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Nursing 4 Exam 4 > Unit 18 Acute Multiple Injury/Trauma/Emergency > Flashcards

Unit 18 Acute Multiple Injury/Trauma/Emergency Flashcards

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1
Q

Define trauma.

A

Any bodily injury caused by violence or force

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2
Q

What are the different types of trauma?

A

Kinetic

Chemical, electrical, radiation burns

Lack of essential agents, i.e oxygen or hear

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3
Q

What are the types of Kinetic Trauma?

What happens in both?

A

Blunt: Injury occurs without impairing skin integrity, beneath skin

Penetrating: Injury occurs that is obviously impairing skin integrity

Tissue deformity and injury to organs occurs with both

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4
Q

What are the risks factors for kinetic trauma?

A

Age - young/elderly

Gender - Male

Alcohol/Drug use

Income

Geography

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5
Q

What is the good samaritan act?

What are basic individual rights?

A

Covers you if you help someone in need

Right to emergency care whether or not they have insurance or are a criminal

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6
Q

What is involved in ACLS (Advanced Cardiac Life Support)?

A

Beyond BLS w/ AED, usually medications and other interventions

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7
Q

What are the causes of death from trauma that happen within minutes? Within hours? Within days to weeks?

A

Causes of death from trauma within minutes:

  • Brain injury
  • Spinal cord injury
  • Cardiac Injury
  • Arterial Injuries

Within hours:

  • Subdural/Epidural hematoma
  • Ruptured Spleen and liver

Within days to weeks:

  • Sepsis
  • MODS
  • DIC
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8
Q

What is the definition and goal of triage?

A

Definition: Process used to determine the severity of illness or injury in a patient

Goal: give priority care to the most critically ill or injured patient

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9
Q

What are the triage classifications?

A

Emergent - Life threatening, highest priority
ex: cardiac arrest, airway compromise, sudden vision or conscious changes

Urgent - Serious but not life threatening
ex: fracture, abdominal pain, certain wounds

Non-urgent - non life threatening
ex: sprains, strains, simple lacerations

Fast tract: typical do`ctors office problem

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10
Q

What can the nurse use to gather information from a trauma PT?

A

OPQRST (onset, provocation, quality, radiates, severity, treatments tired before ER)

SAMPLE

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11
Q

What is the primary survey for emergencies?

A

A: Establish Airway (if c-spine stabilization necessary use jaw thrust instead of head tilt chin lift)

B: Breathing - quality, lung sounds, chest symmetry

C: Circulation - check all peripheral pulses

D: Neurological disability? -LOC, GCS, Pupils

E: Exposure - remove all clothing, put in hosp. gown

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12
Q

What is the secondary survey for emergencies?

A

F: Full set of VS/ Facilitate family presence

G: Give comfort measures

H: History and head to toe assessment

I: Inspect posterior

J: Jump back and reassess, will help determine how to proceed

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13
Q

What are Emergency Life Threatening Conditions

A

Airway obstruction:

  • Manifestations - hypoxia, hypercapnia
  • Management - hemliech meunuver, forceps, endoscopy

Hemorrhage:

  • Causes - open wounds, ruptured artery below surface
  • Management - 2 large bore IVs, type and screen, O- blood if crossmatch not done yet
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14
Q

What are examples of Traumatic Brain Injuries?
What are secondary issues?
What is the collaborative management?

A

Sports injury, MVA, Falls.

Secondary issues:

  • ICP
  • Intracranial bleed
  • Impaired auto-regulation

Collaborative management:

  • Neuro assessment
  • CT/MRI/Spinal tap
  • Sx
  • Medications
  • Nursing interventions to lower ICP
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15
Q

Describe the spinal cord injuries complete spinal cord injury vs incomplete.

A

Complete:

  • Severed completely w/total loss of sensory/motor function
  • aka “transection”

Incomplete:

  • “partial transection”
  • Sensory/motor fibers preserved below injury allowing partial function
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16
Q

What are types of Incomplete Spinal Cord injuries?

A

Central cord injury:

  • Deficit in upper extremities w/loss of motor and sesory function
  • Injury or edema to central spinal cord

Anterior cord syndrome:

  • Loss of pain, temp, motor below injury
  • Maintains touch, vibration, sensation

Brown sequard syndrome:

  • spinal cord has vertical cut
  • aka “epsilateral paralysis”
  • damaged side, loss of motor function (hemiparaplegia)
  • non damaged side, loss of sensation (hemianesthesia)
17
Q

When would you assume a C-spine injury?

A

MVA’s

Diving accidents

Falls

Trauma

18
Q

What are the mechanisms of spinal cord injury?

A

Hyperextension

Hyperflexion

Compression

Penetrating

19
Q

Describe Neurogenic shock vs Spinal shock.

A

Neurogenic shock:

  • Loss of vasomotor tone
  • Impairment of autonomic function below lesion
  • Hypotension, bradycardia, warm skin
  • Severe vasodilations and decreased cardiac output
  • Find cause and eliminate, provide increasing blood flow interventions like passive leg raising, etc

Spinal Shock:

  • Loss of spinal reflexes
  • Flaccid paralysis
  • Occurs within a few minutes of spinal cord injury
  • May lose continence during time
  • Will resolve on it’s own over time
20
Q

What is Autonomic Dysreflexia?

What are the signs and symptoms?

A

Sudden increase in SBP and DBP w/ bradycardia Abnormal exaggerated autoimmune response
Life threatening

Signs and symptoms:
-Above T6 initial spinal shock
-Above level of injury,
profuse diaphoresis, goose bumps, and flushed skin 
-Below injury pale skin
-Severe throbbing headache
21
Q

What are nursing interventions for Autonomic Dysreflexia?

A
  • Place PT in sitting position
  • Notify PCP

-Assess for cause:
Retention
Kinks
Fecal impaction

  • Monitor VS
  • Give nifedipine or nitrate as prescribed to lower BP
22
Q

What are the types of eye trauma and what is the management for each?

A

Chemical: irrigate w/water or normal saline

Foreign body: stabilize until further intervention

Leading cause of blindness among children and young adults

23
Q

What are types of cardiothoracic trauma?

A 
Myocardial contusion 
Cardiac tamponade 
Pulmonary contusion
Flail chest
Pneumothorax 
Hemothorax
24
Q

What organs are mostly affected in abdominal trauma?

What is the collaborative management of abdominal trauma?

A

Liver and spleen

Assessment, Dx, Sx

25
Q

Describe pelvic trauma and what to assess/anticipate.

A

Can be a fracture of the pelvis

Assess for rectal or vaginal bleeding

Assess for hematuria

Anticipate: X-rays, CT scan, IV pyelogram

26
Q

What can a musculoskeletal trauma cause?

What is more likely to cause a comminuted fracture (bone into fragments)?

A

Can cause a contusion, laceration, or fracture

A crush injury

27
Q

When there is injury to the back what should the nurse suspect?

A

Renal trauma

28
Q

What is the collaborative management of renal trauma?

A

Urinalysis

CT

Ultrasound

IV fluids

29
Q

What are heal related emergencies?

A

Heat cramps

Heat exhaustion

Heat stroke

30
Q

What are signs and symptoms of heat cramps and exhaustion?

What’s the treatment?

A

Fatigue
N and V
Extreme thirst
Hyperthermia

Tx: Rest and fluid replacement, remove clothing

31
Q

What are signs and symptoms of heat stroke?

What’s the treatment?

A

> 100.4 temp
Absence of perspiration
ALOA
Decreased BP

Tx: Cover w/ wet sheets, remove clothing, cold fluids,

32
Q

What are cold related emergencies?

What are signs and symptoms and treatment of hypothermia?

A

Frostbite:

  • superficial
  • deep

Hypothermia

  • core body temp < 95F (35C)
  • medical emergency

Symptoms: shivering, confusion, bradycardia

Tx: Remove from cold, rewarm them, monitor ABC’s

33
Q

What do you want to do for a snake bite?

A

Provide first aid, identify what bit you, and go to the ER

34
Q

During a mass casualty event what’s the goal?

A

Save the most viable

Greatest amount of ppl saved possible

35
Q

What should be asked to a PT with a suspected hemorrhagic fever?

A

Have they recently traveled?

36
Q

What is the protocol for infectious triage and care?

A

-Quickly screen, identify, and isolate suspected infectious agent or:
Ebola, Smallpox, anthrax, plague, hemorrhagic viral agents.

  • Provide safe environment and minimize exposure to other ppl
  • Donning and doffing of appropriate PPE
  • Quarantine
37
Q

What happens regarding death in the ED?

A

Maintain belongings with PT

Notify next of kin (ask them to come to the hospital, do not give information over the phone)

Suspect autopsy will be performed

Is he/she a possible organ donor?

38
Q

If a PT develops compartment syndrome what should the nurse be alert for?

A

Dark, scanty urine

39
Q

What is the best way method to assess for a DVT in a client with a spinal cord injury?

A

Leg girth

Nursing 4 Exam 4 (6 decks)

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