Burns, thermal injuries and endocrine disorders Flashcards
What is a 1 deg burn
superficial
no blistering or sluoghing
What is a 2 deg burn
blistering
Should you pop a blister
no
What are some signs of an inhalation injury
blackness around their nares, mouth or clothes
trouble swallowing
hoarseness
high carboxyhemoglobin level
How long will you likely be in the hospital after an inhalation injury and why
24 hours to monitor you for the extent of the damage
What percentage of burns will the pat be transfered to seattle
30%
Burns that involve face, hands, feet, genitals, perineum, or major joints
3rd degree burns in any age group
Electrical burns, including any lightning injury
Chemical burns
Inhalation injury
What is a consideration for incountering someone being electrocuted
do not touch them
What do we check first if its a large burn, electrical or inhalation burns
ABC’s
What is the greatest threat of a large burn
hypovolemic shock
Who are at increased risk of hypovol shock from a large burn
cardio pats
What are cardio pats more likely to get after a burn
hypovol shock
dysrthmia
VTE’s
What type of diagnostic test might be used to assess a lower resp inhalation injury
bronchoscopy
What is Most common complication in the emergency phase after a burn
Acute Tubular Necrosis (ATN)
What types of IV access will a larger burn pat likely get
Central access
PICC
Swans Gans
What is the next priority after the fluids have been addressed after a burn
wound care
What is an allograft
skin from skin donor cadavers
What is a homograft
skin from same species usu from live person like your self (i.e. human to human)
What route of med admin should not be used on burn pats
IM
What are some lipid soluble hormones
Steroids and thyroid hormone
What are some water soluble hormones
Insulin, growth hormone, and prolactin
What is acromegaly
over production of growth hormone
What are the manis of acromegaly
elarged hand feet
large protruding jaw
big thick tongue
Who are more likely to get a pituitary adenomas
african americans
What will be people with removed pituary glands need
lifelong meds to replace their thyroid hormone, sex hormones, and glucocorticoids
NURSING CARE POST PITUITARY SURGERY
no blowing nose drip pad under the nose increase bed 30 deg assessment for hemtoma formation Monitor peripheral vision, visual acuity, extraocular movements, and papillary response
NURSING CARE OF SIADH
monitor I/O with SG’s, heart, and LOC
What is the pat has a severe case of low sodium with SIADH and the doc order 3% saline
tell them they pat will need to be transfered to the ICU cause 3% can only be given there
NURSING CARE OF DI
Give DDAVP
monitor no HA
Monitor vitals and urine SG
for acute DI fluids replaced by IV hypotonic saline or D5
causes of graves dis
insufficient iodine supply, infection, stress, cigarette smoking
What are some drugs that are used to treat thyroid storm
include propylthioracil (PTU) and methimazole (Tapazole)
How long will the drugs for thyroid storm usu take to work
1-2 wks
POST-OP CARE THYROID SURGERY
monitor pat q2h for 24hr for
resp distress from hemorrhage
Trousseau’s sign and Chvostek’s sign from hypocalcemia
control pain
Have (trach tray) suction equipment readily available
S/S of hypocalcemia
↑ neuromuscular excitability (Tingling, muscle spasm-particularly in hands, feet, and facial muscles, intestinal cramping, hyperact bowel sounds
seizing up
Prolonged QT interval, cardiac arrest
Chvostek & Trousseau sign
Symptoms of hypothy
Fatigue, lethargic, experience personality and mental changes, impaired memory, weight gain
myxedema
Cooling with ice or cold water within the first _______ minutes reduces depth of the injury
1 min
What is a potential complication with myxedema
myxedema coma
What are some manifestations of myxedema coma
hypothermia
hypoT
hypoventilation
What is the care with myxedema coma pats
labs for TSH, FT3, FT4, cortisol, ACTH, and glucose
respiratory support due to resp failure as major cause of death
support BP
passively warm them up
IV glucose for hypoG
What is cushings syndrome
chronic high levels of cortisol
What are some mani’s of cushings syndrome
round flushed face (moon face) fat pad on back of neck abdominal striae thin skin weak muscles HTN easy bruising
What is addison’s disease
hyposecretion of adrenal cortex or of ACTH from pituitary
What is decreased in addisons disease
glucocorticoids
mineralcorticoids
androgens
What are some symptoms of addisons disease
fatigue anorexia hypoT hyperpigmentation hypoG salt craving decreased libido
What is PHEOCHROMOCYTOMA
a tumor in the adrenal medulla that causes overproduction of catecholamines (epi and norepi)
What are some manifestations of PHEOCHROMOCYTOMA
severe HTN
pounding HA
tachycardia with palps
profuse sweating
What is the main treatment for PHEOCHROMOCYTOMA
surgical removal
When someone comes in to DKA and they receive IV insulin when can they eat
not until theyre off the IV insulin to subQ
How often will blood sugars need to checked when on IV insulin
every hour
What is troussea’s sign
when you blow up a blood pressure cuff on the arm and they get tetany in their hand/arm
What is chvosteks sign
cheek spasm when you brush against it
How do you know if a transplant pat is rejecting the transplant
biopsy’s of that organ
Why is a fever not a sign of a transplant rejection
because those pat will be on a antirejection med so their immune system will be suppressed so no fever response
What are transplant pats at high risk for
infection
Do not give TPA if
they just had surg
new onset of HA
any clotting/bleeding problems already
hemorrhagic stroke
examples of anticoag’s
lovonox
plavix
coumadine
What pats are at higher risk for hemorrhagic stroke
HTN
Anticoag’s
Fam Hx
head aneurysm
What is coumadines antidote
Vit K
How to trouble shoot a pulse ox sat
compare the pulse reading on the device and one that you get by counting to make sure they are the same
then check that the oxygen supp is connected and on
What is the antidote for valium
romazican
What is normal bicarb level
22-28
What signs might you see in someone with a basilar skull fracture
battle sign
clear drainage from ears or nose
rhinorrhea
periorbital bruising
When is coumadine usu given
at night
What can you give to diabetes that are hypoglycemic that cant take anything in the mouth or nose
glucagon
dextrose 50
What is DI
deficient amount of ADH or impaired renal responses
What are some signs of DI
polydipsia
low SG
hypernatremia
What timeframe can TPA be given in to be effective
first 3 hours
