NR 341 Week 5 Nursing Care: Trauma and Emergency

Student Name

Chamberlain University

NR-341 Complex Adult Health

Prof. Name

Date

Nursing Care for Trauma: Key Considerations

Nursing care for trauma patients requires a detailed and systematic approach to ensure safety, stabilization, and recovery. For example, when a homeless client presents to the emergency department with hypothermia, reflected by a core body temperature of 87ºF (30.5ºC), the nurse must anticipate and assess specific findings. These may include bradypnea, lethargy, absent patellar reflex, dilated pupils, shivering, hypertension, elevated hematocrit levels (55%), Kussmaul respirations, and tachycardia. Each of these findings provides crucial insight into the severity of hypothermia and directs interventions to stabilize the patient.

In addition, submersion injuries are often encountered in emergency nursing practice, particularly among children. These injuries result from hypoxia due to immersion in liquid. Freshwater aspiration causes alveolar fluid absorption and pulmonary edema, whereas saltwater aspiration draws fluid from circulation, impairing oxygen exchange and worsening hypoxia. Both conditions can lead to cerebral injury and edema if not promptly treated. Management focuses on restoring oxygenation, correcting fluid imbalances, supporting vital organ function, and rewarming if hypothermia is present.

Trauma Types and Management

Penetrating trauma is a common emergency scenario and occurs when an object pierces the skin, creating an open wound. Examples include gunshot wounds and stabbings, which can cause severe complications such as intracranial injuries, spinal cord damage, hemorrhage, and organ perforation. The severity of abdominal trauma depends on the organs involved, while extremity injuries can cause long-term disability due to blood loss or fractures.

Nurses must also monitor for indicators of adequate resuscitation, which include:

• Stable hemodynamics and renal output

• Normalized body temperature

• Serum lactate < 2 mmol/L

• Arterial pH between 7.35–7.45

• Hemoglobin > 9 g/dL

• Balanced serum calcium and potassium levels

• Normal coagulation profile

• Effective pain management

These parameters signal that the patient is responding positively to interventions.

Emergency Preparedness and Triage

Emergencies can stem from internal threats (e.g., power failure, structural collapse) or external threats (e.g., biological, chemical, radiologic, or explosive events). During mass casualty incidents (MCI), rapid triage is essential.

The START (Simple Triage and Rapid Treatment) method uses a color-coded system:

For example, a patient not breathing with no radial pulse receives a black tag, while a patient with weak pulse and shallow respirations receives a red tag for immediate care.

When a client arrives immobilized on a backboard with significant leg deformities, key nursing actions include monitoring vital signs (blood pressure, heart rate, respiratory rate, oxygen saturation), removing wet clothing, ordering laboratory tests, and initiating continuous ECG monitoring.

Table of Nursing Care Considerations

Traction and Its Types

Traction is a method used to align bones, decrease pain, and facilitate healing.

1. Skin Traction

   • Applied via boots, splints, or adhesive materials attached to the skin.

   • Mainly short-term, reduces muscle spasms before definitive treatment.

   • Risk: Skin breakdown.

2. Skeletal Traction

   • Involves inserting pins/wires into the bone with weights attached.

   • Provides long-term stability for fractures.

   • Risk: Infection at pin sites.

Compartment Syndrome

What is compartment syndrome?
It is a condition where swelling increases pressure inside a muscle compartment, restricting blood flow and nerve function.

What are the symptoms?

• Severe pain unrelieved by analgesics

• Pulselessness below the injury site

• Pallor, paresthesia, paralysis, poikilothermia

What are the interventions?

• Avoid elevating the extremity above heart level

• Do not apply ice (to prevent vasoconstriction)

• Emergency fasciotomy may be required

• Ongoing monitoring for infection post-surgery

Fat Embolism Syndrome

What is it?
A potentially fatal complication following fractures of long bones, ribs, or pelvis where fat globules enter circulation.

Symptoms (24–48 hours post-injury):

• Respiratory distress, chest pain, dyspnea, tachypnea

• Hypoxemia, cyanosis, anxiety

• Petechial rash (neck, axilla, conjunctiva)

Management:

• Maintain oxygenation

• Prevent hypovolemic shock

• Correct acidosis

• Blood transfusions and vasopressors if needed

• Gentle immobilization of fractures to prevent further fat release

Rhabdomyolysis

Rhabdomyolysis results from skeletal muscle breakdown, releasing myoglobin, which can obstruct renal tubules and cause acute kidney injury (AKI).

Key Signs:

• Dark brown or cola-colored urine

• Elevated creatinine and CK levels

• Symptoms of AKI (oliguria, electrolyte imbalance)

Management includes:

• Aggressive IV fluid hydration

• Monitoring renal function

• Correcting electrolyte disturbances

Types of Burns

Burn injuries differ based on etiology:

Depth and Location of Burns

• Superficial (1st degree): Only epidermis; painful, red, intact sensation.

• Deep partial-thickness (2nd degree): Epidermis + dermis; blisters, painful.

• Full-thickness (3rd/4th degree): All skin layers + nerve endings destroyed; requires grafting.

Location also determines severity—burns on the face, chest, or neck threaten airway, while burns on hands, feet, or joints affect mobility and self-care.

Rule of Nines and Risk Factors

• Rule of Nines: Quick TBSA estimate (e.g., anterior arm = 4.5%).

• Lund-Browder Chart: More accurate, especially in children.

Risk factors delaying recovery:

• Chronic illnesses (heart, lung, renal disease)

• Diabetes or peripheral vascular disease

• Malnutrition

• Associated trauma (fractures, head injuries)

Priorities in Burn Management

The first priority is stopping the burning process and removing the source. Focus is then placed on ABC assessment:

• Airway: Look for soot, singed nasal hairs, voice changes.

• Breathing: Assess for stridor, wheezing, labored breathing.

• Circulation: Monitor pulses, elevate burned limbs.

Phases of Burn Management

1. Emergent Phase (0–72 hours):

   • Address hypovolemic shock, prevent infection, manage pain, begin fluid replacement.

2. Acute Phase (Weeks–Months):

   • Wound healing, infection prevention, surgical grafting as needed.

3. Rehabilitation Phase (Months–Years):

   • Functional recovery, scar management, psychological support, physical/occupational therapy.

Fluid Replacement and Nutritional Support

The Parkland Formula guides fluid resuscitation:

\text{Total Fluid} = 4 \, ml \times \text{TBSA%} \times \text{Body Weight (kg)}

• 50% in first 8 hours

• 50% over next 16 hours

Example: 19 kg child with 38% TBSA burns = 2,888 ml in 24 hours.

Nutritional support is equally essential—burn patients require high-protein, high-calorie diets to support healing and prevent catabolism.

Skin Graft Types and Complications

• Autografts: Patient’s own skin

• Allografts: Donor skin

• Xenografts: From another species (e.g., pig)

• Synthetic grafts: Artificial substitutes

Complications: Infection, hematoma, seroma, graft rejection, delayed healing.

Conclusion

The management of trauma and burn patients demands rapid recognition, timely intervention, and long-term support. Nurses play a pivotal role in stabilizing patients, preventing complications, and guiding rehabilitation. Evidence-based practices such as the START triage method, fluid resuscitation formulas, and early surgical interventions enhance survival and recovery.

References

American Heart Association. (2022). Advanced cardiovascular life support (ACLS) provider manual.

Chamberlain, R. S., & Sarin, E. (2023). Principles of trauma management.

Harris, J. D., & Miller, D. J. (2021). Management of traumatic brain injury. Journal of Neurotrauma, 38(7), 1012–1024.

National Institutes of Health. (2024). Trauma care: A multidisciplinary approach.

NR 341 Week 5 Nursing Care: Trauma and Emergency

World Health Organization. (2023). Emergency preparedness and response.