Burns, thermal injuries and endocrine disorders Flashcards by Nick Wrobel

What is a 1 deg burn

superficial

no blistering or sluoghing

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What is a 2 deg burn

blistering

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Should you pop a blister

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What are some signs of an inhalation injury

blackness around their nares, mouth or clothes
trouble swallowing
hoarseness
high carboxyhemoglobin level

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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

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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

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What is a consideration for incountering someone being electrocuted

do not touch them

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What do we check first if its a large burn, electrical or inhalation burns

ABC’s

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What is the greatest threat of a large burn

hypovolemic shock

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Who are at increased risk of hypovol shock from a large burn

cardio pats

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What are cardio pats more likely to get after a burn

hypovol shock
dysrthmia
VTE’s

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What type of diagnostic test might be used to assess a lower resp inhalation injury

bronchoscopy

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What is Most common complication in the emergency phase after a burn

Acute Tubular Necrosis (ATN)

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What types of IV access will a larger burn pat likely get

Central access
PICC
Swans Gans

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What is the next priority after the fluids have been addressed after a burn

wound care

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What is an allograft

skin from skin donor cadavers

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What is a homograft

skin from same species usu from live person like your self (i.e. human to human)

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What route of med admin should not be used on burn pats

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What are some lipid soluble hormones

Steroids and thyroid hormone

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What are some water soluble hormones

Insulin, growth hormone, and prolactin

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What is acromegaly

over production of growth hormone

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What are the manis of acromegaly

elarged hand feet
large protruding jaw
big thick tongue

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Who are more likely to get a pituitary adenomas

african americans

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What will be people with removed pituary glands need

lifelong meds to replace their thyroid hormone, sex hormones, and glucocorticoids

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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