Trauma and Chest Injury Management

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Questions and Answers

Which of the following factors does NOT affect the severity of deceleration injuries?

Direction of impact

Duration of hospitalization (correct)

Area of distribution

Initial speed

What is the recommended nursing intervention for the prevention of traumatic and surgical wound infection?

Avoiding contact with any fluids

Administering prophylactic antibiotics (correct)

Frequent dressing changes without sterile technique

Immediate suturing of all wounds

Which nursing management approach is crucial for a patient with a traumatic brain injury?

Encouraging maximum physical activity

Immediately starting physical therapy

Providing unrestricted sensory stimulation

Regular monitoring of neurological status (correct)

What is a significant complication associated with large bone fractures, particularly the femur?

Compartment syndrome Signup and view all the answers

What is a primary nursing implication for managing crush injuries?

Assessment for compartment syndrome Signup and view all the answers

What metabolic condition can result from rhabdomyolysis due to crush injuries?

Hyperkalemia Signup and view all the answers

Which complication is associated with open fractures and soft tissue injuries?

Infection Signup and view all the answers

What type of traumatic brain injury results from the brain moving within the skull due to high-energy impact?

Coup-contrecoup Signup and view all the answers

During the management of crush injuries, which of the following can cause renal failure?

Decreased blood flow to kidneys Signup and view all the answers

Which type of brain injury is characterized by brief changes in level of consciousness without necessarily losing it?

Concussion Signup and view all the answers

What is a common overlap symptom between traumatic brain injury (TBI) and PTSD in military personnel?

Memory loss Signup and view all the answers

What is a complication of compartment syndrome associated with crush injuries?

Hypoxia of tissues Signup and view all the answers

What type of injury occurs primarily due to penetrating trauma or physical impact to the head?

Traumatic Brain Injuries Signup and view all the answers

Which of the following is a common physical effect of traumatic brain injury?

Loss of energy Signup and view all the answers

What cognitive symptom might someone experience after a traumatic brain injury?

Difficulty making decisions Signup and view all the answers

Which behavioral effect could signify the impact of traumatic brain injury on a person?

Easily getting frustrated Signup and view all the answers

What should individuals avoid to aid in the management of traumatic brain injury symptoms?

Consuming alcohol Signup and view all the answers

What is a recommended step for managing symptoms of traumatic brain injury?

Write things down or use electronic reminders Signup and view all the answers

Which of the following should be recognized as a trigger for worsening traumatic brain injury symptoms?

Specific environmental situations Signup and view all the answers

What impact can caffeine have on symptoms of traumatic brain injury?

It could increase symptoms Signup and view all the answers

What is one effect of traumatic brain injury related to vision?

Blurry eyesight Signup and view all the answers

Study Notes

Trauma Injuries

Objectives:
- Describe pathophysiology and nursing implications for crush injuries and compartment syndrome.
- Describe nursing care for prevention and treatment of traumatic and surgical wound infection, and secondary trauma.
- Describe nursing management of patients with traumatic brain injury.
- Discuss the role of nutrition in critically injured patients.

Thoracic/Chest Injuries

Pneumothorax:
- Simple: chest tube needed.
- Open: cover wound, then chest tube.
- Tension: needle decompression, then chest tube.
Fractured Ribs:
- Flail chest: paradoxical chest movements, decreased vital capacity, atelectasis.
Contusions:
- Heart: tamponade, dysrhythmias, decreased cardiac output (CO).
- Lungs: hemothorax.

Abdomen Injuries

Blunt versus penetrating: Lacerated liver, ruptured spleen, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal or pancreas injury, and stomach or intestine rupture are possible injuries. If intra-abdominal hemorrhage is suspected, a focused abdominal sonography for trauma (FAST) can determine the presence of blood in the peritoneal space (hemoperitoneum).

Deceleration Injuries

Factors affecting severity: initial speed, distance and time, direction, and area of distribution.
Possible injuries: brain, organ, and knee injuries.
Restraint injuries, including seatbelt sign.

Large Bone Fractures

Femur: open versus closed, blood loss, compartment syndrome.
Pelvis: open versus closed, stable versus unstable, blood loss, intrabdominal injury.

Infection

Open fractures and soft tissue injuries are relevant.

Crush Injuries

May accompany fractures.
Compartment syndrome.
Rhabdomyolysis (increased lactic acid leading to metabolic acidosis; increased myoglobin leading to renal failure, crystallization of myoglobin in renal tubules).
Toxic effect of myoglobin on renal tubules.
Elevated potassium (K+).
Prolonged immobility; compromised circulation and secondary pressure are factors.

Traumatic Brain Injuries

Caused by outside mechanical forces transmitted to the brain, this includes penetrating trauma and blunt trauma.
Examples of mechanisms such as: hitting windshield in MVC, sports injuries, falling, gunshot wounds (GSW), and blasts.
Blasts in war zones are a significant cause in active-duty military personnel.

Diffuse Injury

Concussion: brief loss of consciousness or changes in LOC.

Diffuse Axonal Injury

Focal injury; contusion (bruising/edema); focal neurologic deficit.
Coup-contrecoup: brain movement inside the skull; high-energy or high-impact mechanisms are implicated.
Skull fracture.

Traumatic Brain Injury (TBI) - Ambulatory and Home Care

Acute rehabilitation, motor and sensory deficits, communication issues.
Memory and intellectual functioning, nutrition, bowel and bladder management, seizure disorders.
Mental and emotional difficulties, progressive recovery, and family participation and education.

Traumatic Brain Injury (TBI) – Military Personnel

TBI symptoms often overlap with PTSD symptoms.
Difficulties in determining the underlying cause.
Possible symptoms include: headaches, difficulty speaking, blurry eyesight, and/or trouble hearing.

Traumatic Brain Injury (TBI) – Cognitive Effects

Difficulty concentrating, trouble with attention, forgetfulness, difficulty making decisions, and repeating things.

Traumatic Brain Injury (TBI) – Behavioral Effects

Becoming angry easily, getting frustrated easily, acting without thinking, having trouble concentrating, drinking more alcohol, and using illegal drugs.

Traumatic Brain Injury (TBI) – Steps in managing TBI symptoms

Get enough sleep, write things down, establish a regular routine, check with someone you trust when making decisions, avoid alcohol and caffeine, cold medications for nasal congestion.

Traumatic Brain Injury (TBI) – Recognize triggers

Keep a record of situations that worsen symptoms.
Hobbies and recreational activities.
Talk to others, friends, and loved ones.
Symptoms will improve with time.

Nutrition

Hypermetabolism of stress.
Facial/Abdominal trauma.
Wound healing.

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Description

This quiz covers essential nursing concepts related to trauma injuries, including the pathophysiology and management of crush injuries, compartment syndrome, and traumatic brain injuries. Additionally, it explores various thoracic and abdominal injuries, their nursing implications, and strategies for preventing infections in critically injured patients.