A patient is brought to the emergency department with a ...

[Davideckstein7]

A patient is brought to the emergency department with a penetrating wound to the neck. The patient is dyspneic and cyanotic and has evidence of subcutaneous emphysema. What does the nurse expect the physician to do initially?
 
  1. intubate the patient because of the severe wound
  2. notify the next of kin regarding the patient's condition
  3. order x-rays of the lumbar area to assess for fractures
  4. administer a beta blocker to alleviate the sympathetic response

Question 2

A patient is admitted to the hospital with injuries from a motor vehicle crash. During the nurse's initial assessment, the patient develops hypotension and severe jugular distension with a tracheal deviation.
 
  What should the nurse suspect is occurring in this patient?
 
  1. tension pneumothorax
  2. hemorrhage
  3. compensatory shock
  4. hypovolemic shock

[kiamars2010]

Answer to Question 1

Correct Answer: 1

Penetrating trauma to the neck is associated with a high degree of morbidity and mortality. Airway involvement includes dyspnea, cyanosis, subcutaneous emphysema, hoarseness, or air bubbling from the wound. The key is early identification of the need for intubation before the patient has no airway at all. The physician will most likely do or prescribe the other options; however, the most important is to maintain the airway.

Answer to Question 2

Correct Answer: 1

A tension pneumothorax is life-threatening and requires immediate intervention. On inspiration, air enters the pleural space, does not escape on expiration, and increases the intrapleural pressure. This pressure collapses the injured lung and shifts the mediastinal contents, compressing the heart, great vessels, trachea, and eventually the uninjured lung. The patient would not have jugular vein distention with a hemorrhage, compensatory shock, or hypovolemic shock.

[Davideckstein7]

Excellent

[lindahyatt42]

TYSM