Trauma & Shock

59 flashcards

What are common causes of pelvic trauma?: Motor vehicle crashes or falls
What should nurses assess for in pelvic trauma/injuries?: 1. Assess for internal abdominal trauma by checking for blood in urine and stool and by monitoring abdomen for the development of rigidity or swelling 2. Assess VS, skin color, and LOC for indications of possible hypovolemic shock from internal blood loss 3. Assess for severe pain - If there is one pelvic fracture, there is usually another fracture 4. Neurovascular status; sensation, movement, capillary refill 5. CT scan
What is the main complication with hip and/or pelvic trauma?: Hypovolemic shock, specifically hemorrhagic Pelvic and hip trauma commonly cause massive blood loss and leakage into the pelvic cavity - Pelvis is close to major organs
What are interventions for pelvic fractures?: Non-bearing: bedrest on firm mattress or bed board Weight-bearing: external fixation or ORIF or both
What is the pathophysiology of a spinal cord injury (SCI)?: Any injury to the spinal cord causing partial or complete disruption of nerve tracts and neurons. SCI ’ edema ’ compromised capillary circulation & venous return ’ necrosis
What are the mechanisms of injury for SCI?: 1. Hyperflexion 2. Hyperextension 3. Axial loading 4. Excessive rotation 5. Penetrating trauma
What is hyperflexion, and what is an example?: Sudden and forceful acceleration of the head forward, causing extreme flexion of the neck - Motor vehicle collision or diving accident
What is hyperextension, and what is an example?: Head is suddenly accelerated and then decelerated - Stretches or tears anterior longitudinal ligament, fractures, or subluxates the vertebrae - Vehicle collision struck from behind or falls when chin is struck
What is axial loading/vertical compression, and what is an example?: Blow to the top of the head can cause the vertebrae to shatter - Bone pieces enter the spinal canal and damage the cord - Results from diving accidents, falls on buttocks, or injury from jumping and landing on feet
What is the difference between complete and partial transection of the spinal cord?: Complete transection results in total loss of sensation, movement, and reflex below the level of injury Partial allows for some function.
What is the difference between paraplegia and tetraplegia?: Paraplegia: paralysis involving only the lower extremities - Injuries in the thoracic, lumbar or sacral vertebrae Tetraplegia [aka Quadriplegia]: paralysis involving all 4 extremities - Injuries to at least one of the 8 cervical segments
What is the neurological level of a SCI?: The lowest segment of the spinal cord that has normal sensory and motor function
What are primary and secondary injuries in SCI?: Primary: result of the initial trauma and usually permanent Secondary: worsens the primary injury ’ major area of concern - Resulting from SCI, including edema and hemorrhage
Why is the secondary injury of edema problematic for SCIs?: Edema can compress the spinal cord ’ “ perfusion ’ necrosis Edema can also ascend the spinal cord and cause injury to other areas ’ the higher up the location ’ worse the S/S
What are common manifestations of SCI?: 1. Ineffective breathing pattern and airway clearance 2. Impaired physical mobility 3. Disturbed sensory perception 4. Risk for impaired skin integrity 5. Loss of bowel and bladder control ’ “ urine & constipation 6. Acute pain
How does the location of the SCI affect the S/S?: Depends on location, usually the higher up the location ’ worse the S/S - Above C3 (mainly C2 & C3) ’ usually fatal as it compresses the diaphragm - Above C4 ’ respiratory difficulty and paralysis of all four extremities - Below C5 ’ may have movement in the shoulder - Intercostal and abdominal muscles will be paralyzed - Reduced lung capacity for inhalation and exhalation
What should a nurse assess for in SCI?: 1. Monitor respirations and breathing patterns 2. Lung sounds and cough 3. Monitor for changes in motor or sensory function; report immediately 4. Assess skin for pressure sores, as they're usually immobilized 5. Assess for spinal shock 6. Monitor for bladder retention or distention, constipation, gastric dilation, and ileus 7. Temperature: potential hyperthermia
How can nurses help maintain proper body alignment and promote mobility?: 1. Log roll with 3 people (1 holds the head and 2 others overlap) - Turn only if the spine is stable and as indicated by the physician 2. Passive ROM at least four times a day if safe and not painful 3. Use a neck brace or cervical collar, as prescribed, when the patient is mobilized 4. Monitor all alignment devices like halo vest for infection & proper fit with circulation
When can a nurse take off the cervical collar?: Cervical collar doesn't come off until imaging shows no more injury AND the patient verbalizes no pain
When a patient has a SCI, why is it important to assess their tubes?: Always assess, clean, and change out Foleys and other tubes in SCI patients for risk of autonomic dysreflexia
What medications are used in SCIs?: 1. Glucosteroids (suppress immune response) 2. Atropine (bradycardia) 3. Dextran (plasma extender) 4. DVT & ulcer prophylaxis 5. Vasopressors 6. Anti-spasmodics & anti-seizure (lorazepam, gabapentin, etc.)
What are the main causes of death in SCI patients, and how can nurses prevent those?: 1. Pneumonia - Incentive spirometry and cough assist to break up mucus 2. Septicemia ’ blood infection that progresses into sepsis & septic shock - Sterile technique when it comes to cleaning traction pins used in devices like traction, halo vest, roto rest bed, etc.
What is spinal shock?: A sudden depression of reflex activity below the level of spinal injury, lasting from day 1 to one year. - Occurs in almost all SCIs
What are the signs/symptoms of spinal shock?: FLAP Below 1. Flaccidity (muscle) 2. Lack of sensation 3. Absent reflexes 4. Paralyzed
What is the pathophysiology of autonomic dysreflexia?: Noxious (harmful) visceral or cutaneous stimuli cause a sudden, massive, uninhibited reflex sympathetic discharge (release of all NTs) ’ stimulus doesn't make it to the brain due to the impaired spinal cord ’ life-threatening stroke risk
What conditions places a patient at risk for autonomic dysreflexia?: Occurs in persons with SCI above T6 Occurs after spinal shock has resolved and may occur years after the injury
What are common triggers of autonomic dysreflexia?: 1. Distended bladder (most common cause) 2. Distention or contraction of visceral organs (e.g., constipation) 3. Stimulation of the skin ’ wrinkles in the sheet, pressure sores 4. UTI, rectal tubes, Foleys
What are the manifestations of autonomic dysreflexia?: 1. Severe pounding headache and apprehension 2. Sudden HTN ’ hallmark sign 3. Profuse diaphoresis and red blotchy skin above the level of injury 4. Pale and piloerection (goosebumps) below the lesion 5. Nausea 6. Nasal congestion 7. Bradycardia
What is the first intervention for autonomic dysreflexia?: Raise HOB and place the patient in a seated position to lower BP ’ q15 minute BP checks
If a patient is suspected of autonomic dysreflexia, what is the assessment steps for the nurse?: 1. Raise HOB to lower BP 2. Empty the bladder using a urinary catheter, irrigate, or change the Foley 3. Examine the rectum for a fecal mass 4. Examine skin 5. Examine for any other stimulus
What is shock?: A systemic condition in which tissue perfusion is inadequate to deliver oxygen and nutrients to support vital organs and cellular function.
What is the pathophysiology of shock?: Inadequate tissue perfusion ’ cells switch from aerobic to anaerobic metabolism ’ lactic acid production ’ cells swell ’ membrane becomes more permeable ’ electrolytes & fluids seep in & out of cell ’ Na+/K+ pump impaired ’ cell death
What are the generalized effects of shock on each organ system?: 1. Heart: “ CO and hypotension 2. Lung: “ gas exchange ’ tachypnea and pulmonary edema 3. Endocrine: ‘ ADH ’ reabsorption of water 4. CNS: “ perfusion ’ drowsy 5. Blood: coagulation abnormalities ’ DIC 6. Renal: “ GFR ’ “ urine output 7. Gl: mucosal ischemia ’ bleeding & ‘ hepatic enzymes
What is the initial stage of shock characterized by?: Cells become leaky and switch to anaerobic metabolism.
What generally characterizes compensated shock?: Perfusion of tissues is inadequate ’ acidosis occurs from anaerobic metabolism ’ hyperventilation ’ compensatory respiratory alkalosis ’ feeling of impending doom: anxiety, restlessness, confusion The body shunts blood away from the skin, kidneys, and GI tract to maintain vital organ function - Vasoconstriction, tachycardia, ‘ heart contractility ’ maintains BP & CO - Clammy skin, hypoactive bowel sounds, “ urine output
What are the signs of progressive shock?: Eventually, the compensation will begin to fail. 1. “ BP and MAP ’ all organs suffer from hypoperfusion 2. CO2 levels increase, alveoli collapse, and pulmonary edema occurs 3. Cardiac dysrhythmias and ischemia 4. Acute renal failure occurs when the GFR cannot be maintained 5. Mental status further deteriorates from decreased cerebral perfusion and hypoxia ’ lethargy
What are the signs of the refractory stage of shock?: Often called the Refractory/Decompensated (Irreversible) Stage of Shock Organs fail, and the shock can no longer be reversed 1. Severe hypotension ’ complete organ failure 2. SpO2 usually falls below 70% 3. Anaerobic metabolism worsens acidosis
What is the general management for shock?: 1. Fluid replacement to restore intravascular volume 2. Vasoactive medications to restore vasomotor tone, improve cardiac function - Vasoactive: nerves and muscles that control blood vessel constriction and dilation 3. Nutritional support to address metabolic requirements
What are common crystalloids and colloids?: Crystalloids: 0.9% NS, LR solution, hypertonic solutions Colloids: albumin, dextran (dextran may interfere with platelet aggregation)
What is cardiogenic shock?: A shock state resulting from impairment or failure of the myocardium ’ direct pump failure (40% necrosis of the left ventricle) “ cardiac contractibility ’ “ CO & SV ’ low MAP ’ pulmonary congestion (high PAWP) + “ systemic and coronary artery perfusion
What are common causes or risk factors of cardiogenic shock?: Usually associated with or caused by valvular heart disease, MI, arrhythmias, cardiomyopathy, and cardiac tamponade
What are the signs of cardiogenic shock?: 1. Chest discomfort 2. Tachycardia & tachypnea ’ hypotension (SBP < 90 or less than 30 from baseline) 3. Urine output < 0.5 - 1 mL/kg/hr 4. Cold, clammy skin with poor peripheral pulses & prolonged capillary refill 5. Pulmonary congestion ’ crackles, pulmonary edema 6. Agitation, restlessness, or confusion
What medications are used in cardiogenic shock?: 1. Dobutamine 2. Nitroglycerin 3. Dopamine 4. Diuretics or vasodilators 5. Other vasoactive medications 6. Antiarrhythmic medications
Are medical devices commonly used in treatment of cardiogenic shock?: Mechanical assistive devices like IABP can reduce the workload of the heart and allow proper rest and healing
What is hypovolemic shock?: Shock state resulting from decreased intravascular volume due to fluid loss Hypovolemia ’ less fluids available to make up blood volume ’ “ CO ’ “ perfusion - Sustained decrease in MAP from decreased circulating blood volume
What are the signs of hypovolemic shock?: Similar to dehydration but more severe 1. Hypotension 2. Tachycardia 3. Cool, clammy skin (pallor), diaphoresis 4. Rapid and shallow breathing 5. Behavioral changes ’ confusion, extreme anxiety, agitation, etc. 6. Little to no urine 7. “ blood volume = “ preload
What are the nursing interventions for hypovolemic shock?: 1. Treatment of the underlying cause 2. Administering replacement blood, medications, and fluids (crystalloids) safely 3. Redistribute fluids through positioning, temperature of the room, and decreasing anxiety - Modified Trendelenburg ’ similar to trendelenburg but only legs are raised
What benefit does modified trendelenburg offer?: Uses gravity to increase blood flow to the brain and heart ’ ‘ CO
What is the biggest complication after hypovolemic shock treatment?: Careful of signs of fluid overload ’ edema, crackles, bounding pulse, respiratory distress, HTN
What is neurogenic shock?: Shock state resulting from loss of sympathetic tone, causing relative hypovolemia - Caused by injuries above T6 Results in disruption in communication pathways between upper motor neurons and lower motor neurons
What are the signs of neurogenic shock?: 1. Symptomatic bradycardia ’ HR < 60 bpm 2. Hypotension ’ SBP < 90 or MAP <65 mmHg 3. Reduced LOC and “ urine output 4. “ Cardiac output 5. SpO2 <95% or symptoms of aspiration (stridor, garbled speech, inability to clear airway) 6. Warm, pink & dry skin - Skin is warm, but the patient is commonly poikilothermic - Neuron damage leads to inability to regulate temperature ’ patients can have a fever or be hypothermic (more common)
What is the treatment for neurogenic shock?: 1. Raise the HOB 30 degrees 2. IV Fluids & vasopressors ’ increase BP 3. Dextran - plasma expander 4. Atropine - increases heart rate 5. Assess for autonomic dysreflexia, as it's common for it to follow neurogenic shock
What is anaphylactic shock?: A circulatory shock state resulting from a severe allergic reaction, causing systemic vasodilation and relative hypovolemia.
What are the signs of anaphylactic shock?: Anaphylaxis S/S + cardiac collapse = shock 1. Headache, lightheadedness, N/V, tachycardia, hypotension, purpura 2. Feeling of apprehension or impending doom. 3. Generalized itching and urticaria ’ angioedema and redness 4. Inflammation ’ bronchoconstriction ’ mucosal edema & excess mucus production 5. Congestion, rhinorrhea, and dyspnea 6. Audible wheezing, crackles, and reduced breath sounds
What is the priority medication for anaphylactic shock, and how does it work?: Priority Medication: epinephrine ’ first-line intervention “ allergy-inducing chemicals like histamine ’ “ swelling (systemic constriction) ’ systemic dilation
How can nurses prevent anaphylactic shock?: Give epinephrine as soon as anaphylaxis starts, so it doesn't develop into anaphylactic shock
What are the nursing interventions for anaphylactic shock?: 1. Maintain patent airway 2. Optimize oxygenation w/ O2 therapy ’ intubate and ventilate if necessary 3. Place the patient in a recumbent position (lower extremities elevated) 4. Provide aggressive fluid resuscitation with colloids 5. Give Benadryl to reverse the histamine effects 6. Administer bronchodilators like albuterol for histamine-induced bronchospasms 7. Administer corticosteroids
What complications can arise from shock?: Disseminated intravascular coagulation (DIC), acute renal failure, and multi-organ failure.
What is the impact of anaerobic metabolism during shock?: It leads to acidosis and further cellular damage.