I.

Clinical Overview

Wounds including injury to soft tissues can vary from minor tears to severe crushing injuries. The primary goal of treatment is to restore the physical integrity and function of the injured tissue while minimizing scarring, preventing infection and preventing further complications. Multiple trauma is caused by a single catastrophic event that causes life threatening injuries to at least two distinct organs or organ system. Morality in patients with multiple trauma is related to the severity of the injuries and number of systems/organs involved. The nurse assumes the responsibility of assessing and monitoring the patient, ensuring airway and ensuring IV access, administering medications and collecting of laboratory specimens. Definition of terms: Wounds Laceration: skin tears with irregular edges and vein bridging. Avulsion: tearing away of tissue from supporting structures. Abrasion: denuded skin. Contusion: blood trapped under the surface of the skin. Hematoma: tumor like mass of blood trapped under the skin.

II.

Risk Factors a. Depressed Areas b. Alcohol Abuse c. Drug Abuse d. House Structure Signs and Symptoms a. Hematoma b. Reddened area c. Headache d. Localized pain e. Mass on the affected area f. Bleeding g. Laceration/Avulsion/Contusion/Abrasion

III.

IV.

Diagnosis and Laboratory Tests Laboratory studies that aid in assessment: Urinalysis to detect hematuria Serial hemoglobin and hematocrit levels to evaluate absence or presence of bleeding White blood cell count to detect elevation (generally associated with trauma) Serum amylase analysis to detect increasing levels which suggest pancreatic injury or perforation of GI tract CT scan permit detailed evaluation Therapeutic Nursing Management The goals of treatment are to determine the extent of injuries and to establish priorities of treatment.

V.

A. Assessment Assessing and monitoring the patient Paralysis of body part Erythema and blistering of the skin Damaged body part appearing swollen, tense and hard

 Collection of laboratory specimen Monitor for bleeding

B. Management Wound is cleansed with normal saline solution. Antibacterial agents such as povidone iodine or hydrogen peroxide should not be allowed to get deep into the wound without thorough rinsing. Patients with soft tissue injury usually have localized pain at the site of injury the nurse then assists with cleaning and debriding of the wound. The nurse should provide wound care to avoid infection and promote wound healing. Intraocular pressure is also suspected when the patient experienced severe injury/trauma.

VI.

Pharmacology

Brand Name
Dexamethasone corticosteroid

Moa
Decreases inflammation, mainly by stabilizing leukocyte lysosomal membranes; suppresses immune response; stimulates bone marrow; and influences protein, fat and carbohydrate metabolism.

Indication
Cerebral edema Allergic and inflammatory conditions

Contraindication

Side effects
CNS: euphoria, insomnia, psychotic behavior, pseudotumor cerebri, vertigo, headache, paresthesia, seizures, depression. CV: hypertension, edema, arrythmias, GI: peptic ulceration, GI irritation, increased appetite, pancreatitis, nausea, vomiting. GU: increase urine glucose, and calcium levels

Nursing Responsibility
Tell patient not to stop drug abruptly or without prescribers consent. Instruct patient to take drug with food or milk. Warn patient about easy bruising. Advise patient to avoid exposure to infections (such as measles and chickenpox) and to notify prescriber if such exposure occurs.

Hypersensitivity Cross-sensitivity with dexamethasone Not recommended for use during pregnancy or lactation.

VII. Complication of the disease Cerebral Edema is one of the complications of injury or multiple traumas. CT scan is done to detect further evaluation. Cerebral edema is the abnormal accumulation of fluid in the intracellular space, extracellular space or both associated with increase intracranial pressure. VIII. Age related Changes/Gerontological Considerations The field of geriatric trauma is still in its infancy. Given the relation between advanced age, associated preexisting medical conditions, and poor physiologic reserve, a poor outcome may be inevitable by the time the geriatric patient presents for medical attention. Greater emphasis should therefore be placed on injury prevention efforts in this patient population. Significant differences exist between older and younger patients in injury patterns, and in the frequency and type of complications. These differences in turn demand prompt diagnostic approaches, aggressive treatment, and unique prevention strategies.

Far Eastern University Institute of Nursing

CASE STUDY
Basco Clarice E. BSN305 Group17B Maam Rosalie Villanueva RN MAN