Unit 3: Abdominal Trauma

Question 1

Blunt Abdominal Trauma

Answer 1

• abdominal organs are more vulnerable to injury than those in the thorax b/c of the lack of protection from the sternum and rub cage
• hollow and solid organs

Question 2

Solid Abdominal Organs

Answer 2

• liver
• spleen
• kidneys
• pancreas
• adrenal glands
• ovaries

Question 3

Hollow Abdominal Organs

Answer 3

• bladder
• large intestines
• small intestines
• stomach
• uterus

Question 4

What do blunt abdominal injuries result from?

Answer 4

• compression
• shearing
• acceleration
• deceleration

Question 5

Blunt Abdominal Trauma may be associated with?

Answer 5

damage to the viscera (internal organs), which can result in massive blood loss or the spilling of intestinal contents into the peritoneal space, and peritonitis

Question 6

Leading causes of blunt abdominal injuries

Answer 6

motor vehicle crashes

Question 7

Compression Injuries in the Abdomen

Answer 7

• caused by the vertebral column pressing the internal organs into an external structure, causing them to bruise or rupture
• this external structure could be a steering wheel or dash board in an MVC or the ground after a fall from a height
• the sudden increase in pressure caused by compression frequently injuries the solid organs
• this overpressure within the abdomen can also cause the diaphragm to tear and be ruptured
• diaphragm injuries can affect ventilation by allowing the abdomen organs and blood from the intra-abdominal hemorrhage to enter the thoracic cavity; can result in compression of the lung or heart, and worst case from cardiac compression, cardiac tamponade

Question 8

Shearing Injuries

Answer 8

• rapid deceleration produces shearing forces, causing tears or ruptures in organs
• when the body stops moving forward, the internal organs continue to move forward in the abdomen, causing tears at the point of attachment to the abdominal wall; blood vessels that enter these organs may also be torn
• kidneys, spleen, and large and small intestines are highly susceptible to shearing injuries

Question 9

Pelvic Fractures

Answer 9

• can be seen in MVCs, pedestrians struck, and falls
• stable or unstable fractures
• genitourinary injuries: bladder ruptures, ureteral transections, and urethral disruptions

Question 10

Clinical Manifestations

Answer 10

• bruising, penetrating injuries, abrasions, lacerations, discolorations, and asymmetry
• Ecchymosis (bruising) around the umbilicus (Cullen’s sign) or flank area (Turner’s sign or Grey Turner’s sign) may indicate intra-abdominal and/or retroperitoneal hemorrhage and should be reported
• with loss of bowel sounds, peritonitis should be suspected
• auscultation of bruits over the abdomen may indicate renal artery, arterial, or aortic damage

Question 11

Diagnosis: Laboratory Tests

Answer 11

• Baseline serum chemistries
• CBC
• Urinalysis
• Type and Cross matched for possibility of blood transfusion

Question 12

Urinalysis

Answer 12

-assessed for blood in the urine

Question 13

Radiological Procedures

Answer 13

-X-rays
-CT
-MRI
>to fully determine severity of the trauma
>if pt able to travel to radiology, a CT is performed to identify specific areas of injury
>attentive to potential spinal cord injuries; accompanied by provider familiar with the care of the trauma patient

Question 14

Diagnostic Peritoneal Lavage (DPL)

Answer 14

• used to diagnose intra-abdominal bleeding
• provider inserts a catheter into the abdominal cavity; fluid is allowed to enter the abdominal cavity and then is allowed to drain
• if fluid that drains out of the abdomen appears bloody; patient prepared for emergency surgery

Question 15

Focused Abdominal Sonography for Trauma (FAST)

Answer 15

• used to scan the abdomen in 3 to 5 minutes

- noting any free fluid in the abdominal cavity

Question 16

Treatment

Answer 16

• dependent on the nature of the injury
• Large-Bore IV lines are inserted, and fluid resuscitation is initiated for volume expansion
• Nasogastric tube (NG) for gastric decompression
• Trauma patients condition can change rapidly and requires vigilant observation
• Indwelling urinary catheter inserted to observe for hematuria, and urinary output for the immediate post-op period

Question 17

Complications of Abdominal Trauma

Answer 17

• directly r/t the injury to the internal organs
• hemorrhagic shock may develop secondary to penetrating trauma
• peritonitis, potentially leading to septic shock, may develop with intestinal damage that allows fecal material to enter the peritoneal cavity
• ischemic bowel and paralytic ileus may occur secondary to the traumatic event
• may develop respiratory distress syndrome and disseminated intravascular coagulopathy

Question 18

Nursing Management

Answer 18

• based on protocols from Advanced Trauma Life Support that follows ABCDE pattern
• airway, breathing, circulation, disability (neurological status), and exposure

Question 19

Assessment and Analysis

Answer 19

-airway management is priority
-vital signs can change very quickly based on the amount of fluid loss,
-clinical manifestations of abdominal trauma are based on type (blunt or penetrating) of trauma, and the organs and structures involved
>tachycardia
>tachypnea
>pain
>bruising
>abrasions
>lacerations
>discoloration
>Cullen’s sign
>Turner’s sign
>absence of bowel sounds
-patient can deteriorate quickly e/ large blood and fluid losses; hypovolemic shock and death can occur rapidly

Question 20

Nursing Diagnosis

Answer 20

• risk for ineffective airway clearance associated w/ trauma
• risk for deficient fluid volume associated w/ blood loss
• acute pain associated w/ tissue damage caused by abdominal trauma

Question 21

Nursing Assessments

Answer 21

• Airway
• Vital signs including oxygen saturation
• LOC using the GCS
• Clinical manifestations of hypovolemic shock
• CBC and urinalysis
• Serum electrolytes
• Urinalysis
• Bowel Sounds
• Area of injury

Question 22

Assessments: Airway

Answer 22

• assess airway clearance b/c patient may have blood and/or vomitus in the oral cavity
• establishment of a patent airway is the priority b/c other injuries are likely w/ abdominal trauma and require adequate oxygenation and perfusion of vital organs

Question 23

Assessment: Vital Signs including oxygen saturation

Answer 23

• vital signs can change very quickly with abdominal trauma
• respiratory rate and effort may increase airway obstruction
• heart rate increases and blood pressure decreases with blood loss
• pulse may increase with pain

Question 24

Assessment: LOC using the Glasgow Coma Scale

Answer 24

• determine LOC b/c there may be associated head injury with motor vehicle accidents
• LOC may also decrease w/ profound hypovolemia

Question 25

Assessments: Clinical Manifestations of hypovolemic shock

Answer 25

-hypovolemic shock and death can occur rapidly and are manifested by decreased BP, increased pulse, diminished peripheral pulses, decreased skin temperature, and decreased urinary output

Question 26

Assessment: CBC and Urinalysis

Answer 26

• hemoglobin and hematocrit need to be monitored b/c values may decrease as fluid resuscitation is started in patients with blood loss
• low values are indicative of the degree of blood loss from the injury

Question 27

Assessment: Serum Electrolytes

Answer 27

baseline serum electrolytes are important in patients who may require nasogastirc decompression b/c potassium loss occurs with NG suctioning

Question 28

Assessment: Urinalysis

Answer 28

assessed for blood in urine

Question 29

Assessment: Bowel Sounds

Answer 29

-with damage to the abdominal organs, there may be a decrease or complete absence of bowel sounds

Question 30

Assessment: Area of Injury

Answer 30

• observe for signs of internal bleeding (Cullen’s and Turner’s sign)
• Assess for entry and exit wounds with gunshot wounds
• Observe area of stabbing, and if the instrument is still in the patient’s body, do not remove and allow the physician to manage the weapon

Question 31

Nursing Actions

Answer 31

• Administer supplemental oxyegn
• Insert large-bore IV and administer IV fluids; prevent shypovolemic shock
• Do not remove object protruding from wound; increase risk of bleeding
• Control bleeding; promotes hemodynamic stability
• Administer antibiotics; prophylactically secondary to risk of internal damage that may lead to peritonitis
• Consult w/ primary provider regarding need for Type and Cross match

Question 32

Nursing Teaching

Answer 32

• Explain to the patient and family all procedures regardless
• Keep family informed about the patient’s condition
• Nutrition and diet; may require long-term TPN or enteral nutrition
• Wound Care; may have tubes, drains, or an ostomy
• Clinical manifestations of infection

Question 33

Evaluating Care Outcomes

Answer 33

• outcome dependent on the nature and extent of the injuries
• priorities are physiological stability as evidenced by stable vital signs, hematocrit and hemoglobin with acceptable parameters, no clinical manifestations of infection, adequate pain management, and stable weight
• patient is independent in care requirements for the postoperative wound, and any associated equipment

Question 34

Safety Alert: Hypovolemic Shock

Answer 34

• manifestations: restlessness, anxiety, cool clammy skin, confusion, weakness, pale color, tachypnea, tachycardia, and hypotension
• nurse should keep the patient calm and warm, elevate lower extremities (unless contraindicated), maintain patent airway, and maintain IV access