Trauma Nursing Process - TNP - TNCC
9th Ed – questions with answers
What |should |you |ask |yourself |after |completing |all |of |your |interventions |and |reassessments?
|- |ANSWERS✔✔ |Does |this |patient |need |to |be |transferred |to |another |hospital, |to |surgery, |or
|to |critical |care?
What |happens |prior |to |patient |arrival? |1-3 |- |ANSWERS✔✔ |1. |Activate |trauma |team
2. |Prepare |trauma |room
3. |Don |PPE
What |happens |following |patient |arrival |but |before |a |decision |to |intubate |has |been |made? |4-
8
may |change |based |on |C-ABC |- |ANSWERS✔✔ |4. |Assess |for |obvious |uncontrolled |external
|hemorrhage |or |unresponsiveness/apnea |and |the |need |to |reprioritize |to |C-ABC
5**. |Assess |level |of |consciousness |using |AVPU
6. |Open |the |airway
7**. |Assess |the |patency |and |protection |of |the |airway
8**. |Assess |breathing |effectiveness
Continue |the |TNP |assuming |the |patient |was |intubated. |9-11 |- |ANSWERS✔✔ |9**. |If
|intubated, |assess |endotracheal |tube |placement
10. |If |intubated, |assess |ETT |position |and |securement
11. |If |intubated, |state |the |need |to |begin |mechanical |ventilation |or |continue |assisted
|ventilation
Continue |the |TNP |following |assessments |of |ETT. |12-15
, **12, |13, |and |15 |are |double-starred |- |ANSWERS✔✔ |12**. |Assess |circulation
13**. |Assess |neurologic |status |using |GCS
14. |Assess |pupils
15**. |Remove |all |clothing |AND |inspect |for |obvious |abnormalities |or |injuries
Continue |the |TNP |following |assessments |of |circulation, |neuro |status, |and |removal |of
|clothing |to |inspect |for |injury. |16-18 |- |ANSWERS✔✔ |16. |Provide |warmth
17. |Obtain |a |full |set |of |vital |signs |and |weight |in |kilograms |(if |not |determined |earlier)
18. |Facilitate |family |presence
Continue |the |TNP |using |the |LMNOP |mnemonic. |19-23 |- |ANSWERS✔✔ |19. |L |- |trauma |panel
|labs
20. |M |- |monitor |(Cardiac, |consider |EKG)
21. |N |- |consider |need |for |NG/OG
22. |O |- |assess |O2 |and |end-tidal |capnography
23**. |P |- |assess |pain |using |appropriate |pain |scale
Continue |TNP |after |LMNOP |(so |after |pain |has |been |assessed). |24-26 |- |ANSWERS✔✔ |24.
|Non-pharmacological |comfort |measures |
25. |Consider |analgesic |med |order
26. |Obtain |pertinent |history
Head-to-Toe |27-43 |- |ANSWERS✔✔ |27. |Inspect |and |palpate |head |for |injuries
28. |Inspect |and |palpate |face |for |injuries
29. |Inspect |and |palpate |neck |for |injuries
-- |Demonstrate |removal |AND |reapplication |of |cervical |collar |for |assessment |(if |indicated).
30. |Inspect |and |palpate |chest |for |injuries
|
31. |Auscultate |breath |sounds
9th Ed – questions with answers
What |should |you |ask |yourself |after |completing |all |of |your |interventions |and |reassessments?
|- |ANSWERS✔✔ |Does |this |patient |need |to |be |transferred |to |another |hospital, |to |surgery, |or
|to |critical |care?
What |happens |prior |to |patient |arrival? |1-3 |- |ANSWERS✔✔ |1. |Activate |trauma |team
2. |Prepare |trauma |room
3. |Don |PPE
What |happens |following |patient |arrival |but |before |a |decision |to |intubate |has |been |made? |4-
8
may |change |based |on |C-ABC |- |ANSWERS✔✔ |4. |Assess |for |obvious |uncontrolled |external
|hemorrhage |or |unresponsiveness/apnea |and |the |need |to |reprioritize |to |C-ABC
5**. |Assess |level |of |consciousness |using |AVPU
6. |Open |the |airway
7**. |Assess |the |patency |and |protection |of |the |airway
8**. |Assess |breathing |effectiveness
Continue |the |TNP |assuming |the |patient |was |intubated. |9-11 |- |ANSWERS✔✔ |9**. |If
|intubated, |assess |endotracheal |tube |placement
10. |If |intubated, |assess |ETT |position |and |securement
11. |If |intubated, |state |the |need |to |begin |mechanical |ventilation |or |continue |assisted
|ventilation
Continue |the |TNP |following |assessments |of |ETT. |12-15
, **12, |13, |and |15 |are |double-starred |- |ANSWERS✔✔ |12**. |Assess |circulation
13**. |Assess |neurologic |status |using |GCS
14. |Assess |pupils
15**. |Remove |all |clothing |AND |inspect |for |obvious |abnormalities |or |injuries
Continue |the |TNP |following |assessments |of |circulation, |neuro |status, |and |removal |of
|clothing |to |inspect |for |injury. |16-18 |- |ANSWERS✔✔ |16. |Provide |warmth
17. |Obtain |a |full |set |of |vital |signs |and |weight |in |kilograms |(if |not |determined |earlier)
18. |Facilitate |family |presence
Continue |the |TNP |using |the |LMNOP |mnemonic. |19-23 |- |ANSWERS✔✔ |19. |L |- |trauma |panel
|labs
20. |M |- |monitor |(Cardiac, |consider |EKG)
21. |N |- |consider |need |for |NG/OG
22. |O |- |assess |O2 |and |end-tidal |capnography
23**. |P |- |assess |pain |using |appropriate |pain |scale
Continue |TNP |after |LMNOP |(so |after |pain |has |been |assessed). |24-26 |- |ANSWERS✔✔ |24.
|Non-pharmacological |comfort |measures |
25. |Consider |analgesic |med |order
26. |Obtain |pertinent |history
Head-to-Toe |27-43 |- |ANSWERS✔✔ |27. |Inspect |and |palpate |head |for |injuries
28. |Inspect |and |palpate |face |for |injuries
29. |Inspect |and |palpate |neck |for |injuries
-- |Demonstrate |removal |AND |reapplication |of |cervical |collar |for |assessment |(if |indicated).
30. |Inspect |and |palpate |chest |for |injuries
|
31. |Auscultate |breath |sounds
