Trauma and TBI

Trauma1

100

Name 3 examples of a blunt injury

Contusions, Abrasions, Lacerations, Bone Fractures

200

What is the 30-2-Can Do assessment?

Respiration's greater than 30/minute, cap refill greater than 2 seconds, can a patient follow simple directions?

300

What is assessed in the primary survey?

Airway, Breathing, Circulation, Disability, Exposure

400

Name 3 signs of tensions pneumothorax.

Severe respiratory distress, Hypotension and Unilateral decreased or absent breath sounds

500

Perform Glasgow Coma Scale assessment on one of your team members. (To get the point, the student must perform all checks of the GCS)

1. Assess eye opening 2. Assess verbal response 3. Assess motor response 4. State the score of the assessed person

Trauma 2

100

Name 3 diagnostic studies that might be performed on a trauma patient.

Blood work, X-ray, Focused abdominal sonography for trauma (FAST), Computer tomography (CT), MRI

200

Name 3 examples of injury prevention

Firearms and gun control, Seatbelt, Helmet, Smoke detector

300

What is the priority nursing intervention for a trauma patient arriving in the trauma room?

Assessing the airway

400

Name 3 factors that can affect breathing in a patient who sustained a polytrauma due to a MVC?

Pain, Rib fractures, Pneumothorax/Hemothorax

500

What nursing interventions (not assessment) should you anticipate for a patient arriving to your trauma room after being shot 7 times to the chest and abdomen?

To have at least 2 venous access (16-18 gauge needle) To take blood samples for ABGs, crossmatch, CBC Other relevant answers accepted..

Traumatic Brain Injury1

100

What is the difference between primary brain injury and secondary brain injury?

Primary brain injury occurs at the time of the trauma whereas secondary brain injury occurs after the initial injury.

200

What are the 4 classical signs of a basilar fracture?

Rhinorrhea Otorrhea Battle’s Sign Raccoon’s Eyes

300

This right may conflict with the health care professional’s broader obligations to provide care and to prevent harm

What is the right to confidentiality

400

When should someone return to the emergency department after sustaining a concussion?

Progressive drowsiness Confusion Vomiting > 3 times Continuous headaches Drainage of fluid from ears or nose Seizures Blurred vision Weakness in any extremity Difficulty in waking up

500

Name 3 factors affecting the ICP.

Arterial pressure, Venous pressure, Intraabdominal and Intrathoracic pressure, Posture, Temperature and Blood gases (CO2)

Traumatic Brain Injury2

100

What is the difference between focal and diffuse brain injury? Provide one example for each

Focal injury occurs in a specific location (subdural hematoma), while diffuse injury occurs over a more widespread area (concussion)

200

Explain the Monroe-Kellie Doctrine.

If the volume in any of the 3 components (brain tissue, blood and CSF) increases and the volume from another component is displaced, the total intracranial volume will not change.

300

Name 3 clinical manifestations of increased ICP.

Change in LOC Changes in vital signs Ocular Signs Decrease in motor function Headache Vomiting

400

Name 4 treatments available to decrease ICP.

Ensuring adequate oxygenation CSF drainage / monitoring Drug therapy Hyperventilation therapy Surgery Nutritional therapy

500

State 3 nursing diagnosis for a TBI patient.

Altered oxygenation due to LOC, ineffective cough Altered tissue perfusion of cerebral blood flow Altered comfort due to hyperthermia, pain, anxiety Altered nutrition due to hypermetabolism and inability to feed themselves Altered mobility due to decreased LOC and bedrest Risk of safety due to seizures, infection, immobility, altered sensory/perceptual & mental status Altered self esteem due to poor body image and dependency 

Traumatic Brain Injury3

100

Provide 3 nursing interventions to maintain an adequate respiratory function in a TBI patient.

Maintain client in a side lying position with head of bed elevated (30º) Suctioning should be kept to a minimum Perform chest physio frequently (Q4hrs) Monitor client for signs of decreased oxygenation, including changes in LOC, decreased PaO2 or SaO2 and increased respiratory rate Abdominal distension can interfere with respiration. NG tube might be needed.

200

It is 7:30 am. You are starting your morning rounds. As you enter Mr. Boom's room, who is a TBI patient, you notice that his HOB is at 30º, that his Foley catheter is draining concentrated urine and that he has D5W infusing at 100cc/hr. What should you be concerned about?

Patient should not be receiving D5W as it is a hypotonic solution which can increase ICP.

300

Mr Boom was calm and cooperative during the morning. When you enter his room in the afternoon, you notice that he is very agitated. He is confused and is unable to tell you what is wrong. In addition to perfomring Mr. Boom's GCS and taking his vital signs, provide one more nursing intervention in this situation.

The nurse should assess Mr. Boom's basic needs such as the need to void or to have a bowel movement or to drink. The nurse should also reduce any stimuli in the room.

400

Demonstrate or explain decortication, decerebration and opisthotonic posturing. (must get all of them right to get the point)

Decortication: flexion of arms, wrists and fingers with adduction in upper extremities. Extension, internal rotation and plantar flexion of the lower extremities. Decerebration: All 4 extremities in rigid extension with hyperpronation of forearms and plantar flexion of feet. Opisthotonic: The person is usually rigid and arches the back, with the head thrown backward. If a person with opisthotonos lies on his or her back, only the back of the head and the heels touch the supporting surface.

500

Why is it important to maintain cerebral blood flow and what is the formula to measure CPP?

The brain requires constant supply of glucose and oxygen. CPP=MAP-ICP