# Risk Factors for Multisystem Trauma - (blank) - Pedestrian vs vehicle - Falls from height - (blank) - Older adults - Alcohol/substance use - (blank) - (blank)

- MVCs - Penetrating trauma (GSWs, stabbing) - Lack of protective equipment (seatbelt, helmet) - Comorbid conditions (cardiac/pulmonary disease)

# General s/s of multisystem trauma - (blank) - (blank) - Pale, cool, clammy skin

- Altered mental status - Hypotension, tachycardia (signs of shock)

# neuro s/s of multisystem trauma - (blank) - (blank) - Seizures

- unequal pupils - decreased GCS

# respiratory s/s of multisystem trauma - (blank) - Tachypnea - (blank) - (blank)

- Dyspnea - Hypoxia - Asymmetric chest rise

# musculoskeletal s/s of multisystem trauma - (blank) - instability - (blank)

- Deformity - Uncontrolled bleeding

# ABCDE: what interventions ensure patent airway? - (blank) - Suction - (blank)

- Maintain cervical spine - Intubation

# ABCDE: What interventions maintain breathing? - (blank) - (blank) - Chest seal if needed

- Oxygen via NRB - Assess breath sounds

# ABCDE: what interventions maintain circulation - (Blank) - (Blank) - Fluids/blood

- Control hemorrhage with pressure - 2 large bore IVs

# ABCDE: what interventions prevent disability - GCS assessment - (blank) - (blank)

- Pupil assessment - BG assessment

# What are secondary interventions for multisystem trauma (post ABCDE) - (blank) - (blank) - Pain management - frequent reassessment - (blank)

- Continuous cardiac/pulse ox monitoring - Foley catheter insertion (if no urethral injury) - Prepare for surgery/radiology

# What labs are important for multisystem trauma? - (blank) - (blank) - Coagulation studies - ABGs - (blank) - (blank) - Blood alcohol/toxicology screen

- CBC - CMP - Lactate (tissue perfusion indicator) - Type and crossmatch

# What are diagnostic procedures for mustisystem trauma? - (blank) - (blank) - x- rays - Continuous ECG monitoring - (blank) - Urinalysis

- FAST exam (bedside abdominal US) - CT scans - ICP monitoring

# What patient education is indicated after multisystem trauma - Importance of follow up care/rehab - (blank) - Pain management plan - (blank) - Physical activity restrictions - (blank)

- Signs of infection/delayed bleeding - Use of safety equipment to prevent future injury - Psychological support/PTSD awareness

# What are potential complications of multisystem trauma? - (blank) - (blank) - AKI - (blank) - Disseminated Intravascular Coagulation (DIC) - (blank) - long-term disability - Death

- Hypovolemic shock - ARDs - Sepsis - MODS

# risk factors for PTSD - (Blank) - Serious accidents/disasters - (blank) - Repeated/prolonged trauma - (blank) - (blank) - Lack of social support - (blank) - Substance use - Family history - Poor coping mechanisms

- Military combat - Sudden loss of loved one - Childhood trauma - Female sex - Prior mental health disorders

# What are s/s of PTSD - (blank) - (blank) - Distressing memories - (blank) - Emotional numbing - Social withdrawal - (blank) - Guilt/shame - (blank) - (blank) - Irritability/anger - Insomnia - (blank) - Diaphoresis - (blank) - HA - Fatigue

- Flashbacks - Nightmares - Avoiding reminders of trauma - Difficulty concentrating - Hypervigilance - Exaggerated startle response - Tachycardia - GI upset

# Nursing interventions for PTSD - (blank) - Calm, nonjudgemental environment - Reduce environmental stimuli - (blank) - (blank) - (blank) - Anxiolytics - Sleep hygiene teaching - Encourage therapy participation

- Assess suicide risk - Encourage expression of feelings - SSRIs/SNRIs - Prazosin for nightmares

# What diagnostic procedures are used for PTSD - (blank) - (blank) - (blank) - CAPS-5 (clinician administered PTSD Scale) - Screening for comorbid depression/anxiety

- Clinical psychiatric evaluation - DSM-5 criteria - PTSD Checklist

# What patient education is indicated for PTSD - PTSD is treatable - (blank) - (blank) - Identify triggers - (blank) - (blank) - Build support system - Benefit of routine and self-care - (blank)

- Importance of therapy adherence - Medication compliance - Use gorunding techniques - Avoid alcohol/drugs - Seek help for suicidal thoughts

# What are complications of PTSD - Major depressive disorder - (blank) - (blank) - (blank) - Relationship problems - Occupational impairment - (blank) - Cardiovascular disease from chronic stress

- Substance use disorder - Chronic anxiety - Sleep disorders - Increased suicide risk

Module 2 Flashcards by Avery Santinelli

Risk Factors for Multisystem Trauma

(blank)
Pedestrian vs vehicle
Falls from height
(blank)
Older adults
Alcohol/substance use
(blank)
(blank)

MVCs
Penetrating trauma (GSWs, stabbing)
Lack of protective equipment (seatbelt, helmet)
Comorbid conditions (cardiac/pulmonary disease)

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General s/s of multisystem trauma

(blank)
(blank)
Pale, cool, clammy skin

Altered mental status
Hypotension, tachycardia (signs of shock)

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neuro s/s of multisystem trauma

(blank)
(blank)
Seizures

unequal pupils
decreased GCS

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respiratory s/s of multisystem trauma

(blank)
Tachypnea
(blank)
(blank)

Dyspnea
Hypoxia
Asymmetric chest rise

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cardiac s/s in multisystem trauma

chest pain
(blank)

dysrhythmias

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abdominal s/s of multisystem trauma

distention
(blank)
(blank)

Rigidity
Gaurding

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musculoskeletal s/s of multisystem trauma

(blank)
instability
(blank)

Deformity
Uncontrolled bleeding

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What is a sign of renal involvement in multisystem trauma?

Decreased urine output

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ABCDE: what interventions ensure patent airway?

(blank)
Suction
(blank)

Maintain cervical spine
Intubation

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ABCDE: What interventions maintain breathing?

(blank)
(blank)
Chest seal if needed

Oxygen via NRB
Assess breath sounds

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ABCDE: what interventions maintain circulation

(Blank)
(Blank)
Fluids/blood

Control hemorrhage with pressure
2 large bore IVs

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ABCDE: what interventions prevent disability

GCS assessment
(blank)
(blank)

Pupil assessment
BG assessment

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What are “secondary” interventions for multisystem trauma (post ABCDE)

(blank)
(blank)
Pain management
frequent reassessment
(blank)

Continuous cardiac/pulse ox monitoring
Foley catheter insertion (if no urethral injury)
Prepare for surgery/radiology

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What labs are important for multisystem trauma?

(blank)
(blank)
Coagulation studies
ABGs
(blank)
(blank)
Blood alcohol/toxicology screen

CBC
CMP
Lactate (tissue perfusion indicator)
Type and crossmatch

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What are diagnostic procedures for mustisystem trauma?

(blank)
(blank)
x- rays
Continuous ECG monitoring
(blank)
Urinalysis

FAST exam (bedside abdominal US)
CT scans
ICP monitoring

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What patient education is indicated after multisystem trauma

Importance of follow up care/rehab
(blank)
Pain management plan
(blank)
Physical activity restrictions
(blank)

Signs of infection/delayed bleeding
Use of safety equipment to prevent future injury
Psychological support/PTSD awareness

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What are potential complications of multisystem trauma?

(blank)
(blank)
AKI
(blank)
Disseminated Intravascular Coagulation (DIC)
(blank)
long-term disability
Death

Hypovolemic shock
ARDs
Sepsis
MODS

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risk factors for PTSD

(Blank)
Serious accidents/disasters
(blank)
Repeated/prolonged trauma
(blank)
(blank)
Lack of social support
(blank)
Substance use
Family history
Poor coping mechanisms

Military combat
Sudden loss of loved one
Childhood trauma
Female sex
Prior mental health disorders

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What are s/s of PTSD

(blank)
(blank)
Distressing memories
(blank)
Emotional numbing
Social withdrawal
(blank)
Guilt/shame
(blank)
(blank)
Irritability/anger
Insomnia
(blank)
Diaphoresis
(blank)
HA
Fatigue

Flashbacks
Nightmares
Avoiding reminders of trauma
Difficulty concentrating
Hypervigilance
Exaggerated startle response
Tachycardia
GI upset

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Nursing interventions for PTSD

(blank)
Calm, nonjudgemental environment
Reduce environmental stimuli
(blank)
(blank)
(blank)
Anxiolytics
Sleep hygiene teaching
Encourage therapy participation

Assess suicide risk
Encourage expression of feelings
SSRIs/SNRIs
Prazosin for nightmares

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Patho of PTSD

Trauma causes persistent activation of the (blank)

Amygdala (fear center)

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What diagnostic procedures are used for PTSD

(blank)
(blank)
(blank)
CAPS-5 (clinician administered PTSD Scale)
Screening for comorbid depression/anxiety

Clinical psychiatric evaluation
DSM-5 criteria
PTSD Checklist

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What patient education is indicated for PTSD

PTSD is treatable
(blank)
(blank)
Identify triggers
(blank)
(blank)
Build support system
Benefit of routine and self-care
(blank)

Importance of therapy adherence
Medication compliance
Use gorunding techniques
Avoid alcohol/drugs
Seek help for suicidal thoughts

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What are complications of PTSD

Major depressive disorder
(blank)
(blank)
(blank)
Relationship problems
Occupational impairment
(blank)
Cardiovascular disease from chronic stress

Substance use disorder
Chronic anxiety
Sleep disorders
Increased suicide risk

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# Risk factors for superficial burns - (blank) - Contact with hot liquids/objects - Minor flame exposure - (blank) - (blank) - (blank) - Occupational exposure - Children/older adults

- Prolonged sun exposure - UV radiation (tanning beds) - Fair skin - Lack of sunscreen/protective clothing

# s/s of superficial burns - (blank) - Pain/tenderness - Mild swelling - (blank) - (blank) - Skin blanches with pressure - Peeling during healing phase - (blank)

- Erythema/redness - Warm, dry skin - No blisters - Intact sensation

# Nursing interventions for superficial burns - (blank) - (blank) - (blank) - (blank) - Avoid ice on skin - Keep area dry and clean - Monitor for redness, drainage

- Cool burn with cool running water for about 20 minutes - Elevate affected area if swollen - Apply aloe or water-based moisturizer - NSAIDs/acetaminophen for pain

# What education is indicated for superficial burns - (blank) - Avoid sun during peak hours - (blank) - (blank) - Increase fluid intake - Use cool compress - Seek care if blistering occurs

- Use sunscreen - Wear protective clothing - Do not pop peeling skin

# What are complications of superficial burns (rare) - (blank) - Hyperpigmentation - (blank) - Dehydration - (blank)

- Infection - Increased sun sensitivity - Progression to deeper burn if improperly treated

# Risk factors for superficial partial thickness burns - (blank) - Brief flam exposure - (blank) - Contact with hot surfaces - (blank) - Occcupational exposure - Children/older adults - Lack of protective equipment

- Hot liquid scalds - Steam burns - Severe sunburn

# What are s/s of superficial partial thickness burns - (blank) - Moist, weeping surface - (blank) - (blank) - (blank) - Blanches with pressure - Intact/increased sensation - Peeling skin during healing

- Bright red/pink wound bed - Blister formation - Severe pain - Edema

# What are nursing interventions for superficial partial thickness burns - (blank) - (blank) - Clean with saline - (blank) - (blank) - Cover with non-adherent sterile dressing - Oral/IV analgesics - (blank) - Oral fluids - (blank) - (blank)

- Cool burn with cool running water for about 20 minutes - Elevate affected extremity - Debride loose blisters if ordered - Apply topical antimicrobial (silver sulfadiazine) - Pre-medicate before dressing changes - Strict hand hygiene/infection prevention - Tetanus update if indicated

# What patient education is indicated for superficial partial thick burns - Keep dressing clean and dry - (blank) - (blank) - Take pain meds as prescribed - (blank) - Avoid sun exposure to healing skin - Attend follow up appointments

- Do not pop blisters - Increase protein and fluids - Watch for signs of infection

# What are potential complications of superficial partial thickness burns - (blank) - Delayed healing - (blank) - Scarring/pigment changes - (blank) - (blank)

- Infection - Dehydration - Progression to deeper burn - Pain-related stress response

# Risk factors for deep partial thickness burns - Prolonged exposure to hot liquids/steam - (blank) - (blank) - (blank) - Occupational exposure - Children and older adults - Lack of protective equipment - (blank)

- Flame injuries - Contact with hot metal/chemicals - Electrical burns - Delayed initial treatment

# What are s/s of deep partial thickness burns? - (blank) - Moist or dry surface - (blank) - Moderate to severe pain - (blank) - Decreased blanching - (blank)

- Red to pale or mottled wound bed - Blisters (may be ruptured) - Edema - Delayed cap. refill

# What are nursing interventions for deep partial thickness burns - Stop burn source - (blank) - (blank) - (blank) - Continuous cardiac/pulse ox monitoring - (blank) - (blank) - Non-adherent sterile dressing - Prepare for skin grafting - IV opiods - (blank) - (blank) - (blank) - Tetanus prophylaxis - Prevent hypothermia

- Apply high-flow oxygen if inhalation suspected - 2 large bore IVs - Begin fluid resuscitation - Debridement of necrotic tissue - Topical antimicrobials (silver sulfadiazine) - Premedicate before dressing changes - Strict I&O - High protein/high calorie diet

# What are labs for deep partial thickness burns - (blank) - (blank) - ABGs (respiratory involvement) - Lactate (perfusion) - (blank) - (blank)

- CBC (infection, hemoconcentration) - CMP (electrolytes) - Albumin (nutrition status) - type and crossmatch

# What are diagnostic procedures for deep partial thickness burns - Clinical depth assessment - (blank) - (blank) - Continuous ECG (electrical especialy) - (blank)

- TBSA estimation - Bronchoscopy if inhalation injury suspected - Wound cultures if infection suspected

# What patient education is indicated for deep partial thicknes burns - (blank) - (blank) - Proper wound care at home - (blank) - (blank) - ROM exercises - Avoid sun exposure

- Expect prolonged healing and/or grafting - Importance of nutrition for wound healing - Signs of infection - Scar management (pressure garments, moisturizers)

# What are potential complications of deep partial thickness burns - (blank) - (blank) - Delayed wound healing - Hypertrophic scarring - (blank) - Chronic pain - Need for grafting - (blank)

- Infection / sepsis - Hypovolemia - Contractures - Psychosocial distress

# What are risk factors for full thickness burns? - (blank) - (blank) - (blank) - Contact with hot metals/tar - Severe scald injuries - Occupational hazards - Delayed emergency care - Children/older adults - Lack of protective equipment

- Prolonged flame exposure - Electrical injuries - Chemical burns

# local s/s of full thickness burns - (blank) - (blank) - Non-blanching - (blank) - (blank) - Visible underlying tissue - (blank)

- White, brown, black, or charred appearance - Dry, leathery texture - Absent sensation or minimal pain (nerve destruction - Severe surrounding edema - Possible circumferential burns (vascular compromise)

# What are systemic s/s of full thickness burns? - (blank) - (blank) - Decreased urine output - (blank)

- Hypotension - Tachycardia - Altered mental status

# What are nursing interventions for full thickness burns - (blank) - High flow oxygen - (blank) - (blank) - Control bleeding - Sterile saline cleansing - (blank) - (blank) - Non-adherent sterile dressings - (blank) - (blank) - IV opioids - Strict I&O - (blank) - Tetanus prophylaxis

- Intubation - Two large bore IVs through unburned skin if possible - Aggressive fluid resuscitation - Surgical debridement - Topical antimicrobials (silver sulfadiazine) - Prepare for excharotomy if circulation compromised - Early excision and skin grafting - Nutritional support (enteral feeding)

# What are labs for full thickness burns - (blank) - (blank) - ABGs (inhalation injury suspected) - Lactate (tissue perfusion) - (blank) - CK/myoglovin (electrical burns) - (blank)

- CBC (hemoconcentration, infection) - CMP (electrolyte abnormalities, renal function) - Albumin (nutrition) - Type and crossmatch

# What are diagnostic procedures for full thickness burns - (blank) - (blank) - Continuous ECG (especially electrical burns - (blank) - Wound cultures if infection suspected

- TBSA estimation - Bronchoscopy (suspected inhalation injury) - Doppler studies (circumferential burns)

# What patient education is indicated in full thickness burns - (blank) - (blank) - Proper wound care - (blank) - ROM to prevent contractures - (blank) - Psyhological support - Sun protection of skin

- Expect surgical grafting and prolonged recovery - Importance of nutrition/hydration - Scar management and pressure garments - Signs of infections

# What are ptoential complications full thickness burns - (blank) - (blank) - (blank) - AKI - (blank) - Hypertrophic scarring - Chronic pain - (blank) - (blank)

- Hypovolemic shock - Infection/sepsis - ARDS - Contractures - Body image disturbance - MODS

# What are risk factors for spinal cord injury (general) - (blank) - Falls from height - (blank) - Penetrating trauma (GSW, stabbing) - (blank) - (blank) - Tumors/infections - Older adults - (blank)

- MVCs - Sports injuries (especially diving) - Osteoporosis - Degenerative spine disease - Alcohol/drug use at time of injury

# What are general s/s of spinal cord injury? - (blank) - loss of sensation below the injury - (blank) - (blank) - Neuropathic pain - (blank)

- Loss of motor function below injury - Bowel/bladder dysfunction - Sexual dysfunction - Spinal shock

# What are s/s of cervical SCI - (blank) - (blank) - Bradycardia, hypotension (neurogenic shock) - Loss of bowel/bladder

- Quadriplegia/tetraplegia - Respiratory compromise (C1-C5) (risk of ventilator dependence)

# What are s/s of thoracic SCI - (blank) - Trunk instability - (blank) - Bowel bladder dysfunction

- Paraplegia - Intercostal muscle weakness

# What are s/s of lumbar/sacral SCIs - (blank) - (blank) - Loss of sphincter control - Sexual dysfunction

- Paraplegia or leg weakness - Saddle anesthesia

# What are nursing interventions for SCIs in the acute phase? - (blank) - ABCs first - (blank) - (blank) - (blank) - Continuous ECG monitoring - Foley catheter - Strict I&O - (blank) - (blank) - Temperature regulation - Pain management - (blank)

- Maintain spinal immobilization - Prepare for intubation if cervical injury suspected - Two large bore IVs - Treat hypotension with fluids/pressors - Log-roll for turning - Frequent neuro checks - DVT prophylaxis

# What are interventions for cervical SCI - (blank) - Diaphragmatic pacing - (blank) - Assisted cough - Suctioning - (blank) - (blank) - Total assist with ADLs

- Mechanical ventilation (C1-C5) - Incentive spirometry - Monitor for bradycardia - Speech/swallow evaluation

# what are interventions for thoracic injuries - (blank) - (blank) - Assist with transfers - (blank) - Wheelchair mobility

- Monitor respiratory effort - Trunk stabilization - Begin sitting balance training

# What are interventions lumbar/sacral injuries - (blank) - (blank) - Bowel program - Sexual counseling

- Gait training/bracing - Bladder retraining

# What are interventions for subacute/rehab phase SCIs - (blank) - ROM - (blank) - Nutrition optimization - (blank) - (blank) - Psychological support

- Turn q2h - Bladder/bowel programs - Spasticity management - PT/OT

# What are interventions for autonomic dysreflexia (injuries T6 up) - (blank) - (blank) - Check bladder first - (blank) - (blank)

- Sit patient upright - Remove tight clothing - Monitor BP q2-5 minutes - Administer antihypertensives

# What are diagnostic tests for SCI - (blank) (gold standard) - (blank) - X-rays - (blank) - Urodynamic studies - PFTs

- MRI of spine - CT scan - ASIA impairment scale

# What patient education is indicated in SCI? - (blank) - (blank) - Bladder/bowel programs - (blank) - (blank) - Fall prevention - (blank) - Sexual health resources - Importance of rehab - Mental health support

- Daily skin checks - Pressure relief techniques - ROM exercises - Signs of autonomic dysreflexia - DVT prevention

# What are potential complications of SCI - (blank) - UTIs - Bowel dysfunction - (blank) - (blank) - Orthostatic hypotension - Chronic pain - (blank) - Depression - (blank) - (blank) - Respiratory failure (cervical)

- Autonomic dysreflexia (T6+) - Pressure injuries - DVT/PE - Pasticity - Osteoporosis - Sepsis

# What are risk factors for sepsis? - (blank) - (blank) - Recent surgery/hospitilization - Older adults/infants - (blank) - Chronic conditions - (blank) - (blank)

- Recent infection - Indwelling devices - Immunocompromised status (steroids, diabetes, cancer, etc.) - Poor nutrition - Open wounds/burns

# What are signs and symptoms of early sepsis? - (blank) - (blank) - (blank) - Warm, flushed skin - (blank) - Hyperglycemia - Decreased urine output

- Fever or hypothermia - Tachycardia - Tachypnea - Altered mental status

# What are s/s of progressive sepsis/septic shock - (blank) - (blank) - Weak pulses - (blank) - Oliguria/anuria - (blank) - (blank)

- Hypotension despite fluids - Cool/clammy skin - Mottling - Confusion/unresponsiveness - Elevated lactate

# What are priority nursing interventions in the first hour of sepsis? - (blank) - (blank) - (blank) - (blank) - Apply oxygen - Continuous monitoring - Foley for strict I&O

- Obtain blood cultures BEFORE antibiotics - Draw lactate - Administer broad spectrum IV antibiotics - Rapid IV crystalloid bolus

# What are secondary nursing interventions for sepsis (after first hours) - (blank) - (blank) - (blank) - Monitor mental status - (blank) - Turn q2h - (blank)

- Frequent vital signs - Maintain MAP >65 - Pressors if hypotension persists - Glucose control - Early enteral nutrition

# What are labs for sepsis? - (blank) - (blank) - CMP - (blank) - Procalcitonin - (blank) - Coagulation panel - Glucose (increased)

- Lactate (increased) - CBC (WBC specifically) - Blood cultures - ABGs (metabolic acidosis)

# What are diagnostic procedures for sepsis? - (blank) - Chest X-ray (pneumonia) - (blank) - Echocardiogram for cardiac involvement

- Blood, urine, sputum cultures - CT/US to identify source

# What patient education is indicated in sepsis (after stabilization) - (blank) - (blank) - Hand hygiene - (blank) - Manage chronic illnesses - Vaccinations

- Complete all antibiotics - Monitor for early infection signs - Proper catheter/wound care

# What are potential complications of sepsis? - (blank) - (blank) - (blank) - DIC - Permanent organ damage - (blank)

- Septic shock - ARDS - AKI - MODS

Module 2 Flashcards

(72 cards)