Page 320 - Critical Care Nursing Demystified

Chapter 6 CARE OF THE TRAUMATIZED PATIENT 305

Insert and monitor NGT drainage to determine ruptured stomach or lower
abdominal trauma.
Monitor indwelling urinary catheter to determine if injury to kidneys.

NURSING ALERT

A patient with an acute abdomen with peritonitis can present with abdominal
guarding, pain, rigidity, and Cullen’s sign. Prepare for emergency exploratory ab-
dominal surgery to determine the cause.

CASE STUDY 1

Roy Scott is on his way to your hospital with hypovolemic shock secondary to
blood loss from an MVC. Roy has the following vital signs: pulse – 120, respirations
– 28, and BP – 100/60. His GCS is 14; he is awake and oriented. An estimated
Estimated Blood Loss (EBL) at the scene of 1 L was determined from a deep lacera-
tion in his right forearm. The prehospital care providers are instructed to start
infusing Roy with LR via two large-bore peripheral IVs until he can be transported Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
to the ECU. What is the preferred solution to start in this instance? Using the 3:1
rule, how much solution should this patient receive on his way to your Trauma I
facility? How would you measure successful fluid resuscitation? What are the pos-
sible complications a nurse should monitor this patient for?

CASE STUDY 2

Prioritize nursing diagnoses for this patient with a traumatic injury.
E.B., age 21, was admitted to the ECU after sustaining a contact sports injury
while playing college football as a quarterback in the final game of the school year.
According to the EMS, the MOI was a hyperflexion injury from being tackled by six
other players. E.B. was unconscious at the scene; his head and neck were stabilized
immediately; C-spine collar was applied in the field and E.B. was transported to the
hospital via helicopter.
In the emergency room E.B. begins to groggily regain consciousness and cannot
recall the previous circumstances leading to his arrival at the hospital. He asks,
“How many minutes are left in the game?” His vital signs are as follows: T – 99.0,
P – 108, R – 24, BP – 138/62. C-spine x-rays reveal he has a partial high cervical
fracture of C-5. CAT scan, blood work, EEG, and urinalysis were all within normal
limits. He is able to slowly respond to all commands. E.B. is diagnosed as having a
“moderate concussion, C-5 partial fracture, and a dislocated left shoulder.”