GI/Burns Flashcards by Carolina Mena

Jaundice occurs when

The flow of bile is obstructed or an excess of RBC destruction

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Portal HTN is the result of

increased pressure throughout the portal resulting from obstruction of blood flow

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What are two consequences of portal HTN

Ascities and varies

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Ascities occurs as a result of failure of the liver to

Metabolize aldosterone which incrases Na and water retention

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Na and water retention decrease

synthesis of albumin

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Ascities may occur with

Cancer, kidney disease and HF

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S/S of ascities

Increased abdominal girth
Rapid weight gain 
SOB
Straie
Distended viens

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Management of ascities

Avoid salty foods
diuretics (Spirinolactone)
Bed rest
Paracentesis

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Hemorrhage from esophageal varices can result from

Lifting heavy objects
straining
Sneezing
coughing 
vomiting

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S/S of esophageal varices

Hematemesis

Melena

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For esophageal varices hemorrhage what med is given to decrease bleeding

Ocetreotide

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Characteristics of a superficial burn

Damage to the epidermis
Caused by low intensity heat
Red with mild edema
Pain
Heals w/in 3-6 days

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Characteristics of a superficial partial thickness wound

Red, weeping surface
Blister formation
Blanch when pressure is applied
Intense pain 
Heals w/in 10-21 days

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Characteristics of a deep partial thickness burn

Less painful, more nerve endings destroyed
Red, dry, no blisters
Edema is moderate
Heals w/in 3-6 weeks

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Characteristics of full thickness burns

Destruction of entire epidermis and dermis
Hard, dry, leathery
Would is white, red, yellow, brown or black
Sensation is reduced or absent

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Characteristics of deep full thickness wounds

Extends beyond the skin into muscle, bone and tendons
Wound is black
Sensation completely absent
Healing takes month

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Causes of burns: dry heat

Results from open flames. Stop, drop and roll

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Causes of burns: moist heat

Contact with hot liquids or steam. Remove saturated clothes

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Causes of burn injury: contact burns

Hot metal, tar or grease. Remove hot substance

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Cardiac alterations that occur after burn injury

Decreasesd CO, perfusion and O2 delivery 
Drop in BP
Increase in heart workload
Hypovolemia
Peripheral edema 
Release of catecholamines causing vasoconstriction
RBCs may be destroyed causing anemia
Elevated hematocrit 
Slow or absent cap refill

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Fluid and electrolyte alterations that occur after burn injury

Edema forms
Hyperkalemia
Hyponatremia
Loss of capillary integrity and fluid localized causing blister formation

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Pulmonary alterations that occur after a burn injury

ALveolar surfactant production decreases
Carbon monoxide combines with hemoglobin
Catcholamine release reducing the O2 delivery

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Signs of possible inhalation injury

Smoky breath
Hoarseness, stridor, wheezing 
Sooty sputum 
Injury occuring in enclosed space
Burns to neck and face 
Dyspnea, tachypnea 
Drroling

Gi alterations that occur after burn injury

Risk for ACS
Decreased peristalsis 
Decreased bowel sounds
Formation of Curlings ulcer 
Elevated blood glucose
N/V, abd distention

During a burn injury, if there is muscle damage, what is released from the muscle cells

Myoglobin

Myoglobin is excreted thru the

Kidneys

If there is inadequate blood flow thru the kidneys, the myoglobin occludes the renal arteries resulting in

Kidney failure

What are the priorities in the Emergent phase of a burn injury (onset of injury to 48hrs)

``` Establish an airway (100% humidified oxygen) Fluid replacement (LR) Encourage pt to cough up secretions Maintain body temp Prevent infection Indwelling cath NG tube (TBSA over 25%) ```

What information is obtained during a assessment following a burn injury

``` Time of injury Source of heat How did it happen? Interventions taken? Drugs/alcohol factor Events occuring from time of burn to admission ```

Signs of caron monoxide poisoning

``` Headache Confusion Tinnitus Nausea Absence of cyanosis or pallor ```

What is the ABA fluid resuscitation formula

4ml x pt weight kg x %TBSA

For fluid resuscitation, how is the infusion regulated

Half of the infusion within the first 8 hrs, the second half is given over the next 16hrs

What is the appropriate urinary output for thermal and chemical injuries

30-50ml/her

What is the appropriate urinary output for electrical injuries

75-100ml/hr

What are the priorities during the acute phase (48hrs- wound closure)

``` Maintenance of resp/cardio status F/E balance Infection prevention Pain management Splint and position client Perform ROM exercises Nutrition (up to 5000cal/day) ```

Complications that can occur during the acute phase include

Pneumonia Malnutrition Loss of musculoskeletal function Infection and sepsis

How to perform wound cleaning

Mild soap, water and wash cloth to prevent infection. Hair in and around the burn area should be clipped short or shaved. Temp of water should be maintained at 100 degrees and room temp should be maintained at 80-85 degrees to prevent hypothermia

Mechanical debridement

Pt immersed in tub or has small areas of wound washed at bedside Nonviable tissue is removed by forceps or scissors Wet-to-dry dressing not encouraged

Natural debridement

The devitalized tissue separates from the underlying viable tissue spontaneously

Chemical/enzymatic debridement

Topical agent is applied directly to the burn wound. Enzymes digest collagen in necrotic tissues

What is the most important energy source for burn patients

Carbohydrates

When the oral route is used, what kin of diet should burn pt be on

High protein | High calorie

Examples of topical antimicrobial drugs used at every dressing change to prevent infection

Silver sulfadiazine

Rehabilitation phase (wound closure to when pt returns to highest possible level of functioning)

Psychosocial adjustment Prevention of scars Resumption of preburn activity May take years

What are the 2 underlying alterations the development of hepatic encephalopathy

Inability of the liver to detoxify by products of metabolism. Portosystemic shunting

What is considered the major etiologic factor in te development of encephalopathy

Ammonia. It enters the brain and excites peripheral benzo type receptors stimulating GABA

Serum ammonia levels can be lowered by

Elimination of protein from diet | Antibiotics (neomycin sulfate) which reduces the number of intestinal bacteria capable of converting urea to ammonia

Other factors that unrelated to ammonia levels that can cause hepatic encephalopathy includes

``` Excessive diuresis Dehydration Infections Surgery Fever Meds (diuretics that cause K loss, tranquilizers, sedatives) ```

Early sx of hepatic encephalopathy

Confusion Sleep during the day and restless at night Asterixis Simple tasks become difficult In early stages, DTR are hyperactive with worsening of condition these reflexes disappear

What medication is given to reduce ammonia levels

Lactulose

Lactulose can be given with _____ to mask sweet taste

Fruit juice

For comatose pts, lactulose can be given

In NG tube or enema

Other nursing interventions for a pt with hepatic encephalopathy

IV glucose to minimize protein breakdown Administration of vitamins Correct electrolyte imbalance (especially K+)

Hepatitis A transmission and sx

Fecal-oral route. Ingestion of food or liquid that is infected. Anorexia is the most severe/common. No jaundice

Management of Hepatitis A

Bed rest, nutritious diet. During periods of anorexia the pt should receive frequent small meals eupplemented with IVF with glucose

Hepatitis B transmission and sx

Transmitted thru blood, saliva, semen and vaginal secretions. Sx include loss of appetiete, dyspepsia, aabdominal pain, malaise, generalized aching and weakness. The liver is tender and enlarged