NR 574 FINAL EXAM
Hubert is a 68-year-old male who fell 8 feet from a ladder landing on
his right side. He has confirmed fractures to ribs 4 and 5, anteriorly
and laterally. When he takes a deep breath, the injured area of the lung
moves inward. He reports severe pain. Vital signs: blood pressure
(BP) 110/72; heart rate (HR)
110; respiratory rate (RR) 28; pulse oximetry (SpO2) 92% on 2 liters
nasal cannula What is the most appropriate management for Hubert? -
ANSWERS-Admit to intensive care unit (ICU) and administer
fentanyl patient controlled analgesia (PCA)
Serena presents to the ED after being struck in the chest with a pipe
during an altercation. Assessment findings include jugular vein
distention (JVD) and distant heart tones. Vital signs: BP 88/72; HR
122; RR 32.Which of the following is the priority intervention for
Serena? - ANSWERS-Pericardiocentesis
Avi is a 43-year-old male who was brought to the ED after an MVC.
Emergency medical services (EMS) personnel were unable to intubate
him and are providing ventilation by bag valve mask. Avi is intubated
in the ED. Immediately after intubation, he is hypotensive.
Assessment findings show significant tracheal deviation to the right,
neck vein distention, and no movement of the left side of the chest.
What is the priority intervention for Avi? - ANSWERS-Needle
decompression
,Kehr's sign - ANSWERS-Referred pain down the left shoulder;
indicative of a ruptured spleen.-due to the presence of blood or other
irritants in the peritoneal cavity when a person is lying down and the
legs are elevated.
causes/risk factors of abdominal compartment syndrome -
ANSWERS-gastric distention ileus bowel obstruction peritoneal
hemorrhage (traumatic or spontaneous)ascites increased bowel wall
edema from high volume resuscitation septic shock mass transfusion
burn fluid resuscitation obesity positive pressure ventilation
physical exam findings of abdominal compartment syndrome -
ANSWERS-abdominal distention rigid or firm abdomen abdominal
pain with palpation nausea vomiting decreased urine output
significant positive intake versus output over 48 hours shock
symptoms (hypotension and tachycardia)
how to assess intraabdominal pressure - ANSWERS-indirectly by
assessing bladder pressure.-pt supine: HOB no higher than 20 degree-
bladder should be completely decompressed before beginning.-A
foley catheter is connected to a transducer which is zeroed at the
midaxillary line, and a small amount of saline (20-35 milliliters [ml])
is injected into the bladder while the end-expiratory pressure is
measured.
When assessing intraabdominal pressure, what is a normal bladder
pressure? - ANSWERS--Normal bladder pressure values <12
millimeters mercury (mmHg)
,When assessing intraabdominal pressure, what bladder pressure is
considered abdominal compartment syndrome? - ANSWERS->
12mm Hg are consistent with intraabdominal hypertension, and
pressures greater than 20mmHg are considered abdominal
compartment syndrome.
treatment of abdominal compartment syndrome - ANSWERS-
Abdominal compartment syndrome is a surgical emergency!
-decompressive laparotomy to reduce intraabdominal pressure.-A
decompressive laparotomy consists of creating a midline incision into
the ab- domen which allows the bowel to expand outside of the
abdominal wall until the swelling is diminished. -The portion of the
bowel unable to be returned to the abdominal cavity is left outside the
abdomen and the abdominal wall is left open for a period to facilitate
perfusion. Clients who undergo decompressive laparotomy and are
left with an open abdominal incision must undergo staged abdominal
wound closure.
risk factors for intra-abdominal trauma - ANSWERS-rollover motor
vehicle collision driver of vehicle steering wheel deformity airbag
deployment thigh level of vehicle damage unrestrained fall from a
height greater than 8ft stabbing shootings explosions with shrapnel
risk factors for traumatic renal injury - ANSWERS-men under the age
of 30.Renal trauma often occurs due to rapid decelerations that cause
tearing injuries, direct blows to the back or flank, or penetrating
injuries directly to the proximity to the kidney.-Penetrating trauma
that enters anterior to the axillary line is more likely to result in a
renal injury as well
, Post-splenectomy clients are at high risk for rapidly progressing
sepsis due to immunoglobulin G (IgG)-coated bacteria and
encapsulated organ- isms. what vaccinations are recommended? -
ANSWERS-Pneumococcal 13-valent conju- gate (PCV13-
Prevnar)Haemophilus influenza type b (Hib-ActHIB) Meningococcal
vaccine (Menactra) Meningococcal serogroup B (Bexsero)
Post-splenectomy clients are at high risk for rapidly progressing
sepsis due to immunoglobulin G (IgG)-coated bacteria and
encapsulated organisms. when should the patient receive
recommended vaccinations? - ANSWERS-Vaccinations that
specifically target these causative organisms should be administered
14 days post-surgery or before hospital discharge
Exploratory laparotomy for splenic injury? When? - ANSWERS-
Exploratory laparotomy is the priority in a hemodynamically unstable
client with splenic injury. Repair may be accomplished by suturing
the tear or removing a portion of the spleen; however, serious
bleeding will most likely require splenectomy.
embolization can be used to treat splenic lacerations. Who does not
met the criteria for this? - ANSWERS-Embolization should not be
performed in clients older than55 years, due to the thinning of the
splenic capsule and increased risk of bleeding.
Grade I and II liver lacerations treatment. - ANSWERS--observation
(ICU)-rarely require surgical treatment.-bedrest for at least 24 hours-
serial H/H monitoring-blood transfusions if needed.-Follow-up CT
Hubert is a 68-year-old male who fell 8 feet from a ladder landing on
his right side. He has confirmed fractures to ribs 4 and 5, anteriorly
and laterally. When he takes a deep breath, the injured area of the lung
moves inward. He reports severe pain. Vital signs: blood pressure
(BP) 110/72; heart rate (HR)
110; respiratory rate (RR) 28; pulse oximetry (SpO2) 92% on 2 liters
nasal cannula What is the most appropriate management for Hubert? -
ANSWERS-Admit to intensive care unit (ICU) and administer
fentanyl patient controlled analgesia (PCA)
Serena presents to the ED after being struck in the chest with a pipe
during an altercation. Assessment findings include jugular vein
distention (JVD) and distant heart tones. Vital signs: BP 88/72; HR
122; RR 32.Which of the following is the priority intervention for
Serena? - ANSWERS-Pericardiocentesis
Avi is a 43-year-old male who was brought to the ED after an MVC.
Emergency medical services (EMS) personnel were unable to intubate
him and are providing ventilation by bag valve mask. Avi is intubated
in the ED. Immediately after intubation, he is hypotensive.
Assessment findings show significant tracheal deviation to the right,
neck vein distention, and no movement of the left side of the chest.
What is the priority intervention for Avi? - ANSWERS-Needle
decompression
,Kehr's sign - ANSWERS-Referred pain down the left shoulder;
indicative of a ruptured spleen.-due to the presence of blood or other
irritants in the peritoneal cavity when a person is lying down and the
legs are elevated.
causes/risk factors of abdominal compartment syndrome -
ANSWERS-gastric distention ileus bowel obstruction peritoneal
hemorrhage (traumatic or spontaneous)ascites increased bowel wall
edema from high volume resuscitation septic shock mass transfusion
burn fluid resuscitation obesity positive pressure ventilation
physical exam findings of abdominal compartment syndrome -
ANSWERS-abdominal distention rigid or firm abdomen abdominal
pain with palpation nausea vomiting decreased urine output
significant positive intake versus output over 48 hours shock
symptoms (hypotension and tachycardia)
how to assess intraabdominal pressure - ANSWERS-indirectly by
assessing bladder pressure.-pt supine: HOB no higher than 20 degree-
bladder should be completely decompressed before beginning.-A
foley catheter is connected to a transducer which is zeroed at the
midaxillary line, and a small amount of saline (20-35 milliliters [ml])
is injected into the bladder while the end-expiratory pressure is
measured.
When assessing intraabdominal pressure, what is a normal bladder
pressure? - ANSWERS--Normal bladder pressure values <12
millimeters mercury (mmHg)
,When assessing intraabdominal pressure, what bladder pressure is
considered abdominal compartment syndrome? - ANSWERS->
12mm Hg are consistent with intraabdominal hypertension, and
pressures greater than 20mmHg are considered abdominal
compartment syndrome.
treatment of abdominal compartment syndrome - ANSWERS-
Abdominal compartment syndrome is a surgical emergency!
-decompressive laparotomy to reduce intraabdominal pressure.-A
decompressive laparotomy consists of creating a midline incision into
the ab- domen which allows the bowel to expand outside of the
abdominal wall until the swelling is diminished. -The portion of the
bowel unable to be returned to the abdominal cavity is left outside the
abdomen and the abdominal wall is left open for a period to facilitate
perfusion. Clients who undergo decompressive laparotomy and are
left with an open abdominal incision must undergo staged abdominal
wound closure.
risk factors for intra-abdominal trauma - ANSWERS-rollover motor
vehicle collision driver of vehicle steering wheel deformity airbag
deployment thigh level of vehicle damage unrestrained fall from a
height greater than 8ft stabbing shootings explosions with shrapnel
risk factors for traumatic renal injury - ANSWERS-men under the age
of 30.Renal trauma often occurs due to rapid decelerations that cause
tearing injuries, direct blows to the back or flank, or penetrating
injuries directly to the proximity to the kidney.-Penetrating trauma
that enters anterior to the axillary line is more likely to result in a
renal injury as well
, Post-splenectomy clients are at high risk for rapidly progressing
sepsis due to immunoglobulin G (IgG)-coated bacteria and
encapsulated organ- isms. what vaccinations are recommended? -
ANSWERS-Pneumococcal 13-valent conju- gate (PCV13-
Prevnar)Haemophilus influenza type b (Hib-ActHIB) Meningococcal
vaccine (Menactra) Meningococcal serogroup B (Bexsero)
Post-splenectomy clients are at high risk for rapidly progressing
sepsis due to immunoglobulin G (IgG)-coated bacteria and
encapsulated organisms. when should the patient receive
recommended vaccinations? - ANSWERS-Vaccinations that
specifically target these causative organisms should be administered
14 days post-surgery or before hospital discharge
Exploratory laparotomy for splenic injury? When? - ANSWERS-
Exploratory laparotomy is the priority in a hemodynamically unstable
client with splenic injury. Repair may be accomplished by suturing
the tear or removing a portion of the spleen; however, serious
bleeding will most likely require splenectomy.
embolization can be used to treat splenic lacerations. Who does not
met the criteria for this? - ANSWERS-Embolization should not be
performed in clients older than55 years, due to the thinning of the
splenic capsule and increased risk of bleeding.
Grade I and II liver lacerations treatment. - ANSWERS--observation
(ICU)-rarely require surgical treatment.-bedrest for at least 24 hours-
serial H/H monitoring-blood transfusions if needed.-Follow-up CT
