Download Trauma Nursing Core Course (TNCC) 9th Edition Written Exam 2024: Questions and Answers and more Exams Traumatology in PDF only on Docsity!
Trauma Nursing Core Course (TNCC)-
9th edition Written Exam 2024 Questions
and Answers.
What are the late signs of breathing compromise? - Correct Answer - Tracheal deviation
- JVD What are signs of ineffective breathing? - Correct Answer - AMS
- Cyanosis, especially around the mouth
- Asymmetric expansion of chest wall
- Paradoxical movement of the chest wall during inspiration and expiration
- Use of accessory muscles or abdominal muscles or both or diaphragmatic breathing
- Sucking chest wounds
- Absent or diminished breath sounds
- Administer O2 via NRB or assist ventilations with a bag-mask device, as indicated
- Anticipate definitive airway management to support ventilation. Upon initial assessment, what type of oxygen should be used for a pt breathing effectively? - Correct Answer A tight-fitting nonrebreather mask at 12-15 lpm. What intervention should be done if a pt presents with effective circulation? - Correct Answer - Insert 2 large caliber IV's
- Administer warmed isotonic crystalloid solution at an appropriate rate What are signs of ineffective circulation? - Correct Answer - Tachycardia
- AMS
- Uncontrolled external bleeding
- Pale, cool, moist skin
- Distended or abnormally flattened external jugular veins
- Distant heart sounds What are the interventions for Effective/Ineffective Circulation? - Correct Answer - Control any uncontrolled external bleeding by:
- Applying direct pressure over bleeding site
- Elevating bleeding extremity
- Applying pressure over arterial pressure points
- Using tourniquet (last resort).
- Cannulate 2 large-caliber IV's and initiate infusions of an isotonic crystalloid solution
- Use warmed solution
- Use pressure bags to increase speed of IVF infusion
- Use blood administration tubing for possible administration of blood
- Use rapid infusion device based on protocol
- Use NS 0.9% in same tubing as blood product
- IV = surgical cut-down, central line, or both.
- Blood sample to determine ABO and Rh group
- IO in sternum, legs, arms or pelvis
- Administer blood products
- PASG (without interfering with fluid resuscitation) What are factors that contribute to ineffective ventilation? - Correct Answer - AMS
- LOC
- Neurologic injury
- Spinal Cord Injury
- Intracranial Injury
- Blunt trauma
- Pain caused by rib fractures
- Penetrating Trauma
What is a Combitube? - Correct Answer A dual-lumen, dual-cuff airway that can be placed blindly into the esophagus to establish an airway. If inadvertently placed into trachea, it can be used as a temporary ET tube. There are only two sizes: small adult and larger adult. What is a Laryngeal Mask Airway? - Correct Answer Looks like an ET tube but is equipped with an inflatable, elliptical, silicone rubber collar at the distal end. It is designed to cover the supraglottic area. ILMA, does not require laryngoscopy and visualization of the chords. What is Needle Cricothyrotomy - Correct Answer Percutaneous transtracheal ventilation. (temporary) Complications include:
- inadequate ventilation causing hypoxia
- hematoma formation
- esophageal perforation
- aspiration
- thyroid perforation
- subcutaneous emphysema What is Surgical Cricothyrotomy? - Correct Answer Making an incision in cricothyroid membrane and placing a cuffed endo or trach tube into trachea. This is indicated when other methods of airway management have failed and pt cannot be adequately ventilated and oxygenated. Complications include:
- Aspiration
- Hemorrhage or hematoma formation or both
- Lac to trachea or esophagus
- Creation of a false passage
- Laryngeal stenosis How do you confirm ET Tube/Alternative Airway Placement? - Correct Answer - Visualization of the chords
- Using bronchoscope to confirm placement
- Listening to breath sounds over the epigastrum and chest walls while ventilating the pt
- CO2 detector
- Esophageal detection device
- Chest x-ray How do you inspect the chest for adequate ventilation? - Correct Answer Observe:
- mental status
- RR and pattern
- chest wall symmetry
- any injuries
- patient's skin color (cyanosis?)
- JVD or tracheal deviation? (Tension pneumothorax) What are you looking for when auscultating lung sounds? - Correct Answer Absence of BS:
- Pneumothorax
- Hemothorax
- Airway Obstruction Diminished BS:
- Splinting or shallow BS may be a result of pain What are you looking for when percussing the chest? - Correct Answer Dullness:
- hemothorax Hyperresonance
- Pneumothorax
Explain Obstructive Shock. - Correct Answer Results from inadequate circulating blood volume because of an obstruction or compression of great veins, aorta, pulmonary arteries, or heart itself. Some causes:
- Cardiac tamponade (may compress the heart during diastole to such and extent that atria cannot adequately fill, leading to decreased stroke volume).
- Tension pneumothorax may lead to inadequate stroke volume by displacing inferior vena cava and obstructing venous return to right atrium.
- Air embolus may lead to obstruction of pulmonary artery and subsequent obstruction to right ventricular outflow during systole, with resulting obstructive shock Explain Distributive Shock. - Correct Answer Results from disruption in SNS control of the tone of blood vessels, which leads to vasodilation and maldistribution of blood volume and flow. (Neurogenic and Septic Shock). Neurogenic shock may result from injury to spinal cord in cervical or upper thoracic region. Spinal shock = areflexia and flaccidity associated with lower motor neuron involvement in complete cord injuries; reflexes return with resolution of spinal shock. Septic shock from bacteremia is distributive shock. Endotoxins and other inflammatory mediators cause vasodilation, shunting of blood in microcirculation, and other perfusion abnormalities. What is vascular response? - Correct Answer As blood volume decreases, peripheral blood vessels vasoconstrict as a result of sympathetic stimulation via inhibition of baroreceptors. Arterioles constrict to increase TPR and BP.
What is renal response? - Correct Answer Renal ischemia activates release of renin. Kidneys do not receive adequate blood supply, renin is release into circulation. Renin causes angiotensinogen, normal plasma protein, to release angiotensin I. Angiotensin-converting enzyme from the lungs converts into angiotensin II. Angiotensin II causes:
- Vasoconstriction of arterioles and some veins
- Stimulation of sympathetic nervous system
- Retention of water by kidneys
- Stimulation of release of aldosterone from the adrenal cortex (sodium retention hormone) *Decreased urinary output = early sign renal hypoperfusion and an indicator that there's systemic hypoperfusion. Explain adrenal gland response. - Correct Answer When adrenal glands are stimulated by SNS, release of catecholamines (epinephrine and norepinephrine) from adrenal medulla will increase. Epi stimulates receptors in heart to increase force of cardiac contraction (positive inotropy) and increase HR (positive chronotropy) to improve cardiac output, BP and tissue perfusion. Shock stimulates hypothalamus to release corticotropin-releasing hormone that stimulates pituitary to release ACTH that stimulates adrenal gland to release cortisol.
How would you assess a pt in hypovolemic shock? - Correct Answer (Use Initial Assessment) and then: Inspect:
- LOC
- Rate and quality of respirations
- External bleeding?
- Skin color and moisture
- Assess jugular veins and peripheral veins Auscultate:
- BP
- Pulse pressure
- Breath sounds
- Heart sounds
- Bowel sounds Percuss:
- Chest and abdomen Palpate:
- Central pulse (carotid or femoral)
- Positive inotropic effect (force of contraction) may be evidence by a bounding central pulse
- Palpate peripheral pulses
- Palpate skin temp and moisture Diagnostic Procedures:
- Xrays and other studies
- Labs Planning and Implementation
- Oxygen
- IV's with warmed replacement fluids
- Control external bleeding with direct pressure
- Elevate LE's
- NGT
- Foley
- Monitor and pulse oximeter
- Monitor for development of coagulopathies
- Surgery?
ICP is a reflection of what three volumes? What happens when one increases? - Correct Answer 1. Brain
- CSF
- Blood within the nonexpansible cranial vault As volume of one increases, the volume of another decreases to maintain ICP within normal range. As ICP rises, CPP decreases, leading to cerebral ischemia and potential for hypoxia and lethal secondary insult. Hypotensive pt w/marginally elevated ICP can be harmful. Slightly elevated BP could protect against brain ischemia in a pt with high ICP. Cerebral ischemia can lead to increased concentration of CO2 and decreased concentration of O2 in cerebral vessels. CO2 dilates cerebral blood vessels = increase blood volume and ICP. What are the early signs and symptoms of increased ICP? - Correct Answer - Headache
- N/V
- Amnesia regarding events around the injury
- Altered LOC
- Restlessness, drowsiness, changes in speech, or loss of judgement What are the late observable signs of symptoms of increased ICP? - Correct Answer - Dilated, nonreactive pupil
- Unresponsiveness to verbal or painful stimuli
- Abnormal motor posturing patterns
- Widening pulse pressure
- Increased systolic blood pressure
- Changes in RR and pattern
- Bradycardia
Define Minor Head Trauma. - Correct Answer GCS 13- Define Moderate Head Trauma - Correct Answer Postresuscitative state with GCS 9-13. Define Severe Head Trauma. - Correct Answer Postresuscitative state with GCS score of 8 or less. What is a concussion and its signs and symptoms? - Correct Answer A temporary change in neurologic function that may occur as a result of minor head trauma. S/S:
- Transient LOC
- H/A
- Confusion and disorientation
- Dizziness
- N/V
- Loss of memory
- Difficulty with concentration
- Irritability
- Fatigue What are the signs and symptoms of postconcussive syndrome? - Correct Answer - Persistent H/A
- Dizziness
- Nausea
- Memory impairment
- Attention deficit
- Irritability
- Insomnia
- Impaired judgement
- Loss of libido
- Anxiety
- Depression
What is diffuse axonal injury and its signs and symptoms? - Correct Answer (DAI) is widespread, rather than localized, through the brain. Diffuse shearing, tearing and compressive stresses from rotational or accerleration/deceleration forces resulting in microscopic damage primarily to axons within the brain. S/S:
- Immediate unconsciousness
- mild DAI, coma = 6-24 hrs
- severe DAI, coma = weeks/months or persistent vegetative state
- Elevated ICP
- Abnormal posturing
- HTN
- Hyperthermia
- Excessive sweating because of autonomic dysfunction
- Mild to severe memory impairment, cognitive, behavioral, and intellectual deficits What is a cerebral contusion and its S/S? - Correct Answer A common focal brain injury in which brain tissue is bruised and damaged in a local area. Mainly located in frontal and temporal lobes. May cause hemorrhage, infarction, necrosis and edema. Max effects of bleeding & edema peak 18-36 post injury. S/S:
- Alteration in LOC
- Behavior, motor or speech deficits
- Abnormal motor posturing
- Signs of increased ICP What is an epidural hematoma and its S/S? - Correct Answer Results when a collection of blood forms between the skull and the dura mater. Bleeding is arterial=blood accumulates rapidly:
- Compression of underlying brain
- rapid increase in ICP
commonly associated with contusions (frontal & temporal lobes). They result in significant mass effect, leading to increased ICP and neurologic deterioration. S/S:
- Progressive and often rapid decline in LOC
- H/A
- Signs of increasing ICP
- Pupil abnormalities
- Contralateral hemiplegia What are the S/S of a linear skull fx? - Correct Answer - H/A
- Possible decreased LOC What are the S/S of a depressed skull fx? - Correct Answer - H/A
- Possible decreased LOC
- Possible open fx
- Palpable depression of skull over the fx site What are the S/S of a basilar skull fx? - Correct Answer - H/A
- Altered LOC
- Periorbital ecchymosis (raccoon eyes), mastoid ecchymosis (Battle's sign), or blood behind tympanic membrane (hemotympanum)
- Facial nerve (VII) palsy
- CSF rhinorrhea or otorrhea How would you assess a pt with a cranial injury? - Correct Answer (Initial assessment) INSPECTION:
- Assess airway
- RR, pattern and effort
- Assess pupil size and response to light
- Unilateral fixed and dilated pupil = oculomotor nerve compression from increased ICP + herniation syndrome
- Bilateral fixed and pinpoint pupils indicate a pontine lesion or effects of opiates
- Mildly dilated pupil w/sluggish response may be early sign of herniation syndrome
- Widely dilated pupil occasionally occurs w/direct trauma to globe of eye
- Determine if pt uses eye meds
- Abnormal posturing?
- Inspect craniofacial area for ecchymosis/contusions
- Periorbital ecchymosis
- Mastoid's process ecchymosis
- Blood behind tympanic membrane
- Inspect nose and ears for drainage
- Drng present w/out blood, test drng w/chemical reagant strip. Presence of glucose indicated drng of CSF
- If drng present and mixed with blood, test by placing drop of fluid on linen or gauze. If a light outer ring forms around dark inner ring, drng contains CSF
- Assess extraocular eye movement (Tests cranial nerves, III, IV, VI)
- Performing extraocular eye movements indicates functioning brainstem
- Limitation indicates orbital rim fx w/entrapment or paralysis of either a cranial nerve or ocular muscle
- Determine LOC with GCS PALPATION
- Palpate cranial area for:
- Point tenderness
- Depressions or deformities
- Hematomas
- Assess all 4 extremities for:
- Motor function, muscle strength and abnormal motor posturing
- Sensory function DIAGNOSTIC PROCEDURES
- Lab Studies
What are S/S of penetrating trauma/open or ruptured globe? - Correct Answer - Marked visual impairments
- Extrusion of intraocular contents
- Flattened or shallow anterior chamber
- Subconjunctival hemorrhage, hyphema
- Decreased intraocular pressure
- Restriction of extraocular movements What are the S/S of orbital fracture (orbital blowout fracture)? - Correct Answer - Diplopia (double vision)
- Loss of vision
- Altered extraocular eye movements
- Enophthalmos (displacement of the eye backward into the socket)
- Subconjunctival hemorrhage or ecchymosis of the eyelid
- Infraorbital pain or loss of sensation
- Orbital bony deformity What is LeFort I fracture and its S/S? - Correct Answer Transverse maxillary fx that occurs above level of teeth and results in separation of teeth from rest of maxilla. S/S:
- Slight swelling of maxillary area
- Possible lip lac's or fractured teeth
- Independent movement of the maxilla from rest of face
- Malocclusion What is LeFort II fracture and its S/S? - Correct Answer Pyramidal maxillary fx=middle facial area. Apex of fx transverses bridge of nose. Two lateral fx's of pyramid extend through the lacrimal bone of the face and ethmoid bone of skull into the median portion of both orbits. Base of the fx extends above level of the upper teeth into maxilla. CSF leak is possible. S/S:
- Massive facial edema
- Nasal swelling w/obvious fx of nasal bones
- Malocclusion
- CSF rhinorrhea What is LeFort III fracture and its S/S? - Correct Answer Complete craniofacial separation involving maxilla, zygoma and bones of cranial base. This fx is frequently associated w/leakage of CSF and fx mandible. S/S:
- Massive facial edema
- Mobility and depression of zygomatic bones
- Ecchymosis
- Anesthesia of the cheek
- Diplopia
- Open bite or malocclusion
- CSF rhinorrhea What are the mandibular fracture S/S? - Correct Answer - Malocclusion
- Inability to open the mouth (trismus)
- Pain, especially on movement
- Facial asymmetry and a palpable step-off deformity
- Edema or hematoma formation at the fracture site
- Blood behind, ruptured, tympanic membrane
- Anesthesia of the lower lip What are neck injury S/S? - Correct Answer - Dyspnea
- Hemoptysis (coughing up blood)
- Subcutaneous emphysema in neck, face, or suprasternal area
- Decreased or absent breath sounds
- Penetrating wounds or impaled objects
- Pulsatile or expanding hematoma
- Loss of normal anatomic prominence of the laryngeal region
- Bruits
