Exam 2

Question 0

What is the criteria for SIRS

Answer 0

two or more of the following:
temp greater than 38 or less than 36
HR greater than 90bpm
RR greater than 20 or PaCO2 less than 32torr
WBC >12k or < 4k
More than 10% immature (band) forms

Question 1

What puts a pt at high risk for SIRS

Answer 1

ANY injury that causes hypoperfusion. Not just infection

Question 2

What are the 4 reasons for shock

Answer 2

alteration in blood volume
decrease in contractility of the heart
any alteration in blood flow
any alteration in vascular resistence

Question 3

What is shock

Answer 3

decreased tissue perfusion with impaired cellular metabolism. Causes an increase in metabolic needs and O2 demands

Question 4

Describe the initiation stage of shock

Answer 4

hypoperfusion
inadequate O2 delivery 
Decreased CO 
Increased sympathetic NS activity
difficult to determine, not incredibly pronounced

Question 5

What are the stages of shock?

Answer 5

initiation
compensatory
progressive
refractory

Question 6

Describe the compensatory stage of shock

Answer 6

reversible
neural, endocrine, and chemical compensation.
blood is shunted toward vital organs
initially bounding pulses then weaker
Increase HR decrease Urine output

Question 7

Describe the progressive stage of shock

Answer 7

hypoperfusion
decreased cap blood flow
aerobic to anaerobic metabolism!! - hypermet state
lactic acid production - aggressive FR above 4.0
Low BP, decreased CO, decrease contractility
Intravascular to interstitial fluid shift

Question 8

What is the definitive lab test for shock and what are the values?

Answer 8

Lactic acid testing - shows us overall picture of imp tissue perfusion

aggressive fluid resuscitation above 4.0

Question 9

Refractory stage

Answer 9

IRREVERSIBLE
dysrythmias 
endothelial damage
cerebral ischemia
AKI
thrombis formation

Question 10

What is the Parkland burn shock formula for the FIRST 24hrs

Answer 10

4mL x kg x TBSA

Give first half over 8 hours, then second half over next 16hrs

Question 11

A pt is admitted to the ED with severe burn injuries. No fluids were started pre hospital. What solution would you hang first

Answer 11

Lactate Ringers - isotonic crystalloid

For BURN shock

Question 12

A client is just reaching 24hrs post admit for severe burn injury. The bag of lactate ringer’s is finished infusing. What do you do?

Answer 12

Obtain colloid containing fluid such as dextrose in water + potassium as per the second 24hr parkland formula

Question 13

What is the urine output goal for a pt in shock?

Answer 13

0. 5-1.0mL/kg/hr for adults

1. 0mL/kg/hr for children

Question 14

A pt presents w a burn injury that appears wet and weeping and blanches briskly. The pt is in terrible pain. What would you consider this burn and how long would you tell the pt before it heals

Answer 14

A partial thickness burn - 2nd degree

it will heal in 7-10days can be up to 21

Question 15

A pt presents with a burn injury that is red with patchy white areas that blanch when you apply pressure. There is only a scant amount of plasma leakage. What would you consider this burn and how long would you tell the pt it will be before it heals

Answer 15

a Deep partial thickness burn (2nd degree, deep)

it will heal in 2-4weeks and is usually excised and grafted.
Could heal w contractures if not treated

Question 16

A pt presents with a burn injury that doesn’t blanch. What would you consider this burn and what would you tell the pt of its tx?

Answer 16

A full thickness or 3rd degree burn
eschar created from destruction of epithelial elements

skin grafting is required

Question 17

What is important to note about superficial burns?

Answer 17

They are not counted in the formula for fluid resuscitation

Question 18

A pt presents to the ED with LOC and cherry red skin. Their HR is 160 & RR 26. What would be your assumption and what would you do?

Answer 18

The pt is experiencing Carboxyhgb levels of 40-60% and I would treat w 100% O2 IMMEDIATELY.

Question 19

A pt is experiencing burn shock. You are most concerned about fluid imbalance at what point?

Answer 19

within the first 8hrs, during the greatest shift in fluid!

Question 20

The nutritionist is coming to talk to your pt that has severe burn injuries about her needs. What do you expect the RD to discuss with the pt

Answer 20

The need for INCREASED caloric intake d/t hypermetabolic state
35-50cal/kg
High calorie, high protein, high carb!

Question 21

you’re reviewing orders for a pt with severe burn injuries. The orders are as follows: LR @ 600mL/hr. TPN via PEG at 50mL/hr and Morphine 10mg q4hr SQ. Which order would you question

Answer 21

morphine. No IM or SQ injections w burn victims bc ou don’t know about absorption.

IV opiates are indicated

Question 22

Describe wound care for a burn victim

Answer 22

Tetanus is there is any chance they haven’t had booster in last 5yrs
topical antimicrobial NOT indicated for ER care - only once they’re in the hospital
Cover with clean DRY dressing or sheets
hydrotherapy to slough off dead tissue
keep wound moist AFTER 24hrs to promote new tissue growth
keep pt warm

Question 23

You get report on one of your pts for the day:
HR 120
WBC 20k
\+ Blood culture 
Lactic acid level of 4.6
What do you expect the current dx to be?

Answer 23

severe sepsis

criteria for SIRS + KNOWN infection + organ dysfunction e/b increased lactic acid levels

Question 24

You go in to a pt room and find them to be extremely tachycardic and have a temp of 38.6c. You know the pt has not tested positive for any infection. What do you do

Answer 24

Call the physician with a recommendation that the pt is experiencing SIRS