AC 3 Exam 2 Flashcards
What are some symptoms of a Black widow bite?
Pain, redness, edema, numbness, tingling, etc.
There is a great seizure risk with this
Multi-system problems
Severe abdominal pain, HTN
What are some symptoms of a snake bite?
Pain
Warmth, edema, if severe, anaphylaxis
High risk for airway compromise & respiratory failure
Renal damage
Clotting abnormalities
Numbness, tingling, etc
How do you manage a Black widow bite?
Tetanus shot
Ice/cold to bite to decrease action of neurotoxin
Opioid pain meds
Monitor VS
How do you manage a snake bite in the hospital?
Supplemental O2; intubation if needed
2 Large-bore IVs
Anti-venom
What education needs to be provided to prevent a Black widow bite?
Wear gloves/arms when working on gardens
Don’t apply heat; it will increase circulation, meaning venom will get distributed to the body faster
What is the nurse’s role in the hospital disaster system?
Prioritize victims who are likely to survive vs. not
Rapid discharge of patients
What are some ways to prevent drowning?
Observation in & around water
Don’t swim alone
Avoid alcohol/drugs
Test depth of water
Rescue equipment
Why is knowing how much & what kind of water important when someone drowns?
Salt water & contaminated water are more dangerous than fresh water; salt water causes F&E shifts and causes more water to be drawn into lungs
Contaminants = sepsis
What education can you provide to prevent altitude related illnesses?
Don’t ascend too quickly
Take oral acetazolamide 24 hours prior to ascent & 2 days into trip if you have a history of altitude-related illness
Drink lots of fluid
What are some symptoms of altitude related illnesses?
Acute mountain sickness: headache, anorexia, N/V, chills, irritable, looks hungover, SOB at rest or exertion, tachy or bradycardia, normal BP to orthostatic hypo
High-altitude cerebral edema: Extreme. mental status changes, impaired judgement, CN dysfunction
High-altitude pulmonary edema: SOB, pink frothy sputum, crackles
How does the 3-Tier triage system work?
Divides into Emergent (life threatening), Urgent (quickly/not life threatening), and non-urgent (can wait without fear of deterioration)
What are some examples of emergent situations using the 3-tier triage system?
Respiratory distress
Chest pain
Stroke
Active hemorrhage
Unstable VS
Anything that needs to be seen immediately; if not, we lose a system
What are some examples of urgent situations using the 3-tier triage system?
Severe abdominal pain
Displaced or multiple fractures
Pneumonia (that is not in respiratory distress)
But if any of these were to involve some kind of unstable VS, they would be emergent
What are some examples of non-urgent situations using the 3-tier triage system?
Skin rash
Strains & sprains
Colds
Simple fractures
Why do we have to use specific words like “death” and “died” when describing death to family members?
If we use words like expired, or passed away, they might not understand. Using vague words can be understood as there is still a chance that the patient can be resuscitated, which gives families false hope. We can’t do that
What 3 things need to be considered when discharging a patient and providing education?
Their primary language
Visual/hearing acuity
Education level
Why is CT more preferred initially than MRI when we have a trauma patient?
Because CT is faster than MRI
What’s the difference between the primary survey and the secondary survey in the ED?
Primary is checking briefly to see if the patient is alive; airway secured? are the breathing? (ABCDE) etc.
Secondary is more like the head-to-toe assessment that we do normally; more in-depth than primary
ABCDE is usually how we prioritize care. What if we were to have a patient who has a massive uncontrolled bleeding?
Then we do CABDE; we need to control the bleeding (circulation) first.
Why is knowing the mechanism of injury important?
To make sure to assess and do testing accordingly to plan the treatment. For example, for GSW, we need to know if it went through, where it entered from, if the bullet is still in there, etc.
What’s the biggest difference between the heat exhaustion and heat stroke?
Heat stroke is a emergency; involves altered mental status and no sweating.
No sweating is a bad sign. You’re body is not compensating
Heat exhaustion, you are very sweaty; body is trying to cool itself down by it
Why do we not use aspirin or antipyretics for heat stroke?
Because the patient is not having a fever. It’s heat from outside. So we just cool them down with cooling blanket, ice, and cooled NS.
What kind of temperature are we measuring when the patient has a heat stroke?
Core temperature; rectal or foley probe
Why do we not want heat stroke patients to shiver?
Shivering is the body’s attempt to keep heat. We don’t want to keep heat. So we give Benzos to not shiver
Why is drinking alcohol a bad idea when you are hypothermic?
Alcohol is a diuretic; diuresis = blood shunting to major organs.
Also, you won’t feel that you are hypothermic, which will make everything bad. You are more at risk for death
Why is close monitoring of electrolytes important when rewarming the patient after hypothermic event?
Rewarming increases risk for F&E shifts, metabolic abnormalities, acute respiratory distress syndrome, renal failure, and pneumonia
How is frostbite related to compartment syndrome?
Affected tissues become crystallized and traps those soft tissues inside like a cast. Therefore at least an hourly check is needed
You are caring for a pt with a frostbite on the feet. Place the following interventions in the correct order.
- Immerse the feet in warm water 99-102 degrees
- Remove the victim from the cold environment
- Monitor for signs of compartment syndrome
- Apply a loose, sterile, bulky dressing
- Administer a pain medication
2
5
1
4
3
What education is needed so snake bite can be properly managed before coming to the hospital?
Remove jewelry & clothes due to swelling
Call 911 since there is a high risk for airway compromise
Take a picture of the snake and the affected site
Immobilize extremity at heart level
No incise, suck wound, apply ice, or use tourniquet
Come to the hospital to get anti-venom
What’s the patho behind altitude-related illnesses?
Increased altitude = decreased barometric pressure = decreased pressure = decreased O2 available
Leads to edema and hypoxia
What’s one thing you need to check before giving someone an oral acetazolamide for altitude-related illnesses?
Check for sulfa allergy
What medication is used to decrease cerebral edema caused by altitude-related illnesses?
Dexamethasone.
It doesn’t really help with pulmonary edema though
It’s a steroid so anti-inflammatory
How does viagra help with altitude-related illnesses?
It causes pulmonary vasodilation
Prehospital drowning education
If diving, spinal stabilization
Rapid rescue & airway clearance
Abdominal or chest thrusts only if airway obstruction or cardiac arrest
Do we give rescue breaths even if they inhaled water?
Yes; if have a pulse, give breaths & chest thrust to get water out of lungs
Why is gastric decompression expected to drown patients?
They probably got water in their stomach. That’s going to be uncomfortable & if it’s contaminated water, we want it out
How does the triage color tag system work?
Red - immediate; will not survive if not seen immediately
Yellow - not in immediate danger but needs observation or possible later re-triage
Green - “walking wounded” needs medical care at some point, but after more critical injuries
White - dismiss; minor injuries
Black - dead/can’t survive
What causes hypovolemic shock?
Acute loss of fluid/blood; dehydration, hemorrhage
But also: surgery, liver disease, cancer therapy, meds, etc.
What does decreased MAP mean?
Decreased perfusion
What are the stages of shock?
- initial stage
- compensatory stage
- progressive stage
- refractory stage
What happens during the compensatory stage of shock?
Mild tachycardia, hypotension
But we’re good, stable. compensating
What happens during the progressive stage of shock?
Tachycardia, hypotensive.
Lactate produced; acidosis. check ABGs
What happens during the refractory stage of shock?
Everything is deteriorating
Hypotensive but not responding to fluid, blood, pressors, etc.
We’re dying
What are the first signs of shock?
Increased HR, changes in pulse quality
What are we focusing on when treating hypovolemic shock?
Reverse shock, restore fluid volume, prevent complications
What indicates that the body has good perfusion?
Good/adequate/normal urine output
What meds are we giving when treating hypovolemic shock?
O2
Fluids/blood
Vasoconstrictors (dopamine, levo, neo)
Inotropics (dobutamine, milrinone, dopamine, epi)
Sodium nitroprusside
Why do we give O2 to hypovolemic shock patient?
Increase the amount of available O2 to all the blood they have
How do vasoconstrictors work?
Constricts blood vessels; increases MAP, venous return, and contractility
Causes decreased peripheral perfusion
How do inotropics work?
Increases contractility; increases cardiac output, therefore increases BP
Why might we use sodium nitroprusside for shock patients?
It dilates coronary arteries; for HTN or cardiogenic patients
How often should we check vitals in shock patients?
Q15 mins until shock resolved
What measures amount of blood coming to the right atrium (preload)?
CVP
Why is preload important?
Shows fluid status.
Low preload = low fluid available in body for perfusion
Why is glucose check important in shock patients? What range should we maintain?
Shock increases the body’s demand. Glucose check is to see if the body can handle it; we’re checking both the pancreas (insulin) and liver (glucagon) by checking sugar.
150-180 is ideal
Insulin decreases what electrolyte?
Potassium
What usually causes cardiogenic shock?
Acute MI
What’s happening during cardiogenic shock?
Heart’s ability to pump is impaired; therefore decreased cardiac output and BP
What are the risk factors for cardiogenic shock?
cardiac injury; MI, degeneration, tamponade, cardiomyopathies
How do we know if fluid is the problem when treating a shock patient?
Check CVP and assess them
How do we manage cardiogenic shock?
Support the pump
Avoid dehydration and also fluid overload
Inotropes
Reduce workload
What are some ways to reduce the workload of the heart?
Rest
Devices (LVAD, balloon pump)
What’s the Parkland formula?
4 x % of burn x pt’s weight in kg = required first over 24 hours
Divide that by 2 and give the half in first 8 hours of injury and other half in next 16 hours
What does 1st degree burn look like?
Superficial; only top of the epidermis
Dry, pink-red, no edema, pain, peels away
Ex) sunburn
What does 2nd degree burn look like?
2 types:
Superficial partial thickness; into dermis
Moist red, blanching
Blisters
Mild-moderate edema
Deep partial thickness; extend deeper into dermis
Less moist, less blanching, less painful
Soft/dry eschar
Scar deposition, contraction & limited re-epithelialization
What does 3rd degree burn look like?
Full thickness; entire dermis, sometimes subQ fat
Dry, black, brown, yellow, white, red
Severe edema
No pain or blisters
Hard eschar non-elastic
Skin graft needed
Contraction & scar deposition
What does 4th degree burn look like?
Deep full thickness; damage down to bone, muscle, and tendon
Black
Severe edema
No pain or blisters
Hard eschar non-elastic
Grafting may not work
High risk of infection
At what burn stage do you start to see eschar & contraction?
Deeper 2nd degree burn
At what burn stage do you start not to feel pain?
3rd degree
How does burn increase risk for metabolic acidosis?
Fluid and electrolyte loss from burn -> hypovolemia -> decreased perfusion to body -> lactate is produced -> metabolic acidosis
What are the 3 phases of burn?
Emergent (resuscitation) phase
Acute (healing) phase
Rehab (restorative) phase
What happens during the emergent (resuscitation) phase of burn?
Time of injury up to 48 hours
Fluid resuscitation (parkland formula)
ABCs
Pain relief
Are burn patients more at risk for hyperthermia or hypothermia?
Hypo because loss of skin = loss of insulation. Burn also causes fluid loss which decreases body temp
How long is the acute (healing) phase of burn?
36-48 hours after injury and lasts until wound closure complete
What happens during acute (healing) phase of burn?
Wound care management
Infection prevention
What are some cardiovascular changes that can happen to burn patients?
Increased HR
Decreased cardiac output (up to 36 hours after injury)
Possible MI
What type of diet are burn patients on?
High calorie, high protein
Why is LR more preferable than NS when treating burn patients?
Electrolyte imbalance
What are some pulmonary changes that can happen to burn patients?
Lung inflammation
Particles in lungs
Sloughing of lining of bronchi due to heat
Alveoli edema
Inhalation burn
What are some GI changes that can happen to burn patients?
Fluid shifts
Decreased blood flow to GI tract due to either hypovolemic or fight/flight vasoconstriction = risk for paralytic ileus
GI secretions & gases increase
Abdominal distention
Risk for Curling’s ulcer
Why do we give PPIs, H2 blockers, etc. to burn patients?
Prophylactic; they are at risk for Curling’s Ulcer (stress ulcer)
Why do we give prophylactic abx to burn patients?
No skin barrier
Increased risk of infection (raw skin)
Inflammatory process suppresses immune function
What are some s/s of inhalation burn?
SpO2, breathing change
Soot under, burnt nose hair
Breath sounds (stridor/wheezing)
Where should smoke/carbon monoxide detectors be placed?
Each bedroom
Each hallway
Kitchen
Stairways
Entrance of home
How can carbon monoxide poisoning be a side effect of burn?
Home releases CO when burns
What are some s/s of carbon monoxide poisoning?
Big headache
Symptoms like hypoxemia (SOB, wheezing, confusion, etc.)
Depends on carboxyhemoglobin level
How do you treat CO poisoning?
GIve lots (100%) of O2; 15L on nonrebreather
Anna is a burn patient. Burn happened at 0300 and now it’s 0400. Fluid resuscitation amount was calculated using the Parkland formula and 4500 cc is required for the first 8 hours. How should you program your pump?
4500/7; and hour has already passed so we need to give 4500 in 7 hours.
643cc/hr
Why would you wear gloves and PPE when caring for burn patients?
Because they are at a high risk for infection; kind of like leukopenia patients. Reverse isolation
What electrolyte are we monitoring during early phase of burn?
Potassium
What can be done to prevent contracture on the hand and UE that’s burnt?
Elevate hands
Apply splints as prescribed
Work with PT
Why do we not want to wash burn area with cool tap water and put lotion on?
Infection.
Cool sterile water and prescribed, sterile packed wound care supplies can be used instead
Who are at risk for HIV?
IV drug users
Healthcare workers
Sexually active (esp. multiple partners)
Sex workers
What are some symptoms of acute HIV infection?
Flu-like; fever, night sweats, chills, headaches, muscle weakness, sore throat, rash (means viral infection), diarrhea
How does lab work look like as HIV progresses?
More CD4 & T cells infected
Decreased WBC
Increased antibodies that are incomplete or nonfunctional
Increased macrophages that function abnormally
Does a positive rapid HIV test mean that you have HIV?
No; it can show false positive. You need both ELISA and Western Blot to confirm HIV
ELISA alone does not confirm HIV; western blot does. However, western blot is usually done after a positive ELISA so you would still do both
What does Class 0 HIV mean?
First positive HIV test
Regardless of T cell count
No change in stage until 6 months after
What does Class 1 HIV mean?
T cell count > 500
No AIDS related illnesses
What does Class 2 HIV mean?
T cell count 200-499
No AIDS related illnesses
What does Class 3 HIV mean?
Class 3 = AIDS
T cell count < 200
or
AIDS related illness (even if counts normal)
What does unknown HIV class mean?
Confirmed HIV but don’t really have T cell/CD4 count right now (unknown)
AIDS related illness unknown
How is HIV transmitted?
Sexual transmission, blood (parenteral; contaminated needles), perinatal
Mosquito does not transmit HIV
How can you prevent HIV?
Safe sex; condom use, monogamous
Don’t share needles
What medications are used for HIV pre-exposure prophylaxis (PREP)?
Tenofovir/Emtricitabine 300mg
Can you miss a dose of PREP?
Yes, but if you miss more, you need to restart regimen within 7 days
How long do you need to take PREP for it to protect you from HIV?
7 days of consistent dosing
Can you miss a dose of medication if you have HIV?
No
What kind of medication is used to treat HIV?
Antiretroviral
These are expensive so you need community resources
What are the 4 common opportunistic infections that HIV patients may have as a complication?
Pneumocystis jiroveci pneumonia
Toxoplasmosis encephalitis
Candida albicans (yeast infection)
Mycobacterium Tuberculosis
HIV patients have a higher risk of cancer; what are some examples?
Malignant lymphomas
Kaposi’s sarcoma
Cervical & anal cancers
How should we care for HIV patients in the hospital?
Private room
Assess for infection, especially mouth and skin for any open wound, sarcoma, etc
Turn cough deep breath
Encourage activity
Why are HIV patients at high risk for dehydration?
HIV causes diarrhea. HIV meds also can cause diarrhea. Therefore double diarrhea = high risk for dehydration
What kind of food should HIV patients avoid?
Fatty, spicy, fresh (low immune) foods
Also sugary, alcohol, caffeine
What labs need to be monitored in HIV patients to ensure adequate protein/nutrition?
Ferritin, albumin, prealbumin, hemoglobin
Why might tube feeding/TPN be expected in HIV patients?
It is hard for them to maintain weight and nutritional status
What medication is used to treat oral candida?
Fluconazole (diflucan)
What medication is used to help stop diarrhea?
Loperamide (imodium)
