ALL TNCC QUESTIONS BANK...., Tncc, TNCC Written Exam, TNCC Written Exam, TNCC class, TNCC/TCRN, TNCC Written Exam Review, TNCC, TNCC Skill Demonstration, Tncc, TNCC, TNCC EXAM, TNCC Written Exam, TNCC Written Exam, Tncc, TNCC, Trauma Nursing II, TNCC feb

ALL TNCC QUESTIONS BANK...., Tncc, TNCC Written Exam, TNCC Written Exam, TNCC class, TNCC/TCRN, TNCC Written Exam Review, TNCC, TNCC Skill Demonstration, Tncc, TNCC, TNCC EXAM, TNCC Written Exam, TNCC Written Exam, Tncc, TNCC, Trauma Nursing II, TNCC feb 2018 Document Content and Description Below Primary concern when a person cannot stop coughing/clearing their throat following house fire/smoke? -☑ Airway/Intubate Lab evidence of cellular perfusion -☑ Base Excess (Less than - 6 is BAD) Multiple people are in the ER of different ages who all go to the same church. They all have the same symptoms. What is the most likely cause? -☑ Biologic Suspected shock type with a spinal cord injury -☑ Distributive Shock (Includes neurogenic) Patient has GCS of 3, unequal pupils (one sluggish, one blown), and is posturing. What is the cause? - ☑ Herniation Middle Meningeal Artery -☑ Epidural Hematoma (results from collection of blood that forms between dura mater and skull) Prior to having a concussion (TBI), the patient had a brain injury that was not fully healed. What is the cause? -☑ 2nd Impact Syndrome Bowel sounds heard in the L chest. What is this a symptom of? -☑ Ruptured diaphragmSymptoms of __________________: include muffled heart sounds and hypotension -☑ Pericardiocentesis How should you dress a severed limb? -☑ Sterile gauze with normal saline THEN put ice on it Amylase level looks at _____________ -☑ Pancreas What should you do if your patient has hyphema (collection of blood inside the front part of the eye?) - ☑ Sit HOB up to 30 degrees Principle that people have to take action after suffering a loss in order to decrease severity, seriousness, or painfulness -☑ Mitigation What organ is most at risk following a gunshot -☑ Liver 8 year old child with longitudinal thigh lacerations -☑ Sign of child abuse Bleeding around belly button -☑ Cullen's Sign What would cause an inaccurate reading from an 02 saturation probe? -☑ Carboxyhemoglobin (increase FiO2 to 100%) General study of forces and their effects on living tissue and the human body -☑ Biomechanics Study of energy transfer as it applies to identifying actual or potential injuries -☑ Kinematics Refers to the separation of tissue resulting from a sound and/or hydraulic wave force- the effect is a crushing pressure wave which creates a temporary cavity, followed by a rapid and violent closing of the cavity. -☑ CavitationThis rapid motion can lead to crushing, tearing, and shearing forces on tissue -☑ Cavitation Used in OR; does not provide protection against aspiration and not recommended in patients who have eaten recently. It is a supraglottic airway. -☑ Laryngeal Mask Airway Single tube retroglottic device inserted into the esophagus and traps the glottis opening between an esophageal cuff and an oropharyngeal cuff. Designed with 2 ports/lumens each with a separate cuff. Does NOT provide protection against aspiration and is not indicated in children. It is a retroglottic airway. -☑ King Tube Types of Shock (4) -☑ Hypovolemic, Obstructive, Cardiogenic, Distributive Hemorrhage is the leading cause. Can result from vomiting, diarrhea, and burn trauma. Decreased circulating volume --> decreased preload. Therapy includes replacing the type of volume that was lost. - ☑ Hypovolemic Shock Results from hypo perfusion of tissue due to an obstruction in either the vasculature or heart. Therapy aimed at relieving the obstruction and improving perfusion. -☑ Obstructive Shock Two classic examples of obstructive shock -☑ Cardiac tamponade and tension pneumothorax Results from pump failure in the presence of adequate intravascular volume. Lack of CO and end-organ perfusion secondary to a decrease in myocardial contractility and/or valvular insufficiency. Therapy includes inotropic support, antidysrhythmic medications, and correction or treatment of underlying cause. -☑ Cardiogenic Shock Results from the misdistribution of an adequate circulating blood volume with the loss of vascular tone or increased permeability. Treatment is to provide volume replacement, increase systemic vascular resistance with medications (pressors) and possible antibiotics. -☑ Distributive Shock Examples that can cause distributive shock -☑ Anaphylactic shock, septic shock, neurogenic shock___________________: Impairs thrombin production and platelet function _____________ ______________: Impairs thrombin production _______________________: Results in depletion of clotting factors through hemodilution and the impaired ability to produce clotting factors. -☑ Trauma Triad of Death 1. Hypothermia 2. Metabolic Acidosis 3. Coagulopathy Stages of Shock (3) -☑ 1. Compensated 2. Decompensated vs Progressive 3. Irreversible Complete craniofacial separation involving maxilla, zygoma, orbits, and bones of the cranial base. Assessment findings include: massive facial edema, mobility and depression of zygomatic bones, ecchymoses, diplopia, and open bite or malocclusion. -☑ LeFort III Transverse maxillary bone fracture that occurs above the level of the teeth from the maxilla. Assessment findings include: independent moment of the maxilla from the rest of the face, slight swelling of the maxillary area, lip laceration or fractured teeth, malocclusion. -☑ LeFort I Pyramidal maxillary bone fracture involving the mid-face area. The apex of the fracture transverses the bridge of the nose. Assessment findings include: massive facial edema, nasal swelling with obvious fracture of the nasal bones, malocclusion, CSF rhinorrhea -☑ LeFort II Can be caused by blunt trauma. Air escapes from the injured lung into the pleural space, and negative intrapleural pressure is lost resulting in partial or complete collapse of the lung. S & S: dyspnea, tachypnea, decreased/absent breath sounds on injured side, chest pain. Treatment: based on size, symptoms, and stability. Chest tube may be placed to evacuate pleural air and maintain lung expansion - ☑ Pneumothorax Air enters the intrapleural space but cannot escape on expiration. The increasing intrathoracic pressure causes the lung on the injured side to collapse. If pressure is not relieved, the mediastinum can shifttoward the uninjured side compressing the heart/great vessels/and opposite lung. S & S: anxiety, severe restlessness, severe respiratory distress, significantly diminished or absent breath sounds on injured side, hypotension, distended neck/head/upper extremity veins, tracheal deviation, or a shift toward uninjured side. Treatment: Needle thoracentesis and chest tube insertion -☑ Tension Pneumothorax Collection of blood in pericardial sac. Mechanism of injury is typically penetrating trauma. Compresses the heart and decreases ability of the ventricles to fill causing decreased SV and CO. S & S: hypotension, muffled heart sounds, distended neck veins, tachycardia or PEA, dyspnea, cyanosis, chest pain. Surgical evacuation will be needed. -☑ Cardiac Tamponade __________________ Shock: Spinal cord injury at T6 or above. Temporary loss of vasomotor tone and sympathetic innervation. Temporary duration usually <72 hours. S & S: hypotension, bradycardia, loss of ability to sweat below level of injury. -☑ Neurogenic ______________ Shock: Spinal cord injury at any level. Transient loss of reflex below the level of injury. Variable duration. S & S: flaccidity, loss of reflexes, bowel/bladder dysfunction. -☑ Spinal Significant muscle damage and cellular destruction releases myoglobin: a muscle protein; into the bloodstream. Classic symptoms: muscle pain/numbness/changes in sensation, muscle weakness/paralysis, dark red/brown urine. -☑ Rhabdomyolysis What does MIST mnemonic mean? -☑ M: Mechanism of Injury I: Injuries sustained S: S&S in the field T: Treatment in the field Older adults are harder to intubate due to ______________ ____________ -☑ cervical arthritis Leading cause of preventable death after injury -☑ Hemorrhage Room Air = ____% FiO2 -☑ 21%1 Liter of O2 = ____% FiO2 -☑ 4% Patient snoring = insert __________ airway -☑ Oral Airway (OPA) Avoid _______________ when administering oxygen/ventilation -☑ hyperoxia Resuscitation Adjuncts (LMNOP) -☑ L: Lab M: Monitor cardia rhythm and rate N: Naso or Oro-gastric tube insertion O: Oxygenation or ventilation analysis P: Pain assessment and management Do not place ___________________ in head trauma patients -☑ nasogastric Right breath sound ONLY following intubation = ________________ -- pull out -☑ Mainstem Massive Blood Transfusion: Monitor ___________ levels: sodium acetate binds with ____ so levels decrease. -☑ Calcium Hypercapnia causes _________________; Hypocapnia causes __________________ -☑ Vasodilation; Vasoconstriction Usually seen in athletes, second TBI, 2nd injury occurs BEFORE 1st injury recovers, rare but usually fatal. -☑ Second Impact Syndrome ____________ ___________ Injury: shearing or tearing. Diagnosed with MRI. Widespread microscopic hemorrhage. -☑ Diffuse Axonal Injury (Cannot recover from this; shearing/tearing portion DOES NOT heal) Muffled heart sounds -☑ Cardiac tamponade? Pericardial fluid?Most frequently injured organ -☑ Liver Most frequently injured organ from BLUNT trauma -☑ Spleen Pain Ladder: Step 1: Non-opioids for mild pain Step 2: Weak opioids for mild to moderate pain Step 3: Strong opioids for moderate to severe pain -☑ 1: Tylenol, Ibuprofen, Ketorolac 2: Codeine 3: Morphine, Fentanyl, Dilaudid Signs of increased compartment syndrome -☑ Increased pain, feels tight/very painful, but nothing looks wrong Ischemia develops -- Pressure Fasical Development -- Impaired Blood Flow. 6 P's: Pressure, pallor, pulses, paresthesia, paralysis. Extremity goes to level of the ___________!!! NO ______!! -☑ Compartment Syndrome: Level of heart; NO ice!! Control bleeding with direct pressure, elevate, apply tourniquets. -☑ Amputation Wrap in saline gauze, put in bag, then put that bag in another bag filled with ice. Label bag. -☑ Removed limb A ____ and ___ approach is used by all members of the trauma team to provide optimal care for the trauma pt. -☑ Systematic , Organized Trauma is injury to living tissue caused by ... -☑ An extrinsic agentA traumatic incident may be classified as ....(assault or suicide) or ... (falls or collisions) -☑ Intentional;unintentional .... is the study of energy transfer as it applies to identifying actual or potential injuries -☑ Kinematics The general study of forces and their effects -☑ Biomechanics How external forces in the environment are transferred to the body -☑ Mechan