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NSB236 EXAM WITH VERIFIED ANSWERS AND QUESTIONS
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NSB236 EXAM WITH VERIFIED ANSWERS AND QUESTIONS...
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NSB236 EXAM WITH VERIFIED ANSWERSAND QUESTIONS
Identify the elements of a neurovascular assessment.
The 6P's - Pain, Pallor, Paralysis, Paraesthesia, Pulse & Polar
Pain – a good indicator of injury in pt. is conscious
Pallor – the colour of limbs bilaterally? CRT >2 seconds indicated vascular
compromise
Paralysis - movement of all limbs
Paraesthesia - Change in limb sensation
Pulse - equal and bilateral, check and compare to both sides
Polar - Temperature of limbs compared to others
What is the Munro-Kelly doctrine?
Munro-Kelly Doctrine = The cranial cavity is a closed space, it maintains a
given pressure known as the Intracranial pressure (ICP), it contains three
compressible components; blood, cerebrospinal fluid (CSF) and brain tissue. An
increase in any 1 of these components requires a decrease in one of the other 2
to maintain ICP.
What is CPP & how is it calculated?
Cerebral Perfusion Pressure [estimate of cerebral blood flow], the pressure
required for perfusion to take place across the vessels in the brain.
CPP = MAP - ICP
*Average CPP is 85 mmHg
Cerebral anoxia is possible under 60 mmHg
S&S of ICP
Decreased LOC, Headache, Vomiting, Pupillary abnormalities, Visual
abnormalities, motor dysfunction, speech disturbances & changes in vital signs.
What is Cushing's triad?
Cluster of symptoms which reveal impending brain herniation which occurs
when the cerebellum in forced through the foramen magnum due to increasing
ICP - symptoms are hypertension
bradycardia &
irregular respirations
,What is compartment syndrome?
Compartment syndrome is a serious condition that involves increased pressure
in a muscle compartment. It can lead to muscle and nerve damage and problems
with blood flow.
Decreased Compartment Size (cast & binding)
Increased Compartment Size (bleeding, oedema, burns etc.)
External Pressure (lack of movement for prolonged time)
What is external fixation and what are its associated nursing considerations?
External Fixation is used to quickly stabilize a fracture quickly, it can be
adjusted as healing occurs. Method of choice for pelvic fracture.
Nursing Considerations: Regular wound care of insertion site, pain relief,
pressure injury care, positioning.
What is the assessment criteria for Thoracic Injuries and common injuries?
Assessment: Inspection, palpation, percussion, auscultation, x-ray, ultrasound,
CT scan, MRI.
Common Injuries: Pneumo/Haemo Thorax, rib fractures, sternal fractures,
spinal injuries, Myocardial injury etc.
What is a (Haemo)pneumothorax?
Blood and/or air in the pleural space which prevents the full expansion of the
lung resulting in decreasing functional area for gas exchange.
One way valve - air can get into the pleural space but cannot leave it.
What is the purpose of Intercostal catheters & Underwater sealed Drainage?
ICC & UWSD: Allows air and fluid to escape the pleural space, the water trap
acts as a one way valve.
Nursing Consideration:
1. Swinging (literal swinging of the tube indicates change in thoracic pressure)
2. Bubbling (The escape of air from the pleural space)
3. Draining (fluid draining from the pleural space)
What is the assessment criteria for Intrabdominal trauma and associated issues?
Assessment: Inspection, auscultation, percussion, palpation, x-ray, ultrasound
(FAST scan), CT & MRI.
Associated Injuries: Intrabdominal sepsis, damage to abdominal aorta and
femoral vessels, retroperitoneal hematoma, pelvic fracture and renal injury.
What is fail chest?
, A scenario where multiple ribs sustain multiple fractures and become
independent of the chest wall, floating on top of the lung and pleura. In addition
to being extremely painful, impaired respiration can occur and rib fragments
may puncture the pleura or vessels, causing hemothorax and/or pneumothorax
at any time.
2 or more fractures in 2 or more places
Define a Skull Fracture and list the 3 types.
A skull fracture is a break in the continuity of the skull.
01. Linear
02. Comminuted/depressed
03. Basilar
What are the 5 types of Traumatic Brain Injuries?
Extra Dural Haematoma (blood between Dura & skull)
Sub Dural Haematoma (blood between Drua and Arachnoid Layer)
Sub Arachnoid Layer (Below the arachnoid layer of the brain)
Penetrating Injury (damage to skull, brain tissue and vasculature)
Diffuse Axonal Injury (Shearing of Axons to axonal disconnection)
What are the clinical implications of a base of skull fracture?
When clinically suspected or know - NO NGT
CSF Leak - communication w/ external environment to brain (infection risk)
Clear fluid coming from ear or nose
Can check if CSF is present with a dipstick (+ Glucose - CSF)
Clinical Management of a base of skull fracture?
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