A patient is admitted with lacerated liver as a result of blunt abdominal trauma. Which of the following nursing interventions would not be appropriate for this patient?
A. Monitor for respiratory distress.
B. Monitor for coagulation studies.
C. Administer pain medications as ordered.
D. Administer normal saline, crystalloids as ordered.
Correct Answer: C. Administer pain medications as ordered.
Pain medication may mask signs and symptoms of hemorrhage, further decrease blood pressure, and interfere with assessment of neurologic status and additional abdominal injury. With the potential for hemorrhage, nonsteroidal anti-inflammatory drugs (NSAIDs) probably should be avoided. Acetaminophen with or without small quantities of mild narcotic analgesics may be all that should be prescribed initially. Minimize use of analgesics in patients who are admitted for observation.
Option A: The evaluation of any trauma patient begins with evaluating the airway, accessing the breathing, and managing the circulation. The diagnosis of intra-abdominal injury following blunt trauma depends primarily on the hemodynamic status of the patient. Once the airway is protected, it is mandatory to protect the cervical spine.
Option B: Because the presentation is often not straightforward, the diagnosis can be difficult and often time-consuming. Besides pain, the patient may present with bleeding per rectum, unstable vital signs, and the presence of peritonitis. The physical exam may reveal marks from a lap belt, ecchymosis, abdominal distention, absent bowel sounds, and tenderness to palpation.
Option D: After the primary survey is complete, patients who are hypotensive require aggressive fluid resuscitation. If hemodynamic instability persists, blood should be typed and crossed, but in the meantime, immediate transfusion with O negative blood can be done (O+ for males and women past childbearing years). All patients with blunt abdominal trauma who have signs of peritonitis, frank bleeding, or worsening of clinical signs require an immediate laparotomy.
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