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4-Fourth Semester > exam 2- musculoskeletal, shock, trauma, burns > Flashcards

exam 2- musculoskeletal, shock, trauma, burns Flashcards

1
Q

CT scan-

does what

uses what

A

provides 3d pictures to evaluate trauma

uses contrast dye

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2
Q

Mri

uses what

watch for what

A

uses radioactive fields to visualize structures and diagnose-

wathc for metal stuff

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3
Q

Duplex venous ultrasonography-

shows what

diagnosis what

A

shows how well blood moves in legs

diagnoses dvt

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4
Q

Bone Scan-

what looks at

what does increased uptake mean

make sure

A

visualses bone

  • uptake is increases in osteomyelitis, osteopsos, and cancers//

make sure pt is hydrated

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5
Q

Arthroscopy

looks into what

A

–looks into diseases of the knee and may remove fluid

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6
Q

Arthrocentesis-

does what\

after you do what

A

needle that obtains synovial fluid from joint-

after need to apply compression

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7
Q

Serum Calcium lab value-

what does decreased mean

what does increased mean

A

decreased means malabsotpion,

increases means bone cancer/fractures

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8
Q

CBC with diff.-

shows what

or what counts

A

show anemia, or platelet counts

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9
Q

CMP (BUN, creatinine, sodium, glucose

assessing what

A
  • assessing renal function
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10
Q

Erythrocyte sedimentation rate (ESR)

detects what

what does high mean

A
  • detects inflammation-

high means inflammation

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11
Q

PT & INR / PTT-

why important to know

what does low mean- give what

what does high mean- give what

A

important to know for anticoagulant therapy-

low means its clotting fast- give hep/warfarin

high means takes longer to clot- give vit k/ protamine/ FFP

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12
Q

Wound culture-

know what

A

know correct specimen for antibiotic

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13
Q

Uric Acid-

diagnoses what when elevated

A

diagnoses gout when elevated

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14
Q

D-Dimer – what does high diagnose

A

diagnoses dvt/pe

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15
Q

Renal Labs-

what assessing
why

A

assessing renal function

  • renal labs help in treatment of pt
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16
Q

Osteogenesis Imperfecta (Brittle bone disease)

what type of disorder

what bones

A

Connective tissue disorder

fragile bones that are more likely to fracture

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17
Q

Osteogenesis Imperfecta (Brittle bone disease)
Clinical Manifestations:

multiple
what sclera
what skin
increased
large
what height
lose what

A

multiple fractures

, blue sclera,

thin and soft skin,

increased joint hyper reflexibility,

large exterior fontanel,

and short height,

will lose hearing

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18
Q

Osteogenesis Imperfecta (Brittle bone disease)

diet x2

A

calcium and vitamin d supplements

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19
Q

Osteogenesis Imperfecta (Brittle bone disease)

how fast does it happen

who does it happen to

A

Progressive, and diagnosed as child ages

Genetic- affects males and females the same

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20
Q

Osteogenesis Imperfecta (Brittle bone disease)

what education

no more what

consult who

A

Education on cast care

No contact sports/ playgrounds/ no tossing in air

Pt/ot consult

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21
Q

Osteogenesis Imperfecta (Brittle bone disease)

what risk
manage what

A

fall risk

manage fracture

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22
Q

Cast care

what assessment
inspect for
what in cast
keep it what

A
  • nuero assessments,

inspect for hot spots,

nothing in cast,

keep clean and dry,

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23
Q

Muscular Dystrophy
Types: Duchenne (most common childhood form-genetic-males)

Clinical Manifestations:

see when
difficulty
frequent
tire when
abnomral
positive

A

see around school age

Walking difficulty,

frequent falls,

tires easily with activity,

abnormal gait,

positive Gower’s maneuver

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24
Q

Muscular Dystrophy
Medical Management:

is there a cure
what care
prevent what
or what

what care

A

No cure

Supportive care,

prevention of infection (respiratory due to weakness of respiratory muscles)

or spinal deformities

Self care deficits – support family- refer home caer

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25
Q

Muscular Dystrophy

weak heart-> leads to what

weak diaprhagm-> leads to what

A

Will have weakened heart muscle and lead to HF

And have weak diaphragm and lead to respiratory failure/infections

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26
Q

Muscular Dystrophy

loss of
chronic
f

A

Loss of muscle mass

Chronic inflammation

Fibrosis- scaring of tissue

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27
Q

Muscular Dystrophy

what chronic meds

A

Chronic corticosteroid usage to decease inflammation in resp

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28
Q

Muscular Dystrophy

may end up w what

will require what

A

May end up w vent and trach support

Will require a wheelchair

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29
Q

Scoliosis

what looks like

causes are what

A

Lateral S- or C-shaped curvature of the spine

Cause may be congenital, idiopathic, acquired

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30
Q

Scoliosis

when do you check

A

Check around kindergarten -10-12 age before puberty growth spurt

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31
Q

Scoliosis Clinical Manifestations

what pain
what back
how walk
what when walking
what gait

A

: back pain,

curved back,

walk uneven,

sway when walking,

wider gait

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32
Q

Scoliosis Mild treatment

A

pt/ot exercise to decrease the curvature

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33
Q

Scoliosis Moderate treatment

A

: brace (Milwaukee or Boston) to prevent further curvature

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34
Q

Scoliosis Severe treatment

A

: spinal fusion with tortious shell brace

(to prevent instability)

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35
Q

Paget’s Disease

what type of disease

affects how many bones

A

Progressive genetic disease = larger and softer bones

Can affect a single bone or multiple

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36
Q

Paget’s Disease

what type of disorder

increased

increased

A

Disorder with Bone Remodeling

Increased Bone Reabsorption

Increased Bone Growth

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37
Q

Paget’s Disease

skeletal
what bones
potential for what

A

Skeletal Deformities,

Fragile Bones,

potential fractures(risks for bleed , clot and infection)

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38
Q

Paget’s Disease

in what bones

how do bones look (L/S/U)

A

Excessive bone reabsorption and excessive bone formation in long bones like legs

Bones become large, soft and unstable

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39
Q

Paget’s Disease Complications

what pain
a
d
increased risk

A
  • bone pain,

arthritis ,

deformaites,

inc fracture risk,

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40
Q

Paget’s Disease Diagnose w

A

bone scan,

xray

ct

mri

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41
Q

Paget’s Disease Draw what labs

A

serum alkaline phosphate

and a calcium

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42
Q

Paget’s Disease Treatment

what meds

how do those work

A

biphophates (aledronate) and also calcitonin –

increases strength of bone
By inhibiting bone reabsorption

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43
Q

Paget’s Disease

decreased what risk
by decreasing risk for what

A

Decrease risk for bleed by decreasing risk of fracture

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44
Q

Pagets disease- supplements x2

A

Supplements- calcium and vitamin d

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45
Q

Amputations

what is amputation

what is primary
what is secondary

A

Partial or total removal of extremity

primary- emergency event

secondary- chronic disease

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46
Q

Amputations
Can you think of any diseases and or risk factors for amputation?

o
d
p
h
hyper
c

A

osteosarcoma(bone tumor)

Diabetes,

peripheral vascular disease,

HTN,

hyperlipidemia,

cardiovascular disease

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47
Q

Amputations Are there any Health Promotions that can be utilized to aid in prevention?-

get what
increase what
education on what

A

get glucose under control,

increase exercise,

education on nutrition

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48
Q

Amputations Complications

I
d h
p p
c

A

infection

delayed healing

phantom pain

contractions

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49
Q

Amputations Infection s/s

d
r
f
what hr
what bp

A

– drainage,

redness,

fever,

high hr

low bp

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50
Q

Amputations
Delayed healing

s
decreased
what imbalances

A

–smoking,

decreased cardiac output,

electrolyte imbalances

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51
Q

Amputations Phantom pain

treat w what

t
m
p m

A
  • treat w

tens,
mirror,

pain meds

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52
Q

Amputations Contractures

teach what
what excercises

A
  • teach to extend joint to prevent,

rom excercises

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53
Q

below knee amputation

assessment

p
s
lab
wound
temp how often

A

pain

skin

wbc

wound-redness/edems

temp every 4-8 hrs

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54
Q

below knee amputation
pt teaching

do what appropriatly
stump what
positioning what
resume

A

wrap stump appropriately

stump exercises

positioning of stump

resume physical activity asap

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55
Q

Trauma associated Amputations -Save the digit if possible!

put on what
dont put where
keep it what

A

Put on ice but not in ice- like in plastic bag in ice

Don’t put in any liquid like water/milk- don’t want it to get mushy/ infection

Keep it cool if you can

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56
Q

When should a tourniquet be considered?

only when

if its small- then do what

A

Only if massive hemorrhage-

if its something small- wrap it and keep above head to decrease bleeding and hospital asap

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57
Q

Trasnverse fractures

linear fractures-

A

Transverse- fracture across bone

Linear- fractue long way

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58
Q

oblique nondisplaced-looks like

obloquy displaced- looks like

A

Oblique nondisplaced- looks like / and bone is intact

Oblique displaced looks like / bone split

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59
Q

Spiral fracture

A
  • curves around bone
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60
Q

what does stable fracture mean

what does unstable fracture mean

A

Stable means bone maintains alignment

Unstable means bone moves out of alignment

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61
Q

if there’s an open fracture

risk for what

need what

what support

A

penetrates skin- risk for infection

  • needs antibiotics,

nutritional supports, vit c, diet

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62
Q

Closed

inc risk of what x2

A
  • inc risk of hemorrhage and bleed
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63
Q

Fracture care in emergency

what to fracture
maintain
prevent

A

immobilize fracture,

maintaine perfusion

prevent infection

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64
Q

Fracture care - splint

maintains what
prevents what

A

maintain normal alignment

prevent dislocation

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65
Q

fractures

diagnosed w

what decreases pain

A

Diagnoses with x ray

Nsaids will decrease pain

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66
Q

fracture care-diet
high

A

high protein

high calcium

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67
Q

Traction fracture care

prevents what

do not do what

A
  • prevents muscle spams by constantly pulling on fractured bones

, do not remove weights

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68
Q

Fractures nursing diagnosis
Manage acute pain

monitor

move pt how

put affected extremity where

encourage what

adminster what

A

-monitor vs

, move pt gently or slowly,

elevate above heart,

encourage adjuntive like deep breathing or relaxation

, administer meds as persribed

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69
Q

Fractures nursing diagnosis
Reduce risk for impaired peripheral neruoravasucal function-

assess what
monitor fr what
monitor what in cast

A

asses perfusion,

assess nail beds,

monitor for edema,

monitor tightness of cast

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70
Q

Fractures nursing diagnosis

Reduce risk of infection-

what technique
administer what
promite what

A

sterile technique,

administer antibiotics,

promote nutritional intake,

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71
Q

Fractures nursing diagnosis
Promote physical mobility-

turn how often
teach what

A

turn every2 hrs,

teach rom on limbs,

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72
Q

Rib fracture
Flail chest: -what looks like

impairs what

Fractures: Trauma related

A

fracture of 2 or more adjacent ribs in 2 or more places  free-floating segment that moves in opposite direction of rib cage

impairs respirations

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73
Q

Rib fracture

what 2 complications

Fractures: Trauma related

A

pneumothorax and hemothorax

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74
Q

Pelvic fracture

montior for what
what is sign of that

A

Monitor for hemorrhage!

if blood is coming out of urethra could be sign of internal hemorrhage

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75
Q

pelvic fracture

pain where

cant use what/ until when

A

Might have pain to back or hip area(may signify internal bleed),

No foley catheters until all bladder/urethral trauma have been cleared-

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76
Q

pelvic fracture

how move them
keep what
how many people

A

can logroll for movement-

keep shoulders in line w hip

have multiple people help.

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77
Q

Femure fracture

monitor for what
monitor for what else
what to leg
frequent what

A

Monitor for hemorrhage!

Monitor for fat embolism,

stabilize leg,

frequent assessments

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78
Q

Very vascular in pelvis-

need to think how

what is priority

pelvic fractures

A

Need to think of bleed- they are a bleed until proven otherwise

Priority is bleeding and ruling out bleeding- because its very vascular in pelvis

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79
Q

pelvic fracture diagnostics

get what
what if bleeding

A

ct of abdomen and pelvis

ultrasound if bleed

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80
Q

Immobile and broke a big bone-

preventing what
how

pelvic fracture

A

prevent blood clots-

scd, compression socks, anticaogs

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81
Q

pelvic fracture

dont move unless what

no foley until when

also ned to watch what

A

Don’t move unless log role- improper movement can cause damage- shoulder in line with hip

No foley unless you’ve ruled out trauma

Also think about fat emboli- watch for s/s

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82
Q

when to get ultrasound in pelvic fracture
if complaining about

what pain
what other pain

what type of pelvic pain

pelvic fracture

A

Lower abdominal pain,

low back pain,

pelvic pain like cramping or shooting-

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83
Q

Rib Fractures -> Flail chest

is ti bad

occurs w what

A

Medical emergency- flair chest

Can occur w cpr, motor veihicle accident, fall, sport injury

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84
Q

Rib Fractures -> Flail chest

try not to do what

keep what

A

Try not to move unintentionally -

keep chest straight

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85
Q

Rib Fractures -> Flail chest

when do you give chest tube

A

Chest tube depends on if anything is in plueral space

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86
Q

Rib Fractures -> Flail chest
Its incredibly painful to breath, so they are

what breathers

risk for what x2

A

shallow breathers

puts them at risk for atelectasis and pneumonia

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87
Q

how to prevent pneumonia -what meds x2

make sure what

A

prevent w pain relief- opioids and nsaids

are sure to is on pain schedule

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88
Q

what do you give if they have pneumonia

s
f
may need what

A

steroids

fluids

maybe need intubation

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89
Q

Rib Fractures -> Flail chest

watch what x2

what means may need chest tube

A

watch symmetry and lung sounds

if one side isn’t moving then may need chest tube or x ray

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90
Q

Rib Fractures -> Flail chest
Rn after procedure of chest tube

assess how often

have pt do what//nurse do what as well

check system why

A

Assess respiration status every 4 hrs,

have patient take deep breathes (if painful pre-medicate)

check the system to ensure that drainage is patent and that the tubing is free of dependent loops or kinks

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91
Q

rn chest tube

make sure stays what

document what

risk for what

what do you do if chest tube comes out

A

make sure its sealed

document how much drainage

risk for clots

place sterile petroleum jelly over to prevent air from coming in

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92
Q

Chest tube management could be used for what

place for what x2

A

place for

pneumothorax (air in pleural space)

hemothorax ((blood in pleral space)

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93
Q

Femur (long bone) Fractures

Why are there higher risks for complications in a long bone fracture vs a small bone fracture?-

A

because the long bones are highly vascular and contain more blood

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94
Q

What are the surgical interventions for this fracture? (Procedures)

Femur (long bone) Fractures

A

normally, a metal rod is inserted into leg

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95
Q

What is the nurse’s role in management of this disorder? post op
assessing what w pt

Femur (long bone) Fractures

A

assess cap refill

pedal pulses

all vitals

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96
Q

What are the potential complications?

Femur (long bone) Fractures

A

Dvt/pe

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97
Q

Femur (long bone) Fractures

what is key
decreases what

A

Early stabilization of fracture is key

  • Risk for fat emboli decreases when you put leg straight out Because bone marrow cant leak into system
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98
Q

Complications of musculoskeletal Trauma

pressure from what
f e
d
I
I h
disruption of what

A

Pressure from edema and hemorrhage

Fat emboli

Deep venous thrombosis (PE)

Infection

Impaired healing

Disruption of neural transmissio

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99
Q

compartment syndrome-

increased what
due to what

A

increase pressure

due to blood or fluids accumulation during musculoskeletal trauma

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100
Q

compartment syndrome- Usually in lower leg or forearm-

causes what
causes a
leads to what

A

causes pressure on nerve endings and pain-

causes a decrease in blood flow to area

And leads to ischemia

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101
Q

compartment syndrome-Manifestations– inflammation around muscle constricting blood flow, builds up pressure-

a lot
decreased
what defecits

A

a lot of pain,

decreased palpable pulses

Circulatory and nuero deficits(cant feel or cant move things like toes)

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102
Q

compartment syndrome-

what happens if not releived

if not treated it can cause what x2

A

If not relieved the patient can go into rhabdo( intrinsic aki)

If not treated asap it can cause sepsis and irreversible muscle trauma

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103
Q

compartment syndrome- interventions

what immediately

remove any what

A

Alleviate pressure immediately!

Remove any tight fighting dressing, casts, or clothing

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104
Q

compartment syndrome- Fasciotomy

what is it
incision is left to what

A

surgical incision of the muscle fascia to relive pressure within the compartment.

Incision is then left open to heal.

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105
Q

compartment syndrome-

won’t do what
put what on

A

Will not recast them-

put a splint on and let it heal

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106
Q

Interventions- compartment syndrome -What is patient at risk for?

I
o
n
additional

mostly 24-48 hrs after limb surgery

A

infection

osteomyelitis,

necrosis,

additional nerve damage,

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107
Q

fat embolism- how does it work

A

Fat globules released from the bone marrow into the bloodstream due to Fx lodge in pulmonary vascular bed or peripheral circulation →S/Sx of embolism  respiratory failure or death due to pulmonary edema

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108
Q

fat embolism-

What is the difference between blood clot (PE) & fat embolism?

what only occurs in fat embolism

A

difference is that is not a clot , it is a bunch of bone marrow,

petechiae only occur w fat embolism (because of clotting cascade due to fracture)

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109
Q

fat embolism

cant give them what

will be on what

A

Never give these patients heparin- already have thrombocytopenia

Will be on corticosteroids to reduce inflammation and pulmonary edema

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110
Q

fat embolism- may need what available

What kind

A

may need blood products available

plasma and FFP- contain cloning factor

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111
Q

fat embolism Diagnosis Lab:
what

ESR
Ca
rbc/platelts
what lipase

what diagnostic

A

↑ESR,

↓ Ca+,

↓ RBC & platelets,

↑ lipase level

angiogram- diangostic

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112
Q

fat embolism

cant use foley until when

A

no foleys until identified that there is no internal bleed,

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113
Q

Interventions- fat emboli

prevention- early what

A

Early stabilization of long bone fracture

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114
Q

Interventions- fat emboli

similar to blood clot embolism except

need prompt what

A

anticoagulants are not indicated (oxygen)

Prompt identification

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115
Q

Interventions- fat emboli

may require what

A

May require intubation and mechanical ventilation

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116
Q

Pulmonary embolism

what is it

A

Obstruction of blood flow to pulmonary system due to clot
Fat emboli are most common nonthrombotic PE

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117
Q

Pulmonary embolism s/s-

d
s
what pain
c
what hr
what rr
what in lungs
what temp

A

dyspnea,

sob,

pluertic chest pain,

, cough,

tachycardia,

tachypnea,

crackles in lungs

low grade fever

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118
Q

Pulmonary embolism
Prevention

what meds
early
using

A
  • prophylactic anticoags,

early ambulation

, using compress stockings,

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119
Q

Pulmonary embolism
Diagnoses w

A

d dimer

chest ct

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120
Q

Pulmonary embolism meds-

what med
what if massive pe

A

anticoagulant - heparin iv and oral warfarin

massive pe is throbolytics like tpa or streokpinase

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121
Q

if anticoagulants fail for pulmonary embolism then you get what

A

then you need surgery and umbrella filter will be inserted into vena cava to catch emboli

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122
Q

Pulmonary embolism

what is antidote for heparin
what is antidote for warfarin

A

protamine is antidore for herpain

vit k is antidote for warfarin

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123
Q

Pulmonary embolism nursing diagnosis-

Promote effective gas exchange-

assess what
record
place where
monitor what

A

assess resp status,

record loc,

place in high fowlers,

monitor abg,

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124
Q

Pulmonary embolism nursing diagnosis-Promote aqeuqute cadiac output-

listen to what
record
assess
monitor
admisnter

A

listen to heart sounds,

record i/o,

assess skin color,

monitor cardiac rhythm,

administer meds as ordered

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125
Q

Pulmonary embolism nursing diagnosis-Reduce risk for bleeding and hemorrhage-

assess
keep what
avoid what
maintain what
maintain

A

asses for bleeding,

keep antidotes at bedside,

avoid invasive procedures,

maintain firm pressure on injection sites,

maintain adequate fluid intake

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126
Q

Deep Vein Thrombosis

Indirect causes include

what blood flow
what injury
increased what

A

↓ blood flow

Blood vessel injury

Increased clotting due to reaction to blood loss

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127
Q

Deep Vein Thrombosis-Prevention measures

what to fracture
early what

A

Immobilization of fracture

early ambulation

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128
Q

Deep Vein Thrombosis-Interventions

need for what
what meds
what devices

A

need for assessment in fractures (checking neruo in legs, feet, pulses, check BIL) & immobility,

anticoagulants (also prophylactic),

compression stockings

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129
Q

Deep Vein Thrombosis-If pts are complaining of-

what pain
t
s
w
r

A

calf pain,

tenderness,

swelling ,

warmth,

redness

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130
Q

DVT
pt may do what
feels like what
what is tall tale sign

A

Pt may rub,

feels like Charlie horse in spot,

tall tale sign is very specific area of pain,

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131
Q

Deep Vein Thrombosis

stop what immediately

A

STOP rubbing/ DO NOT massage,

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132
Q

Deep Vein Thrombosis

diagnosis

A

get venous ultrasound

and d dimer to diagnose

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133
Q

Deep Vein Thrombosis Treat w/ what meds

A

Anticoagulants LMW heparins(enoxaparin) and oral warfarin or potneitnal surgery

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134
Q

Deep Vein Thrombosis-When taking anticoags-

report what
use what
what toothbrush
no what drink
no what food
no what med

A

report any bleeding

, use electric razor,

soft bristle toothbrush,

no alchohol,

no vit k,

no nsaids /aspirin

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135
Q

Deep Vein Thrombosis- how could it be avoided

increased
elevating
giving what
placing

A

Increased ambulation and movement

Elevating foot of bed

Give prescribed phrolactic meds – LMW heparins or oral
anticoagulants

Placing SCD and TEDS

136
Q

DVT nursing diagnoses- Manage pain-

assess
measure
apply

A

assess pain,

measure calf,

apply warm heat,

137
Q

DVT nursing diagnoses- Promote tissue perfusion-

assess p
assess s
what to extremities
knees what
what applainces
change positions how often

A

asses pulses,

assess skin,

elevate extremities,

knees slightly bent,

weight dispersion appliances, c

hange positions every 2 hrs

138
Q

DVT nursing diagnoses-Reduce risk for bleeding-

report what
monitor what

A

report any bleeding,

monitor labs(inr, aptt),

139
Q

DVT nursing diagnoses- Promote mobility-

encourage what
_ and _ _
increase what
assist w

A

encourage rom,

C and DB,

increased fluid intake

, assist w ambulation,

140
Q

Infection (could lead to osteomyelitis)

inc risk when

more likely in what

A

↑ risk when blood supply is decreased

More likely in open than closed fractures because bone is exposed to enviroemnt

141
Q

osteomyelitis may be caused by what

may lead to what x2

A

May be caused by contamination from injury or surgery

sepsis and tissue death & necrosis

142
Q

Infection (could lead to osteomyelitis)-Most at risk are delayed healing

d
p
chronic
m o

A

-Diabetics,

peripheral vascular disease,

chronic neuropathy,

morbidly obese

143
Q

Infection (could lead to osteomyelitis)-Antibiotics-

may need what

what ones are used

watch what

A

may need picc or iv

vanco/genta mycin is used or ceft drugs-

watch renal labs-

144
Q

Infection (could lead to osteomyelitis)
Nutrition:

decrease want
offer what
possible what
what 2 vitamins

A

decrease sugar and complex carbs,

offer protein,

possible increae in calcium and zinc,

vit d and c_

145
Q

Infection (could lead to osteomyelitis)

what environment
obtain what
watch for what

A

Get inro cool environment

Obatin vitals,

watch for s/s of sepsis

146
Q

Infection (could lead to osteomyelitis)

diagnostics

A

(WBC) ,

pro calcitonin,

esr( sepsis and inflammation) ,

flat panneled x ray,

maybe mri,

bone scan

147
Q

Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome

manifestations

what pain
s
b
changes in what
decreased what

(occurs after nerve or musculoskeletal trauma)

A

Persistent pain,

swelling,

burning,

changes in skin color and texture,

decreased motion r/t CNS or PNS damage

148
Q

Treatment: what agent

Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome (occurs after nerve or musculoskeletal trauma)

A

sympathetic nervous system blocking agent

(local anesthetic)

149
Q

meds:

n
t
g
c

Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome
(occurs after nerve or musculoskeletal trauma)

A

NSAIDs,

Tramadol(narcotic),

Gabapentin(nerve pain),

Clonidine patch (antihypertensive)

150
Q

Delayed union - what is it

A

(lack of healing after 6mths)

151
Q

Nonunion- what is it

persistent what

A

(lack of healing) →

persistent pain and movement at the fracture site →

152
Q

will need what in nonunion

A

need for surgical intervention for potential refusion or new screws put in

153
Q

what happens if non union healing happens in elderly

A

may need palliative care

bed lift, bed ridden, may hospice- control pain

154
Q

What are factors that negatively influencing healing?

a
h
what status
what diseases
s

A
  • age,

health,

immune status

, chronic diseases,

smoking

155
Q

nutrition in msk injury

increase what
p
c
f/v
what 2 vitamins

A

protien

calcium

fruits/vegtables

vitamin d/b12

156
Q

what foods to avoid in MSK injury

A

complex carbs and high sugar

157
Q

Types of Trauma

m v m

A

major vs minor

158
Q

types of blunt trauma

d
a
s
c
c

A

Deceleration

Acceleration

Shearing

Compression

Crushing

159
Q

what is penetrating trauma

A

Foreign object enters the body

160
Q

I
b i
i_ _

types of trauma

A

inhlation

blast injury

Intimate partner violence

161
Q

what is class 1
class 2
class 3

trauma

A

Class 1 Life-threatening
Class 2  Multiple injuries
Class 3  least severe

162
Q

what is lethal trio

h
a
c

A

hypothermia

acidosis

coagulopathy

163
Q

Trauma: primary survey (assessment)

a
b
c
d
e

A

A- Airway establishment, c-spine immobilization (hold neck straight)

B- Breathing – ventiallary indepedeance

C- Circulatory – cap refill, skin color, temp, pulses

D- Disability- Neuro checks, pupils, response to stimuli

E- Exposure/full body assessment to determine what happened

164
Q

Trauma- will need what-preferably

what is golden hour

A

Need an iv- preferably as large as possible aSAP/

golden hour is when prompt treatment helps prevent against death

165
Q

Secondary survey (subjective -SAMPLE)

F
G
H
I

A

F- Full set of vitals

G- Giving comfort, physical and emotional

H- Head to toe and H&P

I- Full Inspection

166
Q

Trauma :: Head/Neck (airway obstruction) Highest PRIORITY ->

maintenance of what

stabilize what- when let it go

A

maintenance of airway

stabilization of cervical spine- c spine must be cleared before you can let go

167
Q

Trauma :: Head/Neck (airway obstruction)

Jaw thrust-

if when
this will do what

A

if pt is unresponsive,

this will manually open airway

168
Q

Trauma :: Head/Neck (airway obstruction)

always give what

maybe what

A

Always give high flow 02,

maybe Combitube or endotracheal intubation

169
Q

Trauma :: Head/Neck (airway obstruction)

pts tend to do what when in trauma

A

Pts tend to hyperventilate when they are in trauma

170
Q

Trauma :: Head/Neck (airway obstruction)

What else would you assess for the airway?
Look listen and feel

what depth
what chest
t d
check what
assess risk for what

A

Respiration depth

Symmetrical chest

Tracheal deviation

Check JVD and chest trauma

Assess risk for flail chest- cpr or rib

171
Q

Trauma :: Thoracic Effects-
Pneumothorax (Tension) manifestations

j
severe
t d

A

JVD,

severe distress,

tracheal deviation/

172
Q

what do you need immediately w tension pneumothorax

A

need immediate needle thoracostomy

(large bore needle into 2nd ICS @ MCL

then insert chest tube)

pulls out air so lungs can re-expand

173
Q

Trauma :: Thoracic Effects

Flail Chest (on MSK trauma PP)-

see what s/s
and d

will require what

A

sinking w inspiration and protrusion w exhalation-

dyspnea-

will need surgery or mechanical vetntilation

174
Q

Trauma :: Thoracic Effects-
Thoracic contusion-

what is it
impairs what

A

bruisding of thoracic tissue-

impairs gas exchange due to hemorrhage

175
Q

Trauma :: Thoracic Effects-Diaphragmatic rupture-

what is it

causes what

A

herniation of abdominal contents into thoracic cavity

, causes respiratory comprimise

176
Q

Trauma :: Thoracic Effects
Cardiac tamponade

what is it
will need what

A

 blood in pericardial sac 

need pericardiocentesis-

177
Q

pericardiocentesis

A

large bore needle into pericardial sac into heart and remove fluid

178
Q

Trauma :: Thoracic Effects

Aortic rupture (most likely fatal)- why fatal

A

by time they can get the treatment they need they died from hypovolemia

179
Q

chest tubes are places where

always assess for what

A

chest tubes may be placed at bed side

Always assess for uneven inspirations

180
Q

What is difference between placement from hemothorax and pnemothorax

A

h- bottom

p- on top

181
Q

what is triss score

A

TRISS score  Use age of pt., type of trauma, systolic BP, RR, injury severity score, and GCS to predict survival

182
Q

Emergency Department Care

get a what

if pt. is conscious or bystanders –

try to figure out what

A

Thorough assessment,

if pt. is conscious or bystanders – need to get as much history and what happened as possible!

– try to figure out what type of injury it was- interview everyone

183
Q

KNOW: in emergency department care

A

Blood type,

cross and match,

CBC,

ABGs,

alcohol level,

urine drug screen

, preg. test,

imaging (CT, MRI)

184
Q

try to do what
also need to get what type of tests

Emergency Department Care diagnosis

A

Try to identify the pt/

get cbc, renal function and liver function because it can affect how you care for pt

185
Q

Diagnostic peritoneal lavage–

what happens
what means a problem

Emergency Department Care diagnosis

A

large bore needle attached to syringe-

if flank blood is taken out then the pt is immediately taken back to or for laparotomy-

186
Q

what is Diagnostic peritoneal lavage used to diagnose

Emergency Department Care diagnosis

A

used to determine if there is internal bleeding wherever the lavage is performed (

187
Q

Medications trauma->Blood components & crystalloids

do what

A

Replace volume

188
Q

Inotropic & vasopressive meds -dopamine- epinepherine-

purpose is to do what:
increase what:
causes what:

Medications trauma

A

purpose is to increase Cardiac output-

Increase myocardial contractility

Cause vasoconstriction so that blood stays in core and organs are perfused

189
Q

remember what w inotropic meds

A

Remember ”you cannot squeeze a dry tank!” Give fluids first and in conjunction give the inotropics but do not give just inotropics. Meds won’t work without enough fluids.

190
Q

Medications trauma-Opioids

used for what
use
need what first

A

used for pain

Be sure to use carefully,

need full assessment first-watch bp and respiratory

191
Q

Medications trauma-Immunizations

give what

A

If unable to remember or not within the last 5 years – give a tetanus booster

192
Q

meds- trauma

full of what
replaces what
what type of iv fluid

LR (ringer lactate, lactated ringers)

A

Electrolytes

Replaces fluid volume/Volume replacement

Isotonic

193
Q

NS (0.9% sodium chloride)-meds

replaces what
what type of iv fluid
only fluid

trauma- meds

A

Replaces fluid volume/Volume replacement

Isotonic

Only fluid given w/ blood

194
Q

Whole blood- meds trauma

replaces what

contains what

risks are what

A

Replaces blood volume & 02

Contains everything (RBCs, plasma, etc.)

Risks: incompatibility and FVO

195
Q

Packed RBCs

replaces what
increases HGB by what
do what prior
no what

trauma meds

A

Replaces 02 carrying capacity

1 unit = increase of hgb by 1 g/dL

Warm prior to admin if indicated and ordered

No clotting factors

196
Q

Platelets

used for what
raises by how much

trauma meds

A

Used for thrombocytopenia

1 infusion = raise platelets by 30,000-50,000

197
Q

Albumin

is what
do not
can be used

trauma meds

A

Blood expander- Expands blood volume in shock

Do not substitute for whole blood

Can be used for diuresis

198
Q

FFP (fresh frozen plasma)

used for what
what before
has what
used for when

trauma meds

A

Used for coagulopathy

Thaw before using

Has clothing factors

Use for pt. on coumadin involved in trauma to stop bleeding

199
Q

Cryoprecipitate

used for what
w low

trauma meds

A

Used for coagulopathy

w/ low fibrinogen

200
Q

blood typing

+ can receive
- can reive

what each letter can

A

+ = +,-

-= -

each letter can get its own letter

201
Q

Transusion reactions-Febrile

causes what

A
  • causes fever and chills in first 15 minutes
202
Q

Transusion reactions-Hypersensitivity

u
i

A
  • urticaria(reddeded wheals)

and itching

203
Q

Transusion reactions

Hemolytic-clumping of rbc,

what in face
what in vein
h
what bp
what pain

A

flushing of face,

burning on vein,

Headache

, hypotension,

lumar pain

204
Q

Other risks- transfusion reactions

c o
imbalances
I d

A

circulatory overload,

electrolyte imbalances,

infectious diseases

205
Q

Manage airway clearance

might have
increased
monitor x2

Interventions (post initial trauma) A,B,C, I

A

Might have tracheostomy

Increased confusion = check 02!

Monitor loc and 02

206
Q

Risk of infection
Clostridium (if laying out in field for awhile)
MRSA, necrotizing fasciitis, tetanus

h
what precaution
provide what x2

Interventions (post initial trauma) A,B,C, I

A

Hand hygiene,

standard precautions,

provide fluids and nutrition

207
Q

Impaired mobility

provide what
_ and _ _
I s
want to prevent what

Interventions (post initial trauma) A,B,C, I

A

provide active or passive excercises,

Cough and deep breathing,

Incentive spirometry,

prevent DVT/PE, Fat emboli,

208
Q

mental Interventions (post initial trauma) A,B,C, I

A

Grief & loss
New coping
Transition of care to home or other facility

209
Q

trauma-emergency surgery

indicated when
despite
and there is

A

Indicated when patient remains in shock,

despite resuscitation

and there is no obvious external sign of bleeding

210
Q

Organ Donation

A

Consent given by donor & another person

Encourage individuals to express what they want

211
Q

Shock

what is it
lack

A

Systemic imbalance between oxygen supply and demand (O2 and/or perfusion issue)

Lack of oxygen to the cell

212
Q

To maintain homeostatic regulation need:

sufficient
uncomprimised
sufficient
healthy

A

Sufficient CO (cardiac output)

Uncompromised vascular system

Sufficient volume of blood

Healthy tissues that use 02

213
Q

what is cardiac output=

how calculate

A

amt. of blood pumped with each contraction

SV x HR

214
Q

flow rate for nasal cannula

215
Q

flow rate for simple face mask

216
Q

flow rate for Ventura mask

217
Q

flow rate for non rebreather

218
Q

flow rate for high flow nasal cannula

219
Q

SVR

A

resistance of peripheral circulation

220
Q

map goal

goal
need what for perfusion

A

70-110

*need to be at 60 to have proper perfusion

221
Q

MAP drop

how calculate

A

subtract top from bottom

then divide this number from the original top number

222
Q

Stage 1 stage of shock

map drops how much

volume drops how much

A

MAP drops less than 10 mmHg from normal levels

(volume decreased by 500 ml)

223
Q

Compensatory shock

map drops how much

volume how much

A

MAP falls to 10-15 mmHg from normal levels

(volume decreased by 25-35%)

224
Q

Stage 2 stage of shock

map how much
volume drop how much

A

 MAP of 20 mmHg from normal levels

(volume decreased by 35-50%)

225
Q

Stage 3

what type of shock

what type of care

A

 Refractory or Irreversible Shock (Death is imminent) –

comfort care- body is no longer compensating

226
Q

Stage 1-Early, Reversible

what MAP
what decrease in blood volume

A

map drop less then 10

decrease less then 500 mls

227
Q

Stage 1-Early, Reversible

Sympathetic nervous system

increases what x2
which does what

shock compensation

A

increases heart rate and the force of the cardiac contraction

which increases the cardiac output

228
Q

Stage 1-Early, Reversible

Sympathetic stimulation also causes what

increases what

shock compensation

A

peripheral vasoconstriction

which increases MAP

229
Q

Stage 1-Early, Reversible
symptoms:

what hr
what map

will see what lab

A

Slight increase in heart rate

Slight decrease in MAP

see an increase in lactic acid

230
Q

Stage 1.5-Compensatory Shock

map drops how far

volume drops how far

A

MAP drops 10-15 below baseline

volume drops 1000

231
Q

Stage 1.5-Compensatory Shock

what hr
what bp
slight what

A

Hr will be up,

bp slight down,

may have slight changes in loc- confusion and lethargic

232
Q

Stage 1.5-Compensatory Shock

give pt what
because may need

A

Make sure to give pts fluids-

may need inotropic drugs and they need fluids to work-

233
Q

Stage 1.5-Compensatory Shock

need what
need a detailed

A

Need to put 02 on pateitn

  • need a detailed nuero assessment
234
Q

Stage 1.5-Compensatory Shock

try to get what
replace what w what

A

try to get multiple large bore iv,

replace volume w whole blood, fluids

235
Q

Stage 1.5-Compensatory Shock

labs

A

Cbc w diff,

want h/ h,

some electrolytes,

inflammatory like sed rate // esr//c reactive protein// pro cal/ lactic acid

236
Q

Stage 1.5-Compensatory Shock

Sympathetic nervous system releases what x2

causes what

Compensatory mechanisms

A

epinephrine and norepinephrine

-causing vasoconstriction, increased cardiac output and increased peripheral perfusion

237
Q

Stage 1.5-Compensatory Shock- The RAA system response occurs as perfusion to the kidneys decreases–

converts what
results in what
which does what

Compensatory mechanisms

A

this conversion of Angiotensin I to Angiotensin II

results in the kidneys absorbing water and sodium

which increases the blood volume…maintaining MAP

238
Q

Stage 1.5-Compensatory Shock-The hypothalamus releases adrenocorticotropic hormone-

secretes what
retain what

Compensatory mechanisms

A

secretes aldosterone-

retains water and sodium

The posterior pituitary releases antidiuretic hormone

239
Q

Stage 1.5-Compensatory Shock-
As MAP falls in this stage, a fluid shift from

where to where

does what

Compensatory mechanisms

A

interstitial space to the capillaries occur

raising blood volume

240
Q

compensatory mechanisms do what

however……

stage 1.5- compensatory shock

A

Compensatory mechanisms are able to maintain blood pressure and thus tissue perfusion to vital organs, preventing cell damage

The compensatory mechanisms can only maintain MAP for a short period of time, if proper treatment is not provided shock will progress

241
Q

Stage 2: Intermediate or Progressive Shock

map how far
blood volume how far

A

Begins after MAP falls 20mmHg below baseline

Blood volume loss of 35-50% ( 1800-2500mL of fluid)

242
Q

Stage 2: Intermediate or Progressive Shock

what happens to compensatory mechanisms

but cant what

A

Compensatory mechanisms remain activated,

but can no longer maintain MAP for organ perfusion

243
Q

Stage 2: Intermediate or Progressive Shock

what happens to cells
cells where become hypoxic

A

Cells become oxygen deficient from the sustained vasoconstriction

Cells in the heart and brain become hypoxic

244
Q

Stage 2: Intermediate or Progressive Shock

Affected cells switch from

what to what
causes what to form

what is now present in body

A

aerobic to anerobic metabolism

causing the formation of lactic acid—

Acidotic State in the body is now present

245
Q

Stage 2: Intermediate or Progressive Shock

fluid goes where

A

Then Fluid shifts back into the interstitial space

246
Q

Stage 2: Intermediate or Progressive Shock

what is diminished

A

Perfusion

to skin, skeletal muscles, kidneys and GI organs are diminished

247
Q

Stage 2: Intermediate or Progressive Shock

–General state of acidosis and hyperkalemia ensues that waht

A

If not treated RAPIDLY, the patient will become Stage 3 or Irreversible

248
Q

Stage 2: Intermediate or Progressive Shock-Need to transfer to icu

pt feels how/ may not be
what rr
what bp
what hr
sense of what
what skin

A

Pt will feel horrible/ may not be respsonsive or not making snese

tachypnic,

bp down

hr up,

impending doom

cold clammy skin

249
Q

what helps acidosos

what med
what else

A

sodium bicarbonate

fluids

250
Q

Stage 3: Refractory or Irreversible Shock

what happens

A

Death of cells is followed by death of tissues, which results in death of organs

251
Q

Stage 3: Refractory or Irreversible Shock

what is initiated

are in what

A

Comfort care is initiated- in patient hospice-

are in metabolic acidosis

252
Q

Stage 3: Refractory or Irreversible Shock

may be what
can give what

A

Msy be intubated-

can give pain meds-

253
Q

Hypovolemic shock

what type of problem

what decreases

happens from what

A

Volume problem

venous blood return decreases

Can happen from trauma, massive bleeding,

254
Q

Hypovolemic shock s/s

what bp
what skin
what hr
what pulse

A

hypotensive

pale cool clammy skin

high hr

thready pulse

255
Q

Hypovolemic shock

replace what- w what

what type of meds

what device

A

replace volume- replace blood and fluids

Vasopressers- dopamine

Intubation to hemodynamically stable

256
Q

Hypovolemic shock- what happens if it is from a bleed

A

go to or and fix bleed

257
Q

Cardiogenic shock

what isn’t working

decrease in what
increase in what

A

Pumping mechanism is not working

decrease in cardiac output

increase in 02 demand

258
Q

when do you see cariogenic shock

A

end stage CHF

end stage COPD

259
Q

cardiogenic shock s.s

what bp
what hr
what rr
s
w
a I
c
what in lungs
what skin

A

hypotension

tachycardia

increased rr

SOB,

wheezing,

, activity intolerance,

cyanotic

, crackles in lungs

cool clammy skin

260
Q

Treatment?

what iv
what therapy
v

cariogenic shock

A

iv fluids

02 theray

vasopressors

261
Q

obstructive shock

what is it

from what

A

obstruction in heart or vessels

from tamponade, pneumothorax, PE

262
Q

obstructive shock s/s

decreased

reduced

A

decreased cardiac output and bp-

reduced tissue perfusion

263
Q

Obstructive shock

treat what

A

treat cause-

like anticoagulants,

oxygen,

treat effects of disease

264
Q

what is septic shock

A

Pathogens entered in blood, ruptured cell membranes are toxic and disrupt vascular, coagulation, immune, inflammatory system

265
Q

who does septic shock happen to

A

Immunocompromised pts are at risk-

chemo, imunosuppresents, chronic illness, traumatic injury, old adult, poor nutrition, smokers

266
Q

Septic shock- s/s - warm stage

what temp
what rr
what bp
what hr
f
w/c
possible

A

increase body temp,

tachypnea,

hypotension,

tachycardia-thready

, flushed,

weakness/chills,

possible diarrhea

267
Q

Septic shock-If not caught early it will progress to cool stage-

o
what temp
l
change
s
possible

Older adults may skip warm stage

A

oliguria,

decreased body temp,

lethargic,

change in loc,

shaking, possible anuria,

268
Q

Septic shock
Treatment?

a
what drugs
v
a
c
f

A

Antibiotics- (mycin/ ceft- broad spectrum)

Inotropic drugs

Vasopressors,

Antivirals

Corticosteriods

Fluids

269
Q

Septic shock

do what if change in loc

A

Make sure to do glascow coma scale if change in loc

270
Q

Neurogenic shock

what is neurogenic shock

A

Imbalance between PSNS and SNS causes a dramatic reduction in systemic vascular resistance

271
Q

who does neurogenic shock happen to

A

Neuro pts like head injury, spine injury, untreated pain, insulin reaction, severe heat exposure,

272
Q

neurogenic shock s/s

change
what bp
what hr
L
o
what temp

A

change in loc,

hypotension,

bradycardia-pounding,

lethargic,

oliguria,

low core body temp

273
Q

neurogenic shock treatment

do what
dont do what

A

identify cause and treat cayse

dont overload on fluids

274
Q

potential meds for neurogenic shock

iv what
what therapy
what agents
what if severe bradycardia

A

iv fluids

02 therapy

intorpoic agents

atropine if severe bradycardia

275
Q

Anaphylactic shock

exposure to what

causes what

A

Humoral mediated hypersensitivity reaction- vasodilation, pooling of blood leads to hypovolemia

Exposure to allergy

276
Q

Anaphylactic shock

d
w
what appearance
r/a
imdending
p e
what bp
what tempature
what hr

A

dyspnea,

wheezing,

flushed appearance,

restless/ anxious

, impending doom,

pulmonary edema,

hypotensive,

high body temp,

high hr,

277
Q

swelling where in anaphylactic shock

A

May have swelling on lips, on tongue, edema in lungs, angioedema,

278
Q

treatment in analphatic shock

e
c

A

epi

corticosreiods

279
Q

Shock interventions-labs

A

Hbg/Hct,

ABGs,

Electrolytes,

BUN,

serum creatinine,

blood cultures

, WBC w/ diff,

Cardiac enzymes

280
Q

Shock interventions-meds

A

Depends on type…diuretics, calcium, antiarrhythmics, antibiotics, epi, antihistamines

281
Q

Shock interventions- 02

A

ALL pt. need 02! Their 02 Saturation does not matter!

282
Q

Shock interventions- replacing what

A

fluids and blood

283
Q

Disseminated Intravascular Coagulation (DIC)

what causes thus

what look like

A

Severe cases of sepsis can lead to DIC

Widespread clotting and bleeding

284
Q

Disseminated Intravascular Coagulation (DIC)
ranges from:

bleeding ranges from-
p
e
p
what bleed

A

Bleeding ranges from oozing to frank hemorrhage from every body orifice,

petechia,

ecchymosis,

purpura,

gi bleed

285
Q

Disseminated Intravascular Coagulation (DIC)-labs

A

d dimer,

clotting factor,

h/h,

platelet count

286
Q

Disseminated Intravascular Coagulation

what from where
b
c
d
what hr
what bp
changes

A

oozing from punctures,

bruising,

cyanosis,

dyspnea,

tachycardia,

hypotension,

mental status changes

287
Q

treatment for DIC

h

f and p

potential

A

heparin,

ffp and platlets,

potential blood

288
Q

Epidermis- what does it do

A

it is the protective layer

289
Q

Dermis

houses what

A

houses nerves and blood vessels

290
Q

subcutaneous

provides what
protects

A

provide insulation in fat and protects organs

291
Q

Burns can cause what changes

A

Burns cause physiologic, metabolic, and psychological changes

292
Q

Removal of skin -> changes in what

due to what

Burns

A

change in functioning of most body systems (metabolic, endocrine, respiratory, cardiac, hematologic, and immune functioning)

due to fluid losses and large inflammatory processes

293
Q

Inhallation burns take priority- s/s

what hairs
what mucosa
what in mouth
what voice
what cough

A

signed nasal hairs,

excoriated oral mucosa,

soot or black in back of mouth,

horse voice,

frequent cough,

294
Q

Always check mouth- why In burns

can do what

A

if suspect inhalation injury we will prophylactically intubate them

295
Q

Types of Burns-Thermal

what from what
open
direct

A
  • sclads from steam,

open flames,

direct contact w hot object

296
Q

Types of Burns
Chemical

need to know what

A
  • need to know chemical and antidote
297
Q

Types of Burns
Electrical

l s
and what else

A
  • lighting strike and high voltage electrical current
298
Q

Types of Burns-Radiation

A
  • uv radiation
299
Q

Types of Burns-Inhalation- inhale what

A

–smoke inhalation

300
Q

Superficial Burn-sunburn or minor injury-

only what is involved
how does skin look

A

only the epidermis layer of the skin is involved –

skin is pink, no scars

301
Q

Partial Thickness Burn-
Superficial partial thickness-

involves what

what is given

A

involves upper 1/3 of dermis

– analgesics are given

302
Q

Deep partial thickness-

extends where

needs what(e/G)

A

extends deeper into dermis – needs excision and grafting

303
Q

Full-Thickness Burn

involves what

looks how

needs what to heal

A

-involves all layers of the skin-

looks all sorts of yellow/brown and dry,

needs skin grafting to heal

304
Q

Rule of nine

anterior leg-

poster leg-

groin is

abdomen in

butt in

anterior chest is

posterior chest in

each anterior arm is

each posterior arm is

anterior head is

posterior head is

A

anterior leg- 9 each

poster leg- 9 each

groin is 1

abdomen in 9

butt in 9

anterior chest is 9

posterior chest in 9

each anterior arm is 4.5

each posterior arm is 4.5

anterior head is 4.5

posterior head is 4.5

305
Q

Chest/face/throat burns = what issues

A

Airway/breathing issues

306
Q

Major burns defined as:

what % in under 40
what % in over 40
what % full thickness burns

A

over 25% TBSA adults less than 40

> 20% TBSA adults more than 40

> 10% TBSA full thickness burns

307
Q

Major burns defined as:any burns where

A

ANY burns to face, eyes, ears, hands, feet or perineum

308
Q

major burns -

what type of high injury

all what else

A

High voltage electrical injuries

All inhalation burns or involve major trauma

309
Q

Nursing Interventions :Fluid Resuscitation

needed in what % or more burns

310
Q

Nursing Interventions :Fluid Resuscitation- major burns

what type of fluid
through what

want that temp why

A

Crystalloids (warm LR)

through large bore IV catheters-

want warm because we don’t want them to lose cals through shivering

311
Q

Consensus formula (Parkland formula)

what is formula
administer how mich in 8 hrs, then how much next 16

fluid resuscitation

A

LR: 2-4 mL x kg x TBSA burn

Administer ½ during first 8 hrs, then remaining for 16 hrs

312
Q

Watch hourly urine – in parkland formula

A

should be 0.5 mL/kg/hr

313
Q

Respiratory managment - burns

HOB where
what frequently
use what
place tube when
use what

A

Hob at 30 degrees

Sucction frequently

Use incentive spiroemty

Place a tube if impending airway obstruction

Use humidification in room

314
Q

Medications- burns
-Topical antimicrobial agents

A

Silver nitrate / Silvadene cream

315
Q

Medications- burns-Pain meds

intravenous what

what before wound care

use what else

keep pt on what

A

Intravenous narcotics – MSO4 3-5mg q 5-10 min, around the clock initially

benzos 1h B4 wound care

Non-pharm also…temp is good, distractions,

Keep pt on pain schedule

316
Q

Medications- burns-Prevention of gastric hyperacidity (Curling/stress ulcers)

what meds
what else when bs are active

A

H2 blockers or PPI (Pantoprazole, etc)

Antacid, once BS active x 4 quadrants

317
Q

why give lorazepam in burns

cant give what- what only

A

to decrease muscle spams from pain

no oral meds until they are stable- IV only

318
Q

Medications- burns-Infection prevention

what vaccine
what meds
what field
what room

A

Tetanus vaccine

Antibiotics-cephalozolin,, ceftriaxone,

Sterile field all the time

Every room is negative pressure

319
Q

Treatments- burns-Escharotomy

prevents what

how does it work

A

: prevents compartment syndrome-

make incisions through thickened dead skin to improve circulation

320
Q

Treatments- burns-Pre- escharocotomy

try to get where
may need what x2

A

try to get them to surgery,

may need to be intubated, pain meds

321
Q

Treatments- burns-Debridement

what is it

A

: removes dead tissue to allow healing

322
Q

Treatments- burns-Autografting

how does it work

A

– transplant skin from one spot to over burn

323
Q

Treatments- burns-Autografting

what for healing- risk for

daily assessment of what

elevate what

A

Immobilization for healing- risk for clots

Daily assessment and skin care as graft heals; mild soaps and lotion

Elevation of new graft sites

324
Q

Health Promotion / Nutrition- burns - how much cals do they need per day

A

4000-6000 kcal/day

325
Q

may need what for burns

start what to feed/ how fast

Health Promotion / Nutrition- burns

A

May need supplemental feedings-

Start NG tube feedings within 24-48 hr injury

326
Q

when do you not use NG tube in burns and use TPN

c/s u
b o
other

A

Curling/stress ulcer,

bowel obstruction

other intolerances

327
Q

TPN

must have what

monitor b g
monitor what levels

monitor what test

A

must have a CVAD

Monitor Blood Glucose

Monitor electrolyte and protein levels

Monitor kidney and liver blood tests

328
Q

Small burns

clean w what
what tehcnique
apply what
what pain meds

A

Daily cleaning w mild soap and water

Steril technique for dressings

Apply topical agents

Mild analegiscs

329
Q

Maintatin skin itnergrity-

provide what
elevate where
immobilize graft for how long
move pt how
clean what

Burns nursing interventions

A

provide wound care,

elevate wound above heart,

immobilize skin graft sites for 3-5 days,

move pt slowly,

clean burns,

330
Q

Maintain fluid balance-

assess what
monitor what
what daily
test what
maintain what environment

Burns nursing interventions

A

assess bp/hr,

monitor i/o,

weigh daily,

test stools for blood,

maintain a warm eviroment,

331
Q

Manage acute pain-

measure what
adminster what
explain what

Burns nursing interventions

A

measure pain,

administer analgesics as prescribed,

explain procedure

332
Q

Reduce risk of infection-

daily what
monitor for what
maintain what

Burns nursing interventions

A

daily wbc counts,

monitor for s/s of infection,

maintain a aseptic enviroemnt,

333
Q

Assist w physical motility-

perform what
apply what

Burns nursing interventions

A

perform rom, apply splints,

334
Q

UAP can do what

LPN do what

A

UAP can do vs, urine output. I/o

LPN can give oral meds

335
Q

administration of blood

hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for

A

hand hygiene,

open y tubing,

all clamps in off,

spike ns bag and put on iv pole,

prime with ns,

prepare blood-invert2-3 times,

spike blood,

close ns,

prime with blood, attach to vad,

regulate blood flow- initial 15 minutes (rate 60-120 ml/hr)

montor for reaction

336
Q

normal levels

ph
hco3
pac02

A

ph-acid - 7.35-7.45 alk

hco3-(met acid )22- 26 (met alk)

pac02- (acid )45- 35(alkalosis)

4-Fourth Semester (3 decks)

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