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113 Cards in this Set

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This is injury to human tissues and organs resulting from the transfer of energy from the environment.
trauma
An injury that occurs without intent, an result of random chance.
accident
This kills more people between the ages of 1 and 44 than any other disease or illness
trauma
This is the person or group at risk of injury from trauma
the host
The source of the energy transmitted to the host in trauma (can be mechanical, gravitational, thermal, electrical, physical, or chemical)
mechanism
the most common type of energy transferred to a host in trauma
mechanical
The most common mechanical source of injury in all adult age groups is what?
motor vehicle
This component of trauma describes whether it occurred on purpose or not
intention
This is the final component of trauma. An example would be an icy road
environment
This is an important component of environment that may affect one's risk of trauma
occupation (eg a firefighter would have a higher risk than an accoutant)
This type of trauma causes injury to a single part or system of the body and is usually treated in the physician's office or the ED
minor trauma
a fractured clavicle, a small 2nd degree burn, or a laceration requiring sutures are examples of what kind of trauma
minor trauma
This type of trauma involves serious single-system (such as the traumatic amputation of a leg) or mulitple system injuries
multiple trauma
multiple trauma is most often the result of what
motor vehicle accidents
This type of trauma occurs when there is no communication between the damaged tissues and the outside environment
blunt trauma
this type of trauma is caused by deceleration, accleration, compression, and crushing
blunt trauma
this type of trauma occurs when a foreign object enters the body, causing damage to body structures (most commpnly the brain, lungs, heart, liver spleen, intestines, and vascular system)
penetrating trauma
these type of injuries result from th temperature and velocity of air movement and the force of projectiles from the explosion
blast injuries
T or F: Blast injuries are more severe in water than air
TRUE: They travel farther and faster in water than air
-Name the three classes of trauma centers
-Which class treats the most severe injuries
-which class has to have personnel on residence 24 hours per day
-class 1, 2, or 3
-class 1
-class 1
this type of death happens at the scene from injuries such as a torn thoracic aorta or decapitation
immediate death
this type of death happens happens occurs within several hours of the injury (eg from shock or a delay in recognizing injuries)
early death
this type of death occurs one or more days after the injury and results from multiple organ failure, sepsis, and coagulapothies
late death
assessment of this is the highest priority in the trauma client
airway
All trauma clients should receive supplementation with this until they are stabilized
high flow oxygen
this is the preferred method of airway management if the client is unable to maintain oxygenation or an open airway
intubation
laryngoscopy causes a significant increase in this, which can be dangerous in a closed head injury
Intracranial pressure (ICP)
Administration of this 3 to 5 minutes prior to intubation can reduce the increase in ICP that is common with intubation
Lidocaine
A penetrating trauma to the neck is associated with a high degree of these two things
morbidity and mortality
Approximately 3 to 6% of major trauma victims have injuries to this part of the body?
C-Spine injuries
True or false: The probability of C Spine injury is increased if the follwoing criteria are met:
-absence of midline cervical spine tenderness
-normal alertness
-absence of intoxication
-absence of a painful distracting injury
-no focal neuologic defects
FALSE: It is decreased if the criteria is met
this results when air enters the potential space between the parietal and visceral pleura
pneumothorax
A special type of pneumothorax that is life threatening and requires immediate attention.
tension pneumothorax
a tension pneumothorax can lead to collapse of these
lungs
-the immediate short term life saving intervention for a tension pneumothorax is what?
-describe the procedure
-a needle thoracostomy
-large bore needle in inserted into the second intercostal space at the midclavicular line. All air and fluid are aspirated
What are the two best ways immediately control hemorrhaging in an emergency
1. direct pressure over the wound
2. direct pressure over arterial pressure points
Injuries to the integument (skin) are generally not as serious as other injuries, except for what
burns
rupture of the large bowel results in the escape of feces, which can result in this
peritonitis
TorF: musculoskeletal injuries are not considered a high prioroty in the care of the client with multiple injuries, except for life or limb threatening injuries such as a dislocated or pulseless extremity
TRUE
TorF: Musculoskeletal injuries may provide clues to the presence of other serious injuries (eg a fractured clavicle may indicate an associated thoracic injury)
TRUE
A common complication of sever injury and a frequent cause of death in ICUs. It is a progressive impairment of two or more organ systems caused an uncontrolled inflammatory response
Mulitple Organ Dysfunction Syndrome (MODS)
the suddenness and seriousness of trauma may cause what type of crisis in both the client and their family
psychological
Morbidity and mortality rates are reduced when the client is transported to a facility that can manage their injuries within an hour of the injury. This hour is known as what?
the Golden Hour
The primary goal of this exam (used in the ED) is to evaluate the presence of blood in body cavities where it is not supposed to be
FAST (forward assessment by sonography in trauma)
in this ED evaluation used for trauma an incision is made in the abdomen and any free blood is aspirated. If there is more than 10 mL, exploratory surgery is started.
diagnostic peritoneal lavage
Which is used more often, the FAST exam or diagnostic peritoneal lavage
FAST exam
these scans can discover injuries to the brain, skull, spine, spinal cord, chest, and abdomen
CT scans
These scans can discover injuries to the brain and spinal cord
MRI
What type of blood is a person usually given in trauma situations: whole or packed blood
whole
this is the most common transfusion reaction. Fever and chills result
febrile reaction
this transfusion reaction results in the appearance of uticaria (reddened wheals on the skin) and itching
hypersensitivity reaction
this is the most dangerous type of transfusion reaction and can cause renal failure.
hemolytic reaction
manifestations of this type of transfusion reaction include flushing of the face, burning in the vein, HA, uitcaria, chills, fever, lumar pain, abdominal pain, chest pain, N&V, tachycardia, hypotension, and dyspnea
hemolytic reaction
this is started when the client remains in shcok despite and there is no obvious sign of blood loss
emergency surgery.
True or False: An important responsibility of the nurse when a client is undergoing emergency surgery is to speak with the family as soon as possible and keep them informed about what is happening to their family member
TRUE
Can a spouse, adult children, parents, adult siblings, gaurdian, or any authorized adult give consent for organ donation
Yes
Can these people donate organs:
-currently abuse IV drugs
-previously untreated infections such as septicemia
-any malignancy other than a brain tunor
-have active tuberculosis
No
Can HIV + patients donate blood
only to HIV + recipients
it is the nurses responsibility when caring for an adult client who is an organ donor to:
-maintain systolic BP of ____mmHg

-Maintain urine output of > _____ mL

-maintain O2 sat of _____% or higher
90
30
90
when administering O2 in trauma, you want to maintain O2 sat between what two levels
94 and 100%
pulse oximetry is not effective when the client has been exposed to this gas (eg a house fire)
carbon monoxide
-An early sign of an ineffective airway is change in the clients what
-give some examples
-behavior
-restlessness, anxious, combative
an intense sustained emotional response to a disastrous event including crying, sleep problems, suspiciousness, and fear
post-trauma syndrome
these should be taught to the client undergoing post trauma syndrome
relaxation techniques (deep breathing, guided imagery, etc)
Name five nursing Diagnoses associated with trauma
-Ineffective Airway Clearance
-risk for infection
-impaired physical mobility
-spiritual distress
-post trauma syndrome
This is a clinical syndrome characterized by a systemic imbalance between O2 supply and demand.
shock
TorF: Shock results in a state of inadequate blood flow to body organs and tissues, causing life-threantening blood flow to body organs and tissues, causing life-threatening cellular dysfunction
TRUE
the amount of blood pumped into the aorta with each contraction of the left ventricle (each heartbeat)
stroke volume (SV)
the amount of blood pumped PER MINUTE into the aorta by the left ventricle
cardiac output (CO)
The formula for this is SV X HR (heart rate)
Cardiac output (CO)
the product of cardiac output and systemic vascular resistance
mean arterial pressure (MAP)
the formula for this is CO X SVR
Mean arterial pressure (MAP)
What happens to MAP and tissue perfusion when CO, SO, or total blood volume rises
it increases (it decreases if the CO, SO or total blood volume decreases)
the sympathetic nervous system maintains the smooth muscle surrounding the arteries and arterioles in a state of partial contraction called what?
sympathetic tone
True or False: increased sympathetic stimulation increases vasoconstriction and SVR; decreased sympathetic stimulation allows vasodialation which decreases SVR
TRUE
Shock is triggered by a drop in this
MAP
This stage of shock is characterized by:
-a decrease of MAP of 10 mmHg or less from normal
-blood loss of up to 500 mL
--imperceptible symptoms
-increased HR
-Vasoconstriction (increased SVR, MAP)
Stage 1: Early, Reversible
This type of shock (included in stage I) is characterized by:
-drop in Map of 10-15mmHg from normal
-blood loss of 1000mL or more (25-35%)
-increased RR
-decreased urinary output
-the fluid moves into the vasculature
Compensatory
This stage of shock is characterized by:
-MAP drop of 20 mmHg or more from normal
-1800-2500mL of blood loss (35-50%)
-no perfusion
-vasoconstriciton leads to hypoxia
-the beginning of anerobic metabolism which leads to the buildup of lactic acid which causes metabolic acidosis
-sodiium and H2O enter cells and they burst
-heart and brain become ischemic (eg MI)
-aggressive Treatment is required or patient will probably die
Stage II: Intermediate or Progressive
In this stage of shock nothing can reverse it and death occurs
Stage III: refactory or irreversible shock
In which stage of shock can hyperkalemia and cardiac dysrythmias occur
Stage II: Progressive
True or false: There is usually no problem auscultating BP in shock
FALSE: It is often dificult or impossible and is an inaccurate measure of BP hemodynamic monitoring is used instead)
This is a complication of decreased perfusion in the lungs which results in noncardiogenic edema
acute respiratory distress syndrome (ARDS) or "shock lung"
In this syndrome, production of surfactant is impaired, and the alveoli collapse or fill with fluid
ARDS or shock lung
-What happens to blood flow to the stomach and intestines during shock
-Why
-it is redirected to the heart and brain
-they need it more
These may happen 2 to 10 days follwoing the original cause of shock
gastric ulcers
the primary effect of shock on the neurologic system involve changes in this
mental status and orientation (beginning with apathy and lethargy and continuing to coma)
oliguria indicates progressive shock. This is less than how many mL per hour
20 mL/hr
-What happens to the skin color of Caucasians in shock
-what about those of African, HIspanic, or Mediterranean descent
-turns pale
-paleness of lips, oral mucosa, nail beds, and conjunctiva
what happens to body temperature and thirst in shock
body temp decreases, some people become thirsty
this type of shock is caused by a decrease in intravascular volume of 15% or more and is the MOST COMMON type of shock
hypovolemic (it can occur with other types)
this type of shock occurs when the heart's pumping ability is compromised to the point that it cannot maintain cardiac output and adequate tissue perfusion
cardiogenic shock (eg MI)
Caused by an obstruction in the heart or great vessels that either impedes venous return or prevents effective pumping action
obstructive shock
includes several types of shock that result from widespread vasodialation and decreased peripheral resistance
distributive (or vasogenic) shock
this type of shock is the leading cause of death in ICU and is one part of a progressive syndrome called systemic inflammatory response syndrome (SIRS)
septic shock
Is septic shock usually caused by gram positiv (Staph and Strep) or gram negative (Pseudomonas, E. coli, Klebsiella) bacteria
gram negative ALTHOUGH IT CAN BE CAUSED BY GRAM +
the mortality rate for septic shock is what percnet, even woth treatment
60%
True or False: Clients at risk for septic shock are those who have been hospitalized, have debilitating chronic illnesses or have poor nutritional status
TRUE
In this phase of shock (the early phase) vasodialation results in weakness and warm flushed skin and high fever and chills caused by sepicemia
warm phase
in this phase of septic shock hypovolemia causes cold, moist skin, oliguria, and changes in mental status. Death may result from heart, respiratory, or renal failure
cold phase (late phase)
This type of shock is the result of an imbalance between parasympathetic and sympathetic stimulation of vasular smooth muschle. Blood pools in the venous and capillary beds.
neurogenic shock
This type of shock is the result of a widespread hypersensitivity reaction
anaphylactic shock
True or False: Anaphylactic shock can occur with the first exposure to an allergen
FALSE (only after the first exposure)
-Changes in H&H usually occur in this type of shock
hypovolemic
-in hypovolemic shock resulting from hemorrhage, H&H are usually lower or higher than normal
-what about H&H in hypovolemic shock resulting from intravascular fluid loss
-what about in
-lower
-higher
what happens to pH in shock
decreases
what happens to BUN, serum creatine, specific gravity, and osmolality in shock
they all increase
what happens to serum cardiac enzymes in cardiogenic shock (eg LDH, CPK, and SGOT)
increase
what med is used to treat acidosis in shock
sodium bicarbonate
this is the most effective treatment for clients in hypovolemic shock
administration of blood or IV fluids (through massive amounts eg, two large bore peripheral lines or a CV line)
-the goal of blood administration in hypovolemic shock is to keep the hematocrit level between what percents
-what about hemoglobin (between what g/100mL)
-hematocrit between 30 and 35%
-hemoglobin between 12.5 and 14.5 g/100 mL
how you position a client who is in shock
-supine position
-legs elevated to 20 degrees
-trunk flat
-head and shoulders elevated higher than the chest (about 10 degrees)
- Is the Trendelenburg position still recommended for clients in shock
-why or why not
-no
-it causes the abdominal organs to press against the diaphragm, decreases filling of the cororany arteries and starts aortic and caridac sinus rhythms