Multiple InjuriesDescription

-
Is a physical injury or wound thats inflicted by an external or violent act; it may be intentional or
unintentional; involve injuries to more than one body area or organ
Etiology
-
Weapons
-
Automobile collision
-
Physical confrontation
-
Falls
-
Unnatural occurrence to the body
*Type of trauma which determines the extent of injury
-
Blunt trauma leaves the body intact
-
Penetrating trauma disrupts the body surface
-
Perforating trauma leaves entrance and exitPathophysiology
-
A physical injury can create tissue damage caused by stressand strain on surrounding tissue which
results to infection, pain ,swelling and potential compartment syndrome or it can be life threatening if it
affects a highly vascular or vital organ

Diagnostics
-
Chest Xray detect rib and sterna fractures, pneumothorax, flailchest, pulmonary contusion and
lacerated or ruptured aorta
-
Angiography studies performed with suspected aorticlaceration or rupture
-
Ct scan, cervical spine Xrays, skull Xrays, Angiogram test for a patient with head trauma
-
ABG analysis to evaluate respiratory status and determineacidotic and alkalotic states
-
CBC to indicate the amount of blood loss
-
Coagulation studies to evaluate clotting ability
-
Serum electrolyte levels to indicate the presence of electrolyte imbalances

Nursing Diagnoses
-
Ineffective Airway Clearance


-
Ineffective Breathing Pattern
-
Impaired Gas Exchange
-
Deficient Fluid Volume
-
Decreased Cardiac Output
-
Impaired Tissue Perfusion
-
Impaired Skin Integrity
-
Risk for infection
-
Anxiety
-
Pain
-
Disturbed Body ImageNursing Management
-
Assess the patients ABCs and initiate emergency measures
-
Administer supplemental oxygen as ordered
-
Immobilize the patients head and neck with an immobilizationdevice, sandbags, backboard and tape
-
Assist with cervical Xrays
-
Monitor VS and note significant changes
-
Immobilize fractures
-
Monitor the patients oxygen saturation and cardiac rhythm for arrhythmias
-
Assess the patients neurologic status, including LOC andpapillary and motor response
-
Obtain blood studies, including type and crossmatch
-
Insert large bore IV catheter and infuse normal saline or lactatedRingers solution
-
Assess the patient for multiple injuries
-
Assess the patients wounds and provide wound care asappropriate; cover open wounds and control
bleeding byapplying pressure and elevating extremities
-
Assess for increased abdominal distention and increased


diameter of extremities
-
Administer blood products as appropriate
-
Monitor the patient for signs of hypovolemic shock
-
Provide pain medication as appropriate
-
Provide reassurance to the patient and his familyPharmacotherapy
-
Tetanus immunization
-
Antibiotics for infection control
-
Analgesics for painClient Education
-
Provide explanations of all procedures done
-
Families usually require emotional support and honestdiscussions about therapeutic interventions and
plans



27
XI. REFERRALS and RECOMMENDATIONHEALTH TEACHINGS
Name of patient:REDMedications

Instructed client as well as the significant others about the indications andmechanisms of actions of
each drug that the doctor ordered so that withouthesitation they will really comply all the medications
given with them.

Adherence to the medication promotes improvement of condition.Exercise

Encouraged frequent changes of position according to his comfort like sitting onbed if his body can
tolerate and by turning to sides to prevent bedsores.

Avoid over strenuous activities

Encouraged passive range of motion to promote proper circulation and preventmuscle
atrophy/complication brought by immobility.

Instructed also the client at home to balance his daily activities especially whendischarged.

Encouraged patient to do deep breathing exercises/ Relaxation TechniqueTreatment

Advised/Emphasized the importance to adhere to treatment regimen. That is tofacilitate faster
improvement of present condition and prevent complication.

Bed rest is important to prevent over fatigability then ambulate with in tolerablelimits

Encouraged to apply lotion such as Johnson lotion and petroleum jelly to his dryand cracked skin to
prevent further skin injury.

Advised to have a regular check up at the nearest health center/health careprovider for check up
monitoring.

Increased fluid intake up to 6-8 glasses a day

28
Outpatient (CHECK-UP)


Instructed the clients family to come back one week after discharged for further
follow-
up and evaluation of the clients health condition. This is very important so
that the health condition of the client will be evaluated if there is betterimprovement. The physician
should see and examine the physical appearance ofthe client.Diet

Taught the importance of eating green leafy vegetables such as alugbati,malunggay, saluyot
because this will prevent constipation especially at this timebecause his peristalsis decreases due to
limited movement

Encouraged low salt intake. The use of salt as a flavoring agent needs to becontrolled because this is
usually the cause of fluid retention.

Encouraged intake of vitamin C, such as home made lemonade and orangesbecause the patient has
post surgical incision that will aid in healing.

Increased intake of protein because this is important for skin integrity.

Increased intake of fruits and vegetables because this can provide vitamins andminerals for
nutrition.The family or the significant others is advised to comeback on the scheduleddate of visit with
the physician together with the referral form given during time ofdischarged on the exact time/date and
place specified for monitoring/rechecking of hiscondition. The family is also encouraged to monitor the
patient and to not allow thepatient to do strenuous activities that would be a cause of further
exacerbation of theinjured area. We encouraged the patient
s family to let the patient eat more fruits and
vegetables as well to have rich in fiber to prevent constipation. And lastly encouragedthe family or the
significant others to have regular visit to the health center or clinic andavoid self-medication or taking
medications out of what is being prescribed.




Motorcycles are becoming more popular as a means of transportation.However, per vehicle-mile traveled, a
motorcyclist is 37 times more likely to die in acrash and 9 times more likely to be injured (NHTSA, 2008f). As the
motorcycleitselfoffers almost no protection, the occupant is subject to severe forces similar tothose experienced
by an ejected automobile or truck occupant. Head injury iscommon, especially in the absence of a helmet. There
may be multiple fractures andlarge, painful abrasions with imbedded debris (road rash).Before looking at
injurypatterns, it is helpful to review some of the physi
cs involved. Newtons First Law of
Motion states that an object in motion will remain in motion until acted on by anotherforce. Thus, a vehicle in
motion will keep moving until something

a tree, anothervehicle, the brakes, or some other force

causes it to slow down, stop, or changedirection. When such a force is applied, people in the vehicle will continue
to move atthe original speed and direction until a force such as the seat belt, the steering wheel,or the windshield
causes them to slow down, stop, or change direction. Even then, theorgans of the body will continue in motion
until slowed or stopped by the bones andother supporting structures within the body.The forces on the vehicle,
the body, and the organs are applied in sequence.This sequence is rapid if the vehicle strikes a fixed object and
much less so during acontrolled stop. If this sequence were to be observed in slow motion, the body and
theorgans would seem to move toward the point of impact. This is important because itprovides clues as to
where to look for injury.Remember that it is not only the change in speed that causes the damage but how
fastthe change occurs. Going from 60 mph to a full stop may do no damage if it happensover a few seconds. But
if the change occurs over a few milliseconds, a much greaterforce is involved, and it can be deadly. Anything that
increases the stopping time willdecrease the forces involved. This is the reason for such safety features as crush
zones
in the vehicles front end, a collapsible steer
ing column, and the stretch in seat belts.