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/clinical/pted/hffy/trauma/7289.hffy

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UWHC,UWMF,

Clinical Hub,Patient Education,Health and Nutrition Facts For You,Trauma

Your Stay on the Trauma Unit (F4/4) (7289)

Your Stay on the Trauma Unit (F4/4) (7289) - Clinical Hub, Patient Education, Health and Nutrition Facts For You, Trauma

7289

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Your Stay on the
Trauma Unit (F4/4)





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Welcome to the University of Wisconsin Hospitals and Clinics Trauma Unit.

Welcome to the University of Wisconsin Hospital & Clinics Trauma Service. We
are honored to be serving you and your family members. Our primary goal is to
provide you with the best trauma care possible during you or your family member’s
stay.
The University of Wisconsin Trauma Service has a tradition of providing excellent
care. There are many consulting services in addition to your Trauma Team who will
be checking in with you during your stay to coordinate your care and help you to
have the best physical and psychological recovery.
We are providing you with this Trauma Booklet to you to provide education about
your injuries, how to care for yourself both in the hospital and when you go home, as
well as the discharge process. Also included in the booklet is information about
your Health Care Team and the different services you may see at the University of
Wisconsin Hospital and Clinics.
We hope you find the booklet helpful. Feel free to speak with us at any time about
your care, concerns or suggestions. Our goal is to make sure your patient
experience at UWHC is excellent, regardless of the reason for your stay.
Sincerely,
Your Health Care Team

Table of Contents

Welcome to the University of Wisconsin Hospitals and Clinics Trauma Unit.. 3
Your Health Care Team............................................................................... 4
Visitor Policy ............................................................................................... 7
Your Hospital Stay on the Trauma Unit ....................................................... 9
Spine Precautions ...................................................................................... 10
Medicines .................................................................................................. 13
Common Injuries and Treatment ............................................................... 16
Potential Problems after Trauma ............................................................... 21
Discharge Process ...................................................................................... 24
Important Phone Numbers ........................................................................ 26

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Your Health Care Team______________________________________________
During your stay in the hospital you will see many people who are part of the team
caring for you. Together we will create a care plan that we will update and change
as needed. You are a vital member of the team. If you have any questions or
concerns let one of the team members know. Our number one goal is to help you
feel confident and comfortable from the day of admission until discharge. Here we
will tell you more about what each team member does. Knowing who and when to
call with questions or concerns may be helpful.

Doctors: You will meet a number of doctors. Although there are many, the main
(Attending) doctor will be a Trauma Surgeon, who will oversee your care. You
will also get to know Resident doctors.

Attending Trauma Surgeons

Dr. Agarwal Dr. Faucher Dr. Gibson Dr. Ingraham Dr. Jung


Dr. Liepert Dr. O’Rourke Dr. Scarborough

Advanced Practice Nurses: These nurses have advanced training. They are Nurse
Practitioners or Clinical Nurse Specialists. They are experts in their fields of
nursing. They will support the staff nurses and provide expert knowledge to
improve your care.

Nurse Practitioners

Tatum Curry Kelly Laishes Amy Stacey Jen Yeager
APNP APNP APNP APNP

Clinical Nurse Specialist Clinical Nurse Manager
Alazda Kaun, MS, RN, CNRN Alysia Hanson, RN, MSNc, PCCN

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Primary/Team Nurse is registered nurse (RN) who is assigned to care for you 24
hours a day on the unit. Your nurse will assess your pain, symptoms, provide
medication, and discuss your needs and concerns. He or she works with you and
all members of your health care team including your doctors, social worker, case
manager, pharmacist, therapists and anyone else involved in your care to help you
express your needs and concerns. He or she then works with you to create a plan
for your day and plan for your stay. Let your nurse know what is important to you.
This will help him or her to take better care of you. Your nurse is the “go-to”
person for any questions you have about your care and will direct your questions to
the correct member of your health care team.

Nursing Assistants (NA) work closely with your nurse to help care for you by
taking vital signs, walking, bathing, and helping you use the bathroom.

Each day as you get better, nurses and nursing assistants teach you how to care for
yourself. You can expect to see 2-3 Nurses and 2-3 NAs in a 24-hour period.
They will intentionally round on you every hour during the day and every two
hours at night to check in and see if you need anything. Use the call light to let us
know of any other needs, questions, or concerns you may have in between rounds.

Nurse Case Managers assist you with discharge planning. This process begins on
the day of admission and lasts until discharge. They will review your medical
records and meet with you to form a discharge plan. The Case Manager will
answer questions about the trauma plan of care and talk with Doctors, Nurse
Practitioners, Therapists, Home Care Providers and Rehabilitation or Skilled
Nursing Care Facilities.

Social Workers assist in finding available resources, assist with insurance issues,
and help with financial concerns. They also assist in filling out Power of Attorney
for Health Care paperwork or setting up legal guardianship.

Pharmacists will review both your home and hospital medicines when you arrive
at the hospital. They teach patients and families how to prepare medicines, the
dosing schedule and possible side effects before discharge. On your discharge day,
they will again review any changes with you including new medications you need
to take at home.

Dieticians assist in helping you meet your nutritional needs. They assess and keep
track of your nutritional status and provide feedback to you and the trauma team.
They promote nutritional goals, and teach and guide you during trauma recovery.

Orthopedic Doctors specialize in broken bones. These doctors work closely with
the trauma team to develop a plan of care for your broken bones.

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Neurosurgery Doctors specialize in brain injuries. If you have a head injury or
brain bleed, these doctors work closely with the trauma team to develop a plan of
care for your head injury.

Neurospine or Orthospine Doctors specialize in fractures of your spine. If you
have a broken bone in your spine, these doctors will work closely with the trauma
team to develop a plan of care for your spine fractures. They may recommend no
intervention, bracing the injury, or surgery depending on the severity of the injury.

There are also other specialty doctor teams who may be consulted by the trauma
team. The facial trauma team specializes in facial fractures. The ophthalmologist
may come to assess your vision if you have any eye injuries. All these teams work
closely with your trauma team to develop a plan of care to help your injuries heal.

Therapists:
Respiratory Therapists (RT) assess and treat breathing problems caused either by
the trauma or those that you may have had before. They are experts in caring for
your airway and the ventilator (breathing machine) and work closely with your
trauma team.

Occupational Therapists (OT) focus on self-care skills and other daily tasks.
They will help you regain upper body movement, overall function, teach new
techniques or provide adaptive equipment to help you perform normal daily tasks.
They will help find resources for home and help decide whether you will need
further rehab on a Rehab Unit or in a Skilled Nursing Facility.

Physical Therapists (PT) assess and treat problems with movement or balance.
The PT works on sitting, walking, balance, and strength. They will teach you how
to begin moving again on your own, as you are able. They will help find resources
for home and help decide whether you will need further rehab on a Rehab Unit or
in a Skilled Nursing Facility.

Speech Language Pathologists (SLP) will assess and treat changes in speaking
and thinking skills. This includes trouble with word finding, focus, understanding
language, and recall. They assist patients who have trouble speaking because of
muscle weakness in the face or tongue or because of a tracheostomy (breathing
tube). They will help find resources for home and help decide whether you will
need further rehab on a Rehab Unit or in a Skilled Nursing Facility.

Swallow Therapists will help those who can’t swallow or have trouble eating.
They often are present at meal times to help patients learn to eat and swallow as
before your injury.


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Additional Support Staff
Pastoral Care Staff provide spiritual and emotional support for patients and their
families. This support is offered to people of all faiths, and to those who do not
belong to any religious group. Chaplains can be reached 24 hours a day.

Health Psychologists are experts in helping people to adjust to injury. They teach,
counsel, and provide support and coping methods for both the patient and family.
They also watch changes in patients’ behavior, thinking and mood. They help
patients deal with the psychological impact of trauma.

Radiology staff are involved in the diagnostic evaluation of the trauma patient.
Radiology staff includes those who take X-rays, CT scans, and MRI scans.

Phlebotomists draw blood for lab testing.

Orthotics custom fit a variety of braces for trauma injuries.

AODA Physicians and Counselors are the team who cares and counsels patients
with substance abuse or dependence concerns.

Visitor Policy_______________________________________________________

F4/4 Nurses Station Phone Number: (608) 890-6400
Visiting Hours 8am - 9pm. Visitors are guests of you and your family.

Primary supports
We support a patient and family centered approach to care. As you are part of the
team, we ask that you provide us with the names of the people who you want
involved in planning your care. Primary supports are people who provide you with
the support you need and are relatives, best friends, spouses, or partners. Primary
Supports are welcome to come to the hospital at any time, but this decision is up to
you, the patient or your patient representative.

A Primary Support person is allowed to stay overnight in your room with you. If
you have more than one Primary Support person, we ask that only one person stay
overnight in the room at a time. The person that stays overnight must be 18 years
of age or older. If you know that someone will be staying with you, tell your nurse
and we will provide a cot for sleeping, as long as one is free. Also, your
support person must have a visitor pass to allow them to stay after hours. Ask your
nurse how to get one.

There may be times that visits are not allowed due to nursing cares being carried
out, especially in the IMC. If this is the case, we will ask your visitors to wait in
the waiting room and we will let them know when it is okay to visit.

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Parking and Validation
For every patient, there is one parking pass that is available to be used during your
hospital stay. You will need to go to the admissions desk to get your pass
validated. If you have questions, please ask your nurse or the health unit
coordinator.

Emotional Changes
You may be feeling worried, sad, angry, or scared. These and many other feelings
can occur while in the hospital. It takes time to deal with your health problems,
treatment, and the new changes in your life. Every person copes in their own way.
Some have found it helpful to talk about their feelings with the people close to
them and to ask for their support. Talk to your doctor, nurse, chaplain or other
members of the Health Care Team as you are comfortable. We can connect you
with helpful resources at UW Hospital and support groups in the community.

Confidential Patients
Some patients may choose to have no visitors and no phone calls - we call this a
"confidential patient.” Some reasons for this are:
• You don’t want others to know you are in the hospital
• You do not feel safe
• You were a victim of a crime
• You were involved with a crime

If you choose to have this confidential status, the staff will flag your name in the
computer, and your name will not be posted in any public area or at the nurse’s
station. This means that if someone calls and asks about you or what room you are
in, staff will reply, “I have no record of that patient being in our hospital.” Any
mail, gifts, and flowers that are sent to you while you are in the hospital will also
be returned to the sender.

If there are certain people that you would like to visit, you must inform those
visitors of your room number and phone number. If at any time you change your
mind about being a confidential patient, talk to your nurse and your status will be
changed in our system. At that point we could tell your visitors or those who call
the desk, your room and phone number.


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Your Hospital Stay on the Trauma Unit________________________________

Trauma patients may come from the Emergency Department, Operating Room, or
the Intensive Care Unit (ICU). Once you arrive on F4/4, you will meet your Nurse
and Nursing Assistant, learn about your room, and get settled in. Your family and
friends are welcome to visit you in the room as well.

Your vital signs (temperature, heart rate, blood pressure, breathing rate, oxygen
level) will be checked often, even through the night, until your doctor decides that
less frequent vital signs are needed. The nurse will perform an assessment of you
when you are admitted, which includes Health Assessment questions and a
complete physical exam.

Intentional Rounding
Your nurse will check on you often, at least every hour to start with. During the
hours of 6am to 10pm, a staff member, most likely your Nurse or Nursing
Assistant, will check on you each hour. During these checks, staff members will
check to see if you need anything such as pain medication, going to the bathroom,
repositioning, or anything else. In addition the staff members may also perform
routine tasks such as dressing changes or give you medicine. From 10pm to 6am a
staff member will check on you every two hours. If you are sleeping during this
time, the staff member will not disturb you. We always want you to use your call
light if you need something or someone right away in between intentional
rounding.

Equipment
At first, most trauma patients will have the tubes and equipment listed below.
 Intravenous (IV) Line: Most often placed in your hand or arm to provide
fluids and medicine until it is safe for you to take food and drink by mouth.
 Nasal Cannula: A tube under your nose to give you oxygen.
 Pulse Oximeter (Pulse ox): A plastic clip or sticker placed on your finger or
toe that tells us your oxygen level.
 Telemetry (Tele): A small battery pack with five electrode wires that attach
to small stickers on your chest. This allows doctors and nurses to keep track
of your heart rate and rhythm continuously. While on telemetry, you will
need to stay on the unit.
 Cervical Collar (C-collar): A collar around your neck to prevent you from
moving your neck. All trauma patients are treated as if there is a spinal
injury until the doctors look at the spine scans and determine if there is an
injury or not.
 Foley Catheter (Foley): A catheter (tube) to drain urine from your bladder.
 Elastic stockings (TEDs) and leg wraps (SCDs) that inflate and deflate to
improve blood flow in your legs to prevent blood clots.


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Length of Stay
The standard length of stay is hard to predict for Trauma patients, but there are
goals that need to be met before discharge. These include:
• You are able to eat food and drink liquids
• You can move around safely
• You have a return of bladder and bowel function
• You have reasonable pain control with oral medicines
• PT, OT and Speech Therapists feel you are safe to be discharged
• You will also have a Discharge Checklist in your room to help you
understand what needs to be completed before you can leave the hospital.
Together, with you and your family, we will decide when you will be discharged
so that you can plan for this day and time. We will work with you to help you meet
all of your goals in order to be discharged home. Some patients may need more
time to recover from injury, and may need a stay in a Rehabilitation Center, a
Skilled Nursing Facility, or a Traumatic Brain Injury Center. We will discuss
discharge options with you and those involved in your care as those needs become
clear to your Health Care Team.

Spine Precautions
All trauma patients are treated as if there is a spinal injury until their spine x-rays
or CT scans are read by the attending radiologist. This may not take place until the
next day. It will depend on what time of day you are admitted.

Cervical (C) Spine Precautions
A brace is placed on the neck to be worn at all times until an attending radiologist
has reviewed the spine imaging and a physical exam of the neck is performed.
Most patients are placed in a temporary collar called a Philadelphia (Philly) collar.
If there’s a bone or ligament injury found in the neck, a patient may then need to
wear a PMT collar. If you need to wear either of these collars, no pillows are
allowed under the head, no lifting your arms above your head, and no lifting
greater than 10 pounds.

Thoracic (T) and Lumbar (L) Spine Precautions
You are to remain flat on your back at all times unless you are lying on your side
and straight alignment is maintained with pillows until an attending radiologist has
reviewed the spine imaging. Depending on the type of T or L spine injury you
have, you may need to either lie flat or have your head of the bed less than 30
degrees. Your doctors and nurses will let you know your restrictions.


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Progression of Activity
No Spine Injury Found
Getting out of bed is a vital part of getting better. Once your spine imaging is
reviewed, you will be allowed out of bed. You should not attempt to get out of bed
on your own. Nursing staff or physical therapists will help you out of bed for the
first time as sometimes you may get dizzy or lightheaded and may feel weaker than
before the accident.

Proven Spine Injury
If you are found to have a spine injury, you may need to wear a brace to keep your
spine aligned. Once your brace is placed, x-rays need to be done to check that
your spine stays aligned in your brace. After these x-rays are completed, you need
to remain in precautions until a spine doctor has reviewed the x-rays. If your spine
is stable, you will be allowed to advance your activity. If your spine is unstable,
you may need surgery. Your Spine Team will discuss this with
you.

Coughing and Deep Breathing
Your nurse will ask you to breathe deeply, cough, and use an
incentive spirometer. You may try to avoid deep breathing
because it can be painful but deep breathing is very important to
help you prevent pneumonia. Pain medicine can be given to help
control your pain while deep breathing.
To cough and deep breathe
1. Place a pillow over your chest or abdomen to lessen the pain when
coughing.
2. Breathe in deeply and slowly through your nose. Hold it.
3. Exhale slowly through your mouth.
4. Repeat two more times.
5. Breathe in again and hold it, and then cough.
6. Repeat every hour while you are awake.
Incentive Spirometer
1. Exhale and place your lips tightly around the mouthpiece.
2. Take a slow deep breath. Slowly raise the Flow Rate Guide between the
arrows.
3. Hold it. Continue to inhale, keeping the guide as high as you can for as
long as you can, or as directed by your nurse or respiratory therapist.
4. Exhale and relax. Remove the mouthpiece and breathe out as usual.
5. Slowly, repeat 10 times per hour while you are awake.


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Diet
When you are not eating or drinking you will be given IV fluids (fluids through
your veins) to keep you hydrated. To keep your mouth moist, you may use swabs
dipped in ice chips and water. Your nurses and doctors will listen for sounds from
your abdomen, ask if you are passing gas or stool, ask if you have any nausea or
vomiting, and ask about your appetite. All of this helps the Health Care Team
know if the bowels are starting to function or “wake up.” If you had surgery, you
can expect that your bowel function will not return for a couple of days, often 3-5
days later.

When you are healthy enough to begin eating, start slowly by drinking clear
liquids. This includes juice, jello, broth, popsicles, etc. Then move on to full
liquids such as milk products, creamed soups, pudding, Ensure
®
drinks, or protein
shakes. If this goes well you may advance to “real food.” For some that will be a
general diet, in which you can eat what you’d like. The best way to advance your
diet is to start out slow and then progress. Eat only what feels good and tastes
good. If you begin to feel sick to your stomach or full, you should stop eating and
tell your nurse.

If you followed a special diet at home (Diabetes, Low Sodium, Lactose Free, etc)
or have food allergies, please talk to your Health Care Team about this to ensure
we provide you with the same diet during your stay.

Foley Catheter
You may need to have a urine catheter (Foley) placed. This tube sits in your
bladder to allow for a constant draining of urine out of your bladder and into a bag.
You may still have the urge to pass urine. If you have a full feeling let your nurse
know right away as your catheter may need to be repositioned to allow it to drain.
Your Foley will remain in place until the doctors decide the best time for it to be
removed. After your Foley is removed, we will still need to record the exact
amount of urine output so we ask that you empty your bladder using the collection
device that sits in the toilet or a urinal. Sometimes patients cannot pass urine when
the Foley is removed. Your bladder function will be assessed every 4 - 6 hours. If
you are unable to empty your bladder fully, you may need to undergo straight
cathing. Straight cathing is where a catheter is inserted in your bladder allowing it
urine to drain out and is then removed. If this happens often, a Foley catheter will
likely need to be placed again. You may be placed on a medicine to help you
urinate. If you need a Foley catheter at discharge, your nurse will teach you how
to care for your Foley at home and you will be set up with outpatient follow up.


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Compression Stockings (TEDs or Ace wraps) and Sequential Compression
Devices (SCDs)
To prevent blood clots, the doctor may order you to wear compression stockings
on your legs while you are in the hospital. This puts pressure on the deep veins
and helps with blood flow. You will wear these stockings all day and night except
for an hour during the day when we give your legs a break. During the time you
are lying in bed, you also will wear SCDs that provide a constant massage to your
lower legs. This helps blood return to your heart. If we are not able to fit you with
the proper TED hose, your nurse will wrap your legs with ace bandages to control
any swelling you may have in your legs.

Chlorhexidine Gluconate (CHG) Bathing
While in the hospital, CHG soap (Hibiclens®) will be used for bathing. This
special soap is used because it reduces the numbers of germs on your skin for a
longer period of time compared to other soaps. According to the Centers for
Disease Control and Prevention (CDC), studies show that your chance of getting a
hospital acquired infection (HAI) is lower when the number of germs on your skin
is lower. It is important to use the CHG soap because it reduces your chance of
getting an HAI which could lead to a longer hospital stay. Most of the time, CHG
is not needed at home. However, sometimes patients do need to bathe daily at
home with CHG soap (Hibiclens®). Your doctor or nurse will tell you if you need
to use CHG at home.
How to bathe with CHG Soap (Hibiclens)
• If you have any open skin areas, check with a nurse before using CHG
(Hibiclens®) to shower.
• Wash your hair using regular shampoo. Then rinse your hair.
• Wash your face using the Aloe Vesta® 3 in 1 Foam or Johnson’s Baby Bath®.
• Use CHG (Hibiclens®) like you would use a liquid soap. Put it directly on
your skin and wash gently.
• Rinse well with warm water.
• Do not use your regular soap after you use the CHG (Hibiclens®) soap.
• Dry your skin with a towel.
• If you need to use a lotion, only use the Aloe Vesta®, Cetaphil®, or
Aquaphor® lotion given to you by the hospital. This is important because
the use of other lotions does not allow CHG to do its job in killing germs.
• If you have any skin irritation (skin that is red, itchy, or burns), rinse the CHG
(Hibiclens®) off your skin and let your nurse know right away.

Medicines
A pharmacist will visit with you to confirm the medicines you took at home.
Nurses will give you medicines throughout the day. At first, when you are not able
to eat or drink, some of the medicines you take at home may be given to you in

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your IV. Not all medicines come in IV form. Others may be held until your doctor
feels they are safe to begin taking again. Once you are eating and drinking, your
medicine will be switched back to pill form.

You will likely get medicines in the hospital that you may or may not have taken at
home. Below is a list of common medicines given to trauma patients:
• Bowel medicines – medicines taken to prevent constipation. They may be in
pill form or given by rectum. There are many causes of constipation in the
trauma patient, such as limited mobility, use of narcotics, and direct effects
from the trauma. Medicines that may be given include Docusate
®
, Senokot
®
,
Milk of Magnesia, Miralax
®
, Bisacodyl suppositories, Fleet enema, or
magnesium citrate.
• Blood thinners – medicines that prevent blood clots from forming. Most
patients are given a blood thinner (heparin or Enoxaparin
®
) as a shot in their
fatty tissue - either in the abdomen or the back of the arm. Some patients may
need blood thinners on a long-term basis and will be started on Coumadin
®

(warfarin) pills. While you are on blood thinners, you will need your blood
drawn often to check your blood counts.
• Stomach ulcer prevention – At first you will not be able to eat or drink so
you may be prescribed anti-ulcer medicine. This includes Ranitidine
®
and/or
Pantoprazole
®
. If you were not taking these before your trauma, they will
likely be stopped when you are discharged.

Pain Medicine
Good pain control helps you heal faster, leave the hospital sooner, and prevent
problems. Drug and non-drug treatments can help prevent and control pain.
You will be asked to rate your pain on this scale:
0-10 Number Pain Scale
_______________________________________________________________________
0 1 2 3 4 5 6 7 8 9 10
No Mild Moderate Severe Worst
Pain Pain
Your pain control goal should be at a level that will allow you to deep breathe, eat,
be active, take part in therapy, and sleep. This may mean that you may not be
pain-free but your pain should not prevent you from being able do these things.
We need to ask you what your pain level is, so that we know how well the
medicine is working. Tell us about your pain and above all, tell us if it is not going
away. Do not worry about being a “bother.” Pain medicine may cause you to
become drowsy, dizzy, or lightheaded and you are the only one who can tell us
about your pain, so be honest so we can help keep your pain controlled and side
effects managed. Below are some pain treatment options.


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IV Pain Medicine
If you are not ready to eat or drink you will be offered IV pain medicine to help
control your pain. The most common drugs used are morphine and
hydromorphone. IV pain medicine tends to work quickly, but it wears off faster
than pain pills. Once you are eating food, you will be started on oral pain pills and
your IV medicine will be stopped.

Patient Controlled Analgesia (PCA)
Some patients will be placed on Intravenous Patient
Controlled Analgesia (PCA). This device allows you to give
your own dose of pain medicine instead of by your nurse.
PCA is used because the patient is the best judge of how much
pain they are feeling. Each person may need a different
amount of medicine to relieve their pain. PCA allows you to
take the medicine when you feel you need it. To receive a
dose, all you need to do is press the green button. When you
press the button, pain medicine goes into your IV. Your nurse
will let you know how often you can push your button to get pain medicine. You
can only get pain medicine when the green button is lit, so you cannot overdose
with the PCA. For your safety it is vital that only you, the patient, press the button
to receive pain medicine. Your nurse will check with you to make certain you are
comfortable and that you are using the pump as you should. Please tell your nurse
how your pain medicine is working so they can make changes if needed. When
you are eating again, your PCA will be stopped and you can ask for pain pills.

Patient Controlled Epidural Analgesia (PCEA)
Some patients will have an epidural with Patient Controlled Epidural Analgesia
(PCEA) to help control pain. A very small catheter is placed in your back
(between your vertebrae or back bones) and is set to give you constant pain
medicine through your epidural space. You may also have a button to push as
needed every 30 minutes. This button helps to control your pain and cannot be
overused; the machine will not let you. For your safety it is vital that only you, the
patient, press the button to receive pain medicine. Anesthesia doctors will see you
every day and check the medicine in the epidural and to make sure it is working as
it should. If your pain is still not under control, the anesthesia doctors will discuss
ways to improve it. While you have an epidural, the nurses will check on you
every 2 hours (even through the night). You may also need to have a urine catheter
(Foley) in place until the epidural is removed.

If you have both an epidural (PCEA) and PCA, use the epidural first. The epidural
button is black, and does not change colors when you push the button. For your
safety it is vital that only you, the patient, press the button to receive pain
medicine.

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Oral pain pills
Your nurse will explain the pain pills your doctor has prescribed for you. This
includes the drug, dosage, and frequency of administration. Long acting pain
medicine (OxyContin
®
or MS Contin
®
) are typically scheduled twice a day. Short
acting pain medicine (Oxycodone
®
, Norco
®
, Percocet
®
) are given on an as needed
basis - you need to ask for these pain medicines when you feel that you need them.
We suggest that you ask for pain pills when you first notice the pain. Do not wait.
The pain pills take 30-45 minutes to start working. Do not drive, operate
machinery, or drink alcohol while taking pain medicine. If you take the medicine
for pain as prescribed, it is rare to become addicted. If you are concerned about
addiction, talk with your Health Care Team.

Nonpharmacologic Pain Relief
This would include: relaxation, imagery, distraction, skin stimulation, hot and cold
compresses, music, massage, and acupuncture. Music therapy has been shown to
decrease pain, pain medicine use, anxiety, and distress. UWHC provides a music
channel to all patient rooms. Also F4/4 provides TVs with USB ports that are able
to play music of the patient’s choice. You may choose to bring in an iPod from
home for use while in the hospital. Ask your nurse about alternative pain therapy
that is offered. Some may include a personal cost to the patient such as massage.

Common Injuries and Treatment______________________________________

Mild Traumatic Brain Injury
A mild traumatic brain injury (MTBI) occurs when someone loses consciousness
for less than 20 minutes after being struck in the head. The person may not be able
to recall being struck in the head for as long as 24-48 hours after the injury. The
patient is often in the hospital less than 48 hours or may not be hospitalized at all.

What will my recovery be like after a MTBI?
Some people, but not all, will suffer a post-concussion syndrome. Post-concussion
syndrome symptoms may include:
• A headache that doesn’t go away no matter what you do for it.
• Feeling dizzy
• Feeling tired
• Irritability or less able to handle frustration
• Forget things
• Have trouble paying attention
• Take longer to do what used to come easily
• Problems with sleep
• Feeling anxious or depressed
• Trouble keeping track of more than one task at one time

17


Post-concussion syndrome may begin within days or weeks of the injury and may
last for weeks to months. Most symptoms are gone within 6 months. Often
families will have more trouble coping than the person with the MTBI.

Ask your doctor when you can return to work as this is different for everyone.
You must avoid:
• Contact sports such as football, rugby, and ice hockey
• Drinking alcohol
• Riding a bicycle or skating without a helmet
It is crucial that you avoid a second brain injury because it could make it even
harder for you to be able to handle daily life.

If you notice any of the post-concussion syndrome symptoms getting worse or if
you are having trouble taking part in your normal activities, call your doctor. The
doctor may order more tests or arrange for an occupational, physical, or speech
therapist to help you return to normal.

Spine Fractures
Spine fractures are breaks in the bones of the cervical, thoracic, or lumbar spine.
You may be managed in one of three ways:
• Further x-rays at follow-up clinic appointments
• Use of a brace
• Surgery to repair the injury
If you notice any changes in numbness or tingling, or changes in how your bowel
and bladder work, let your health care team know right away.
Most patients with spinal fractures are treated with brace therapy to help align the
spine and heal the fracture. There are many different types of braces. If a brace is
needed, an orthotics specialist will come and fit you with your brace. Staff will
provide you with an educational Health Facts for You handout specific to your
brace and will teach you how to properly use your brace prior to discharge.

Rib Fractures
Rib fractures can be very painful, but the pain gets better with time. Pain medicine
will not take all of the pain away. You may have more pain when breathing deeply
and coughing. The main treatment for rib fractures is pain relief and clearing your
lungs to prevent pneumonia. There is no brace that heals rib fractures. It is vital
that you use your incentive spirometer. It helps to take deep breaths. You will be
asked to cough and deep breathe, even though it hurts. Splinting your chest over
the broken rib using a pillow can help you cough and deep breathe more easily.



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Liver Laceration
The liver secretes bile which breaks down the fat in food. It also filters harmful
toxins from the blood. It has many other functions. A liver laceration is a tear that
causes bleeding. It can be large or small. It may need to be repaired in surgery.
The tests that you may have done include: CT scan, MRI, or FAST. Treatment
includes:
• Frequent blood draws. These tests can reveal if the liver is still bleeding. If
these remain stable, surgery may not be needed. If your blood counts start to
decrease, surgery may be needed to repair the tear.
• Frequent abdominal exams.
• You may be on bed rest. This helps to keep the tear from getting bigger. It
also prevents more bleeding.
• You may not be allowed to eat until your health care team decides whether
you will need surgery or not.

Spleen Laceration
The spleen filters the blood. It helps to keep your body healthy by clearing blood-
borne bacteria. A spleen laceration is a tear that affects the main blood vessels to
the spleen. A tear can be any size from small to large. The risk with a spleen tear
is that it may bleed, requiring surgery to remove the spleen. Treatment includes:
• Frequent blood draws. If your blood counts remain stable, surgery may not
be needed. If your blood counts start to decrease you will be watched
further or more tests may be done. Some people require surgery to have the
spleen removed in order to stop the bleeding. If a spleen needs to be
removed, a person can still lead a long and healthy life.
• Frequent abdominal exams.
• You may be on bed rest to prevent the tear from getting bigger or causing
more bleeding.
• You may not be allowed to eat until your doctor decides whether you will
need surgery or not.

Kidney Contusion/Hematoma/Laceration
A kidney contusion or hematoma is a bruise to your kidney. A kidney laceration is
a cut in the kidney wall. Treatment includes:
• Frequent blood draws. If your blood levels remain stable, surgery may not
be needed.
• We will also be checking your kidney function tests (BUN/creatinine) often.
• You will have a Foley catheter placed so we can measure your urine output.
A Foley is also used to see if you are passing blood through your urine. In
some cases, doctors will order bladder irrigation. This is a constant flushing
of the bladder. Your nurse will let you know if the doctors decide to do this.


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Bladder Rupture
Bladder rupture is caused by blunt or piercing injury. A rupture is a tear to the
bladder wall. Symptoms of a bladder rupture include: lower abdominal pain or
tenderness, bloody urine, trouble passing urine or no urine output. Common tests
that will be run are a CT scan and a cystogram. Treatment includes:
• Surgery to repair the rupture
• Foley catheter placed in the ER or during surgery; remains in place until
bladder is healed, often for a number of weeks after discharge

Bony Fractures
A fracture is a break of a bone in the body. The symptoms of a bone fracture may
vary. It depends on the type of fracture, location, and how severe the break is.
Symptoms of a fracture include a deformed body part, pain, swelling, bruising,
bleeding, and trouble moving the body part. Tests used to find a fracture include
an x-ray, physical exam, and/or CT scan. Treatment of a bone fracture also varies
based on the fracture, location, and severity. Treatment includes:
• Immobilization of the fracture, either with a cast or splint.
• Some doctors will apply traction to the bone to help align the bones before
surgery.
• Compound fractures are treated with surgery, where the bones are secured
using screws and plates. Then they are splinted to help provide support
during the healing process.
• Some bone fractures will require you to receive antibiotics. If this is the
case your doctor or nurse will let you know.
• While your bones are healing, you will need to limit your lifting or putting
weight on the injury. Elevate the injured area if possible and apply ice to the
injured body part if swelling occurs.

Road Rash and Abrasions
Abrasions (road rash) are surface injuries to the skin and the tissue below it. It is
caused by rubbing or scraping. Road rash should heal within 2 weeks if you take
good care of the wounds and keep them clean.

Daily Wound Cares
1. Wash your hands with soap and water before touching your wound.
2. Remove old dressing. Do not soak in water to remove. When a dry
dressing is removed, it cleans away dead tissue and debris.
3. Wash your wounds gently once a day with antibacterial soap such as
Dial
®
and a clean washcloth. Wash off creams, soft scabs, and any loose
dead tissue. You may have a small amount of bleeding.
4. Rinse your wounds well with plain water.
5. Dry off the skin around the wound with a towel.
6. Apply a thin layer of Bacitracin
®
to all open wounds.

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7. Apply a thin layer of moisturizing lotion to all healed areas of skin that
surround the open wound.
8. Apply Cuticerin
®
or Aquaphor
®
(non-stick) gauze to all open wounds.
9. Secure dressing with gauze as needed.

Signs of Infection
• Increased redness and swelling around the wound
• Foul smelling drainage or pus from the wound
• Flu-like symptoms (fever, chills, nausea or vomiting and muscle aches)

Care of Healed Skin
• The skin is healed when it appears dull pink or red, is not moist or
weepy, and no longer stings when you touch it. Newly healed skin needs
creams applied to prevent drying and cracking.
• Apply creams free of alcohol such as Elta
®
lite, Aquaphor
®
, Eucerin
®
, or
Nivea
®
as often as needed to keep the skin moist and soft.
• Once your wound is healed, stop using the Bacitracin
®
, Cuticerin
®
or
Aquaphor
®
gauze and gauze dressings.

Tobacco Use and Wound Healing
Smoking or tobacco use causes blood vessels to become smaller. The smaller
vessels have a hard time bringing oxygen, nutrients, and healing factors to the
wound. This can cause the wound healing process to take longer. Carbon
monoxide is a poison produced by tobacco that enters your blood cells. This
poison lowers the level of oxygen in your blood. When you use any form of
tobacco (smoking or chew), the risk of a wound infection will increase. Tobacco
use also effects how fast your bones will heal. Quitting smoking is the best thing
you can do to help your wound and bones heal faster, safer, and with fewer
problems. If you’d like to quit, please let your nurse know and we can get you
information on smoking cessation.


21

Potential Problems after Trauma______________________________________

Infection
Common sites of infection include: wounds, any foreign device (Foley catheters,
IV lines, drainage tubes, etc). Signs and symptoms of a wound or site infection
include areas of redness, swelling, drainage, or odor. Other symptoms may include
pain not controlled by pain medicine and fever over 100.4°F for 2 times taken four
hours a part. Signs of a urinary tract infection (UTI) include frequency, urgency,
burning with urination, foul smelling urine, or cloudy urine. Please tell your health
care team if you have any of the above signs or symptoms of infection.

Prevention is key. You and your family can do a lot to prevent the spread of
infection in hospitals, clinics, and communities. The key is to use safety measures
known as standard precautions. Hand hygiene is the number one way used to
prevent the spread of germs. You should encourage your visitors and expect your
health care team members to use alcohol gel or wash their hands with soap and
water before they enter your room and after they leave to help prevent the spread
of germs.

Blood Clots
DVT (Deep Vein Thrombosis) is a blood clot that forms in the deep veins of the
body, mostly in the legs. DVTs alone are not life threatening unless the clot breaks
free and moves to the lungs where it can lodge in blood vessels there. This is
called a PE (Pulmonary Embolism) and it can be dangerous. The risk of
getting a PE is fairly low. We work to prevent DVTs or a PE by having you wear
compression stockings, SCDs, and take frequent walks. This helps to increase
blood flow in your legs and decrease your chances of a blood clot. Your doctor
will prescribe a blood thinner (heparin or enoxaparin) that is often given as a shot
in your abdomen or the back of your arm.

Constipation
Many things can cause constipation in the trauma patient. Some of these causes
are surgery, the type of injury, being less active and use of pain medicine. Pain
medicine slows down bowel movements moving through the colon. This causes
the stool to become hard. If you have hard stools, they are fewer in number, or you
have trouble passing them, then you have constipation.

While in the hospital, you will be given daily bowel medicines. These may
include: stool softeners, Miralax
®
, Milk of Magnesia
®
, suppository, enemas, or
magnesium citrate. We want you to return to the bowel routine you had at home.
Our goal is for you to have a bowel movement at every day to every other day.


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Once you are home, you will need a plan to avoid constipation. Stick to the plan as
long as you are taking narcotic pain medicine. Review your plan with your doctor
or nurse. Here are some things that may be part of your plan. (If you need to
follow a special diet, talk to your doctor before making any changes.)

• Eat foods that have helped you to relieve constipation in the past.
• Eat foods high in fiber, as long as they have been approved by your doctor. This
includes foods such as uncooked fruits, raw vegetables, and whole grains and
cereals. Try prune juice. If you are not hungry, do not force yourself to eat fiber.
• Drink plenty of liquids. Eight to ten 8-ounce glasses of fluid each day will help
keep your stools soft. Warm liquids often help your bowels to move.
• Exercise as much as you are able each day or at least every other day. Increase
the amount you walk as you can. Check with your doctor or nurse about the
exercises that are best for you.
• Plan your bowel movements for the same time each day, if you can. Set aside
time for sitting on the toilet.
• Aim for a bowel movement every day or every other day.

High fiber food
Cereals &
flours
Bran cereals, whole-wheat bread, rye bread and crackers, wheat
germ, corn, cornmeal, wild rice, brown rice, barley
Fruits Fresh, canned, or dried fruits, especially those with skin or seeds
(apples, plums, pears, peaches, tomatoes, berries, raisins, and
dates)
Vegetables Any raw or cooked vegetable (not overcooked) such as carrots,
cabbage, peas, dry beans, and lentils

What about stool softeners and laxatives?
Many people taking pain medicine need the help of a stool softener. This may not
work alone. You may also need a gentle laxative. Be sure to check with your
doctor before taking any of these on your own.

Your doctor or nurse may suggest taking a laxative on schedule rather than waiting
for constipation to occur. There are many types and brands of laxatives, and most
do not need to be prescribed. Talk to your doctor about which may work best for
you.

What about bulk laxatives and fiber, like Metamucil?
Bulk laxatives and fiber like Metamucil absorb water and expand to increase bulk
and moisture in the stool. If your constipation is from taking pain medicine, this is
not the best option to use. They should only be used if you are able to drink plenty
of fluids throughout the day.

23

Ileus
An ileus is a blockage of the intestines (bowel). The ileus prevents movement of
food, fluid, and gas through the intestines. An ileus may be caused by any type of
surgery, pain medicines, lack of activity, or injury type. Being less active also may
cause an ileus. Signs and symptoms include:
 Nausea
 Vomiting
 Stomach cramps
 Bloating
 Lack of bowel movements and gas

We treat an ileus by stopping food intake, giving you IV fluids, and we may place
a nasogastric (NG) tube in your stomach to relieve any pressure and prevent
vomiting. You should be as active as you can while being treated for an ileus.
This helps your intestine to wake up. Signs and symptoms that your ileus has
healed include normal bowel sounds, only small amounts of liquid coming out of
your NG tube, passing gas, having bowel movements, decreased bloating, a soft
abdomen, no nausea or vomiting, and being able to handle a clear liquid diet.

Pneumonia
Pneumonia is an infection of one or both lungs, often caused by bacteria, viruses,
or fungi. While in the hospital other causes include fluid and atelectasis.
Atelectasis is a partial collapse of the lung that can be caused by a blockage of the
air passages. It occurs in trauma patients due to immobility and not being able to
clear lung secretions due to injuries. To help prevent pneumonia:
• Cough & deep breathe
• Use the incentive spirometer every hour while
awake
• Get out of bed and walk in the halls when able
• Use pain medicine to help you cough and deep
breathe
• Work with therapies (Physical, Occupational,
and Respiratory Therapy);
Treatment includes antibiotics, incentive spirometry,
PEP (positive expiratory pressure), CPAP (continuous
positive airway pressure), oxygen, and walking.


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Discharge Process___________________________________________________
The length of your hospital stay depends on your trauma. Your discharge plan will
be based on your injuries, the amount of care you will need at discharge, and
therapy recommendations.

Discharge Home
The standard length of stay is hard to predict for trauma patients, but there are
certain goals that you will need to meet before discharge. To help plan and prepare
for leaving the hospital, we will discuss a discharge date with you each day.
Please understand this date may change. When you are ready to go home, we will
work with you to set a time for your discharge that is convenient for you and your
family. Our goal is to have you leave the hospital within 30 minutes this discussed
discharge time.

You can help in your discharge process by telling us early if you have any special
circumstances about your discharge, such as having a long ride home or limits to
times when you can be picked up. This will help coordinate your discharge time as
well as your discharge appointments to the best of our ability.

We will review a Discharge Checklist with you similar to the following:
� You and your Doctor and/or Nurse Practitioner discussed your discharge plan
� You are able to eat food and drink.
� Your pain is under control with oral pain medicine.
� You are able to urinate and have had a recent bowel movement.
� You have met with the social worker and/or case manager regarding home
health, medical equipment, outpatient therapy, and/or rehab program if needed.
� You are able to move around safely and have been cleared by Physical
Therapy and Occupational Therapy if applicable.
� Speech therapy has met with you (if needed) and say you are okay to go home.
� You have transportation home.

Once these standards are met, your trauma doctor or nurse practitioner will write
an order for you to be discharged. After these orders are written, the following
needs to take place:
� All of your follow-up appointments have been made.
� The Pharmacist has met with you and provided you with education about your
discharge medicines. He or she will also give you all your written
prescriptions.
� Your After Care Hospital Plan (ACHP) has been reviewed with you by your
nurse. This includes your activity orders, lifting restrictions, your diet at
home, wound care teaching, follow-up appointments, any special instructions,
and phone numbers to call if you have questions or concerns.

25

Activity Restrictions after Discharge
Slowly increase your level of activity based your restrictions written in your
discharge instructions. Check with your doctor if you are not sure an activity is
right for you. Listen to your body. Let comfort be your guide. If it hurts, stop.

Check with your doctor about:
 When you can return to work
 When you can resume having sex
 Driving - Do not drive if you are taking pain medicine

Going to a Facility
Some patients who are not safe to be at home will be transferred to a Rehabilitation
or Skilled Nursing Facility where further care is given. The table below lists some
of the rehab options that you may need.

Inpatient Rehab

 You would transfer to a hospital rehab center that would
provide intense therapy.
 Patients need to meet strict standards to be accepted into
this type of program (such as, being able to do three hours
of therapy a day).

Long-term
acute care
(LTAC) nursing
facility
 You would stay at an acute care hospital.
 Not able to do three hours of therapy (see above).
 These patients still have complex health care needs but are
not eligible for the option above.
 Those with ongoing breathing problems may need this type
of placement.
Skilled Nursing
Facility
 Patients are stable but still need more therapy and being
discharged home is not possible.

Outpatient
Therapy
 Patients would receive therapy during scheduled clinic
visits, but would live at home.

Home Care  A therapist comes to the home to provide therapy.
 Consists of Nursing/PT/OT. Infrequent visits.



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Follow Up Appointments
If you are discharged during the week, UWHC staff will make your appointments
for you. They will be listed on your discharge sheet with the date, time, and
Physician or Nurse Practitioner you will be seeing in clinic. We will also list a
phone number for you to call if you need to change your appointment. If there is
more than one clinic visit to schedule, our staff will try to arrange them for the
same day. This may not always be possible because not all doctors work in the
clinic on the same day.

If you are discharged on the weekend, your appointments may not be scheduled for
you because most clinics are closed on weekends. The clinic should call you and
set up these appointments, but if they do not call, please call the clinic on
Wednesday. Your discharge sheet will list what doctor you need to follow up
with, when they would like you to return to clinic, and the clinic phone number.


When to Call the Doctor
• Acute shortness of breath
• Unusual pain that you haven’t had before
• Pain not controlled by pain medicine
• Nausea and vomiting that does not stop
• Abdominal bloating or distention
• Severe fatigue that doesn’t go away
• Signs of infection: redness, warmth, swelling, foul odor or drainage
• Fever of 100.4°F or 38°C for 2 readings taken four hours apart.
• Any unusual or prolonged bleeding

Important Phone Numbers
Trauma Clinic ......................................................... 608-263-7502
Burn Clinic .............................................................. 608-263-7502
Neurosurgery Clinic ................................................ 608-263-7502
Orthopedics Clinic .................................................. 608-263-7540
Plastics Clinic .......................................................... 608-263-6782
ENT Clinic .............................................................. 608-263-6190
Ophthalmology Clinic ............................................. 608-263-6414
Outpatient Pharmacy ............................................... 608-263-1280
Hospital Paging Operator ........................................ 608-263-0486
Patient Relations ..................................................... 608-263-8009
Toll-Free .................................................................. 1-800-323-8942
UW Emergency Room ............................................ 608-262-2398

If you think you are having emergency symptoms, call 911.

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Here are my Questions??





















































Your health care team may have given you this information as part of your care. If so, please use it and call if you
have any questions. If this information was not given to you as part of your care, please check with your doctor. This
is not medical advice. This is not to be used for diagnosis or treatment of any medical condition. Because each
person’s health needs are different, you should talk with your doctor or others on your health care team when using
this information. If you have an emergency, please call 911. Copyright ©2/2016. University of Wisconsin Hospitals
and Clinics Authority. All rights reserved. Produced by the Department of Nursing. HF#7289.