| Course | NUR-4320 Nursing Care of Clients with Complex Health Conditions |
|---|---|
| Module | Module 3 |
| Paper type | Critical care paper: hemorrhagic shock after trauma |
| Length | About 1,056 words, 6 pages |
| Format | APA 7 student paper |
| School | Thomas Edison State University |
| Program | B.S.N., Accelerated Second Degree |
| Updated | October 2026 |
Free sample paper for NUR 4320 Module 3
Stop the Bleeding First: A Motorcyclist in Hemorrhagic Shock at a New Brunswick Trauma Center
Student Name
B.S.N., Accelerated Second Degree, Thomas Edison State University
NUR-4320: Nursing Care of Clients with Complex Health Conditions
Mentor Name
Month Day, Year
Stop the Bleeding First: A Motorcyclist in Hemorrhagic Shock at a New Brunswick Trauma Center
The Patient
Mr. Okafor and the trauma center are invented. Mr. Okafor, 27, lost control of his motorcycle on a wet highway and struck a guardrail. Paramedics found him pale and anxious, with a heart rate of 132 and a blood pressure of 84/50. They applied a pelvic binder because his pelvis was unstable and brought him in within thirty minutes of the crash. On arrival he was cold, his capillary refill was slow and he was asking what had happened over and over. The student was assigned to the trauma bay for an observation and assisting shift.
The Primary Survey
The primary survey taught in ATLS (American College of Surgeons Committee on Trauma, 2018) addresses the most immediate threats to life in order: airway with cervical spine protection, breathing, circulation with hemorrhage control, disability and exposure with prevention of heat loss. In a patient with external bleeding that is massive, control of that bleeding comes first. For Mr. Okafor, the airway was open, breathing was fast but adequate and circulation was the problem. A bedside ultrasound found no blood in the abdomen or around the heart, which pointed to the pelvis as the source of blood loss.
Why Bleeding Kills
Severe bleeding leads to a deadly cycle in trauma. Blood loss lowers temperature and causes acidosis, and both impair clotting. Large volumes of crystalloid dilute the remaining clotting factors. Each problem worsens the others, so modern trauma care limits crystalloid, replaces lost blood with blood products in balanced ratios and keeps the patient warm.
Tranexamic Acid
Over 20,000 injured adults judged to be bleeding heavily, or likely to, were enrolled at 274 sites in 40 nations and randomly given tranexamic acid, a drug that slows the breakdown of clots, or placebo (CRASH-2 trial collaborators, 2010). Death from any cause within four weeks was lower with tranexamic acid, 14.5 percent compared with 16.0 percent, and deaths from bleeding were also reduced. There was no increase in clotting events such as heart attack or stroke. Later analyses showed that the benefit depended on early use, within three hours of injury, which is why the time of the crash matters to the nurse.
Balanced Transfusion
Holcomb et al. (2015) randomly assigned severely injured patients predicted to need massive transfusion at twelve North American trauma centers to receive plasma, platelets and red cells either in equal 1:1:1 proportions or with half as much plasma and platelets, 1:1:2. Mortality at 24 hours and 30 days did not differ significantly, but hemostasis was reached more often with 1:1:1, and fewer of those patients bled to death within the first day. There was no increase in complications. The trial supports early, balanced use of plasma and platelets with red cells.
| Source | Main finding | Nursing role |
|---|---|---|
| ATLS (American College of Surgeons Committee on Trauma, 2018) | Primary survey in order of threat | Know the sequence; prevent heat loss |
| CRASH-2 (CRASH-2 trial collaborators, 2010) | Tranexamic acid lowered deaths when given early | Record time of injury; give within three hours as ordered |
| Holcomb et al. (2015) | 1:1:1 improved hemostasis; fewer bleeding deaths | Manage massive transfusion and product order |
Nursing Diagnoses
The student identified deficient fluid volume related to active blood loss, risk for hypothermia related to exposure and cold blood products and anxiety related to injury and an unfamiliar setting.
In the Trauma Bay
The team leader called for the massive transfusion protocol. The nurse gave tranexamic acid, one gram over ten minutes, fifty minutes after the crash, and the student wrote the time on the trauma flow sheet. Blood products arrived in coolers, and the nurse and a second nurse checked each unit against the patient's identity before giving it through a rapid warmer. The student helped track the products given, which by the end of the first hour were six units each of red cells and plasma plus one pack of platelets. The pelvic binder was checked to make sure it sat over the greater trochanters, not the iliac crests.
Warming and Monitoring
The student placed warm blankets, helped set up a forced-air warmer and checked his temperature every fifteen minutes. The nurse watched for signs of transfusion reaction and for low calcium, since the citrate in stored blood binds calcium, and calcium was replaced as ordered. Mr. Okafor went to interventional radiology, where a bleeding pelvic artery was blocked.
Supporting the Patient
Mr. Okafor was frightened and confused. The student stood at his head, told him his name, where he was and what was happening and repeated the information each time he asked. His parents arrived, and the chaplain stayed with them until the surgeon could speak to them.
Evaluation
After embolization, his heart rate fell to 98, his blood pressure rose to 118/70, his temperature remained above 36 Celsius and his lactate fell over six hours. He did not have a transfusion reaction.
After Embolization
Mr. Okafor returned to the surgical ICU with the binder still in place until the orthopedic team could fix the pelvis. The nurse watched his lower legs for swelling, pain and pulses, since bleeding and fractures can raise pressure in the muscle compartments. A later tertiary survey, a full head-to-toe check the next day, found a broken finger missed in the trauma bay, a reminder that serious injuries can hide smaller ones. Blood clot prevention began once the surgeons agreed the bleeding had stopped.
A Team Lesson
The student noticed how the trauma leader kept a place at the end of the bed and did not touch the patient, directing others and keeping the whole picture in view. Each nurse had a defined role, one recording and one managing products, so tasks were not duplicated or forgotten. The calm in the room came from preparation, not luck.
Limits
CRASH-2 was conducted in many countries with varied trauma systems, and PROPPR did not show a mortality difference at 30 days. Massive transfusion protocols differ between centers. A student assists, observes and documents, and does not check blood products as the second nurse.
Conclusion
Mr. Okafor's pelvic bleeding called for fast, coordinated action. The primary survey set the order, CRASH-2 supported early tranexamic acid, and PROPPR supported balanced transfusion. Careful timing, product tracking, warming and calm orientation carried the evidence into the trauma bay.
References
American College of Surgeons Committee on Trauma. (2018). Advanced trauma life support: Student course manual (10th ed.). American College of Surgeons.
CRASH-2 trial collaborators. (2010). Effects of tranexamic acid on death, vascular occlusive events, and blood transfusion in trauma patients with significant haemorrhage (CRASH-2): A randomised, placebo-controlled trial. The Lancet, 376(9734), 23-32. https://doi.org/10.1016/S0140-6736(10)60835-5
Holcomb, J. B., Tilley, B. C., Baraniuk, S., Fox, E. E., Wade, C. E., Podbielski, J. M., del Junco, D. J., Brasel, K. J., Bulger, E. M., Callcut, R. A., Cohen, M. J., Cotton, B. A., Fabian, T. C., Inaba, K., Kerby, J. D., Muskat, P., O'Keeffe, T., Rizoli, S., Robinson, B. R. H., . . . van Belle, G. (2015). Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: The PROPPR randomized clinical trial. JAMA, 313(5), 471-482. https://doi.org/10.1001/jama.2015.12
What the NUR 4320 Module 3 instructions ask for
Trauma is one of the conditions in TESU's catalog paragraph for NUR-4320, and with no syllabus posted, module three is planned as a trauma resuscitation paper. A strong paper describes the injured patient and the mechanism, explains the primary survey and why bleeding becomes a deadly cycle, applies trial evidence on tranexamic acid and transfusion ratios, writes nursing diagnoses, describes the nurse's roles in a massive transfusion and warming and evaluates the response. Some sections assign burns or chest trauma instead. Check whether the brief asks for a full secondary survey and whether your hospital's massive transfusion protocol should be described. Many mentors also want to see what happened after the patient left the trauma bay, such as a tertiary survey or watching for compartment problems. Plan a sentence on clot prevention once bleeding stops.
Inside the NUR 4320 Module 3 example
An invented 27-year-old motorcyclist with a pelvic fracture, in shock at a New Brunswick trauma center, opens the paper. The ATLS primary survey, the cycle of bleeding, cold and acidosis, the CRASH-2 trial and the PROPPR trial are explained, with a table that pairs each with a nursing role. Tranexamic acid fifty minutes after injury, tracked blood products through a warmer, binder position, calcium, embolization and repeated orientation follow, and his vital signs and lactate improve. The next day's tertiary survey, compartment checks and a look at who did what in the trauma bay come before the stated limits and the conclusion.
Where the marks sit in the NUR 4320 Module 3 rubric
Trauma papers earn credit for an orderly primary survey, a clear explanation of why bleeding, cold and acidosis worsen one another, accurate reporting of the tranexamic acid and transfusion trials, timed nursing actions, attention to warming, blood product safety and calcium, care for the frightened patient and evaluation. Noting the hour of injury, since tranexamic acid helps only when given early, stands out. Explaining binder position shows practical knowledge. Group authors such as trial collaborators and a trauma committee should be cited exactly as published. Following the patient beyond the trauma bay to the tertiary survey and clot prevention shows a complete view of trauma care. Describing team roles shows an understanding of how resuscitation is organized.
NUR 4320 Module 3 help from the desk
Trauma papers often list ATLS steps without the nurse's role; describe what the nurse does at each one. Another common gap is giving crystalloid freely without mentioning its harm. Record the time of injury. Track blood products. Warm the patient and every unit. Check calcium during massive transfusion. Orient the patient often. Tell us your patient and your brief, and a free first draft follows. Follow your patient into the next day. Note anything the tertiary survey found. Describe the roles in the room and who led. Mention how the binder was checked.
Write yours, or have the desk draft it
This paper is an original model document written by our desk, not a submitted student paper and not an official Thomas Edison State University document. Read it for the moves, then write your own to the instructions in your classroom. If you want one built to your exact prompt and rubric, the first custom sample is free and arrives in 24 to 48 hours.
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NUR 4320 Module 3 questions, answered
Where can I find a free NUR 4320 Module 3 sample paper?
The trauma hemorrhage paper about an invented motorcyclist in New Brunswick, from the primary survey to balanced transfusion, can be read here.
When should tranexamic acid be given after injury?
Early, within three hours of injury, when the CRASH-2 analyses found it reduced deaths from bleeding.
What did the PROPPR trial compare?
Plasma, platelets and red cells in 1:1:1 versus 1:1:2 ratios; 1:1:1 improved hemostasis without a 30-day mortality difference.
Why keep a trauma patient warm?
Cold impairs clotting and worsens acidosis, feeding the cycle that makes bleeding harder to stop.
Why check calcium during massive transfusion?
Banked blood contains citrate, which lowers calcium, and too little calcium impairs both clotting and heart contraction.