Polytrauma Lesson Plan

8/2/2019 Polytrauma Lesson Plan

1/32

Sr.

no

SPECIFIC

OBJECTIVESDURATION CONTENTS

TEACHING

LEARNING

ACTIVITY

A V

AIDS BLACKBOARDACTIVITY EVALUATION

Introduction

The number of vehicles has grown from a mere306,000 in 1951 to 58,863,000 by 2002 (Ministry of RoadTransport and Highways, Transport Research Wing 200102). An examination of years of potential life lost indicatesthat injuries are the second most common cause of deathafter 5 years of age in India (Mohan and Anderson 2000).As per the report of 2001, 2,710,019 accidental deaths,108,506 suicidal deaths and 44,394 violence-relateddeaths were reported in India. There has been an increasein accidental deaths from 122,221 to 188,003, from 40,245to 78,450 for suicidal deaths and from 22,727 to 39,174 forviolence-related deaths between 1981 and 1991. The

injury mortality rate was 40/100,000 population during2000. The number of deaths due to accidents increased by47% during the period 19902000; 93% were due tounnatural causes and 7% (17,366) due to natural causes.The mortality rate among different age groups was: 8.2%(60 years). Seventythree per cent of total deathsoccurred among men, with a ratio of 3:1 between men andwomen.


2/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


Definition

Trauma

unintentional or intentional damage to the

body resulting from acute exposure to thermal,mechanical, electrical, or chemical energy or from

the absence of such essentials as heat or oxygen.

Unintentional injuries are the leading causes

of death in people between the ages of 1 and 34

years. In the 35- to 44-year age bracket,

unintentional injury is second only to cancer as a

leading cause of death.

Traumatology is the branch of surgery which

deals with trauma patients and their injuries

Polytrauma

Physical injuries or insults occurring simultaneously

in several parts of body

Crush Injuries

Crush injuries occur when a person is caught betweenobjects, run over by a moving vehicle, or compressed bymachinery.
http://www.medterms.com/script/main/art.asp?articlekey=8184http://www.medterms.com/script/main/art.asp?articlekey=5603http://www.medterms.com/script/main/art.asp?articlekey=5603http://www.medterms.com/script/main/art.asp?articlekey=8184


3/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


Mechanism of injury

The mechanism of injurymay indicate the

need for additional diagnostic workupand

reassessment. The mechanism of injury is related tothe type of injuring force and the subsequent tissue

response. Injury occurs when the force deforms

tissues beyond their failure limits. Wounds vary

depending on the injuring agent. The effect of injury

also depends on personal and environmental

factors, such as the persons age and sex, the

presence or absence of underlying disease process,

and the geographic region. Force may or may not be

penetrating. The injury delivered from force depends

on the energy delivered and the area of contact. In

penetrating injury, the concentration of force is to a

small area. In blunt or nonpenetrating injury, the

energy is distributed over a large area. The

predominant feature affecting the impact is speed,

or acceleration:

FORCE = MASS X ACCELERATION


4/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


Types of trauma

1. Blunt Injury

Mechanisms of blunt injury include MVCs,

falls, assaults, and contact sports. Multiple injuriesare common with blunt trauma, and these injuries

are often more life-threatening than penetrating

injuries because the extent of the injury is less

obvious and the diagnosis can be more difficult.

Blunt injury is caused by a combination of forces.

These forces include acceleration, deceleration,

shearing, crushing, and compressive resistance:

Accelerationis an increase in the velocity (or

speed) of a moving object.

Deceleration, on the other hand, is a decrease

in the velocity of a moving object.

Shearingoccurs across a plane when structures

slip relative to each other.

Crushingoccurs when continuous pressure is

applied to a body part.

Compressiveresistanceis the ability of an

object or structure to resist squeezing forces or

inward pressure.

In blunt trauma it is the direct impact that

causes the greatest injury. Injury occurs when there

is direct contact between the body surface and the

injuring agent. Indirect forces are transmitted

internally with dissipation of energy to the internal

structure. The extent of injury from an indirect force

depends on transference of energy from an object to


5/32

the body. Injury occurs as a result of energy

released and the tendency for the tissues to be

displaced on impact.3 Accelerationdeceleration

injuries are the most common causes of blunt

trauma.

2. Penetrating Injury

Penetrating trauma refers to an injury

produced by foreign objects penetrating the tissue.

The severity of the injury is related to the structures

damaged. The mechanism of injury is caused by the

energy created and dissipated by the penetrating

object into the surrounding areas.3 The amount of

tissue damaged by a bullet is determined by the

amount of energy that transfers into the tissue along

with the amount of time it takes for the transfer tooccur. The surface area over which the transfer is

distributed also contributes to tissue damage.

Velocity determines the extent of cavitation and

tissue damage. Low-velocity missiles localize the

injury to a small radius from the center of the tract

and have little disruptive effect. They cause little

cavitation and blast effect, essentially only pushing

the tissue aside. It is important to obtain a brief

description of the mechanism of gunshot injuries,including the weapon, the ammunition, and

ballistics. This essential information is used to guide

the assessment of patients who sustain injuries from

these weapons. All trauma patients must be

undressed and inspected for entrance and exit

wounds during the assessment process.


6/32

3. Stab Wounds and Impalements

A stab wound or impalement is a low-velocity

injury. The main injury determinants are length,

width, and trajectory of the penetrating object and

the presence of vital organs in the area of the

wound. Although the injuries tend to be localized,

deep organs and multiple body cavities can be

penetrated.

4. Surface trauma

Surface trauma includes any injury that does

not break the skin (closed wound) and any open

wound in which the skin surface is broken. Types of

closed wounds include contusions (bruising) and

hematomas (collection of blood under the skin).

Types of open wounds include abrasions,lacerations, avulsions, amputations, and

punctures.

Abrasions are a scratching of the epidermal

and dermal layers of the skin. They bleed very little

but can be extremely painful because of inflamed

nerve endings..

Puncture wounds result from sharp, narrow

objects such as knives, nails, or high-velocity

bullets. They can often be deceptive because theentrance wound may be small with little or no

bleeding. It is difficult to estimate the extent of

damage to underlying organs as a result. Puncture

wounds usually do not bleed profusely unless they

are located in the chest or abdomen.

Lacerations are open wounds resulting from

snagging or tearing of tissue. Skin tissue may be


7/32


8/32

5. Head Trauma

Sharp blows to the head can cause shifting of

intracranial contents and lead to brain tissue

contusion. The pathophysiology of head trauma can

be divided into two phases. The first phase is the

initial injury that occurs at the time of the accident

and cannot be reversed. The second phase involvesintracerebral bleeding and edema from the initial

injury, which causes increased intracranial pressure

(ICP). Management of head trauma is directed at

the second phase and involves decreasing ICP.

Early and late Signs and Symptoms of Increased

Intracranial Pressure.

Early Signs and Symptoms of Increased ICP

Headache

Nausea and vomiting Amnesia

Altered level of consciousness

Changes in speech

Drowsiness

Late Signs and Symptoms of Increased ICP

Dilated nonreactive pupils

Unresponsiveness

Abnormal posturing Widening pulse pressure

Decreased pulse rate

Changes in respiratory pattern


9/32

6. Chest trauma

Chest trauma can damage the heart and

lungs and cause life threatening injuries, including

pericardial tamponade, hemothorax, tension

pneumothorax, and flail chest. Potentially life-

threatening injuries include pulmonary and

myocardial contusion, aortic and tracheobronchialdisruption, and diaphragmatic rupture. Chest trauma

can result in laceration of lung tissue and cause a

change in the negative intrapleural pressure. Air or

blood leaking into the intrapleural space collapses

the lung, resulting in a pneumothorax (air) or

hemothorax (blood) and ineffective ventilation. In a

tension pneumothorax, air is trapped in the pleural

space during exhalation, resulting in increased

pressure on the unaffected lung. The heart, greatvessels, and trachea shift toward the unaffected side

of the chest. As a result, blood flow to and from the

heart is greatly reduced, causing a decrease in

cardiac output. An uncorrected tension

pneumothorax is fatal.

Chest trauma can also injure the heart and

great vessels and reduce the amount of circulating

blood volume. The heart may be bruised

(myocardial contusion) or may sustain direct trauma.

Cardiac tamponade occurs when blood

accumulates in the pericardial sac and increases

pressure around the heart. The increased pericardial

pressure prevents the heart chambers from filling

and contracting effectively. A patient with cardiac

tamponade exhibits hypotension, tachycardia, and

neck vein distention and requires immediate


10/32

intervention to reduce the pressure in the pericardial

sac and restore normal filling and contraction of the

heart chambers.

7. Abdominal Trauma

The organs of the abdomen are vulnerable to

injury because there is limited bony protection. Injuryto organs such as the spleen and liver, which have a

rich blood supply, can result in rapid loss of blood

volume and hypovolemic shock. Abdominal

organs may be injured as a result of severe blunt or

penetrating trauma. If hypotension is present,

intraabdominal hemorrhage may exist. If the urinary

bladder ruptures, urine leaks into the abdomen and

blood may be detected at the urinary meatus or

perineum. Penetrating trauma can cause lacerationsto abdominal organs, resulting in rapid blood loss

and hypovolemic shock.

8. Musculoskeletal Trauma

Fractured bones can result in blood loss,

compromised circulation, infection, and immobility.

Unstable pelvic fractures can cause injury to the

genitourinary system or disrupt the veins in the

pelvis. Fractures of large bones such as the femur

and tibia can cause significant blood loss. For

example, a fractured femur can cause up to 1500

mL of blood loss and a fractured tibia or humerus

can cause up to 750 mL of blood loss. Joint

dislocations can cause neurovascular compromise

by applying pressure to the nerves and blood

vessels.


11/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


PATHOPHYSIOLOGY


12/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


Complications

1. COMPARTMENT SYNDROMECompartment syndrome occurs when

the pressure withinthe fascia-enclosed

muscle compartment is increased, causing

blood flow to the muscles and nerves in the

compartment to become compromised,

thereby resulting in tissue ischemia.37 This

ischemia then leads to tissue damage, which

compromises nerve and muscle function. A

prolonged elevation of compartmental

pressure leads to death of the muscles and

nerves involved. Intracompartmental

pressures that exceed 30 to 40 mm Hg cancause muscle ischemia, and pressures

greater than 55 to 65 mmHg cause

irreversible muscle death.

2. DEEP VENOUS THROMBOSISDVT is a significant risk for all trauma

patients, especiallythose with

musculoskeletal injuries. It is known as a

common, life threatening complication of

major Trauma. The danger of DVT is that it

may progress to pulmonary embolus. The

administration of low-dose heparin or low

molecular-weight heparin and the use of

intermittent pneumatic compression devices

are recommended to prevent DVT.

The pathophysiology of DVT, and later


13/32

pulmonary embolus, is related to Virchows

triad:

Venous stasis from decreased

blood flow, decreased muscular

activity, and external pressure

on the deep veins.

Vascular damage orconcomitant pathological state

Hypercoagulability

3. FAT EMBOLISM SYNDROMEFat emboli are fat globules in the lung tissue and

peripheralcirculation after a long bone fracture or major

trauma. Fat emboli may or may not cause systemic

symptoms. Fat embolism syndrome is a serious (but rare)

manifestation of fat emboli that involves progressive

respiratory insufficiency, thrombocytopenia, and adecrease in mental status. It usually occurs within 72 hours

of injury. Clinical indications of this syndrome include

tachypnea, dyspnea, cyanosis, tachycardia, and fever.

Nurses should be aware of the potential for fat embolism

syndrome to develop and monitor the patient for

hypoxemia with pulse oximetry. The patients neurological

status is also monitored for signs of a decreasing mental

status

4. Shock5. Haemmorrhage6. Stroke7. Disseminated intravascular coagualopathy


14/32


15/32


16/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


Management

1. Pre-hospital Management

The trauma patient has a greater chance of a

positive outcomeif definitive care is initiated within 1

hour of injury.Care begins in the prehospital arena

and is continued throughout the hospital stay. There

are currently two theories about prehospital

management of patients, the stay and play theory

and the scoop and run theory.5 Proponents of the

stay and play theory believe that time in the field

can be well spent stabilizing the patients physiologic

status, whereas proponents of the scoop and run

theory believe that only life-threatening issues

should be addressed in the field. Several studiesdemonstrated that the time taken to establish

intravenous access was longer than the transport

time to definitive care. This prolongation of transport

was associated with an increase in patient mortality.

Therefore, it was suggested that each emergency

medical system (EMS) evaluate its approach to

prehospital management, taking into account the

transport time to definitive care. For example, in an

urban area, the scoop and run theory may beappropriate because transport time to a definitive

care setting is very short. In a rural area, however,

the extra minutes that it may take to stabilize the

patient may have a positive impact on the overall

outcome because of the long transport time. The

advanced trauma life support (ATLS) guidelines


17/32

state that the emphasis for assessment and

management in the prehospital phase should be

placed on maintaining the airway, ensuring

adequate ventilation, controlling external bleeding

and preventing shock, maintaining spine

immobilization, and transporting the patient

immediately to the closest appropriate facility. Theprehospital priority of maintaining adequate airway,

breathing, and circulation (ABCs) may be difficult to

attain owing to the mechanism of injury. It is

imperative that cervical spine immobilization be

maintained at all times during airway management

and transport to definitive care. After assessing and

managing the ABCs, the trauma patients

neurological status is assessed, including level of

consciousness and pupil size and reaction. Oncethis primary assessment is complete, a secondary

assessment is done to determine any other injuries.

The prehospital providers must consider the

facility that will receive the patient. Transporting the

patient to a level I facility allows definitive care to be

initiated earlier in the process, thereby reducing

patient mortality. Transport of the patient to a lesser

facility for stabilization, followed by transport to the

definitive care setting later on, is associated with

higher patient mortality rates.

2. In-Hospital Management

In-hospital patient management entails a rapid

primaryevaluation and resuscitation of vital

functions, a moredetailed secondary survey, and

initiation of definitive care. According to the ACS,


18/32

adhering to this sequence allows for the efficient

identification of life-threatening conditions.

PRIMARY SURVEY

During the primary survey, each priority of care is

dealtwith in order. The patients assessment does

not continue to the next phase until each precedingpriority is effectively managed. For example, if a

patient does not have a patent airway, breathing and

ventilation cannot be established. Therefore, it is

during this initial phase that life-threatening injuries

are identified and managed. So, if the patient does

not have a patent airway, endotracheal intubation,

chest tube insertion, and central line access may be

initiated and intravenous fluid and blood products

may be administered to maintain life-sustaining vitalsigns before moving on to the next phase of the

evaluation.

Assessing the patient for evidence of hypovolemia is

essential. Blood loss can result from an external

injury, associated with obvious bleeding, or from an

internal injury, where bleeding may not be obvious.

Any of these injuries can lead to inadequate tissue

perfusion, which equals traumatic shock. It is

necessary to first stop the bleeding with

compression or surgery and then replace the lost

intravascular volume. Some signs of hypovolemia

include pallor, poor skin integrity, diaphoresis,

tachycardia, and hypotension. Usually, trauma

patients arrive at the trauma center with a large-bore

intravenous line already in place, with intravenous

fluid running in rapidly.


19/32

During the resuscitation period, an

electrocardiogram (ECG) is done. The patient is

placed on a monitor with pulse-oximetry and end-

tidal carbon dioxide monitoring. A Foley catheter

and a nasogastric or orogastric tube are placed, and

bloodwork is sent to the laboratory for evaluation.

Bloodwork analysis includes evaluation ofelectrolytes, hemoglobin and hematocrit, blood type

and crossmatch, and arterial blood gases (ABGs), if

the patient is expected to have a high level of injury.

The patient is also assessed for hypothermia. The

trauma patient is often subjected to environmental

factors, which, along with his or her altered

physiological state and possible wet clothing,

predispose the patient to hypothermia. Measurestaken by health care professionals, such as the

infusion of room-temperature intravenous fluids or

exposure of the patients body to inspect for injuries,

can exacerbate hypothermia. Warm fluids and

blankets are used whenever possible to increase

body temperature or maintain normothermia.


20/32

SECONDARY SURVEY

Once the primary survey is completed, a moredetailed secondarysurvey is initiated. This survey

begins at the headand works down to the patients

feet. Nonlife-threatening injuries are revealed

during this survey. During this time,a plan is

developed and the appropriate diagnostic tests (e.g.,

x-rays, ultrasound studies, computed tomography

[CT] scans, angiographic studies) are ordered for

the patient. This is also the time when a more

detailed patient history can be obtained, as well asimportant information regarding the mechanism of

injury. The nurse asks the field providers for

information regarding the incident because the

patient may not be able to speak or may not

remember the event. Family and friends might be

helpful in providing additional information about the

patient.

1. FLUID RESUSCITATION

Most trauma patients have a fluid volume deficit

that must be corrected. The goals of fluid

resuscitation are to maintain physiological

support of circulation and oxygen transport while

avoiding physiological and hemostatic

deficiencies. It is essential to have adequate

intravascular volume and oxygen-carrying


21/32

capacity to transport needed nutrients to the

tissues. To guide fluid resuscitation, the nurse

uses the patients physical assessment and

hemodynamic parameters.

Crystalloids

Typically, crystalloids are used in the trauma

patient.Crystalloids contain water and otherelectrolytes that arepremixed into the fluid.

These electrolytes may include sodium,

potassium, and chloride. Crystalloids can be

further broken down by their tonicity. The tonicity

is based on the amount of sodium in the solution.

Crystalloids can be classified as isotonic,

hypotonic, and hypertonic.

Hypertonic saline has been shown to enable a

more rapid restoration of cardiac function with a

smaller volume of fluid. It is supplied either in a

3%, 7.5%, or 23.4% sodium chloride (NaCl)

solution. As little as 4 mL/kg, if given rapidly, may

have the same hemodynamic effect as several

liters of isotonic crystalloid. Hypertonic saline has

the effect of shifting water into the plasma. This

water comes from the red blood cells, interstitial

space, and tissue. The result is a rapid increase

in blood volume, which supports and improves

hemodynamics. Hypertonic saline increases the

mean arterial pressure and cardiac output, which

then leads to peripheral vasodilation. The

peripheral vasodilation allows for an increase in

total splanchnic, renal, coronary, and mesenteric

blood flow. The initial management of trauma

patients often requires the rapid infusion of 2 L of


22/32

isotonic crystalloid as rapidly as possible, while

trying to obtain a normal heart rate and blood

pressure. However, research has shown that the

infusion of crystalloids in patients with

hypotension can cause more harm by displacing

a hemostatic clot, only to cause more bleeding.

The infusion of crystalloid also further dilutes thepatients hemoglobin and can increase

intraperitoneal blood loss.

Colloids

Colloids can also be given to resuscitate a

trauma patient.Colloids, such as albumin,

dextran, and hetastarch, createoncotic pressure,

which encourages fluid retention andmovement

of fluid into the intravascular space. Proponents

for colloid use have argued that less volume of

fluid is necessary to achieve hemodynamic

stability and the fluid is retained in the

intravascular space longer. Despite possible

advantages, there is no clear evidence that

colloids are superior to crystalloids for

resuscitation of the trauma patient. Potential

complications, such as anaphylaxis and

coagulopathy, have been reported with certain

colloids. These potential adverse affects,

together with higher costs, make colloid use less

desirable than crystalloid use for resuscitation of

trauma patients

Blood Products

Blood products are considered an excellent


23/32

resuscitation fluid. Red blood cells increase

oxygen-carrying capacity and allow for volume

expansion. Blood also stays in the intravascular

space for longer periods of time compared with

the other resuscitation fluids. Although there is

some concern about bloodborne pathogens and

transfusion reactions, it is essential tounderstand the advantages offered by blood

transfusion.

Blood should be transfused when patients are

hemo-dynamically unstable or are showing signs

of tissue hypoxia despite crystalloid infusion.

Cross-matched blood is preferred but is not

always possible if emergent transfusion prohibits

type and crossmatching of the patients blood. O-

negative blood is the preferred type of

uncrossmatched blood, especially in women of

childbearing age. O-positive blood may be used

in male and postmenopausal female patients. If

the patient requires large amounts of blood,

transfusion of fresh frozen plasma and platelets

is initiated. It is important to replace coagulation

factors and platelets not contained in blood. In

the event of massive blood transfusions, the risk

of acute respiratory distress syndrome (ARDS)

and disseminated intravascular coagulation(DIC) is heightened. An extended period of

hypotension increases the possibility of renal

failure.

Autotransfusion is another common modality

used in the hemorrhaging trauma patient.

Obviously, the nature of trauma prevents


24/32

patients from donating their own blood, as they

could in an elective surgery. However,

sometimes blood is salvaged from wounds,

drains, and body cavities. Most often blood is

saved from a chest tube underwater seal device.

A cell saver is connected into the system and the

blood from the wound collects there. Once full,the cell saver is disconnected from the

underwater seal device and this blood is then

transfused into the patient using a

macroaggregate filter.

Blood Substitutes

Blood substitutes have been developed but have

not been approved for use in all countries. These

agents do not require crossmatching and do not

carry the risk of bloodborne pathogen

transmission. Blood substitutes have a long shelf

life and are not immunosuppressive. They also

have a lower viscosity then blood, which

promotes flow and peripheral oxygen delivery.


25/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


NURSING MANAGEMENT

1. Ineffective tissue perfusion: cerebral, related to

cerebral edema

EXPECTED OUTCOME: The patient maintains

adequate cerebral homeostasis without cerebral

edema as evidenced by a GCS of 14 or greater.

Give oxygen as ordered to maintain adequate

oxygenation of brain tissues and prevent

cellular damage from hypoxia at the cerebral

level.

If the patient has an altered level of

consciousness or deteriorating respiratory

effort, anticipate and assist with endotrachealintubation as needed to provide respiratory

support to patient.

Elevate the head of the patients bed 15 to 30

degrees, if possible, to reduce ICP.

Maintain the patients head position at midline

to ensure unobstructed venousdrainage to

help reduce ICP.

Maintain intravenous access for fluids to

maintain hemodynamic stability and accessfor medications.

Monitor mannitol IV, an osmotic diuretic, as

ordered to decrease cerebral edema.

If the patient is agitated, calm the patient as

agitation increases ICP.


26/32

2. Ineffective breathing pattern related to neck

injury or unstable chest wall segment or lung

collapse

EXPECTED OUTCOME: The patient maintains

effective respiratory rate and experiences improved

gas exchange in the lungs.

If the cervical spinal cord has beentraumatized, the effectiveness of breathing

may be altered. If signs of respiratory distress

are present, use the jaw thrust or chin lift

maneuver, along with suction and airway

adjuncts as needed to maintain patency of

the airway.

Maintain cervical collar and backboard to

prevent further injury.

Give oxygen as ordered to improve tissueoxygenation. Advanced adjunct airway

equipment, including an endotracheal tube,

must be readily available.

Administer supplemental oxygen as ordered

to promote tissue oxygenation.

Maintain chest tube drainage system if

inserted to help expand lung.

3. Ineffective airway clearance related to neck

injury

EXPECTED OUTCOME: The patient will maintain

clear lung sounds.

Suction the oropharynx and nasopharynx to

clear secretions and prevent aspiration of

secretions into the airway.


27/32

If the patient vomits, log roll the patient onto

side to prevent aspiration of emesis. Use

suction as needed.

4. Impaired physical mobility related to neck injury

EXPECTED OUTCOME: Patient will maintain

normal movement of extremities for patient. Maintain neck immobility during initial

treatment of a patient with head or neck

trauma to prevent serious injury until trauma

damage is identified.

5. Decreased cardiac output related to

compression of heart and great vessels

EXPECTED OUTCOME: The patient will maintain

vital signs within baseline limits.

Report unstable vital signs to physician as

patient may need immediate surgical

intervention in the operating room.

Explain diagnostic testing to patients with

stable vital signs if radiographic studies are

ordered to determine the extent of cardiac or

pulmonary injury.

Monitor patients vital signs and oxygen

saturation continuously to detect signs of

shock.

6. Deficient fluid volume related to hemorrhage or

abdominal organ injury

EXPECTED OUTCOME: Patient will maintain vital

signs within baseline limits.


28/32

Monitor for signs of shock to detect

hypovolemic shock.

Maintain IV fluids as ordered per 18- or 16-

gauge IV cannulas to restore circulating

volume.

Assist with peritoneal lavage if performed to

detect intra-abdominal hemorrhage. Maintain nasogastric tube if ordered to

decompress the stomach.

Cover abdominal wounds with a sterile

dressing to prevent infection.

If abdominal organs are exposed, cover with

sterile saline-soaked dressings to prevent

tissue necrosis.

Assist with blood and blood products

administration as ordered per agency policyto maintain circulating volume and improve

tissue oxygenation.

7. Impaired physical mobility related to bone injury

EXPECTED OUTCOME: Patient will maintain

movement of extremities normal for patient.

Remove all jewelry before applying a splint as

the extremity may swell after injury.

Maintain extremity in splint in the position

found unless the distal circulation is severely

compromised and keep immobilized if there is

severe pain or deformity. Splinting promotes

comfort and prevents further damage to

surrounding tissue by preventing movement

of broken bone ends.


29/32

Immobilize the joints above and below the

affected area using a folded towel or a pillow

until the patient is evaluated by a physician.

Monitor skin color, temperature, distal pulses,

capillary refill, movement, and sensation of

the extremity after splint application to detect

abnormalities.

8. Acute pain related to tissue trauma

EXPECTED OUTCOME: The patient will experience

relief after measures are provided to relieve pain as

evidenced by verbal and nonverbal expressions of

pain relief.

Apply ice, elevate, and immobilize the

affected area to decrease swelling andrelieve pain.

Provide analgesics as ordered to relieve pain.

9. Impaired skin integrity related to trauma

EXPECTED OUTCOME: The patient will

demonstrate healing of impaired tissue.

Apply direct pressure to open wounds to

control bleeding.

Irrigate open wounds with sterile salinesolution to thoroughly remove dirt and debris

and clean exposed tissue to prevent infection.

10. Risk for infection related to tissue trauma

EXPECTED OUTCOME: The patients wounds will

remain free of infection.


30/32

With open wounds, give tetanus

immunization as ordered if it has been more

than 5 years since one was last given to

prevent infection.

Give antibiotics as ordered to prevent

infection.


31/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


SummaryTill now we have seen about the definition, types,

mechanism of injury, pathophysiology of trauma, diagnosticevaluation and medical and nursing management of patientwith polytrauma.

ConclusionA stitch in time saves nine, and it is better to be

prepared rather than unknown. Trauma can be controlled

but not all, controllable can be prevented by appropriate

human behavior. During trauma help should be implanted

as soon as possible to avoid further casualities.

Assignment

solve the 10 multiple choice questions, 10 marks


32/32

Sr.

no

SPECIFIC


TEACHING

LEARNING

ACTIVITY

A V


BIBLIOGRAPHY:-

1. Lewis, Heitkemper & Dirksen (2000) Medical Surgical

Nursing Assessment and Management of Clinical

Problem (7th

ed) Mosby, pg no. 2552-66.

2. Black J.M. Hawk, J.H. (2005) Medical Surgical

Nursing Clinical Management for Positive Outcomes.

(7th ed) Elsevier, pg no. 2441-54.

3. Brunner S. B., Suddarth D.S. The Lippincott Manualof Nursing practice J.B.Lippincott. Philadelphia, pgno. 32051-59

4. Understanding medical surgical nursing, F A Davis 6thedition, elsieiver publication pg. no. 210-224.

5. www.trauma..org/systemtrauma.html
http://www.trauma..org/systemhttp://www.trauma..org/systemhttp://www.trauma..org/system

Polytrauma Lesson Plan

Documents

Transcript of Polytrauma Lesson Plan