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411 Adult 3 > Exam 3 > Flashcards

Exam 3 Flashcards

1
Q

Functional changes of burn injury

A

Risk for infection
Massive fluid loss
Vitamin D deficiency (full thickness burns cannot activate vitamin D)

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2
Q

Cardiovascular changes with burns
Respiratory changes
GI changes

A

Decreased cardiac output, fluids go into tissue leading to Hypovolemia & Hyponatremia (3rd spacing)
- patient can go into ARDS due to inflammatory response
- reduced GI blood flow leads to curlings ulcer (use proton pump inhibitors & early NG feeding)

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3
Q

Electrolyte imbalances
Diuretic phase begins
When to transfuse a patient

A

Hypovolemia, Hyponatremia, hyperkalemia (direct cell damage), hemoconcentration (increased blood viscosity - high risk for clots)
- in 48-72 hrs & fluid shifts back to normal
- when Hgb is <8 & symptomatic

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4
Q

Superficial thickness burn involves
Color
Edema
Pain
Blisters / eschar
Healing time
Ex.

A

Only epidermal layer
Pink to red
Yes
No / no
3-6 days
Sunburn, flash burn

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5
Q

Superficial partial thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Ex.

A

Upper 3rd of dermis
Pink to red
Mild to moderate
Yes
Yes / no
About 2 weeks
Scalds, flames, brief contact w hot objects

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6
Q

Deep partial thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts?
Ex.
What can happen

A

Deeper into dermis
Red to white
Moderate
Yes
Rare / soft & dry
2-6 weeks
Can be used if healing is prolonged
Scalds, flames, tar, grease, chemicals
- infection, hypoxia, or ischemia can convert wound to full thickness

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7
Q

Full thickens burn involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts required
Ex

A

Destruction of epidermis & dermis
Black, brown, yellow, white, red
Severe
Yes & no
No / hard & elastic
Weeks to months
Yes
Scalds, flames, tar, grease, chemicals, electricity

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8
Q

Deep full thickness involves
Color
Edema
Pain
Blisters / eschar
Healing time
Grafts required
Ex

A

Beyond skin, damages muscle, bone & tendons
Black
Absent
Absent
No / hard & elastic
Weeks to months
Yes
Flames, electricity, grease, tar, chemicals

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9
Q

Contact burns
Chemical injury
Radiation injury
Electrical injury

A
  • hot metal, tar or grease (tar & asphalt go up to 400 degrees)
  • severity depends on duration, concentration, amount of skin exposed & action of chemical
  • when exposed to radiation, cover patient & contain them, once cleared they can be scrubbed down
  • heart stops during electrical injury, shock goes into body & spreads around causing internal damage before exiting
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10
Q

Electrical burn severity
What happens to organs in path
What shouldn’t you do
What should you always do

A

Longer electricity in contact w body = greater the damage
- organs in path of current may become ischemic or necrotic
- never directly touch a patient being electrocuted
- always do an EKG & immobilize C spine, always remove jewelry cs of swelling

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11
Q

Emergency management of burns
Flame burns
Chemical burns
Radiation burns

A

Always assess airway patency, always prophylactically intubate & and administer tetanus toxoid, cover patient, begin fluid replacement
- remove smoldering clothing & metal objects
- DO NOT WET dry chemicals brush them off, remove clothing
- use tongs to remove radiation clothing

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12
Q

Factors affecting airway

A

Injured in closed space
Extensive burns on face
Intra-oral charcoal
Unconscious at time of injury
Singed scalp hair, eyelids, eyelashes
Changes in voice
Use of accessory muscles
Edema & ulceration of airway mucosa

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13
Q

Carbon monoxide poisoning is
Characterized by

A

Leading cause of death from fire
- cherry red color (vasodilation), severe headache & vomiting, AMS - coma - death

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14
Q

Percentage of burns
Head front / back
Chest
Back
Arms front / back
Legs front / back
Private

A

4.5 / 4.5
18
18
4.5 / 4.5
9 / 9
1

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15
Q

Parkland formula for monitoring fluid status

A

4ml x kg x % of burn
50% over first 8 hours from time of injury
50% over second 16 hours

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16
Q

Burns interventions
Non surgical management
Medications
Surgical management

A

Suction airway, keep head of bed at 30 with a ventilator, check chest movement - eschar, humidified oxygen
- IV fluids, monitor preload with CVP line to ensure adequate fluid therapy
- paralytic meds ONLY given by doctors (tracrium, norcuron)
- escharotomy (incision that relieves pressure on chest & improves circulation ; non-painful) / fasciotomy (deeper incision extending through fascia; painful)

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17
Q

Nutrition required during acute phase of burn injury
Local indicators of infection
Systemic indicators

A
  • high caloric needs 5K/day, high protein diets for healing
  • ulceration of healthy skin, lesions in uninvolved/healed skin, excessive wound drainage, pale boggy granulation tissue, odor
  • altered LOC, changes in vitals, oliguria, GI dysfunction, hyperglycemia, Thrombocytopenia, hypoxemia, change in WBC
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18
Q

Topical meds
Surgical management wound covering
Proper positioning

A
  • Silvadene (contra in sulfa allergy), gentamicin sulfate, anticoat (soak to remove)
  • autograft; piece of skin from unburned area, bulky pressure dressing for 3-5 days for vascularization, DO NOT DISTURB DRESSING
  • maintain in neutral body position with minimal flexion to prevent contractures
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19
Q

Hypertrophic scar pressure garment

A

Help prevent contractures
Inhibit venous stasis & edema
Must be worn 23hrs a day, every day for 12-24 months

20
Q

Viral meningitis is
Diagnostic testing of

A

Self limiting - symptoms subside in a few days
- CSF ; must do CT brain for bleeding before a lumbar puncture

21
Q

Bacterial meningitis is
Clinical manifestations
Kernigs & brudzinskis sign
Complications
Care for patient
Treatment

A

Most contagious & most lethal type
- petechiae rash, stiff neck, photophobia, altered LOC, increased ICP (projectile vomiting)
- Kernigs (extension of knee on flexed hip) / brudzin (flexing neck causes flexed hip & knees)
- seizures due to ICP, dysfunction of cranial nerves
- maintain ABC, neuro checks, never medicate for pain with change in LOC, raise HOB to 30 for ICP, lay flat after lumbar puncture
- antibiotics : vancomycin (can cause MRSA) , anti-epileptic drug (#1 is phenytoin: range 10-20, necrotic to tissue, never give fast)

22
Q

Patient position for lumbar puncture
CSF findings in bacterial VS viral

A

Fetal position
Bacterial : cloudy fluid, with decreased glucose & elevated CSF pressure, increased protein

Viral: clear fluid, with normal glucose & normal CSF pressure, slightly increased protein

23
Q

TIA is
Treatment
Key features
TIA work up

A

Temporary neuro dysfunction, warning sign of a stroke
-Preventative - decrease HTN, apspirin or plavix, glycemic control <140
- visual deficits, motor deficits (face droop, ataxia), numbness, aphasia or dysarthria (slurred speech)
- CT brain, Carotid U/S for obstruction, EKG for a fib

24
Q

Thrombotic stroke is due to
Evolution
Onset
Contributing factors
Prodromal symptoms
Neuro deficits
Duration

A

A clot already present in carotid
- Intermittent… worsen symptoms
- Gradual (minutes - hours)
- HTN - atherosclerosis
- TIAs
- Speech deficits, visual problems, confusion
- Improve weeks - months or permanent deficits

25
Embolic stroke is due to Evolution Onset Contributing factors Prodromal symptoms Neuro deficits Duration INR for heart valve
Dislodged thrombus (mainly cardiac) - complete stroke… steady progression - sudden onset - cardiac disease - no symptoms - paralysis, expressive aphasia - rapid improvements 3-3.5
26
Hemorrhagic stroke is due to Evolution Onset LOC Contributing factors Prodromal symptoms Neuro deficits CSF Seizures Duration What should we never do with hemorrhagic stroke
Interrupted vessel integrity - usually abrupt - sudden, gradual if due to HTN - stupor or coma - HTN, vessel disease - focal deficits - bloody CSF - usually have seizures - variable-permanent deficits Never do a lumbar puncture
27
Key features with ICP What is Cushing’s triad
Decreased LOC (lethargy to coma) Changes in speech (aphasia) Blown pupils (dilated & non-reactive) Seizures Decerebrate or decorticate position - Cushing’s triad: severe HTN, widened pulse pressure >40, bradycardia (bad sign of ICP)
28
Presentation of left side stroke Language Memory Vision Behavior Hearing
- aphasia, agraphia - possible deficit - can’t discriminate words & letters, reading problems, right visual field deficit - slowness, cautiousness, anxiety, depression, worthlessness, intellectual impairment - no deficit
29
Presentation of Right side stroke Language Memory Vision Behavior Hearing
- impaired sense of humor - disoriented to time, place & person, can’t recognize faces - loss of depth perception, neglect of left visual fields - impulsiveness, lack of awareness, euphoria, constant smiling, overestimates abilities - loss of tonal variations
30
Stroke lab diagnostics Thrombolytics for stroke Stroke meds Impaired verbal communication
- CT brain (priority), carotid U/S, clotting factors - inclusion: stroke less than 4.5hrs / exclusion: INR <1.7, Hx of stroke & diabetes - warfarin for a-fib, antiplatelets (aspirin & plavix), aspiring is not given within 24 hrs of thrombolytics - expressive aphasia; damage to frontal lobe (broca’s) Receptive aphasia; damage to temporal lobe (wernicke’s)
31
TBI is Acceleration / deceleration injury Open fracture Battle sign Raccoon eyes Basilar skull fracture can cause
Damage to brain from external force - A : external force suddenly puts head in motion / D: moving head is suddenly stopped - highest risk for meningitis - bruising behind ears due to middle cranial fossa fracture - bruising around eyes due to basilar skull fracture - leakage of CSF (halo sign) must test fluid for glucose, potential for hemorrhage
32
Mild TBI - concussion findings Contusion is Laceration is Diffuse axonal injury
- LOC <30 mins, dazed, difficulty remembering or concentrating, sleeping problems, irritability - bruising without tearing of tissue (coup & countercoup) - more serious, tearing of vessels ; can cause hemorrhage or edema - widespread injury due to high speed accident; loss of visual fields, impaired cognitive fxn
33
LOC & GCS in Mild TBI Moderate TBI Severe TBI
- LOC <30 min, GCS 13-15 - LOC 30min - 6hrs, GCS 9-12 - LOC > 6hrs, GCS 3-8
34
As ICP increases Keep what in check Manifestations Management Surgical management
Cerebral perfusion pressure drops (CPP) leading to brain ischemia - keep CPP > 70 & maintain MAP (CPP = MAP - ICP) - decreased LOC, Pupillary changes, projectile vomiting, posturing - propofol (sedative to assess neuro), barbiturate coma for continuous seizure (epilepticus > 20 min), HOB 30 degrees - intraventricular catheter (IVC) ; risk of infection & drainage / decompression: removal of section of skull or craniotomy
35
Subdural hematoma Brain death criteria
Highest mortality because of slow bleeding & going unrecognized - GCS <3, no pupil response, no reflexes
36
Spinal cord injury - secondary injury Spinal shock syndrome patient Symptoms
Hemorrhage or hypovolemia results in shock, decreased perfusion - flaccid paralysis, loss of reflexes below lesion, temporary loss of functions - hypotension, bradycardia, urinary retention, flaccid paralysis
37
Initial assessment patient with SCI Complete injury results in Incomplete injury How do you determine severity
- priority is airway, C3-5 injury requires emergency intubation, assess LOC with GCS - complete loss of motor & sensory fxn below lvl of injury - varying degrees of motor & sensory fxn - must wait for edema to resolve before determining severity
38
Autonomic dysreflexia is Finding 1 Finding 2 Treatment Key features
Exaggerated sympathetic response to noxious stimuli in high level SCI - massive vasoconstriction below lvl of injury : HTN, headache, blurry vision, goosebumps (piloerection) - vagal stimulation leads to vasodilation above injury: diaphoresis - Elevate HOB, remove stimulus - sudden rise in BP, profuse sweating, goosebumps, flushing of skin, blurred vision
39
Oncologic emergencies Sepsis results from SIADH results from Hypercalcemia // treatment
- neutropenia, impaired immunity - small cell lung cancer - increased parathyroid hormone, bone metastasis // biphosphonates: zometa, xgeva, pamidronate
40
DIC Most Common problem Presentations Lab findings Management
- high mortality rate - hemorrhage due to decreased platelets <150 & no clotting factors - petechiae & purpura (bleeding under skin) - increased D-dimer, PT/PTT increased, decreased fibrinogen, decreased Hgb - blood products: FFP, platelets, cryoprecipitate, whole blood
41
Superior vena cava syndrome is Signs & symptoms Late signs
- obstruction of SVC by tumor or thrombus - facial/neck edema, vein distention in head, neck & chest - hemorrhage, cyanosis, decreased BP & LOC
42
Tumor lysis syndrome is 4 hallmark signs Treatments for each
- rapid release of intracellular contents due to chemotherapy - Hyperuricemia, hyperphosphatemia, hyperkalemia, hypocalcemia - colchicine, allopurinol Renagel, calcium carbonate or acetate Glucose w insulin, sodium polystyrene Calcium electrolyte (kyexelate must have bowel movement)
43
Thrombocytopenia is Signs & symptoms
Platelet count < 150,000 / when below <120,000 risk for spontaneous bleeding - bleeding, blood in emesis urine or feces
44
Rule of thumb for any cancer
Early detection is key to effective treatment & survival
45
Head & neck cancer clinical manifestations Post-op considerations
- hoarseness or change in voice, lump in mouth throat or neck, Dysphagia - airway patency #1 priority, skin graft over carotid (protect carotid), report large increases in drainage or purulent / foul smelling drainage

411 Adult 3 (3 decks)

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