TRAUMA NURSING LATEST
PROCESS - TNP -
TNCC 9TH ED
If a patient is intubated, you must state... - ANSWERS-the need to begin
mechanical ventilation or continue assisted ventilation
What 2 elements must be identified when assessing circulation? -
ANSWERS-- Inspect AND palpate the skin for color, temperature, and
moisture
- Palpate a pulse
What are some interventions that may be appropriate when alterations in
circulation are noted? - ANSWERS-- Anticipate goal-directed therapy
for shock
- Apply a cardiac monitor - credit given in Step 20
- Apply a pelvic binder
- Apply a traction splint
- Assess patency of prehospital IV lines
- Compare central and peripheral pulses
- Consider sources of internal hemorrhage
- Control external hemorrhage
END OF
PAGE
1
, TRAUMA NURSING LATEST
PROCESS - TNP -
TNCC 9TH ED
- Draw labs - credit given in Step 19
- Facilitate FAST and/or radiographs to identify source of internal
hemorrhage
- Initiate chest compressions and advanced life support
- Obtain IV or IO access (two sites)
- Palpate central pulse if peripheral pulse is absent
- Tilt pregnant patient or manually displace the uterus
T/F: It is acceptable to have one IV or IO site on a patient with altered
circulatory status. - ANSWERS-False. You must have two sites of
access.
What is assessed in GCS? - ANSWERS-Best eye opening (1-4)
Best verbal response (1-5)
Best motor response (1-6)
What are some interventions that may be appropriate when alterations in
neurological status are noted with GCS? - ANSWERS-- Anticipate the
need for a head CT
END OF
PAGE
2
, TRAUMA NURSING LATEST
PROCESS - TNP -
TNCC 9TH ED
- Anticipate the need for drug-assisted intubation
- Assess bedside glucose (*with altered mental status)
You should determine neurological status using GCS ___ (before / after)
sedation and intubation. - ANSWERS-before
T/F: The GCS is documented as non-testable if there is a factor, such as
sedation or paralytics, interfering with communication. - ANSWERS-
True. This is why you should determine neurological status prior to
administering medication for intubation if possible.
When you remove all clothing, you are also doing what? - ANSWERS-
you're also inspecting for obvious abnormalities or injuries
T/F: When newly identified life-threatening alterations are identified,
intervene as appropriate and reassess. - ANSWERS-True. Always
intervene and reassess.
END OF
PAGE
3
PROCESS - TNP -
TNCC 9TH ED
If a patient is intubated, you must state... - ANSWERS-the need to begin
mechanical ventilation or continue assisted ventilation
What 2 elements must be identified when assessing circulation? -
ANSWERS-- Inspect AND palpate the skin for color, temperature, and
moisture
- Palpate a pulse
What are some interventions that may be appropriate when alterations in
circulation are noted? - ANSWERS-- Anticipate goal-directed therapy
for shock
- Apply a cardiac monitor - credit given in Step 20
- Apply a pelvic binder
- Apply a traction splint
- Assess patency of prehospital IV lines
- Compare central and peripheral pulses
- Consider sources of internal hemorrhage
- Control external hemorrhage
END OF
PAGE
1
, TRAUMA NURSING LATEST
PROCESS - TNP -
TNCC 9TH ED
- Draw labs - credit given in Step 19
- Facilitate FAST and/or radiographs to identify source of internal
hemorrhage
- Initiate chest compressions and advanced life support
- Obtain IV or IO access (two sites)
- Palpate central pulse if peripheral pulse is absent
- Tilt pregnant patient or manually displace the uterus
T/F: It is acceptable to have one IV or IO site on a patient with altered
circulatory status. - ANSWERS-False. You must have two sites of
access.
What is assessed in GCS? - ANSWERS-Best eye opening (1-4)
Best verbal response (1-5)
Best motor response (1-6)
What are some interventions that may be appropriate when alterations in
neurological status are noted with GCS? - ANSWERS-- Anticipate the
need for a head CT
END OF
PAGE
2
, TRAUMA NURSING LATEST
PROCESS - TNP -
TNCC 9TH ED
- Anticipate the need for drug-assisted intubation
- Assess bedside glucose (*with altered mental status)
You should determine neurological status using GCS ___ (before / after)
sedation and intubation. - ANSWERS-before
T/F: The GCS is documented as non-testable if there is a factor, such as
sedation or paralytics, interfering with communication. - ANSWERS-
True. This is why you should determine neurological status prior to
administering medication for intubation if possible.
When you remove all clothing, you are also doing what? - ANSWERS-
you're also inspecting for obvious abnormalities or injuries
T/F: When newly identified life-threatening alterations are identified,
intervene as appropriate and reassess. - ANSWERS-True. Always
intervene and reassess.
END OF
PAGE
3
