexia

bradycardia, hypertension, facial flushing, headache

nursing management for spinal cord injury

spinal cord immobilization

monitor for CV complications (map 85-90 mmhg - IVF and vasopressors)

monitor for pulmonary complications (ventilation depending on injury level)

GI and GU complications (AD)

major nursing consideration for someone who comes in with a maxillofacial injury

AIRWAY

nursing considerations for post maxillofacial surgery patients

may need alternate ventilation (trach)

HOB 30°

wire cutters at bedside

anti emetics to prevent vomiting

what is a flail chest

when three or more ribs are broken with more than one break per rib. it creates a free floating segment that places the rib at an increased risk for perforation.

What is a tension pneumothorax?

air can enter the pleural space but cannot exit, compressing the lung.

for hemothorax:

what is the maximum amount of blood (drainage) needed to notify the MD?

200ml/hr

what is a cardiac tampanade?

120-150ml blood accumulation that increased the intracardiac pressure and compressed the atria and ventricles.

PEA can occur

ST elevation on ECG due to hypoxia

what is pulsus paradoxus

normal fluctuation with respiration 2-4 mg

abnormal is a waveform that increases more then 4mmhg on inspiration. indicates intrathoracic pressure (cardiac tamponade)

potential complication of blunt cardiac injury

tearing of the aorta and or potential rupture of points of attachment

nursing management for blunt cardiac injury

oxygenate

ventilation

pain medication

prevent complications

What is Cullen's sign?

ecchymosis at the umbilicus due to retroperitoneal bleed

What is Grey Turner's sign?

ecchymosis at the flank due to retroperitoneal bleed involving the kidneys

What is Kehr's sign?

Left shoulder pain indicating splenic rupture

list some diagnostic methods for abdominal injury

diagnostic peritoneal lavage (DPL)

FAST ( assess for free fluid)

Bedside xray ( to assess free air)

CT (to assess extent of injury and bleeding)

what is abdominal compartment syndrome

end organ dysfunction caused by intra-abdominal hypertension.

Complication of liver injuries

hemorrhage

hemodynamic instability

coagulopathy

acidosis

hypothermia

complication of splenic injuries

hemorrhage

sepsis

complication of intestinal injuries

sepsis

abscess

fistual formation

complications of trauma that require monitoring

pain

compartment syndrome

VTE

ARDS

hypermetabolism (enteral feedings within 72 hours)

AKI

rhabdomyolysis

Fat embolism syndrome

infection

define shock syndrome

decreased blood flow to the body tissues resulting in cellular dysfuntion and eventual organ failure

what are the four stages of shock syndrome

Initial

Compensatory

Progressive

Refractory

what is the initial stage

circulating volume decreased but not enough to cause serious effects

what is the compensatory stage

blood volume reduced but mechanisms are able to maintain BP and tissue perfusion

neural response: ^ HR and contractility

Hormonal response: activation of the renin-aldosterone-ADH mechanism ( sodium and water retention and vasoconstriction.

what is the progressive stage

unfavourable signs appear

tissue edema

vasodilation

low perfusion

irreversible cell damage.

what is the refractory stage

unresponsive to therapy - death ensues

irreversible, MODS

shock syndrom assessment

SBP <90 mmhg

Map <60

tachycardia

altered mental status

high serum lactate

low hemoglobin and hct

nursing priorities for shock

provide informaiton on patient status, explain procedure and routines

encouraging feelings

family centred care

Explain Hypovolemic Shock.

loss of fluid from the intravascular space

decreasing circulating volume,

low SV, Low CO

decreased cellular oxygen and tissue perfusion

impaired cellular metabolism

Hypovolemic shock treatment

hypovolemic shock nursing priorities

Explain Cardiogenic Shock.

caused by left antierioir wall I ST segment elevations

impaired cardiac output and alterations to contractility and or rate and rhythm.

SBP< 90mmhg

U/O <30ml/hr

ABG show repiratory alkalosis

chest pain, tachycardia

cardiogenic shock treatment

cardiogenic shock nursing priorities

Explain anaphylactic shock

anaphylactic shock treatment

anaphylactic shock nursing priorities

explain neurogenic shock

neurogenic shock treatment

neurogenic shock nursing priorities

explain septic shock

Septic shock treatment

septic shock nursing priorities

explain Multi organ dysfunction syndrome

MODS treatment

MODS nursing priorities

importance of collaborative decision making, communication and symptom management of EOL patients

impact of organ donation and subsequent transplantation on individuals and facilities