Trauma & Surgical mgmt

Which of the following pts have the greatest risk of developing ARDS after a traumatic injury?

A patient who has received large volumes of fluid and/or blood replacement

A restrained patient's status after a motor vehicle crash includes dyspnea, dysphagia, hoarseness, and complaints of severe chest pain. Upon assessment you note that the patient has weak femoral pulses. Which of the following complications and related diagnostic test should be considered?

Aortic dissection and aortogram

Which interventions are appropriate to consider in the management of the geriatric trauma patient? (Select all that apply.)

Ask about recent falls, assess for signs of acute delirum, get a detailed medical hx, obtain detailed list of current meds

To maintain the patient's airway, which interventions are appropriate to implement with a trauma patient who sustained a spinal cord injury? (Select all that apply.)

Avoid hyperextension of the neck Observe respiratory pattern Observe depth of ventilation Maintain complete spinal immobilization

During the assessment of a pt after a high-speed MVC, which of the following findings would increase the nurse's suspicion of a pulmonary contusion? (SATA)

Chest wall ecchymosis Pink-tinged or blood secretions Signs of hypoxia on RA

It is important to prevent hypothermia in trauma pts bc hypothermia is associated with which of the following? (SATA)

Coagulopathies Dysrhythmias Myocardial dysfunction

A trauma patient with a fractured forearm complains of extreme, throbbing pain at the fracture site and paresthesia in the fingers. Upon further assessment, you note that the forearm is extremely edematous and you are now having difficulty palpating a radial pulse. You notify the physician immediately because you suspect

Compartment syndrome

A 36-year-old driver was pulled from a car after it collided with a tree and the gas tank exploded. What assessment data suggest the patient suffered tissue damage consistent with a blast injury?

Crackles (rales) on auscultation of bilateral lung fields Explosive blast energy generates shock waves that create changes in air pressure, causing tissue damage. Initially after an explosion, there is a rapid increase in positive pressure for a short period, followed by a longer period of negative pressure. The increase in positive pressure injures gas-containing organs. The tympanic membrane ruptures, and the lungs may show evidence of contusion, acute edema, or rupture. A low BP and corresponding tachycardia is more suggestive of hypovolemia. Lack of response to stimuli suggests a neurological injury. An irregular heart rhythm may be associated with blunt trauma to the heart (cardiac contusion)

Which of the following pts would require greater amounts of fluid resuscitation to prevent AKI associated with rhabdomyloysis? (SATA)

Crush injury to right arm Light strike of the left arm and chest

A 55-year-old trauma patient hit the steering wheel and has a cardiac contusion. Which are potential complications of the injury? (SATA)

Dysrhythmias, hypotension, MI

ARDS is a complication associated with...

Excessive inflammation and over-resuscitation

Fluid resuscitation is an important compnent of managing the trauma pt. Whic of the folowing statements are true regarding the care of a trauma pt? (SATA)

IV fluids may need to be warmed to prevent hypothermia (fluids of choice: LR and NS-crystalloids) Massive transfusions should be avoided to improve patient outcomes

Trauma pts are at high risk for multiple complications not only due the mechanism of injury but also due to he pt's long-term mgmt. Which of the following statements apply to trauma pts?

Indwelling catheters are a source of infection pts often develop infection and sepsis secondary to central line catheters Pneumonia is often an adverse outcome of mechanically ventilation

A 24-year-old unrestrained driver who sustained multiple traumatic injuries from a MVC has a BP of 80/60 mm Hg at the scene. The PRIMARY SURVEY of this patient upon arrival to the ED:

Is done quickly in the first few mins to get a baseline Ax and establish priorities

Which of the following findings require immediate nursing interventions related to the assessment of a pt with a TBI? (SATA)

MAP 48 mm Hg Non-reactive pupils RR of <10 breaths per min

The nurse has admitted a pt to the ED following a fall from a fist-floor hotel balcony. The pt is 22 y.o. and smells of alochol. The pt begins to vomit in the ED. Which of the following interventions is most appropriate?

Prepare to suction the oropharynx while maintaining cervical spine imobilization

Nursing priorities to prevent ineffetive coagulation include which of the following? (SATA)

Prevent hypothermia Give FFP as ordered Give calcium as ordered

The primary priority for the critical care nurse with regard to the trauma patient is which of the following?

Provide adequate oxygenation and tissue perfusion

Which condition is a common cause of death after chest trauma

Pulmonary contusion

A 72-year-old patient fractured his pelvis in a motor vehicle crash 2 days ago. He suddenly becomes anxious and short of breath. His respiratory rate is 34 breaths per minute, and he is complaining of midsternal chest pain. His oxygen saturation drops to 75%. You suspect:

Pulmonary embolus (PE)

What is the initial symptom of compartment syndrome?

Severe, throbbing pain in the affected area

The trauma patient presenting with left lower rib fractures develops left upper quadrant tenderness, hypotension, and referred pain to the left shoulder. You suspect

Splenic injury

Spinal cord injury causes a loss of sympathetic output, resulting in distributive shock with hypotension and bradycardia. Although blood pressure may respond to fluid resuscitation, what other therapy may be required to compensate for loss of sympathetic innervation?

Vasopressors

In the trauma pt, sypmotoms of decreased CO are most commonly caused by:

hypovolemia

What not to do if a pt is suspected to have a basilar skull fracture?

insert a NG tube

The nurse is caring for a pt who sustained rib fractures after hitting the steering wheel of his car. The pt is spontaneously breathing and receiving oxygen via a face mask; the oxygen sat is 95%. During the nurses Ax, the oxygen sat drops to 80%. The pt's BP has dropped from 128/ 84/60. The nurse assesses that breath sounds are absent throughout the left lung fields. The nurse notifies the physician and anticipates:

needle thoracostomy and chest tube insertion

The need for fluid resuscitation can be assessed best in the trauma pt by monitoring and trending which of the following tests?

serum lactate levels. Useful in assessing acidosis and the need for aggressive fluid resuscitation