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NURS 302/ Med-Surg 2 > FINAL STUFF > Flashcards

FINAL STUFF Flashcards

1
Q

What occurs when there is an injury to the tissues of the body caused by heat, chemicals, electrical current, or radiation?

A

Burns

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2
Q

What are the different kinds of burns?

A

Thermal
Chemical
Smoke Inhalation
Cold thermal

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3
Q

__________ burns are caused by flame, flash, scald, or contact with a hot object?

A

Thermal

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4
Q

What is the most common type of burn?

A

Thermal burns

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5
Q

________ burns are seen in elderly and babies with neuro impairments

A

Thermal

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6
Q

What results from tissue injury and destruction od acids, alkalis, and organic compounds?

A

Chemical burns

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7
Q

What kind of burns are harder to manage?

A

Alkali burns

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8
Q

Why are Alkali burns harder to manage?

A

Because all the damage happens after the alkali is neutralized (Hemolyzed for 72 hours after)

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9
Q

What are the common sites for chemical burns?

A

skin
eyes
RR tract
liver and kidney

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10
Q

What is some nursing care for someone with a chemical burn?

A

Remove the causative agent
Wash the skin
Remove clothes that came in contact with the chemical
Irrigate with large amounts of water

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11
Q

What are three things to do AS A NURSE that comes in contact with a chemical burn?

A
  1. PPE
  2. brush off chemicals- will look like pasta/powder
  3. wash after brushing with copious amount of water.
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12
Q

What is the inhalation of hot air or noxious chemicals that injures respiratory tract

A

Smoke Inhalation Injury

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13
Q

Smoke inhalation injury can cause mortality, this it needs __________ intervention

A

QUICK!

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14
Q

What is the treatment for carbon monoxide poisioning?

A

100% nonrebreather with humidified oxygen

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15
Q

If there has been skin damage caused by carbon monoxide poisoning, they will have a ______-_____ appearance

A

Cherry-red

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16
Q

If there is an _____ airway smoke inhalation injury ; it is above the epiglottis

A

UPPER

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17
Q

An upper airway smoke inhalation injury can be caused by what?

A

Hot air
Steam
Smoke

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18
Q

An upper airway smoke inhalation injury can cause ___________ burn of the oropharynx and larynx?

A

Mucosal

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19
Q

An upper airway burn can quickly lead to a mechanical obstruction, thus making it an

A

EMERGENCY

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20
Q

What are signs and symptoms of a upper airway inhalation injury?

A

Facial burns
Singed nose hairs
Hoarseness and painful swallowing
Darkened oral mucous membranes.

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21
Q

What may be considered if there is an upper airway inhalation injury?

A

INTUBATION

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22
Q

A _______ airway smoke inhalation injury is below the epiglottis

A

LOWER

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23
Q

What causes a lower airway inhalation injury?

A

prolonged exposure to smoke and toxic fumes

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24
Q

What are some possible manifestations of a lower airway inhalation injury?

A

Pulmonary edema (12-24 hours) may progress to ARDS
You need to monitor them for 24 hours!!!!!!!!! This could get bad!

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25
Q

What results from coagulation necrosis caused by intense heat generated by electrical currents

A

Electrical burns

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26
Q

What kind of burn can result from direct damage to nerves/vessels and causes tissue anoxia and death

A

Electrical burns

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27
Q

Electrical burns have an ____ and ______ point

A

Entry and EXIT

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28
Q

A patient with electrical burns is at risk for what 3 things?

A

Dysrhythmias
Severe metabolic acidosis
Myoglobinuria

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29
Q

Why is severity of electrical burns had to determine?

A

Because most of the damage is under the skin and hard to determine the burn surface area

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30
Q

Severity of electrical burns is determined by…

A
  • Voltage
  • Tissue resistance
  • Current pathways
  • Surface area
  • Duration of the flow
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31
Q

What makes an electrical burn possibly life threatening

A
  • when the pathway passes through vital organs
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32
Q

What occurs from true tissue freezing?

A

Frostbite

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33
Q

What occurs causing frostbite?

A

Ice crystal formation in intercellular spaces and destruction of intercellular sodium, chloride, and cell membrane

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34
Q

What are the components of superficial frostbite?

A

Skin and subQ tissues (ear, nose, fingers, and toes)

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35
Q

What are the components of deep frostbite?

A

Muscle
Bone
Tendons

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36
Q

What is some nursing care for cold thermal injury?

A

Immerse in water bath between 98.6-104 / tetnaus prophylaxis

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37
Q

What is the biggest concern as far as cold thermal injuries

A

Watch for compartment syndrome

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38
Q

What is the modern name for a 1st degree burn?

A

Superficial partial thickness burn

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39
Q

What does a superficial partial thickness burn involve?

A

EPIDERMIS

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40
Q

What are the manifestations of a superficial partial thickness burn?
Think of a sunburn

A

Redness but no initial blistering
Blanching with pressure and some pain

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41
Q

What is the modern name for 2nd degree burns?

A

Deep partial thickness burn

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42
Q

What part of the skin is involved in a deep partial thickness burn?

A

THE DERMIS

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43
Q

What are the manifestations of a deep partial thickness burn?

A

Red, shiny skin.
Looks wet and blisters
Lot of pain

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44
Q

Does a deep partial thickness burn involving the dermis need a skin graft?

A

Skin can regrow, so no, no need for a graft

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45
Q

What is the modern name for a 3rd degree burn?

A

Full thickness burn

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46
Q

What parts of the skin does full thickness burn include

A

Fat
Muscle
Bone

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47
Q

What are some manifestations of a full thickness burn?

A

Dry, waxy, leathery look
NO pain (kills the nerve)

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48
Q

Will a dull thickness burn need a graft?

A

YES!

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49
Q

A patient comes into the ED, and has a burn with a lot of blistering and an excruciating amount of pain, you would assume that they have a __________ partial thickness burn

A

DEEP!

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50
Q

Knowing the rule of Nines for burns, what is the front of the legs?

A

9

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51
Q

Knowing the rule of Nines for burns, what is the back of the legs?

A

9%

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52
Q

Knowing the rule of Nines for burns, what is thegroin?

A

1%

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53
Q

Knowing the rule of Nines for burns, what is the front of the arms?

A

4.5%

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54
Q

Knowing the rule of Nines for burns, what is the back of the arms?

A

4.5%

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55
Q

Knowing the rule of Nines for burns, what is the front of the abdomen?

A

18%

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56
Q

Knowing the rule of Nines for burns, what is the back of the abdomen/back?

A

18%

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57
Q

Knowing the rule of Nines for burns, what is the front of the head/neck?

A

4.5%

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58
Q

Knowing the rule of Nines for burns, what is the back of the head/neck?

A

4.5%

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59
Q

What is the possible complications when there is a burn to the face, neck, or chest?

A

Respiratory problems and a possible obstruction

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60
Q

What is the possible complications when there is a burn to hands, feet, joints, and eyes?

A

Difficulty with self care and independence

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61
Q

What is the possible complications when there is a burn ears and nose?

A

Infection risk

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62
Q

What is the possible complications when there is a burn to circumferential areas?

A

Circulatory compromise and compartment syndrome

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63
Q

What are patient risks related to burns?

A

Elderly heal slower than younger
Pre-existing cardiovascular, renal, and respiratory problems
Diabetes/ peripheral vascular disease
Alcohol/ drug use, malnutrition, and chronic disease

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64
Q

What is nursing / medical care for a burn patient even before they get to the hospital

A
  • remove them from the thing that is doing the burning
  • DO NOT immerse in cool water or pack with ice
  • REMOVE burned clothing, wrap in clean dry sheets
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65
Q

What is the first step when you run into a patient that has a chemical burn?

A

Brush solid particles off the skin and water lavage

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66
Q

What is the first step when you run into a patient that has had an electrical burn?

A

Remove from contact to source

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67
Q

If a patient has a small burn (<10% TBSA) you should……..

A

Cover with clean/cool dampened towel

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68
Q

If a patient has a small burn (>10% TBSA) you should check the ___________

A

ABCs

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69
Q

The time after a burn where we need to resolve the immediate life threatening problems and can last up to 72 hours is what phase?

A

Emergent

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70
Q

The emergent phase starts with _____________ and _______ formation and continues until fluid mobilization and diuresis begins

A

HYPOVOLEMIA & EDEMA

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71
Q

There is a risk of __________ shock in the emergent phase because of a massive fluid shift

A

HYPOVOLEMIC

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72
Q

What are clinical manifestations that are seen in the emergent phase of burn victims

A

Shock from hypovolemia and pain
Blisters
Adynamic ileus r/t decreased motility and poor perfusion
Shivering
Change in LOC- assume possible head trauma

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73
Q

What is the normal insensible loss?

A

30-50 mL/hr

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74
Q

In severe burns, what is the fluid loss?

A

200-400 mL/hr

75
Q

In burns, RBCs are hemolyzed thus causes thrombosis, and an elevation in what lab value?

A

Increased hematocrit

76
Q

What electrolyte shifts into the interstitial space and remains until ______________ formation ceases?

A

edema

77
Q

Burn injuries cause a widespread ____________ of the integument system

A

IMPAIRMENT

78
Q

In burns, skin barriers are destroyed lead to decreased __________________________ and changes in ____

A

Decreased immunoglobins and changes in WBCs

79
Q

Why is there an increased risk of infection in burn patients

A
  • inflammatory cascade is high but then is depleted later.
80
Q

What are possible Cardiovascular complications seen in the emergent phase of burns

A

Dysrhythmias and hypovolemic shock
Edema, ischemia, necrosis, paresthesia
Gangrene, and impaired microcirculation
Increased blood viscosity

81
Q

What are possible respiratory complication of the emergent phase of burns

A

Inhalation injury - may not show up til after 24 hours
Upper respiratory tract injury- edema, mechanical airway obstruction, asphyxia, pneumonia, and pulmonary edema

82
Q

What are possible urinary complications in the emergent phase of burns

A

Decreased blood flow to kidneys which can cause renal ischemia and acute tubular necrosis

83
Q

What is some nursing care for the Emergent phase of burns?

A
  • Early intubation and airway management
  • 1-2 large bore IVs for fluid replacement
  • Wound care
84
Q

What is the goal of urine output in the parkland formula?

A

UO should be 0.5-1.0 mL/kg/hr

85
Q

What is the parkland formula

A

4 mL x total burn surface area
(1/2 in the 1st 8 hours, then 1/4 in the next two 8 hours)

86
Q

What are parts of the acute phase of burns?

A
  • Mobilization of extracellular fluids
  • Diuresis
87
Q

When is the acute phase of a burn over?

A

When the burned area is completely covered with skin grafts and the wounds are healed

88
Q

What stage do bowel sounds return to normal in?

A

Acute phase –> fluid mobilization

89
Q

What are the clinical manifestations for the acute phase of burns?

A

Partial thickness wounds form eschar, removed, and then re-epithelization starts.
With a full thickness burn wounds need debridement

90
Q

What lab values would need considered in the acute phase of burns

A
  • Hypernatremia r/t to fluid replacement
  • Hyponatremia r/t hydrotherapy or water intoxication
  • Hyperkalemia r/t renal failure of muscle injury
  • Hypokalmenia r/t hydrotherapy or IV therapy without supplementation
91
Q

What are possible infection complications in the acute phase of burn healing

A

bacteremia or if really bad septisemia

92
Q

What are possible respiratory and cardiac complications in the acute phase of burn healing?

A

Pneumonia

93
Q

What are possible neuro complications in the acute phase of burn healing?

A

Disorientation
Combative behavior and hallucination
ICU psychosis syndrome

94
Q

What are possible musculoskeletal complications of acute phase of burn healing?

A

Decreased ROM and contractures

95
Q

What are possible GI complications of acute phase of burn healing?

A

Paralytic ileus and curling ulcer

96
Q

What are possible endocrine of acute phase of burn healing?

A

INcreased BG and insulin

97
Q

Nursing care for the acute phase of burn healing?

A
  • Wound care
  • Cover the graft
  • Pain management- PRETREAT
  • Physical and occupational therapy
  • Nutritional therapy - high protein and carb
  • Psychosocial care
98
Q

What kind of graft comes from the patient’s own skin?

A

Cultured epithelial autograft

99
Q

What kind of graft is temporary until and autograft is available?

A

Artificial skin

100
Q

What stage of burn healing when the burn wounds are covered with skin/ healed and patient is able to resume a level of self-care activity

A

Rehabilitation phase

101
Q

How long does the rehab phase normally last?

A

4-6 weeks

102
Q

What does the skin look like in the rehab phase?

A

Raised and hypermic

103
Q

Mature healing is reached from ____ months to __ years

A

6 mo. to 2 years

104
Q

What are some education points regarding the rehab phase?

A

Never regains origical color
Will be sensitive to cold, heat, and touch
Protect from sunlight for 1 year (super sensitive)

105
Q

What is nursing care for the rehab phase?

A

Educate about healing wounds
Use emollient water based creams
Cosmetic surgery
ROM for PT and OT
NEEDS
High calorie and high protein diet

106
Q

What is the process that is used to determine patient acuity to allow treatment of most critical first?

A

Triage

107
Q

Who is treated first in Triage?

A

Life
Vision
Limb

108
Q

What ESI classification is used when there is an immediate threat to life, likely to code?

A

ESI-1

109
Q

What ESI classification is used when there is a threat to life within minutes?

A

ESI-2

110
Q

What are some examples of injuries that would classified as ESI-2?

A

Open fracture
Stable chest pain
Risk of losing respiratory drive

111
Q

What ESI classification is used when they could be considered stable for up to 1 hour?

A

ESI-3

112
Q

What are some examples of ESI-3 situations?

A

Acute abdomen
Closed fracture –>Not compartment syndrome

113
Q

What ESI classification is used when they are stable and the treatment can be delayed and only requires some little study or procedure?

A

ESI-4

114
Q

What are some examples of ESI-4 situations

A

Suture
Vaccines

115
Q

What ESI classification is used when they are stable, and they only need an exam and observation?

A

ESI-5

116
Q

A stand for __________ and _____

A

ALERTNESS AND AIRWAY

117
Q

How do you determine LOC by using AVPU?

A

A- alert
V- responds to voice
P- responds to pain
U- unresposive

118
Q

What are signs of a compromised airway?

A

dyspnea, inability to talk, foreign body in airway (hoarse), trauma to the face and neck (fracture of the face)

119
Q

What are ways to maintain an airway?

A

stabilize C-spine
jaw thrust
suction and remove foreign body
insert naso/oropharyngeal airway
lastly would be intubation

120
Q

B stands for ____________-

A

Breathing

121
Q

What are important things to assess for when it comes to breathing?

A

Dyspnea, cyanosis, paradoxical, asymmetric chest wall movement, decreased/absent breath sounds, tachycardia and low BP.

122
Q

What are interventions for a patient who is having trouble breathing?

A

high flow O2 by nonrebreather
bag valve mask for life threatening conditions
monitor the patient response to treatments

123
Q

What are some things to assess when looking at circulation?

A

pulses (peripheral may be absent with vasoconstriction)
skin (color, temp, moisture)
mental status and capillary refill

124
Q

What are interventions for circulation?

A

Insert 2 large bore IVs (18 gauge)
Provide aggressive fluid resuscitation with NS/LR

125
Q

In order to feel pulses…. Radial must be over ______ and femoral must be over ______ and carotid must be over _____

A

SBP 80 to feel radial pulses
SBP 60 to feel femoral pulses
SBP 40 to feel carotid pulse

126
Q

What is mild impariment on the GCS?

A

13-15

127
Q

What is moderate impairment of GCS?

A

9-12

128
Q

What is severe impairment on GCS?

A

3-8 (INTUBATION MUST OCCUR)

129
Q

What are important things to consider and assess when looking at disability

A

LOC according to GCS
Pupil size
Shape
Response to light and equality

130
Q

What should you to when looking at exposure and environmental control?

A

Remove clothing to inspect all areas of the pt.
Minimize temp. loss to avoid hypothermia

131
Q

What are important things to do while resuscitation?

A

Lab tests
Monitor EKG
NG tube
Oxygenate
Pain management– not done until neuro assessments are completed

132
Q

What are important things to establish in a head to toe?

A

Symptoms
Allergies
Med history
PMH
Last meal - important for surgery
Events leading to illness

133
Q

Why is it important to inspect the posterior surface?

A

Logroll the patient to maintain C-spine while inspecting the posterior surface
Provide continued monitoring of the patient and their response to interventions
Prepare for transport to diagnostic tests, units, or facilities

134
Q

What is the prolonged exposure to heat causing a core temp of 99.6-100.4 and can progress to heat stroke

A

Heat exhaustion

135
Q

What are the S/S of heat exhaustion?

A

fatigue, lightheaded, N/V, diarrhea, feeling of impending doom, tachypnea, tachycardia, dilated pupils, mild confusion, ashen color, profuse diaphoresis, hypotension

136
Q

What is the treatment of heat exhaustion?

A

Place in a cool area
Remove clothing
Apply moist sheet and PO fluids
IV fluids in nauseated and replace electrolytes.

137
Q

What is a hallmark sign on heat exhaustion?

A

Perfuse diaphoresis

138
Q

What is the failure of the hypothalamus after heat exhaustion progresses?

A

Heat stroke

139
Q

What are the S/S of heat stroke?

A

vasodilation, increased sweating and respiratory rate deplete fluids and electrolytes (esp. sodium)

At 104 F, sweat glands stop working !!!! altered mentation and circulatory collapse can follow; cerebral edema and hemorrhage occur with thermal brain injury

140
Q

What is the treatment of heat stroke?

A

stabilize ABCs and rapidly reduce temp
remove clothing, cover with wet sheets, large fans, cooling blankets, ice to groin and axilla, immerse in cold bath, administer cool fluid
Once cooled to 104, Tylenol can be given. Higher than that it has no effect (bc the hypothalamus shut down)
Temperature reduction must be aggressive until 102 F
Give chlorpromazine to decrease shivering
Monitor for signs of rhabdomyolysis, myoglobinuria, and DIC

141
Q

What are the risks with rewarming in hypothermia?

A

Afterdrop
Hypotension
Dysrhythmias

142
Q

What is the temp. for mild hypothermia

A

93-97

143
Q

What are the S/S for mild hypothermia? (93-97)

A

shivering, lethargy, confusion, rational to irrational behavior, mild tachycardia

144
Q

What are some things to do to help in mild hypothermia?

A

External warming: passive – move to warm place, warm blankets, remove damp clothes, active – body-body contact, fluid/air filled warming blankets, radiant heat lamps

145
Q

What is the temp. for moderate hypothermia?

A

90-93

146
Q

What are some S/S of moderate hypothermia?

A

Rigidity
Bradycardia and bradypnea
Metabolic and respiratory acidosis

147
Q

What are some interventions for Moderate hypothermia

A

Heated and humidified O2
Warmed IV fluids
Peritoneal and gastric lavage

148
Q

What is the temp. for severe hypothermia?

A

under 90

149
Q

What are the S/S of severe hypothermia?

A

Look dead
Bradypnea and cardia
Asystole and V fib

150
Q

A patient must be warmed to _____ F before being pronounced dead

A

86 F

151
Q

When do you stop rewarming a patient

A

When they reach 90-93 F

152
Q

What occurs when someone become hypoxemic due to submersion in water

A

Submersion Injury

153
Q

What is respiratory impairment after submersion?

A

Drowing

154
Q

What causes immediate pulmonary edema from fluid shifts?

A

Salt water aspiration

155
Q

What causes late pulmonary edema from pathogens

A

Lake water aspiration

156
Q

What is the treatment for a submersion injury?

A

Aggressive resuscitation and may require mechanical ventilation
- Require 24 hours of observation

157
Q

What if a patient has come into the ED after a submersion injury, and there is a decline in mental status, what should you consider?

A

Cerebral edema
Worsening hypoxia
Acidosis

158
Q

What are 2 things that help to decrease absorption in poisoning

A

Gastric Lavage
Activated Charcoal

159
Q

When do you need to perform gastric lavage after poisoning?

A

within 2 hours

160
Q

How do you preform gastric lavage in a poisoned patient

A

Insert NG tibe
Inject 60 mL to dilute contents
Suction back out

161
Q

What are contraindications for Gastric lavage?

A

Caustic agent
Ingestion of sharp agent
Nontoxic substance

162
Q

In order for activated charcoal to be beneficial, it needs to be given within ____ minutes

A

60

163
Q

What are contraindications for activated charcoal?

A

Diminished bowel sounds
Paralytic ileus
Ingestion of antidote

164
Q

What are 2 ways to enhance elimination in poisoning?

A

Cathartics- stimulates motility
Hemodialysis- For acidosis

165
Q

Anthrax, plague, and tularemia are things used in bioterroris, but it can be treated with _____

A

ABX

166
Q

_________ can be prevented or ameliorated with vaccines given 72 hours before

A

Smallpox

167
Q

What is treated with antitoxin

A

Botulism

168
Q

What is the thing used in terrorism that has no known treatment>

A

Hemorrhagic fever

169
Q

What is a chemical terrorism that is a toxic nerve gas that paralyzes respiratory muscles?

A

Sarin

170
Q

What is the treatment for Sarin?

A

Give atropine
Pralidoxime chloride

171
Q

What is a colorless gas that can cause respiratory distress and death with long enough exposure

A

Phosgene

172
Q

What is yellow/brown gas that irritates eyes and causes skin blistering

A

Mustard Gas

173
Q

Mustard gas turns into a liquid and then a _________

A

Paste; remove it!

174
Q

After a bomb goes off, a patient comes in with exposure to 100 RAD, what S/S will they have

A

N/NV, HA, feel sick, malaise

175
Q

After a bomb goes off, a patient comes in with exposure to 100-600 RAD, what S/S will they have

A

Can cause deformity and increase risk of death

176
Q

After a bomb goes off, a patient was to 600 RADs, what will hapen?

A

Immediate death

177
Q

What is an event that overwhelms the community’s ability to respond with existing resources. Produces many casualties

A

Mass causality incident

178
Q

In order to calculate the number of causalities, hospital need to ________ the number of casualties that arrive in the first hour

A

DOUBLE

179
Q

In the colored tag system, black or blue means what?

A

Dead or expectant death

180
Q

In the colored tag system, what does red mean?

A

Immediate threat to life (decreased perfusion and head traume)

181
Q

In the colored tag system, yellow means what?

A

Can delay treatment but may progress to unstable rapidly

182
Q

In the colored tag system, green means what?

A

Minor injuries that can be treated later

183
Q

In the colored tag system, White means what?

A

At the site, but not hurt. Need to be tagged bc they need a psych follow up!

NURS 302/ Med-Surg 2 (5 decks)

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