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Exam (elaborations)

TRAUMA NURSING PROCESS – TNP – TNCC 9TH EDITION LATEST VERSION

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TRAUMA NURSING PROCESS – TNP – TNCC 9TH EDITION
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TRAUMA NURSING PROCESS – TNP – TNCC 9TH EDITION

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When you've finished all of your interventions and reevaluations, what question
should you ask yourself? - ANSWER Is this patient in need of critical care,
surgery, or transfer to another hospital?

What takes place before the patient arrives? 1-3 - First Answer. Set up a trauma
team.

2. Get the trauma room ready.

3. Don PPE


When a patient arrives, what happens before the choice to intubate is made? 4–8


can vary depending on C-ABC - ANSWER 4. Examine for indications of
apparent uncontrollable external bleeding, apnoea or inresponsiveness, and the
necessity to move to C-ABC.

5**. Determine awareness level using AVPU

6. Let the airway open.

7**. Examine the airway's protection and patency.

8**. Evaluate the efficiency of breathing

Assuming the patient was intubated, carry out the TNP. 9-11 - COMMENT
9**. Assess endotracheal tube placement if intubated.

10. Assess the location and securement of the ETT if intubated.

11. Declare that if you are intubated, you must either start mechanical
ventilation or keep up assisted ventilation.

,After the ETT assessments, carry out the TNP. 12–15

Answer 12: Double stars are present in **12, 13, and 15**. Evaluate the flow of
information

13**. Use GCS to evaluate neurologic state

14. Examine students

15**. Take off all clothing AND look for any evident injuries or anomalies.


After assessing neuro status, circulation, and taking off clothing to check for
injuries, proceed with TNP. 16–18 - ANSWER 16. Give warmth

17. Get your weight in kilogrammes and your complete set of vital signs, if you
haven't already.)

18. Encourage family presence


Utilising the LMNOP mnemonic, carry on with the TNP. 19–23 - ANSWER 19.
L-Labs for trauma panels

20. M: Monitor (EKG, take into account cardiac)

21. N: Examine the necessity of NG/OG

22. O: Evaluate end-tidal capnography and O2.

23**. P: Use the proper pain scale to evaluate pain


After LMNOP, or after pain has been evaluated, continue TNP. 24-26 -
ANSWER 24. Non-pharmacological methods for comfort

25. Examine the analgesic medication order.

26. assemble relevant historical data

, Answer for Head-to-Toe 27–43 is 27. Examine and feel the head for any
injuries.

28. Examine and feel for injuries on the face.

29. Examine and feel for injuries on the neck.

-- Show how to take off and put back on a cervical collar for evaluation (if
necessary).

30. Examine and feel for injuries in the chest.

31. Make soft breathing noises.

32. Heart sounds should be audible.

33. Examine the abdomen for wounds.

34. Make noises with your bowels.

35. Check for injuries by palpating the abdomen's four quadrants.

36. Look for injuries on the flanks by palpating them.

37. Examine the pelvis for any wounds.

38. Apply little pressure medially and downward over the iliac crests.

39. Press gently on the pubic symphysis (if the iliac crests are stable).

40. Examine the perineum for any wounds.

41. Think about urine output, or GU.

42. Examine and feel each of the four extremities for any injuries or
neurovascular conditions.

43. Examine and feel the posterior surfaces; DO NOT do so if the patient
appears to be suffering from pelvic or spinal trauma.

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