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Nursing 272: Final Semester > Unit 3: Abdominal Trauma > Flashcards

Unit 3: Abdominal Trauma Flashcards

1
Q

Blunt Abdominal Trauma

A
  • 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
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2
Q

Solid Abdominal Organs

A
  • liver
  • spleen
  • kidneys
  • pancreas
  • adrenal glands
  • ovaries
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3
Q

Hollow Abdominal Organs

A
  • bladder
  • large intestines
  • small intestines
  • stomach
  • uterus
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4
Q

What do blunt abdominal injuries result from?

A
  • compression
  • shearing
  • acceleration
  • deceleration
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5
Q

Blunt Abdominal Trauma may be associated with?

A

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

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6
Q

Leading causes of blunt abdominal injuries

A

motor vehicle crashes

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7
Q

Compression Injuries in the Abdomen

A
  • 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
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8
Q

Shearing Injuries

A
  • 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
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9
Q

Pelvic Fractures

A
  • can be seen in MVCs, pedestrians struck, and falls
  • stable or unstable fractures
  • genitourinary injuries: bladder ruptures, ureteral transections, and urethral disruptions
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10
Q

Clinical Manifestations

A
  • 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
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11
Q

Diagnosis: Laboratory Tests

A
  • Baseline serum chemistries
  • CBC
  • Urinalysis
  • Type and Cross matched for possibility of blood transfusion
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12
Q

Urinalysis

A

-assessed for blood in the urine

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13
Q

Radiological Procedures

A

-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

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14
Q

Diagnostic Peritoneal Lavage (DPL)

A
  • 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
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15
Q

Focused Abdominal Sonography for Trauma (FAST)

A
  • used to scan the abdomen in 3 to 5 minutes

- noting any free fluid in the abdominal cavity

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16
Q

Treatment

A
  • 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
17
Q

Complications of Abdominal Trauma

A
  • 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
18
Q

Nursing Management

A
  • based on protocols from Advanced Trauma Life Support that follows ABCDE pattern
  • airway, breathing, circulation, disability (neurological status), and exposure
19
Q

Assessment and Analysis

A

-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

20
Q

Nursing Diagnosis

A
  • 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
21
Q

Nursing Assessments

A
  • 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
22
Q

Assessments: Airway

A
  • 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
23
Q

Assessment: Vital Signs including oxygen saturation

A
  • 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
24
Q

Assessment: LOC using the Glasgow Coma Scale

A
  • determine LOC b/c there may be associated head injury with motor vehicle accidents
  • LOC may also decrease w/ profound hypovolemia
25
Q

Assessments: Clinical Manifestations of hypovolemic shock

A

-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

26
Q

Assessment: CBC and Urinalysis

A
  • 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
27
Q

Assessment: Serum Electrolytes

A

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

28
Q

Assessment: Urinalysis

A

assessed for blood in urine

29
Q

Assessment: Bowel Sounds

A

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

30
Q

Assessment: Area of Injury

A
  • 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
31
Q

Nursing Actions

A
  • 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
32
Q

Nursing Teaching

A
  • 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
33
Q

Evaluating Care Outcomes

A
  • 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
34
Q

Safety Alert: Hypovolemic Shock

A
  • 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

Nursing 272: Final Semester (79 decks)

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