Page 312 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 297

Prepare the patient for surgery if internal stabilization is needed.
Monitor the patients I & O to detect fluid imbalances.

Insert an indwelling catheter if SCI is in the cervical area to monitor fluid
status.

Anticipate the insertion of a nasogastric tube to prevent paralytic ileus if bowel
sounds are absent.

Monitor the patient for DVT and PE (see Chapter 3 for more information).
Provide emotional support for the patient and family. Rehabilitation is a long
and costly process that requires efforts of a multiple disciplinary team to keep the
patient and family intact mentally, socially, and spiritually.

Cardiac Tamponade

See Chapter 3 (Care of the Patient with Critical Cardiac and Vascular Needs).

Burns

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Burn injuries occur when energy is transferred to the skin from unwanted
heat, chemical, radiation, or electrical current exposure. Exposure destroys
layers of skin leading to tissue destruction and the stimulation of the
inflammatory response. Burns are classified according to cause, location,
body surface area burned, and depth. Location refers to where the burn
occurs in the body. Burns of the head, face and respiratory tree, and geni-
talia are classified as more severe because they can compromise ventilation
and/or can lead to infection. Inhalation of carbon monoxide competes with
oxygen on the hemoglobin molecule, leading to hypoxemia. Inhaling super-
heated material can cause damage to the fragile lining of the respiratory
system, leading to swelling and possibly early airway closure. Sloughing of
necrotic tissue can lead to infection as the protective mechanisms of the
skin are denuded.
Circumferential burns that encompass the entire distance around the extrem-
ity swell and lead to dysfunction and/or diminished blood supply. In the case
of circumferential burns of the chest, swelling may lead to the inability of the
chest muscle to expand during inhalation.
Severity according to body surface area (BSA) is calculated using the Rule
of Nines. See Figure 6–3.