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PATHOPHYSIOLOGY & ETIOLOGY
Blunt trauma leads to damage and internal bleeding. When intra-abdominal pressure are sustained at 12 mm Hg or higher, the patient is now experiencing IAH. If the problem is not corrected, it can lead to ACS, MODS, and death.
ASSESSMENT
Assessments should be thorough and constant with regular re-evaluation.
History: AMPLE assessment, accident/trauma details
Physical Exam: ABCDE primary survey, detailed secondary survey, special attention to abdominal assessment, WSACS Assessment Algorithm
Consider psychosocial needs during and after treatment.
Blunt trauma leads to damage and internal bleeding. When intra-abdominal pressure are sustained at 12 mm Hg or higher, the patient is now experiencing IAH. If the problem is not corrected, it can lead to ACS, MODS, and death.
ASSESSMENT
Assessments should be thorough and constant with regular re-evaluation.
History: AMPLE assessment, accident/trauma details
Physical Exam: ABCDE primary survey, detailed secondary survey, special attention to abdominal assessment, WSACS Assessment Algorithm
Consider psychosocial needs during and after treatment.
NURSING DIAGNOSES/INTERVENTIONS
Diagnosis 1: Ineffective breathing pattern/Impaired gas exchange/Impaired spontaneous ventilation related to pain from fractured ribs, lung contusions, sedation, high blood alcohol content, and intra-abdominal hypertension
Interventions: Ensure patent airway, administer oxygen via non-rebreather mask, monitor ventilator settings, oxygenation status, and acid/base balance (SpO2, ABGs, lactic acid, pH, base deficit, etc.), provide pain medication
Diagnosis 2: Risk for deficient fluid volume related to blood volume loss (hypovolemic shock)
Interventions: Start two large bore IVs to administer blood products (fresh frozen plasma, red blood cells, platelets, cryoprecipitate), fluids, and medications, assess circulation regularly (HR, BP, capillary refill, skin color and elasticity, level of consciousness, urine output, weight), place arterial line to monitor hemodynamics
Diagnosis 3: Ineffective peripheral, renal, gastrointestinal, and cerebral tissue perfusion related to low cardiac output, decreased blood flow to abdominal organs and kidneys, and decreased cerebral perfusion pressure due to increased intra-abdominal pressure
Interventions: Hemodynamic monitoring (SVR, MAP, CVP, CI, SvO2, ABGs, lactic acid, base deficit), renal function (urinary output, glomerular filtration rate, BUN, creatinine blood and urine test), intracranial pressure monitoring (level of consciousness, cerebral perfusion pressure)
Diagnosis 4: Decreased cardiac output related to decreased blood volume (internal bleeding/hypovolemic shock)
Interventions: Start two large bore IVs to administer blood products (fresh frozen plasma, red blood cells, platelets, cryoprecipitate), fluids, and medications, assess circulation regularly (HR, BP, capillary refill, skin color and elasticity, level of consciousness, urine output, weight), place arterial line to monitor hemodynamics.
DIAGNOSTIC TESTING
Measure urinary bladder pressure via Foley catheter.
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Diagnosis 1: Ineffective breathing pattern/Impaired gas exchange/Impaired spontaneous ventilation related to pain from fractured ribs, lung contusions, sedation, high blood alcohol content, and intra-abdominal hypertension
Interventions: Ensure patent airway, administer oxygen via non-rebreather mask, monitor ventilator settings, oxygenation status, and acid/base balance (SpO2, ABGs, lactic acid, pH, base deficit, etc.), provide pain medication
Diagnosis 2: Risk for deficient fluid volume related to blood volume loss (hypovolemic shock)
Interventions: Start two large bore IVs to administer blood products (fresh frozen plasma, red blood cells, platelets, cryoprecipitate), fluids, and medications, assess circulation regularly (HR, BP, capillary refill, skin color and elasticity, level of consciousness, urine output, weight), place arterial line to monitor hemodynamics
Diagnosis 3: Ineffective peripheral, renal, gastrointestinal, and cerebral tissue perfusion related to low cardiac output, decreased blood flow to abdominal organs and kidneys, and decreased cerebral perfusion pressure due to increased intra-abdominal pressure
Interventions: Hemodynamic monitoring (SVR, MAP, CVP, CI, SvO2, ABGs, lactic acid, base deficit), renal function (urinary output, glomerular filtration rate, BUN, creatinine blood and urine test), intracranial pressure monitoring (level of consciousness, cerebral perfusion pressure)
Diagnosis 4: Decreased cardiac output related to decreased blood volume (internal bleeding/hypovolemic shock)
Interventions: Start two large bore IVs to administer blood products (fresh frozen plasma, red blood cells, platelets, cryoprecipitate), fluids, and medications, assess circulation regularly (HR, BP, capillary refill, skin color and elasticity, level of consciousness, urine output, weight), place arterial line to monitor hemodynamics.
DIAGNOSTIC TESTING
Measure urinary bladder pressure via Foley catheter.
NURSING ROLE IN MANAGEMENT & TREATMENT
CLINICAL PRACTICE GUIDELINES
- Continuous assessment and re-evaluation of patient status.
- Administer medications as needed to maintain hemodynamic parameters.
- Work with PT, OT, Social Work, Providers, and Pharmacy.
- Patient education and discharge teaching.
CLINICAL PRACTICE GUIDELINES
- Ensure that your workplace has decided on a device to measure IAP
- Implement the WSACS Assessment Algorithm to screen all suspected patients for IAH
- Continuing Education resources can be found in the journal Critical Care Nurse
Click below for a printable summary about Blunt Abdominal Trauma & ACS.
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Use this slideshow to test your knowledge about Blunt Abdominal Trauma and ACS.
Click below for the Case Study Questions power point.
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