Question 1

Physical patterns observed in child abuse include

Accepted Answer

Often children who are victims of child abuse are identified as such by teachers, daycare providers, or health care providers. The injuries to the child encompass many forms, including bruises, fractures, burns, bites, and welts. The injuries can even be fatal (see Figure 15-29).
Bruising can exhibit many telltale appearances, such as finger marks, which wrap around the child's limb and may show evidence of rings worn by the perpetrator; imprints of electrical cords or hangers; and horizontal wraparound marks left by belts or straps, and possibly buckle marks. These bruises appear on soft tissue and not over bony prominences where normal falls would have caused them to be. The bruising is often seen in areas normally covered by clothing and the bruises are in various stages of healing.
Burns from cigarettes appear as small circles (the diameter of a cigarette), often on hands, feet, buttocks, or genitals. These are at various stages of healing. Another form of burn is the scald burn with the pattern of "dipping," straight lines with no splash marks, a result of the child's being held in scalding water (see Figure 15-30, A and B).
Other observable injuries include teeth marks, with bruising caused by human bites, and raised areas or welts caused by spankings with sticks, paddles, or belts on the buttocks or legs. A fracture, usually greenstick in nature, of a long bone may be noted.
Often the child is withdrawn, avoids eye contact, and does not respond appropriately to painful stimuli. When asked how the injury happened, the child denies any abuse and protects the abuser. In other cases, the child exhibits unusually aggressive behavior and has a neglected appearance.
Neglect is often also considered to be a form of child abuse. When children are not provided with food or shelter, the caretaker is considered to be neglectful. Leaving young children unattended, thus endangering their well-being is also a form of neglect. Child abuse or neglect is a reportable crime in all states, and the health care giver caring for the child victim can be found liable if the case is not reported to the appropriate agency.
Physical, psychological, or sexual injury to a child is considered child abuse. The most commonly observed form is physical abuse because the resulting injuries are usually apparent. Signs of psychological abuse may be evidenced in the actions of the child. Sexual abuse may be discovered collaterally when complaints by the child of discomfort in the genital region are investigated or the child reports the abuse.

Question 2

Complications of survivors of lightning strikes include

Accepted Answer

Prognosis varies according to the extent of the insult. When respiratory efforts are maintained, survival may be possible. Cardiac dysrhythmias are a potential lethal complication of lighting injuries. Prompt institution of cardiopulmonary resuscitation (CPR) when respiratory efforts are found absent may also result in survival of the victim. Those who do not have respiratory or cardiac activity cessation usually survive, but require follow-up examinations of eyes and ears for late-onset problems. Burn treatment of points of entry and exit, as well as treatment of any other skin burns, is required.
The patient should be entered into the EMS without delay. Treatment consists of restoring or maintaining the patient's respiratory effort. If the person is apneic, cardiac function ceases in a few minutes. If the person is in cardiac arrest, CPR must be initiated and continued for an extended period. Cardiac monitoring is indicated, along with observation for cerebral edema and respiratory insult. Fractures and lacerations, burns, and other injuries need to be treated according to facility protocol. Tetanus prophylaxis must be confirmed or administered if necessary. Follow-up eye examinations should be conducted because cataracts may develop in the year after the lightning strike. Treatment of ruptured tympanic membranes should be instituted.

Question 3

_____ is a severe systemic infection, transmitted by a tick, and characterized by a maculopapular rash, small hemorrhages under the skin, and involvement of vital organs.

Accepted Answer

The patient may recall being bitten by a tick, typically during outdoor activity, such as camping and hiking. Patients are frequently unaware of the insects because they are flat and small and may be hidden in an area covered in hair. Several days to 2 weeks later, a sudden onset of fever, severe headache, vomiting, malaise, and myalgia occur. Four days after the onset of fever, a characteristic maculopapular rash is noted, which spreads over the body. Small hemorrhages appear under the skin, the characteristic sign that gives the disease its name. Inflammation of blood vessels (vasculitis) affects the skin and other organs, leading to systemic manifestations in the heart, lungs, kidneys, and nervous system. After 2-3 weeks, the skin begins to peel (see Figure 15-20).

Question 4

FBs in the ear may include

Accepted Answer

FBs in the ear typically range from bugs, pebbles, and bits of cotton to anything small enough to fit in the ear canal.

Question 5

The legal responsibilities of the health care provider in battered spouse syndrome

Accepted Answer

Prevention is difficult because many spouses feel that they deserve the battering and that it is accepted behavior in society as they know it. Raising awareness of the issue in the community and in the educational system and teaching that battering is not acceptable behavior may prevent battering and acceptance of battering in future generations. In Indiana, it is a class D felony when an incidence of violence involves strangulation activity or occurs in the presence of a minor child. The state, not the victim, is the complainant, removing the responsibility of filing a charge from the victim. In addition, batterer's intervention programs are becoming part of the sentencing protocols in domestic violence cases. The legal responsibilities of the health care provider in battered spouse syndrome vary by state but should be known.

Question 6

The soft-tissue injury that occurs when a body part becomes entangled or entrapped, resulting in skin, tissue, and bone being pulled from the body is a(n)

Accepted Answer

With avulsion injuries, a portion of the skin and possibly underlying tissue is torn away, either completely or partially (see Figure 15-2, A and B). The mechanism of this kind of injury is usually one in which the affected body part becomes entangled in machinery, clothing, or some other means of entrapment, causing the skin, tissue, and possibly bone to be torn and pulled away from the body. If the limb or appendage is severed completely from the body, it is termed an amputation.

Question 7

Cumulative trauma disorders include

Accepted Answer

Cumulative trauma disorders, or repetitive motion injuries, are common to numerous occupations. They account for more time lost from work than any other single factor. At risk are those in industries who perform repetitive tasks, including those who keyboard on a regular and continuous basis, cashiers who scan products across conveyor belts, those who target practice, and those engaging in certain other sports. Cumulative trauma is a group of muscular conditions that result from repeated motions performed in the course of daily activities. This condition is caused by repeat movement that is unnatural or awkward motions, such as overexertion, twisting, or muscle fatigue. Soft-tissue injuries that develop over time as a result of repetitive activities cause continuing stress on specific muscles or nerves. These injuries can result from improper posture of the wrist, arm, back, shoulder, or legs. Many occur because of pressure centered on the hand or wrist with frequent repetitive motion for an extended time. In the industrial setting, improper use of handheld tools, especially with excessive or improper grip, can cause cumulative trauma disorders. In addition, continuous vibration contributes to increased occurrence of trauma. Characteristics of cumulative trauma are pain, tingling, numbness, swelling, redness, loss of flexibility, and strength. These disorders include but are not limited to white finger (Raynaud's phenomenon), trigger finger, carpal tunnel syndrome, tennis elbow, thoracic outlet syndrome, de Quervain disease, synovitis, tenosynovitis, and nonspecific tendinitis. Cumulative trauma develops over an extended time period, so the onset of symptoms is insidious. Much investigation may be necessary to pinpoint the repetitive task that has caused the trauma. Ergonomics is an assessment of how a person performs tasks. During the assessment, the individual is observed in a work situation or other action in which a repetitive task is performed. An attempt is made to determine if a subtle or other change in the way the task is done may help to relieve symptoms or prevent an injury from occurring.

Question 8

Compression of the brachial plexus nerves may also be called

Accepted Answer

Thoracic outlet syndrome is the compression of the brachial plexus nerves.

Question 9

All incidents of open trauma have a commonality in

Accepted Answer

Open trauma may involve only the skin surface or it may extend to the soft tissue and structures far below the skin. It may be in the form of an abrasion, in which the skin surface is scraped away, or it may be an avulsion, in which the tissue or an appendage is torn away. The injury can involve only a small area of the skin, as with a puncture wound, a slightly larger area as in an injury caused by a missile, or encompass substantially larger areas, as with crushing injuries. All incidents of open trauma have a commonality, the risk of infection if the wound is not appropriately cleansed and dressed. Pain is also usually involved in most open trauma.
Open wounds can be the source of tetanus infection; therefore, tetanus prophylaxis must be provided. Those who have completed the initial inoculation series for tetanus require a booster dose every 10 years. Those with no previous inoculation history are given TIG (human) and referred to a physician for the complete series of tetanus toxoid inoculations. When the patient has not had a booster injection within the past 10-year period, the booster injection of tetanus, diphtheria, and pertussis (Tdap) is recommended and/or administered.
Bleeding can be a factor in open trauma and must be addressed at once. Some injuries need only basic first aid, whereas others require medical intervention and surgical repair. Regardless of the severity of the injury, appropriate treatment aids healing and lessens scarring. Orthopedic and neurologic traumas are addressed in Chapters 7 and 13, respectively.

Question 10

A soft-tissue injury in which the outer layer of the skin has been scraped away is an

Accepted Answer

Abrasions occur when the outer layers of the skin are scraped away or roughed up and deeper layers are exposed. Abrasions are caused by the friction created when a rough, hard surface comes in contact with skin as a consequence of a scraping or sliding type of motion, often the result of a fall or scrape. Such injuries are often referred to as friction burns, floor burns, rug burns, or road rash.

Question 11

Treatment of a laceration includes

Accepted Answer

Lacerations should be cleansed gently with germicidal soap and water. If the laceration is not too deep and bleeding is controlled, approximating and securing the edges with tape, a butterfly dressing, or sterile adhesive strips (Steri-Strips) may be the only intervention necessary other than a sterile dressing application. In some cases, a new type of "glue" is used to hold the edges together, thereby eliminating the need for sutures. Lacerations that are deep, have jagged edges, or continue to bleed need to be débrided and have the edges trimmed to facilitate good approximation. Bleeding should be controlled by either coagulation or suture. Suturing of the wound will probably be necessary. If the laceration is over a movable joint, immobilization of the area is indicated. A sterile dressing should be applied. Tetanus prophylaxis is confirmed and tetanus, diphtheria, and pertussis vaccination (Tdap) is recommended and/or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure.
As with other work-related injuries, Workers' Compensation forms and any required drug or alcohol screening testing must be completed.

Question 12

The best way to remove the "stinger" from the site of an insect sting is

Accepted Answer

The first step in treating an insect sting is to determine whether the stinger is still present. If it is present, it must be removed to prevent further damage. The best method of removal is scraping across the site of the sting with a plastic card or a fingernail. (The use of forceps or tweezers squeezes more venom into the site.) The area is then cleansed with soap and water. Application of a dry dressing, cold pack, or anesthetic sprays affords some comfort. The person should be observed for any signs of allergic reaction to the sting or bite. Lyme disease, the result of a tick bite, and encephalitis, the result of a mosquito bite, are discussed in Chapters 7 and 13, respectively.

Question 13

A burn that involves destruction of the skin and underlying tissue is termed

Accepted Answer

Diagnosis is made by visual examination and history. In a flame type of burn, it is necessary to determine whether the burn occurred inside an enclosed space or out in the open. The respiratory state of any patient with a flame type of burn must be assessed. The status of the eyebrows, eyelashes, and nasal hair must be determined. Any singeing of these hairs indicates that the patient inhaled the flame or superheated air and that the respiratory status may be in grave danger.
Determination of the depth (see Figure 15-9) and extent (see Figure 15-10) of a burn is important. Pain intensity depends on the amount of nerve tissue that is involved or destroyed. Superficial burns involve only the outer layers of the skin, which usually appear only reddened, and yet these burns are painful. Partial-thickness burns involve all layers of the skin; they produce blisters and are quite painful. Full-thickness burns involve both the skin and the underlying subcutaneous tissue. Resultant destruction of nerve endings often results in minimal pain in that particular area; however, pain may be reported in areas around the periphery of the burn site. Prompt assessment of the percent of skin surface area involved in the burn injury is achieved by applying the rule of nines. The rule of nines provides a fast and fairly accurate calculation of the body surface involved. Percentages used to ascertain the burned tissue area in the adult are as follows: head, 9%; anterior trunk, 18%; posterior trunk, 18%; entire right arm, 9%; entire left arm, 9%; anterior surface right leg, 9%; posterior surface right leg, 9%; anterior surface left leg, 9%; posterior surface left leg, 9%; and perineum, 1%. Percentages in children and infants are slightly different. Another method of designating a percentage of body surface involvement is used by the ICD-9-CM and ICD-10-CM code books. Refer to the current edition of the ICD-9-CM and ICD-10-CM code books for these percentages.

Question 14

Tetanus toxoid prophylaxis is important in any person who has sustained open trauma because

Accepted Answer

Open wounds can be the source of tetanus infection; therefore, tetanus prophylaxis must be provided. Those who have completed the initial inoculation series for tetanus require a booster dose every 10 years. Those with no previous inoculation history are given tetanus immune globulin (TIG) (human) and referred to a physician for the complete series of tetanus toxoid inoculations. When the patient has not had a booster injection within the past 10-year period, the booster injection of tetanus, diphtheria, and pertussis (Tdap) is recommended and/or administered.
Bleeding can be a factor in open trauma and must be addressed at once. Some injuries need only basic first aid, whereas others require medical intervention and surgical repair. Regardless of the severity of the injury, appropriate treatment aids healing and lessens scarring. Orthopedic and neurologic traumas are addressed in Chapters 7 and 13, respectively. Tetanus is addressed in Chapter 2 as follows: The bacillus Clostridium tetani is found in contaminated soil and animal excreta and enters the skin through a puncture wound, laceration, abrasion, burn, or other injury. Puncture wounds are excellent breeding grounds for the bacillus because they lack a good oxygen supply and the bacillus thrives in dead tissue, producing a powerful exotoxin that attacks the nervous system. The incubation period is 3-21 days, with the onset commonly occurring at about 8 days. Tetanus antitoxin immunizations followed by booster doses every 10 years create immunity.

Question 15

Treatment of a puncture wound includes

Accepted Answer

Treatment involves removal of the foreign body (FB), along with copious irrigation of the wound with sterile fluid. A sterile dressing is applied. Tetanus prophylaxis is confirmed or tetanus, diphtheria, and pertussis vaccination (Tdap) is recommended and/or administered if necessary, and antibiotics may be prescribed as an additional prophylactic measure. Impaled objects are stabilized until they can be removed by the physician. As with other work-related injuries, Worker's Compensation forms and any required drug or alcohol screening testing must be completed.

Question 16

The individual who has a body temperature above 105° F; red, hot, and dry skin; headache; dizziness; and shortness of breath is experiencing

Accepted Answer

The person with hyperthermia may be experiencing heat stroke or heat exhaustion as a result of prolonged exposure to extremely hot temperatures. Heat stroke occurs when the person has a body temperature of 105° F or greater. The skin is hot, red, and usually dry. The patient may have a dry mouth, headache, nausea or vomiting, dizziness and weakness, and shortness of breath. The pulse is rapid and strong at the onset, gradually becoming weak, and the blood pressure decreases. The pupils are constricted. Patients exhibit anxiety, mental confusion, irritability, aggression, and even hysterical behavior. In extreme cases, the person collapses and experiences altered levels of consciousness and may have seizure activity.

Question 17

In electrical shock, the current

Accepted Answer

The person who has sustained electrical shock experiences tissue damage from the point of entry of the electricity to the point of exit. The electrical current follows the path of least resistance through the body, usually along nerve routes. The current enters the body at the point of contact with the electrical source and exits at the point of grounding (see Figure 15-12). As the alternating current passes through the body, it may produce muscle contractions, causing the person to be thrown from the source. This can result in lacerations, fractures, or head trauma. One major concern with electrical shock injuries is the development of cardiac dysrhythmias.

Question 18

The rule of nines is used to calculate

Accepted Answer

Diagnosis is made by visual examination and history. In a flame type of burn, it is necessary to determine whether the burn occurred inside an enclosed space or out in the open. The respiratory state of any patient with a flame type of burn must be assessed. The status of the eyebrows, eyelashes, and nasal hair must be determined. Any singeing of these hairs indicates that the patient inhaled the flame or superheated air and that the respiratory status may be in grave danger.
Determination of the depth (see Figure 15-9) and extent (see Figure 15-10) of a burn is important. Pain intensity depends on the amount of nerve tissue that is involved or destroyed. Superficial burns involve only the outer layers of the skin, which usually appear only reddened, and yet these burns are painful. Partial-thickness burns involve all layers of the skin; they produce blisters and are quite painful. Full-thickness burns involve both the skin and the underlying subcutaneous tissue. Resultant destruction of nerve endings often results in minimal pain in that particular area; however, pain may be reported in areas around the periphery of the burn site. Prompt assessment of the percent of skin surface area involved in the burn injury is achieved by applying the rule of nines. The rule of nines provides a fast and fairly accurate calculation of the body surface involved. Percentages used to ascertain the burned tissue area in the adult are as follows: head, 9%; anterior trunk, 18%; posterior trunk, 18%; entire right arm, 9%; entire left arm, 9%; anterior surface right leg, 9%; posterior surface right leg, 9%; anterior surface left leg, 9%; posterior surface left leg, 9%; and perineum, 1%. Percentages in children and infants are slightly different. Another method of designating a percentage of body surface involvement is used by the ICD-9-CM and ICD-10-CM code books. Refer to the current edition of the ICD-9-CM and ICD-10-CM code books for these percentages.

Question 19

Treatment of snakebite includes

Accepted Answer

First aid and intervention at the scene consists of removing the person from the injury site to prevent further risk and keeping her or him calm and quiet. The emergency medical service (EMS) system should be activated. Cleanse the bitten area with soap and water. Any jewelry, including rings or other constricting objects, should be removed from the affected limb. The extremity should be immobilized and, if possible, kept below the level of the heart. Transportation to the nearest emergency facility should be initiated as soon as possible so that aggressive treatment can begin immediately. If it is not possible to reach emergency care within 30 minutes, consideration should be given to suctioning the bite with equipment from a snakebite kit. Antivenin may be given to the patient, and vital functions supported as needed. The protocol for snakebite treatment indicates that cold should not be applied, the wound should not be cut, tourniquets should not be applied, and electrical shock should not be applied.

Question 20

The person suffering from hypothermia experiences

Accepted Answer

Hypothermia, a generalized severe cooling of the body, causes the person to shiver and have a feeling of extreme cold or numbness. Fatigue is followed by loss of coordination, thick speech, and disorientation. The skin appears blue and puffy and ash-colored for dark-skinned people, with the pulse being slow and weak. Core body temperature drops below 95° F. Breathing is slow and shallow, and the pupils are dilated. As the body temperature drops, the person experiences confusion, stupor, and unconsciousness.

Quiz 15: Disorders and Conditions Resulting From Trauma