Monitor for indications of hypocalcemia (tingling of the Blunt abdominal trauma (BAT) is frequently encountered in the form of motor vehicle crashes (MVCs) (75%), followed by falls and direct abdominal impact. Frequently Missed Questions on ATI Medical/Surgical . Predict the products, including their stereochemistry, from the E2 reactions of the following diastereomers of stilbene dibromide with sodium ethoxide in ethanol. elevate head of bed 30 degrees 10. Liver enzymes practice good hand hygiene, avoid crowded areas, avoid raw foods, avoid cleaning pet litter boxes client will need frequent follow up monitoring CD4+ and viral load counts wash dishes in hot water, bathe daily, prevent infections Infection Control: Appropriate Room Assignment (Active Learning Template - Basic Concept, RM FUND 9.0 Ch 11) An accurate history, if possible, will guide subsequent management. 3. The REBOA device is inserted using the Seldinger technique under ultrasound guidance into the femoral artery. A bruit near the epigastric area Correct - A bruit in the aortic area signals the presence of an . Provide peritoneal lavage EMF/SAEMF Medical Student Research Training Grant, SAEMF/CDEM Innovations in Undergraduate Emergency Medicine Education Grant, Career Development and Mentorship Committee, Communications and Social Media Committee, CDEM Medical Education Fellow Travel Scholarship. hypotension treatment for 10 days Because the contents of the hollow organ will go into the peritoneal cavity and cause peritonitis. MVA ETA is 4 min. You realize that you are next up for a patient assignment and run through your mental checklist for abdominal trauma: What organs are most likely to be injured given this mechanism? If a distended bladder ruptures or is perforated, urine is likely to escape into the abdomen. 3. 34(9):47-49, September 2003. during the bronchoscopy. Provide hemodynamic support by administration of fluids and medications Isenhour, J.L. Severity ranges from a controlled subcapsular hematoma and lacerations of the parenchyma to hepatic avulsion or a severe injury of the hepatic veins. Palpate one quadrant at a time for involuntary guarding, tenderness, rigidity, spasm, and localized pain. Epidural Analgesia, High spinal anesthesia Nutrition for the Critically Ill Patient. Next, perform a rapid neurologic examination and assess him head to toe to identify obvious injuries and signs of prolonged exposure to heat or cold. Note the order that the exam should be performed in. Generate a differential diagnosis of potential traumatic injuries based on history, mechanism, and physical exam. Bedside sonography is increasingly useful for diagnosis of hemoperitoneum in BAT. Flush the eyes immediately at the scene of injury with water for at least 15-20minutes. Most common in this situation are mesenteric hematoma, devascularization of the bowel, severe damage leading to rupture of the bowel wall, bruising, and hemorrhage of the abdominal wall that follows the belt pattern. 2. report presence of CSF from nose or ears to provider fingers and toes, carpopedal spasms, convulsions) 3. The perineum, rectum and genitalia should all be examined at this point. Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Childrens Hospital of Philadelphia (CHOP), its physicians and the individual patients in question. Back: signs of penetration. Damage control resuscitation: directly addressing the early coagulopathy of trauma. In gunshot wounds, the type of gun, distance from the shooter, and number of shots heard are all relevant. Compression and shearing are examples. How long is a client hospitalized for observation after sustaining a blunt trauma injury? Abdominal distention 2. Sign in, Spring 2007, Volume :37 Number 4 - Supplement: ED Insider , page 4 - 11 [Free], Join NursingCenter to get uninterrupted access to this Article. Ethambutol: vision changes 1. and digitalis toxicity, all of which increase demands on body metabolism. other symptoms of pericarditis: chest pain, coughing, swallowing difficulties, shortness of breath, relief of pain when sitting and leaning forward, Amputations: Postoperative Interventions to Prevent Complications (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 69), wrap the stump with elastic bandages (figure eight wrap) to prevent restriction of blood flow and decrease edema Severe left shoulder pain; indicates trauma of the spleen. appetite, or malaise. & Doty. Exam; $16.45 ; 0 ; 13 ; ATI RN Adult Medical Surgical Proctored Exam 2019 With Rationals 100% Correct Answers. monitor electrolyte values, Tuberculosis: Client Teaching (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 23), airborne precautions are not needed in the home gout: LOW PURINE DIET (reduce organ meats and shellfish), avoid starvation diets, aspirin, and diuretics In patients with known abdominal trauma, the patient should receive tetanus vaccination if not up to date. If a client has a gun shot wound, what will you be sure to do when cutting off their clothing? 1. Bronchoscopy Implement potassium, phosphate, sodium, and magnesium restrictions, if The survivors of the atomic bombs that were dropped on Hiroshima and Nagasaki have been the subjects of long-term studies of the effects of ionizing radiation on cancer incidence. How would you change the recipe to make sure you have enough? o A possible complication of epidural anesthesia if the dura is punctured Other renal injuries include lacerations or contusion of the renal parenchyma caused by shearing and compression forces; the deeper a laceration, the more serious the bleeding. 5. Look for and document obvious abnormalities, including distension, contusions, abrasions, lacerations, penetrating wounds, and asymmetry. HIV/AIDS: Teaching Home Care (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 86), practice good hand hygiene, avoid crowded areas, avoid raw foods, avoid cleaning pet litter boxes, Infection Control: Appropriate Room Assignment (Active Learning Template - Basic Concept, RM FUND 9.0 Ch 11), for airborne precautions: need private room, masks, negative pressure airflow, Middle and Inner Ear Disorders: Risk Factors for Hearing Loss (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 13, Disorders of the Male Reproductive System: Complication of Continuous Bladder Irrigation Following Transurethral Resection of the Prostate (TURP) (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 65), monitor for bleeding (persistent bright-red bleeding unresponsive to increase in CBI and traction on the catheter or reduced hgb levels), Burns: Findings of Hypovolemic Shock (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 75), Inflammatory Bowel Disease: Appropriate Diet Choices (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 52), recommend high protein, high calories, low fiber foods, Polycystic Kidney Disease, Acute Kidney Injury and Chronic Kidney Disease: Evaluating Teaching About Nutrition (Active Learning Template - System Disorder, RM AMS RN 10.0 Chp 59), restrict dietary sodium, potassium, phosphorous, and magnesium, Medications Affecting Blood Pressure: Client Teaching Regarding ACE Inhibitors (Active Learning Template - Medication, RM Pharm RN 7.0 Chp 20), adverse effects include hypotension, renal impairment, persistent dry cough, rash, headache, dizziness, Pulmonary Embolism: Planning Care for a Client Who Is Receiving Enoxaparin (Active Learning Template - Medication, RM AMS RN 10.0 Chp 24), educate client: tell them to call provider if they have evidence of bleeding such as spots under skin or abnormal bleeding out of gums, vagina, sudden weakness (brain bleed), coughing up blood, Blood and Blood Product Transfusion: Proper Administration Technique (Active Learning Template - Nursing Skill, RM AMS RN 10.0 Chp 40), initiate large bore IV access- 18-20 gauge needle is standard for administering blood blood products, Blood and Blood Product Transfusions: Administering Fresh Frozen Plasma (Active Learning Template - Therapeutic Procedure, RM AMS RN 10.0 Chp 40), initiate large bore IV access- 18-20 gauge needle is standard for administering blood blood products - Check for indications of hypocalcemia, which can result from parathyroid damage Sensory Perception: Advocating for a client who uses sign language. Osteoarthritis, Assist the client to change positions frequently to minimize pain. 6. American College of Surgeons; 2013. avoid fluids with meals (only drink between meals) With blunt trauma, splenic lacerations are the most common injury followed by liver lacerations. Blunt forces cause most bladder injuries. 2. What do knife wounds most commonly occur on the left side of the body? If his viscera are protruding, cover them with a sterile dressing moistened with 0.9% sodium chloride solution to prevent drying. - Conduct continuous cardiac monitoring for dysrhythmias. Acidosis A bruit near the epigastric area 3. Penetrating injuries include gunshot and shrapnel injuries, impalements, and knifings. prescribed (depending on the stage of injury). There a numerous tutorial videos demonstrating eFAST exams. An x-ray is performed and shows a closed tibia fracture. alternate periods of activity with rest to improve tolerance to activities Bowel sounds in the chest may signal a ruptured diaphragm with herniation of the small bowel into the thoracic cavity. and around the tracheostomy holder and plate. Small Bowel, 3. (See "Assessing the Abdomen" in the May issue of Nursing2003 for more on assessment techniques.). Free fluid in Morrisons pouch is concerning for hemoperitoneum, which may require emergent surgical intervention (See Figure 3). Patients may also present via private vehicle, in which case the prudent plan of action is to rapidly assess the ABCs while applying spinal immobilization and proceeding in accordance with ATLS guidelines. o 3 = Eye opening occurs secondary to sound 2023 Wolters Kluwer Health, Inc. and/or its subsidiaries. A vaginal examination can reveal a vaginal injury or the presence of a foreign body, such as bone from a pelvic fracture. 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