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Nurs 726 Med Surg 2 > Final Exam New Info > Flashcards

Final Exam New Info Flashcards

1
Q

What makes up a trauma center designation?

A

Trauma center designation (Level 1 through 4) based on resources, training, staffing, qualifications, services, etc.

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2
Q

What is EMTALA?

A

Must perform a medical screening exam to determine if emergency medical condition exists
If emergency condition exists, must stabilize to their ability or transfer
Specialized facilities must accept transfers if they have capacity to treat

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3
Q

What is the nursing protocol for trauma deaths, suspected homicide, abuse cases, and all deaths within 24 hours of hospitalization?

A

Leave IV lines, indwelling tubes, and all equipment in place
Do not perform post-mortem care prior to speaking with Charge Nurse/ME’s office (dont’ want to wash away evidence)

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4
Q

What are Mechanisms of Injury (MOI)?

A

The type of force that caused the injury that can include:
Blunt trauma, Penetrating trauma, Acceleration-deceleration

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5
Q

What are some of the specific mechanisms of injury requiring trauma centers?

A

High speed MVC, Ejection,
Prolonged extrication or death in cabin
Fall > 15 feet
Penetrating injury between head and torso
2 or more long bone fractures
Pelvic fractures with hemodynamic instability
Automobile vs Pedestrian
Anatomical criteria: amputations
burns, spinal cord injury (SCI)
Physiologic criteria: airway compromise, altered LOC, hypotensive

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6
Q

In terms of triage under mass casualty conditions, what does Emergent mean and what tag is correlated?

A

Emergent (Red Tag): Immediate threat to life or limb

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7
Q

In terms of triage under mass casualty conditions, what does urgent mean and what tag is correlated?

A

Urgent (Yellow Tag): Requires quick or immediate treatment but not life threatening at the moment; major injuries

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8
Q

In terms of triage under mass casualty conditions, what does non-urgent mean and what tag is correlated?

A

Non-Urgent (Green Tag): Can wait several hours without significant risk; minor injuries

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9
Q

In terms of triage under mass casualty conditions, what does expectant mean and what tag is correlated?

A

Expectant (Black Tag): Death expected, unlikely to survive, or is too severe for limited amount of resources available

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10
Q

What is the Emergency Severity Index (ESI)?

A

Ratings from 1-5 that determine how many resources a patient will need to treat

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11
Q

What are the ESI ratings?

A

ESI 1: Requires immediate life-saving intervention
ESI 2: High-risk situation where the patient should not wait
ESI 3: VSS (outside ‘danger zone’) and requires many resources
ESI 4: Requires one resource for provider to reach disposition decision
ESI 5: Requires no resources for provider to reach disposition decision

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12
Q

A patient coming in with abdominal pain, nausea, vomiting, and diarrhea would most likely be rated as an ESI?

A

ESI 3: VSS (outside ‘danger zone’) and requires many resources

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13
Q

A patient coming in with an ankle injury or a UTI would most likely be rated as an ESI?

A

ESI 4: Requires one resource for provider to reach disposition decision

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14
Q

A patient coming in with a sore throat, cold/flu symptoms, or poison ivy would most likely be rated as an ESI of?

A

ESI 5: Requires no resources for provider to reach disposition decision

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15
Q

What are some examples of things that would not be considered a resource in terms of ESI ratings?

A

H&P
Point of Care Testing
Saline Lock
PO Meds
Simple Wound Care
Crutches
Slings
Splints

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16
Q

What are some examples of things that would be considered a resource in terms of ESI ratings?

A

Labs
ECG
Radiographs
CT, MRI, Angiography, Ultrasound
IV Fluids
IV, IM, or Nebulized Medications
Specialty Consultation
Simple Procedures (lac repair, urinary catheter
Complex Procedures– count as 2 resources (procedural sedation)

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17
Q

A primary patient survey would include what type of assessment?

A

ABCDE Assessment

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18
Q

What makes up an ABCDE Assessment?

A

A: Airway/C-Spine
B: Breathing
C: Circulation
D: Disability– Neuro (AVPU)
E: Exposure
Life-saving interventions applied at each step

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19
Q

In the D for disability in an ABCDE assessment, what does AVPU stand for?

A

A— Alert
V— Responsive to Voice
P— Responsive to Pain
U— Unresponsive

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20
Q

What makes up a secondary survey in emergency situations?

A

Comprehensive head-to-toe assessment
SAMPLE history from patient, family, other parties present
Identifies other injuries after immediate threats to life have been addressed
Nurse anticipates:
Insertion of NGT and/or urinary catheter
Preparation for diagnostic studies

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21
Q

What is a SAMPLE history?

A

S: Signs & symptoms
A: Allergies
M: Medications (Medication reconciliation)
P: Past medical history
L: Last oral intake
E: Events leading up to present injury/illness

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22
Q

Emergency Nursing:
What should the nurse be assessing in situations where the patient is bleeding?

A

Source of Bleeding
VS
Shock

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23
Q

Emergency Nursing:
What should the nurse be assessing in situations where the patient is experiencing heat stroke?

A

Decrease in BP
Increase in HR, RR
Confusion or change in behavior
Seizures
Coma

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24
Q

Emergency Nursing:
What should the nurse be assessing in situations where the patient is experiencing either frost nip or frost bite?

A

white waxy appearance of the skin that can be partial or full thickness

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25
Q

Emergency Nursing:
What should the nurse be assessing in situations where the patient is experiencing altitude related sickness?

A

Hypoxia
Dyspnea
Throbbing headache
Progression of cerebral or pulmonary edema

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26
Q

Emergency Nursing:
What nursing management or safety concerns should be used for a patient that is experiencing bleeding?

A

Direct pressure to wound site
Do NOT remove impaled objects
Monitor for internal bleeding that may require volume replacement, blood transfusions, or surgical interventions

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27
Q

Emergency Nursing:
What nursing management or safety concerns should be used for a patient that is experiencing heat stroke?

A

Immediate rapid cooling
Remove clothes
Apply ice packs over major arteries
Apply cooling blanket/cold lavage
Wet the body and then fan to aid in cooling

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28
Q

Emergency Nursing:
What nursing management or safety concerns should be used for a patient that is experiencing frost nip/bite?

A

Warm in water (100.4-105.8)
Pain medication
Tetanus vaccine if needed

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29
Q

Emergency Nursing:
What nursing management or safety concerns should be used for a patient that is experiencing altitude related sickness?

A

Give O2
Decrease altitude
Steroids and diuretics if needed

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30
Q

What is a traumatic brain injury?

A

Damage to the brain from a mechanism of injury or mechanical force–not caused by neurodegenerative or congenital conditions

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31
Q

What are the risk factors for a TBI?

A

Newborns up to 4 YOA: Shaken baby syndrome, toddlers are accident prone
Children: Climbing trees, bicycles w/out helmets
Young adults 15 to 24 YOA: Frontal lobe not fully formed; more risks taken
Adults ≥ 60 YOA: Comorbidities, anticoag therapies, altered senses
Males in any age group: Dumbasses at every age

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32
Q

What are common mechanisms of injury that cause TBIs?

A

Falls, Assaults, MVCs, Sports/Recreation Activities, GSWs, Child Abuse, Domestic Violence, Blast Injuries

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33
Q

What are the common classifications of TBIs?

A

Classified as:
open or closed head trauma
mild, moderate, or severe
primary or secondary

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34
Q

What is the difference between a open or closed head trauma?

A

Open: penetrating trauma, skull fractures
Closed: blunt force trauma, coup-contrecoup forces

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35
Q

What are coup-contrecoup forces?

A

Coup: Forward force
Contrecoup: Brain is forced against back of skull

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36
Q

What factors can influence the severity of a TBI?

A

GCS can help quantify impact of severity
Length of loss of consciousness can help determine severity
Occipital fractures, basilar fractures (check for bruising behind hears)

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37
Q

What makes a TBI primary?

A

Occurs at time of injury
Focal or diffuse
Open or closed

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38
Q

What is a Comminuted Facture?

A

Fragmented bone with depression into brain tissue

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39
Q

What factors classify a TBI as a secondary TBI?

A

Occurs after initial injury
Worsens outcomes
Includes:
Hypotension
Hypoxia
Edema, hydrocephalus
Hemorrhage
Increased ICP
Herniation

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40
Q

TBI Severity Classifications:
What classifies a TBI as mild?

A

No loss of consciousness or + LOC ≤ 30 minutes
Loss of memory of event immediately before or after injury
Focal neurologic deficits
No evidence of injury on CT/MRI

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41
Q

TBI Severity Classifications:
What classifies a TBI as moderate?

A

GCS 9-12

+ LOC 30 mins – 6 hours
Injury may not be visible on CT/MRI

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42
Q

TBI Severity Classifications:
What classifies a TBI as severe?

A

GCS 3-8
+ LOC > 6 hours

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43
Q

What is a subdural hematoma?

A

Venous bleeding into space beneath dura mater and above arachnoid mater

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44
Q

How does a subdural hematoma occur?

A

occurs from tearing of bridging veins within cerebral hemispheres

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45
Q

What is the time frame for an acute subdural hematoma?

A

Acute: within 24 hours–rapid deterioration

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46
Q

What is the time frame for a subacute subdural hematoma?

A

Subacute: 2-14 days–no acute s/s at onset, but hematoma enlarges with progressive sx

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47
Q

What is the time frame for a chronic subdural hematoma?

A

Chronic: weeks to months, often in older adults with forgotten history of head injury–slow but progressive cognitive and personality changes

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48
Q

What is an epidural hematoma?

A

Blood accumulation in the space between the dura mater and the skull

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49
Q

What kind of injuries tend to result in an epidural hematoma?

A

Usually arterial from the middle meningeal artery due to temporal bone fracture, like getting hit with a baseball bat

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50
Q

What is the classic presentation of an epidural hematoma?

A

Classic presentation: immediate loss of consciousness → lucid period → rapid deterioration

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51
Q

For a TBI, how often should you be assessing the GCS?

A

Assess every 1/2hrs, if there is a change more than 2 points provider needs to be notified

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52
Q

What is the association between dilated pupils and ICP?

A

Dilation increase=increase ICP

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53
Q

What are the normal pulse pressures that indicate adequate perfusion to the brain?

A

radial is >80
femoral is >70
carotid >60

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54
Q

A PaCO2 of 40-45 can cause?

A

Cerebral vasodilation leading to increased intracranial pressure

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55
Q

What are the indications for a CSF leak?

A

otorrhea, rhinorrhea, + Halo sign, + glucose

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56
Q

What is a halo sign?

A

Taking a white cloth and if the leakage appears yellow this is a CSF leak

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57
Q

Bilaterial dilated and fixed pupils are a?

A

Ominous sign and the patient is likely not coming back

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58
Q

What are some of the factors that lead to an increased ICP?

A

↑ PaCO2
Increased BP
hypotension
Stimuli (light, noise, restraints, etc)
Lowered HOB
Hyperventilation

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59
Q

What is therapeutic hypothermia?

A

“Artic Sun” medically induced coma. Normally for 24/48 hours and then there is gradual warming. This is done to reduce cerebral edema

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60
Q

What vascular effects do hypoxia or hypercapnia have?

A

Both cause vasodilation

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61
Q

What effects do hypocapnia have?

A

Vasoconstriction

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62
Q

What are the normal values for:
Normal CPP:
Normal ICP:
MAP:

A

Normal CPP: 60-80 mmHg
Normal ICP: 5-15 mmHg
MAP > 60 mmHg to maintain perfusion

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63
Q

What is cerebral blood flow is dictated by?

A

Cerebral blood flow is dictated by and fluctuates with systemic BP

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64
Q

Activity or stimuli can lead to _____BP → _______CBF → ______ICP

A

Activity or stimuli = ↑ BP → ↑ CBF → ↑ ICP

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65
Q

What actions should be avoided to avoid and increased ICP?

A

Coughing
Sneezing
Blowing nose
Restlessness
Straining/Valsalva/Vomiting
High positive airway pressures (PEEP)
Unnecessary suctioning
Unnecessary movement

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66
Q

Increased ICP leads to what change in CPP?

A

↑ ICP → ↓CPP

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67
Q

↓CPP presents a risk of?

A

↓CPP → risk of brain ischemia and poor prognosis

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68
Q

Sustained ↑ ICP leads to?

A

Sustained ↑ ICP →brainstem compression and herniation of brain from one compartment to another

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69
Q

What are the early signs of increased ICP?

A

Adults: headache or change in LOC
Infants: irritability, lethargy, poor feeding, bulge of fontanel
N/V (may be projectile)
Changes in speech
Ataxia - no coordination

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70
Q

What are the late signs of increased ICP?

A

Cushing’s Triad
-Bradycardia (↓ HR)
-Hypertension
-Widened pulse pressure (ex: 120/60 to 180/50)
-bradypnea (↓ RR)

(Cheyne-Stokes respirations; hyperpnea followed by apnea)

Pupillary changes in size and reactivity (dilated, fixed)

Decorticate or decerebrate posturing

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71
Q

What is Decorticate posturing?

A

Decorticate: drawing in of arms to the center and flexion of feet

72
Q

What is Decererate posturing?

A

Decererate: Clenched jaw, neck extensions, arms down at sides adducted

73
Q

What is the formula for MAP?

A

MAP = SBP + 2(DBP)/
3

74
Q

What is the most invasive way to measure ICP?

A

IVC/EVD, and it has the highest risk of infection

75
Q

What are the benefits of measuring ICP with IVC/EVD?

A

Reliable/accurate
Able to sample/drain CSF
Can manage ICP by draining CSF per provider order– monitoring volume drained is essential
Calibrate and balance frequently (after pt is moved/repositioned

76
Q

What are the other less invasive ways of measuring ICP, and what is the negative aspects of their use?

A

Subarachnoid bolts or screws
Subdural/epidural caths
Fiberoptic transducer-tipped cath

Con: not able to drain or sample CSF

77
Q

What types of ventilation and oxygenation problems cause increased ICP?

A

Airway obstruction
Hyperventilation
Suctioning without hyperoxygenation
Positive Pressure Ventilation
PEEP

78
Q

What are the types of positioning that can increase ICP?

A

Prone
Trendelenburg
Extreme hip flexion
Neck flexion, Hyperextension or rotation

79
Q

What factors can increase metabolic rate therefore increasing ICP?

A

Hyperthermia and Seizure Activity

80
Q

What type of stressors can increase ICP?

A

Pain
Disturbing conversation/noise
Bright lights

81
Q

What type of pressures in the abdomen can cause increased ICP?

A

Increase intrathoracic pressure
Valsalva maneuvers
Coughing
Vomiting
Suctioning

82
Q

What are the medications for TBI?

A

Dexamethasone
Methylprednisolone (Solu-Medrol)
Mannitol
Neuromuscular Blocking Agents
Phenytoin

83
Q

How does Methylprednisolone help increased ICP?

A

Corticosteroids to decrease inflammation and edema

84
Q

What are the adverse outcomes of Methylprednisolone treatment for ICP?

A

Hypernatremia
hypokalemia
hypocalcemia
Hyperglycemia
delayed healing, immunosuppression (Cushing’s)
Requires slow taper

85
Q

How must mannitol be administered?

A

Must be given parenterally via IV filter

86
Q

What are the signs of a phenytoin toxicity?

A

Signs of toxicity: Fast uncontrollable eye movements, double vision, dizziness, drowsiness, confusion, lack of coordination, slurred speech

87
Q

To access Cerebral Herniation, what should you look for?

A

Posturing

88
Q

Chronic traumatic encephalopathy that is chronic progressive disease that will show what upon most mortem examination?

A

Accumulation of tau protein
Shrinking of brain

89
Q

What type of paralysis involves all 4 extremities and is the result of a C1-7 injury?

A

Quadriplegia

90
Q

What type of paralysis involves the lower extremities and can be the result of a T1-12 or L1-5 injury?

A

Paraplegia

91
Q

When a patient is experiencing hemiplegia, what is occuring?

A

half of the body is affected

92
Q

What spinal injury should we be immediately concerned with respiratory function?

A

C3-5

93
Q

What are examples of direct injury from blunt force trauma to vertebral column?

A

Fracture, dislocation, subluxation
MVC, falls, sports/recreational activities

94
Q

What are examples of Penetrating injury to the spinal column?

A

GSW
Stabs
lacerations

95
Q

What is Hyperflexion of the neck?

A

:Sudden forcefully accelerated forward causing extreme flexion of the neck. Normally the result of MVC

96
Q

What is Hyperextension of the neck?

A

Head is suddenly accelerated and decelerated, normally the result of MCV rear ending.

97
Q

What causes Axial Loading or Vertical Compression of the spinal chord?

A

These are from diving accidents, falls on the buttocks, or blow to the stop of the head

98
Q

What are examples of Secondary SCI Injuries?

A

Hemorrhage
Edema
-Maximal at level of injury and 2 cord segments above and below
-Impairs microcirculation of cord → ↓ perfusion and anoxia at site
-Cord swelling increases degree of impairment
-Cervical cord swelling can be life threatening

99
Q

What are two of the major concerns for death in relation to spinal cord injuries?

A

Pneumonia and Septicemia

100
Q

What should you be monitoring for T6 injury or above?

A

Assess and monitor for s/s of neurogenic shock (bradycardia, profound vasodilation → hypotension)

101
Q

What are myotomes?

A

a group of muscles innervated by the ventral root a single spinal nerve, control movement

102
Q

What are dermatomes?

A

areas of skin that are supplied by a single sensory nerve root, control sensation

103
Q

What is the ASIA Impairment Scale?

A

used for classification of pts with spinal cord injury
Grades muscle function from 0-5, 0 being total paralysis and 5 being full movement
Uses myotomes and dermatomes for classification

104
Q

What is spinal shock?

A

temporary loss of motor, sensory, reflex, and autonomic function below level of injury

105
Q

How long do most of the symptoms of spinal shock last?

A

48 hours

106
Q

Patients in neurogenic shock are unable to mount an increased _______as a result of a decreased ___________.

A

Patients in neurogenic shock are unable to mount an increased HR as a result of a decreased BP

107
Q

What is expected for a L1 or below SCI?

A

loss of tone throughout colon → bowel incontinence

108
Q

What is expected for a T12 or higher SCI?

A

↓ intestinal peristalsis, absent rectal sensation, and ↑ in anal sphincter tone → constipation

109
Q

What are the actions for neurogenic bladder care?

A

daily use of stool softeners or bulk-forming laxatives
suppository or digital stimulation daily or QOD
development of a bowel schedule
adequate fluids and fiber

110
Q

Why do SCI have trouble with thermoregulation?

A

Loss of ability to vasoconstrict, vasodilate, sweat, shiver below level of injury → take on temp of environment
Most profound in cervical and high thoracic injuries

111
Q

Neuropathic pain arises from?

A

Neuropathic pain arises from nerve root above level of injury
Sharp, burning pain can continue or worsen over time

112
Q

What is the cause of neurogenic shock?

A

Disruption of autonomic pathway and loss of sympathetic nervous system tone → biggest effect on BP & HR

113
Q

What are the symptoms of neurogenic shock?

A

Hypotension, bradycardia, abrupt inability to control temperature
Occurs within 24 hours of injury

114
Q

If a patient experiencing neurogenic shock has a systolic BP of under 90, what is the concern?

A

If SBP <90 mmHg, want to treat because of ↓ perfusion to cord

115
Q

What is the treatment for neurogenic shock?

A

Airway support -> make sure enough O2 to perfuse
Adminster Atropine due to bradycardia
Administer vasopressors like Dopamine
Provide thermoregulation

Airway support, atropine, vasopressors, fluid, thermoregulation

116
Q

What is the cause of spinal shock?

A

Immediate response of the spinal cord to injury

117
Q

What are the symptoms of spinal shock?

A

Absence of all neurologic activity (including reflexes) below level of injury, flaccid paralysis
Loss of peristalsis → absent BS, abdominal distention, paralytic ileus within 72 hours

118
Q

What is the duration and resolution of spinal shock?

A

Usually resolves within 48 hours but may last for weeks
Return of bladder function, reflexes, and muscle spasticity indicates resolution of shock

119
Q

What are the treatment options for spinal shock?

A

Foley Catheter
NG tube
Provide thermoregulation assistance

120
Q

What is autonomic dysreflexia?

A

When noxious visceral or cutaneous stimuli cause a massive sudden inhibited reflex sympathetic discharge in people with high level spinal cord injury

121
Q

What are the symptoms of autonomic dysreflexia?

A

Sudden ↑ BP (↑ 20-40 mmHg in both SPB and DBP)
↓ HR (low normal or bradycardia)
Pounding HA, blurred vision
Sweating, vasodilation, flushing, nasal stuffiness above level of injury
Vasoconstriction, pale, cool, goosebumps below level of injury

122
Q

How is a TSLO Brace applied?

A

Nurse puts on the back matching up the grooves on the waist with the pts waist, soft area between hips and rips, front portion placed overlapping the back.
Middle straps fastened first pulling straps at the same time.
Straps should be snug and hold device in place but allow for normal breathing. Tops and bottoms of straps applied after in the same manner

123
Q

What is a halo fixation device?

A

Used to immobilize the cervical spinal column– worn for 8-12 weeks
Screws placed through the bone and attached to rods that are secured to a non-removable vest worn by client.

124
Q

In an emergency situation for a patient with a halo device, what needs to be done?

A

A wrench used to release the rods from the vest in case of cardiac or respiratory emergency (CPR)
Tape wrench to the front of the vest in the event of emergency and need to remove vest

125
Q

What is the treatment for autonomic dysreflexia?

A

Sit patient up!
Lower legs, if possible
Contact provider STAT
Loosen restrictive clothing
Quickly assess for potential cause
Monitor BP, HR, HA, flushing, diaphoresis, visual disturbances
Administer hydralazine, nitrates, or nifedipine (CCB) for HTN

126
Q

What are some of the potential causes for autonomic dysreflexia?

A

Bladder distention
Catheter tubing kinked, obstructed, etc.
Fecal impaction
Pressure stimuli, ingrown toenails, other sources of pain

127
Q

A Compound (open) fracture is?

A

A fracture skin integrity not intact– open wound
Bone is sticking through skin, bone is in two distinct pieces.

128
Q

What is a displaced fracture?

A

Pieces of bone not in alignment - considered a closed fracture

129
Q

What is a nondisplaced fracture?

A

Non-Displaced Fracture: Bone is in alignment

130
Q

A Spiral fracture occurs from? What population does this present red flags?

A

occurs from a twisting motion and commonly seen in physical abuse cases (warning sign in pediatric population

131
Q

What is an impacted fracture?

A

Impacted: Fractured bone is wedged inside the opposite fractured fragment

132
Q

What is a greenstick fracture?

A

Greenstick: One side is fractured but does not extend all the way across the bone

133
Q

What are the priority concerns when dealing with facial fractures?

A

airway, LOC, vision, CSF leak, brain injury, SCI

134
Q

What are facial fractures classified under?

A

Le Forte is consisting of 3 broad categories based on the level of the fracture
I: Nasoethemoid Complex fracture
II: Maxillary and Nasoethemoid complex fracture
III: Combination I & II plus orbital-zygoma fracture

135
Q

What are the risks associated with casts?

A

compartment syndrome, thermal injuries, pressure injuries, infection, dermatitis

136
Q

What is a splint?

A

Non-circumferential support held in place with elastic bandage

137
Q

What is the Principle of immobilization?

A

joint above and below injured bone is immobilized
Generally used in long bone injuries that would require a very high cast

138
Q

What is the patient education for patient’s with casts?

A

never stick anything down into cast or splint for itching
report s/s of pain, tingling, coolness, pallor; elevate extremity
protect from getting wet

139
Q

What is Skin (Buck’s) Traction?

A

Boot or device placed on client that is connected to rope with weights
Traction applied to skin, which pulls extremity

140
Q

What is Skeletal Traction?

A

Steinmann pins or wires inserted into bone and connected to rope with weights
Traction applied directly to bone
Requires close monitoring for infection and pin site care

141
Q

What is the normal amount for traction weights?

A

15-30lb

142
Q

What is Internal Fixation (ORIF)?

A

ORIF: Open reduction internal fixation
Surgical procedure where rods, screws, and/or plates are placed align and stabilize bone fractures for healing
Will require suture care

143
Q

What is External Fixation?

A

Surgical procedure where rods are screwed into bone and connected to a stabilizing frame outside the body

144
Q

What are the early/late signs of impaired neurovascular status from fractures?

A

Early s/s of impairment: pain, paresthesia, pallor
Late s/s of impairment: paralysis, pulselessness

145
Q

What are the complications of immobility resulting from a fracture?

A

atelectasis, urinary retention, constipation, skin breakdown

146
Q

What does malunion mean?

A

Malunion=fracture is healed incorrectly

147
Q

What does nonunion mean?

A

fracture never heals

148
Q

What is the pathophysiology of compartment syndrome?

A

Edema in one or more of muscle compartments → ↑ pressure within non-expandable fascia → compression on nerves and vasculature → ↓ perfusion and ischemia to muscle
Ischemia can lead to bone necrosis

149
Q

What are the early and late signs of compartment syndrome?

A

Early signs: intense pain (unrelieved with elevation or pain meds), pallor, paresthesia
Late signs: pulselessness, paralysis

150
Q

Compartment pressure no greater than > ____ mmHg

A

Compartment pressure no greater than > 8 mmHg

151
Q

How long does it take for damage from compartment syndrome to occur?

A

Damage can occur in 4-6 hours

152
Q

What is the treatment for compartment syndrome?

A

fasciotomy

153
Q

What is the priority nursing action for compartment syndrome?

A

Notify provider

154
Q

What are the signs and symptoms of osteomyelitis?

A

S/s: bone pain, fever, leukocytosis, erythema and warmth over area

155
Q

What is the treatment for osteomyelitis, and what should be considered when treating?

A

IV abx, surgical debridement with abx bead placement, bone graft
Challenging to treat due to ↓ blood flow and delivery of abx to bone

156
Q

What are the risk factors for Avascular necrosis?

A

Long term corticosteroid use, radiation therapy, history of sickle cell or rheumatoid arthritis

157
Q

What is the pharmaceutical treatment for phantom limb?

A

Beta blockers, antiepileptics (Gabapentin), antispasmotics (Baclophen) or antidepressants are common medications for treatment

158
Q

What are the positioning interventions for amputations in the first 48 hours?

A

Elevate stump on pillow for first 24-48 hours to prevent edema
Position stump in straightened position s/p 48 to help prevent flexion contractures

159
Q

What helps prepare an amputation for prothesis?

A

Use a ‘stump shrinker sock’ or air splint to help shrink and shape stump to prepare for prosthesis

160
Q

In soft tissue trauma, what two types of injuries can result in hemorrhage, hypovolemia, infection?

A

Splenic Injuries and Liver Lacerations/Injuries

161
Q

What are the potential complications of Small Bowel/Colon injuries?

A

peritonitis, ileus, compartment syndrome, need to resection or diverting ostomies

162
Q

What are the potential complications of large fluid volume resitation?

A

paralytic ileus, compartment syndrome, pulmonary edema, fluid overload

163
Q

What is FAST?

A

FAST: Rapid bedside ultrasound assessment for traumatic injuries performed by radiologists, surgeons, paramedics, NP
Tests for blood around heart (pericardial effusion), abdominal organs (hemoperitoneum)
Presence of free fluids in abdomen are normally as a result of bleeding

164
Q

What causes thermal burns?

A

flames, scalding liquids, heat source

165
Q

What causes chemical burns?

A

caustic chemicals through contact, inhalation of fumes, ingestion or injection

166
Q

What causes electrical burns?

A

high voltage (> 1000 volts) vs low voltage (< 1000 volts)– energy is converted into heat

167
Q

What type of electricity has a greater chance of causing cardiac arrest?

A

Alternating current (AC) has higher likelihood in causing cardiac arrest

168
Q

What system failure should you be on the lookout for in a patient with electrical burns?

A

Electrical injury can result in greater release of myoglobin and can result in acute renal failure

169
Q

What are the characteristics of a superficial 1st degree burn?

A

Only epidermis affected
Maybe minimal dermis impacted
Heals in 3-5 days without treatment
Erythema, painful, no edema, blanches with pressure
Not calculated for fluid resuscitation

170
Q

What are the characteristics of a partial thickness burn?

A

Can be further classified into superficial partial thickness or deep partial thickeness
Epidermis and most of dermis affected
Can be further classified as superficial partial thickness or deep partial thickness
Blistering, moist, painful
Deep partial thickness can present with Eschar

171
Q

What are the characteristics of a full thickness 3rd degree burn?

A

Destruction of all skin layers, through fat, fascia, muscle, and/or bone
Thick, dry, leathery appearance
Dry, discolored, no associated pain

172
Q

Inhalation injuries in _____% of patients

A

Inhalation injuries in 20-50% of patients

173
Q

What is the pathology of burns?

A

Acute inflammation -> Intravascular coagulation -> Cellular enzymes and vasoactive substance release ->Activation of complement ->Increased vascular permeability ->Loss of plasma proteins and fluids shift to extravascular space
Edema– peaks at 24hrs s/p burn

174
Q

What is burn shock?

A

combination of distributive and hypovolemic shock

175
Q
A

Nurs 726 Med Surg 2 (6 decks)

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