Ch 11 Trauma And Shock

Front 1

This is injury to human tissues and organs resulting from the transfer of energy from the environment.

Back 1

trauma

Front 2

An injury that occurs without intent, an result of random chance.

Back 2

accident

Front 3

This kills more people between the ages of 1 and 44 than any other disease or illness

Back 3

trauma

Front 4

This is the person or group at risk of injury from trauma

Back 4

the host

Front 5

The source of the energy transmitted to the host in trauma (can be mechanical, gravitational, thermal, electrical, physical, or chemical)

Back 5

mechanism

Front 6

the most common type of energy transferred to a host in trauma

Back 6

mechanical

Front 7

The most common mechanical source of injury in all adult age groups is what?

Back 7

motor vehicle

Front 8

This component of trauma describes whether it occurred on purpose or not

Back 8

intention

Front 9

This is the final component of trauma. An example would be an icy road

Back 9

environment

Front 10

This is an important component of environment that may affect one's risk of trauma

Back 10

occupation (eg a firefighter would have a higher risk than an accoutant)

Front 11

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

Back 11

minor trauma

Front 12

a fractured clavicle, a small 2nd degree burn, or a laceration requiring sutures are examples of what kind of trauma

Back 12

minor trauma

Front 13

This type of trauma involves serious single-system (such as the traumatic amputation of a leg) or mulitple system injuries

Back 13

multiple trauma

Front 14

multiple trauma is most often the result of what

Back 14

motor vehicle accidents

Front 15

This type of trauma occurs when there is no communication between the damaged tissues and the outside environment

Back 15

blunt trauma

Front 16

this type of trauma is caused by deceleration, accleration, compression, and crushing

Back 16

blunt trauma

Front 17

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)

Back 17

penetrating trauma

Front 18

these type of injuries result from th temperature and velocity of air movement and the force of projectiles from the explosion

Back 18

blast injuries

Front 19

T or F: Blast injuries are more severe in water than air

Back 19

TRUE: They travel farther and faster in water than air

Front 20

-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

Back 20

-class 1, 2, or 3
-class 1
-class 1

Front 21

this type of death happens at the scene from injuries such as a torn thoracic aorta or decapitation

Back 21

immediate death

Front 22

this type of death happens happens occurs within several hours of the injury (eg from shock or a delay in recognizing injuries)

Back 22

early death

Front 23

this type of death occurs one or more days after the injury and results from multiple organ failure, sepsis, and coagulapothies

Back 23

late death

Front 24

assessment of this is the highest priority in the trauma client

Back 24

airway

Front 25

All trauma clients should receive supplementation with this until they are stabilized

Back 25

high flow oxygen

Front 26

this is the preferred method of airway management if the client is unable to maintain oxygenation or an open airway

Back 26

intubation

Front 27

laryngoscopy causes a significant increase in this, which can be dangerous in a closed head injury

Back 27

Intracranial pressure (ICP)

Front 28

Administration of this 3 to 5 minutes prior to intubation can reduce the increase in ICP that is common with intubation

Back 28

Lidocaine

Front 29

A penetrating trauma to the neck is associated with a high degree of these two things

Back 29

morbidity and mortality

Front 30

Approximately 3 to 6% of major trauma victims have injuries to this part of the body?

Back 30

C-Spine injuries

Front 31

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

Back 31

FALSE: It is decreased if the criteria is met

Front 32

this results when air enters the potential space between the parietal and visceral pleura

Back 32

pneumothorax

Front 33

A special type of pneumothorax that is life threatening and requires immediate attention.

Back 33

tension pneumothorax

Front 34

a tension pneumothorax can lead to collapse of these

Back 34

lungs

Front 35

-the immediate short term life saving intervention for a tension pneumothorax is what?
-describe the procedure

Back 35

-a needle thoracostomy
-large bore needle in inserted into the second intercostal space at the midclavicular line. All air and fluid are aspirated

Front 36

What are the two best ways immediately control hemorrhaging in an emergency

Back 36

1. direct pressure over the wound
2. direct pressure over arterial pressure points

Front 37

Injuries to the integument (skin) are generally not as serious as other injuries, except for what

Back 37

burns

Front 38

rupture of the large bowel results in the escape of feces, which can result in this

Back 38

peritonitis

Front 39

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

Back 39

TRUE

Front 40

TorF: Musculoskeletal injuries may provide clues to the presence of other serious injuries (eg a fractured clavicle may indicate an associated thoracic injury)

Back 40

TRUE

Front 41

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

Back 41

Mulitple Organ Dysfunction Syndrome (MODS)

Front 42

the suddenness and seriousness of trauma may cause what type of crisis in both the client and their family

Back 42

psychological

Front 43

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?

Back 43

the Golden Hour

Front 44

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

Back 44

FAST (forward assessment by sonography in trauma)

Front 45

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.

Back 45

diagnostic peritoneal lavage

Front 46

Which is used more often, the FAST exam or diagnostic peritoneal lavage

Back 46

FAST exam

Front 47

these scans can discover injuries to the brain, skull, spine, spinal cord, chest, and abdomen

Back 47

CT scans

Front 48

These scans can discover injuries to the brain and spinal cord

Back 48

MRI

Front 49

What type of blood is a person usually given in trauma situations: whole or packed blood

Back 49

whole

Front 50

this is the most common transfusion reaction. Fever and chills result

Back 50

febrile reaction

Front 51

this transfusion reaction results in the appearance of uticaria (reddened wheals on the skin) and itching

Back 51

hypersensitivity reaction

Front 52

this is the most dangerous type of transfusion reaction and can cause renal failure.

Back 52

hemolytic reaction

Front 53

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

Back 53

hemolytic reaction

Front 54

this is started when the client remains in shcok despite and there is no obvious sign of blood loss

Back 54

emergency surgery.

Front 55

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

Back 55

TRUE

Front 56

Can a spouse, adult children, parents, adult siblings, gaurdian, or any authorized adult give consent for organ donation

Back 56

Yes

Front 57

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

Back 57

No

Front 58

Can HIV + patients donate blood

Back 58

only to HIV + recipients

Front 59

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

Back 59

90
30
90

Front 60

when administering O2 in trauma, you want to maintain O2 sat between what two levels

Back 60

94 and 100%

Front 61

pulse oximetry is not effective when the client has been exposed to this gas (eg a house fire)

Back 61

carbon monoxide

Front 62

-An early sign of an ineffective airway is change in the clients what
-give some examples

Back 62

-behavior
-restlessness, anxious, combative

Front 63

an intense sustained emotional response to a disastrous event including crying, sleep problems, suspiciousness, and fear

Back 63

post-trauma syndrome

Front 64

these should be taught to the client undergoing post trauma syndrome

Back 64

relaxation techniques (deep breathing, guided imagery, etc)

Front 65

Name five nursing Diagnoses associated with trauma

Back 65

-Ineffective Airway Clearance
-risk for infection
-impaired physical mobility
-spiritual distress
-post trauma syndrome

Front 66

This is a clinical syndrome characterized by a systemic imbalance between O2 supply and demand.

Back 66

shock

Front 67

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

Back 67

TRUE

Front 68

the amount of blood pumped into the aorta with each contraction of the left ventricle (each heartbeat)

Back 68

stroke volume (SV)

Front 69

the amount of blood pumped PER MINUTE into the aorta by the left ventricle

Back 69

cardiac output (CO)

Front 70

The formula for this is SV X HR (heart rate)

Back 70

Cardiac output (CO)

Front 71

the product of cardiac output and systemic vascular resistance

Back 71

mean arterial pressure (MAP)

Front 72

the formula for this is CO X SVR

Back 72

Mean arterial pressure (MAP)

Front 73

What happens to MAP and tissue perfusion when CO, SO, or total blood volume rises

Back 73

it increases (it decreases if the CO, SO or total blood volume decreases)

Front 74

the sympathetic nervous system maintains the smooth muscle surrounding the arteries and arterioles in a state of partial contraction called what?

Back 74

sympathetic tone

Front 75

True or False: increased sympathetic stimulation increases vasoconstriction and SVR; decreased sympathetic stimulation allows vasodialation which decreases SVR

Back 75

TRUE

Front 76

Shock is triggered by a drop in this

Back 76

MAP

Front 77

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)

Back 77

Stage 1: Early, Reversible

Front 78

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

Back 78

Compensatory

Front 79

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

Back 79

Stage II: Intermediate or Progressive

Front 80

In this stage of shock nothing can reverse it and death occurs

Back 80

Stage III: refactory or irreversible shock

Front 81

In which stage of shock can hyperkalemia and cardiac dysrythmias occur

Back 81

Stage II: Progressive

Front 82

True or false: There is usually no problem auscultating BP in shock

Back 82

FALSE: It is often dificult or impossible and is an inaccurate measure of BP hemodynamic monitoring is used instead)

Front 83

This is a complication of decreased perfusion in the lungs which results in noncardiogenic edema

Back 83

acute respiratory distress syndrome (ARDS) or "shock lung"

Front 84

In this syndrome, production of surfactant is impaired, and the alveoli collapse or fill with fluid

Back 84

ARDS or shock lung

Front 85

-What happens to blood flow to the stomach and intestines during shock
-Why

Back 85

-it is redirected to the heart and brain
-they need it more

Front 86

These may happen 2 to 10 days follwoing the original cause of shock

Back 86

gastric ulcers

Front 87

the primary effect of shock on the neurologic system involve changes in this

Back 87

mental status and orientation (beginning with apathy and lethargy and continuing to coma)

Front 88

oliguria indicates progressive shock. This is less than how many mL per hour

Back 88

20 mL/hr

Front 89

-What happens to the skin color of Caucasians in shock
-what about those of African, HIspanic, or Mediterranean descent

Back 89

-turns pale
-paleness of lips, oral mucosa, nail beds, and conjunctiva

Front 90

what happens to body temperature and thirst in shock

Back 90

body temp decreases, some people become thirsty

Front 91

this type of shock is caused by a decrease in intravascular volume of 15% or more and is the MOST COMMON type of shock

Back 91

hypovolemic (it can occur with other types)

Front 92

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

Back 92

cardiogenic shock (eg MI)

Front 93

Caused by an obstruction in the heart or great vessels that either impedes venous return or prevents effective pumping action

Back 93

obstructive shock

Front 94

includes several types of shock that result from widespread vasodialation and decreased peripheral resistance

Back 94

distributive (or vasogenic) shock

Front 95

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)

Back 95

septic shock

Front 96

Is septic shock usually caused by gram positiv (Staph and Strep) or gram negative (Pseudomonas, E. coli, Klebsiella) bacteria

Back 96

gram negative ALTHOUGH IT CAN BE CAUSED BY GRAM +

Front 97

the mortality rate for septic shock is what percnet, even woth treatment

Back 97

60%

Front 98

True or False: Clients at risk for septic shock are those who have been hospitalized, have debilitating chronic illnesses or have poor nutritional status

Back 98

TRUE

Front 99

In this phase of shock (the early phase) vasodialation results in weakness and warm flushed skin and high fever and chills caused by sepicemia

Back 99

warm phase

Front 100

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

Back 100

cold phase (late phase)

Front 101

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.

Back 101

neurogenic shock

Front 102

This type of shock is the result of a widespread hypersensitivity reaction

Back 102

anaphylactic shock

Front 103

True or False: Anaphylactic shock can occur with the first exposure to an allergen

Back 103

FALSE (only after the first exposure)

Front 104

-Changes in H&H usually occur in this type of shock

Back 104

hypovolemic

Front 105

-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

Back 105

-lower
-higher

Front 106

what happens to pH in shock

Back 106

decreases

Front 107

what happens to BUN, serum creatine, specific gravity, and osmolality in shock

Back 107

they all increase

Front 108

what happens to serum cardiac enzymes in cardiogenic shock (eg LDH, CPK, and SGOT)

Back 108

increase

Front 109

what med is used to treat acidosis in shock

Back 109

sodium bicarbonate

Front 110

this is the most effective treatment for clients in hypovolemic shock

Back 110

administration of blood or IV fluids (through massive amounts eg, two large bore peripheral lines or a CV line)

Front 111

-the goal of blood administration in hypovolemic shock is to keep the hematocrit level between what percents
-what about hemoglobin (between what g/100mL)

Back 111

-hematocrit between 30 and 35%
-hemoglobin between 12.5 and 14.5 g/100 mL

Front 112

how you position a client who is in shock

Back 112

-supine position
-legs elevated to 20 degrees
-trunk flat
-head and shoulders elevated higher than the chest (about 10 degrees)

Front 113

- Is the Trendelenburg position still recommended for clients in shock
-why or why not

Back 113

-no
-it causes the abdominal organs to press against the diaphragm, decreases filling of the cororany arteries and starts aortic and caridac sinus rhythms