Trauma Injuries Student Version PDF

12/2/24 1 Trauma Injuries AMBER THOMAS, DNP, MBA, RN, NPD-BC NURS 486 2 Objectives 1.Describe the pathophysiology and nursing implications for crush injuries and/or compartmental syndrome. 2. 2.Describe nursing care for the prevention and treatment of traumatic and s...

12/2/24 1 Trauma Injuries AMBER THOMAS, DNP, MBA, RN, NPD-BC NURS 486 2 Objectives 1.Describe the pathophysiology and nursing implications for crush injuries and/or compartmental syndrome. 2. 2.Describe nursing care for the prevention and treatment of traumatic and surgical wound infection and secondary trauma. 3. 3.Describe the nursing management of the patient with a traumatic brain injury. 4. 4.Discuss the role of nutrition in the critically injured patient. 5. 3 Thoracic/Chest Injuries Pneumothorax –Simple: chest tube –Open: cover wound, then chest tube –Tension: needle decompression, then chest tube Fractured ribs –Flail chest: –paradoxical chest movements, ↓ vital capacity, atelectasis Contusions –Heart : tamponade, dysrhythmias, ↓ CO –Lungs : hemothorax 4 Abdomen Injuries Blunt versus penetrating Lacerated liver, ruptured spleen, mesenteric artery tears, 1 5 4 Lacerated liver, ruptured spleen, mesenteric artery tears, diaphragm rupture, urinary bladder rupture, great vessel tears, renal or pancreas injury, and stomach or intestine rupture If intra-abdominal hemorrhage is suspected ◦focused abdominal sonography for trauma (FAST) to determine the presence of blood in the peritoneal space (hemoperitoneum) 5 Deceleration Injuries Can cause ◦Brain, organ, and knee injuries Factors that affect severity ◦Initial speed ◦Distance and time ◦Direction ◦Area of distribution ◦ Restraint injuries ◦Seat belt sign 6 Large Bone Fractures Femur ◦Open vs. Closed ◦Blood loss ◦Compartment syndrome Pelvis ◦Open vs. Closed ◦Stable vs. Unstable ◦Blood loss ◦Intrabdominal injury 7 Infection qOpen fractures and soft tissue injuries qDebridement 8 7 qOpen fractures and soft tissue injuries qDebridement qAntibiotics q qSepsis 8 Crush Injuries May accompany fractures Compartment syndrome ◦Rhabdomyolysis ◦↑ lactic acid leading to metabolic acidosis ◦↑ myoglobins leading to renal failure ◦Decreased blood flow to kidneys ◦Crystallization of myoglobin in renal tubules ◦Toxic effect of myoglobin on renal tubules ◦↑ K+ ◦Can be from prolonged immobility compromised circulation secondary to pressures 9 Traumatic Brain Injuries Caused by outside mechanical forces transmitted to the brain –Penetrating trauma –Blunt trauma Examples –Head hitting windshield in MVA –Sports injuries –Falling –GSW –Blasts are a leading cause of TBI for active-duty military personnel in war zones 10 Traumatic Brain Injuries qDiffuse Injury qConcussion: brief changes in LOC w or w/o loss of consciousness qDiffuse Axonal Injury 10 consciousness qDiffuse Axonal Injury q qFocal Injury qContusion: bruising/edema. Can result in focal neurological deficit qCoup-contrecoup: brain moves inside the skull due to high- energy or high-impact injury mechanisms. q qSkull Fracture 11 Traumatic Brain Injury oAmbulatory 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 ◦Family participation and education 12 Traumatic Brain Injury §For military personnel, many symptoms that follow a TBI overlap with the symptoms of PTSD. §Because TBI is caused by trauma and there is symptom overlap, it can be hard to tell what the underlying problem is. §In addition, many people who get a TBI also develop PTSD. §Physical effects may include: ◦Headaches ◦Difficulty speaking ◦Blurry eyesight ◦Trouble hearing ◦Loss of energy 13 1 2  ◦Trouble hearing ◦Loss of energy ◦Change in sense of taste or smell ◦Dizziness or trouble with balance 13 Traumatic Brain Injury 1 COGNITIVE EFFECTS 2 ◦Difficulty concentrating ◦Trouble with attention ◦Forgetfulness ◦Difficulty making decisions ◦Repeating things 3 BEHAVIORAL EFFECTS 4 ◦Becoming angry easily ◦Getting frustrated easily ◦Acting without thinking ◦Having trouble concentrating ◦Drinking more alcohol ◦Using illegal drugs 14 Traumatic Brain Injury Steps in managing TBI symptoms: ◦Get enough sleep ◦Write things down or use electronic reminders if you have trouble remembering ◦Establish a regular, daily routine ◦Check with someone you trust when making decisions ◦Avoid alcohol—it could slow down the healing process and make symptoms worse ◦Avoid caffeine, cold medications that treat nasal congestion, or other products that contain pseudoephedrine may increase the 15  ◦Avoid caffeine, cold medications that treat nasal congestion, or other products that contain pseudoephedrine may increase the symptoms 15 Traumatic Brain Injury §Recognize triggers—keep a record to help identify situations that are more likely to worsen your symptoms § §Take up a hobby or a recreational activity § §Talk to others—to keep you from feeling isolated and to give friends and loved ones a chance to help you § §Remember that symptoms are a normal part of the recovery, and they will get better 16 Nutrition qHypermetabolism of stress q qFacial/Abdominal Trauma q qWound healing 17 References ATI RN Adult Medical Surgical Nursing Book; Edition 12.0 Harding, M. M., Kwong, J., Roberts, D., Hagler, D. & Reinisch C. (2023). Lewis’s Medical-surgical nursing: Assessment and management of clinical problems (12th Ed.). St. Louis: Mosby Elsevier. ISBN: 9780323789615 US Department of Veterans Affairs. (2024). Effects of traumatic brain injury. http://maketheconnection.net/conditions/traumatic- brain- brain injury. http://maketheconnection.net/conditions/traumatic- brain- injury?utm_source=adcenter&utm_medium=cpc&utm_term=trauma tic%20brain%20injury&utm_content=tbi&utm_campaign=KeywordS earch