Management & Treatment
Nursing Diagnoses
ABC Priorities
(For more nursing diagnoses, click on the icon below table.)
Nursing Diagnoses
ABC Priorities
(For more nursing diagnoses, click on the icon below table.)
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MEDICATIONS
- To replace volume: IV fluids, blood products, volume expanders – monitor urinary output (should be at least 0.5mL/kg/hr, cardiac index, blood pressure, heart rate, weight)
- To prevent infection: Prophylactic antibiotics – monitor WBC, temperature
- To provide ventilation and decrease metabolic consumption: Sedation for mechanical ventilation (benzodiazepine, etc.) – perform daily sedation vacation to assess level of consciousness and orientation, Glasgow scale
- To increase cardiac output: Vasoactive agents (norepinephrine, dopamine, etc.) – monitor heart rate, blood pressure, cardiac index
- To increase cardiac output/contractility: Positive inotropes (dobutamine, etc.) – monitor heart rate, blood pressure, cardiac index
- To increase cardiac output if not responsive after IVFs and vasopressors: Corticosteroids – monitor hemodynamics (MAP, SVR, HR, CI) and adrenal function
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INTERDISCIPLINARY COLLABORATIVE CARE
- Radiology (X-ray, CT, Arteriography with possible embolization, Ultrasound)
- Respiratory (intubation, mechanical ventilation, monitoring ventilation/oxygenation status)
- Laboratory (diagnostic peritoneal lavage, CBC with differential, liver panel, coagulation, drug/alcohol test, blood type, blood glucose)
- Surgery (control hemorrhaging, laparotomy to correct abdominal compartment syndrome, liver laceration repair)
- Pharmacy (total parenteral nutrition, blood products, medications)
- Physical Therapy (bed/chair transfers, deep breathing, abdominal strengthening post surgery)
- Nutrition (diet recommendations post-discharge)
- Social Work (referrals to community resources - Alcoholics Anonymous)
- Chaplain (trauma, spiritual distress, mental health, substance abuse, low self-esteem)
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SURGICAL OPTIONS
- Initial operation – assess damage, control hemorrhaging
- Resuscitation surgery: Laparotomy to relieve abdominal pressure (abdominal compartment syndrome)
- Definitive repair – repair any injuries, negative pressure wound vac
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PATIENT & FAMILY EDUCATION
- Acknowledge the traumatic experience - altered comfort, body image, and impaired organ function can be overwhelming
- Allow the patient and/or family to take on daily care activities to develop independence
- Do not let personal judgments regarding the patient's accident interfere with care
- Provide space for the patient and family to express their emotions and concerns
- Be a patient advocate and represent patient's wishes among the interdisciplinary team
- Explain all procedures to patient and family
- Talk about prevention - safe driving (sobriety, speed limits, minimizing distractions)
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POST DISCHARGE FOLLOW-UP MANAGEMENT
- Medications - review medication instructions, side effects, drug interactions
- Signs to watch for and report to provider (provide contact information) - infection, poor wound healing, bleeding
- Schedule follow-up appointments with provider, surgeon, physical therapist, nutritionist
- Home health nurse visits
- Demonstrate and teach-back method for dressing changes, drains, IVs, etc.
- Exercise instructions - walking daily is good exercise, no lifting, lots of rest
- Diet instructions - balanced diet, plenty of fluids
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Sources:
Lewis, S.L., Dirksen, S., Heitkemper, M., Bucher, L., Camera, I.M. (2011). Medical-surgical nursing:
Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby, Inc.
Unbound Medicine. (2011). Abdominal Trauma. Retrieved from http://nursing.unboundmedicine.com
/nursingcentral/ub/view/Diseases-and-Disorders/7350/all/Abdominal_Trauma?q=blunt%
20abdominal%20trauma
Wagner, K. D., Johnson, K.L., Hardin-Pierce, M. G. (2010). High-acuity nursing (5th ed.). Saddle
River, NJ: Pearson Education Inc.
Walker, J., & Criddle, L. M. (2003). Pathophysiology and management of abdominal compartment
syndrome. [Review]. Am J Crit Care, 12(4), 367-371; quiz 372-363.
World Society of the Abdominal Compartment Syndrome. (2013). Information for Patients and
Families. Retrieved from http://www.wsacs.org/for-patients.html
Lewis, S.L., Dirksen, S., Heitkemper, M., Bucher, L., Camera, I.M. (2011). Medical-surgical nursing:
Assessment and management of clinical problems (8th ed.). St. Louis, MO: Mosby, Inc.
Unbound Medicine. (2011). Abdominal Trauma. Retrieved from http://nursing.unboundmedicine.com
/nursingcentral/ub/view/Diseases-and-Disorders/7350/all/Abdominal_Trauma?q=blunt%
20abdominal%20trauma
Wagner, K. D., Johnson, K.L., Hardin-Pierce, M. G. (2010). High-acuity nursing (5th ed.). Saddle
River, NJ: Pearson Education Inc.
Walker, J., & Criddle, L. M. (2003). Pathophysiology and management of abdominal compartment
syndrome. [Review]. Am J Crit Care, 12(4), 367-371; quiz 372-363.
World Society of the Abdominal Compartment Syndrome. (2013). Information for Patients and
Families. Retrieved from http://www.wsacs.org/for-patients.html