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Complex Med Surg - Nrsg 200 > Unit 11 > Flashcards

Unit 11 Flashcards

1
Q

What is Ewing’s sarcoma?

A

It is a small round tumor found in bone and soft tissues. It is most often found in males 10-20 years old, and usually in the pelvis, femur, radius, ribs, or clavicle. It is usually very painful.

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2
Q

What does the ABCD method of evaluating skin lesions entail?

A

A= asymmetry B=border irregular C= color variations D= diameter > 5mm

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3
Q

With a stage 1 pressure ulcer, the skin is intact/not intact, is red, and blanches/does not blanch.

A

Intact. Blanches (because the blood supply is still intact)

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4
Q

With a stage 2 pressure ulcer there is partial thickness loss of the _____ and _____.

A

Dermis. Epidermis.

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5
Q

How deep is a stage 3 pressure ulcer?

A

Through the epidermis and dermis and into the sub Q tissue, but not through the fascia.

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6
Q

After a skin graft, is the affected area kept immobilized or exercised regularly?

A

It is kept immobile for 3-5 days.

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7
Q

What part of the skin does a superficial burn damage? How long does it take to heal?

A

The epidermis. 3-6 days.

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8
Q

What part of the skin does a superficial-partial thickness burn include? How long does it take to heal?

A

All of the epidermis and some of the dermis. 10-21 days

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9
Q

What part of the skin does a deep partial thickness burn include? How long does this take to heal?

A

All of the epidermis and deep into the dermis. 2-6 weeks.

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10
Q

Pertaining to partial thickness burns, which type blanches easily? Which type has blisters? Has the most pain?

A

Superficial partial thickness blanches, has blisters, and is painful.

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11
Q

What does a deep partial thickness burn look like?

A

Blanches slowly, if at all, is red/dry with white areas where burn is deeper.

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12
Q

What does a full thickness burn look like?

A

Covered in hard, dry, leathery eschar, waxy white, yellow, deep red, brown, black, with thrombosed vessels visible.

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13
Q

What happens to blood vessels after a severe burn?

A

Initially they constrict, but they quickly dilate and permeability increases causing capillary leak of plasma (proteins). As proteins leak into the interstitial spaces, fluid follows.

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14
Q

What electrolyte imbalances occur with a severe burn?

A

Hyperkalemia due to dying cells releasing potassium. Hyponatremia, due to sodium shift into the interstitial spaces.

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15
Q

What happens to the blood after a severe burn?

A

Due to dehydration, HGB/HCT/osmolarity↑.

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16
Q

After a severe burn, when does fluid begin to shift back to the vessels?

A

It starts at about 24 hours after.

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17
Q

After a severe burn, when does capillary leak stop?

A

About 48-72 hours after injury.

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18
Q

When fluids shift back into the cells and vessels after a burn, what happens to sodium and potassium levels?

A

Hypokalemia may occur due to its moving back into the cells and being excreted by the kidneys. Hyponatremia may remain or get worse due to kidney excretion and wound losses.

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19
Q

What happens to cardiac output after a severe burn?

A

It drops for 18-36 hours after injury, then returns to normal.

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20
Q

What happens to the gastrointestinal tract after a severe burn?

A

Blood flow is decreased to the area slowing peristalsis. Curling’s ulcers may develop due to reduced mucosal production. Give Zantac/Nexium, etc.

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21
Q

What happens to body temp after a severe burn?

A

Temp may reset to a higher level due to hypermetabolic state.

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22
Q

What happens to blood glucose after a burn? Heart rate? Respirations?

A

All increase.

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23
Q

What are the S/S of pulmonary injury from burns?

A

Hoarseness, brassy cough, drool, difficulty swallowing, wheezing/stridor.

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24
Q

If you are treating a burn patient and his wheezing suddenly stops, what do you do?

A

Prepare to intubate, the airway is closing off.

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25
Q

According to the rule of 9’s, what % of total area is burned if a patient has burns covering an entire arm, his face and chest, and half his abdomen?

A

33.75 %

26
Q

Explain the rule of nines.

A

Legs=18% each. Arms=9% each. Chest/upper back=18% each. Head =9%

27
Q

What is the Parkland formula?

A

The formula for determining how much crystalloid fluid (lactated ringers) to give a burn patient over 24 hours. 4 mL/kg/% TBSA burned.

28
Q

If a patient weighed 200 pounds, and had burns covering the fronts of his arms, his chest and abdomen, and the front of both legs from the knee up, how much fluid would he need in the first 24 hours?

A

14,727 mL. Double check me on this one and let me know if you get the same answer!

29
Q

If a patient needs 24,000 mL of fluid in the first 24 hours, is it given in boluses, or do you just divide 24000 by 24 and set the drip rate?

A

Half is given in the first 8 hours from the time of injury, NOT from the time the entered the facility! The second half is given over the remaining 16 hours.

30
Q

What meds might be given a burn patient to assist the heart in maintaining proper function?

A

Digoxin and dopamine/Dobutamine. (in class she said Dobutamine is better, but page 527 (in the box) it mentions dopamine for the older adult.

31
Q

What is an escharotomy?

A

It is an incision made lengthwise into the sub Q layer of burned tissue to relieve pressure buildup under circumferential burns. It is usually done in a treatment room.

32
Q

What is a fasciotomy?

A

It is an incision made into the fascia of burned tissue to relieve pressure. Because of the depth of the incision, it is usually done in the OR.

33
Q

When does the acute phase of burn injury occur?

A

36-48 hours after injury until wound closure is complete.

34
Q

What are the priority nursing assessments during the acute phase?

A

Cardio and pulmonary systems.

35
Q

When does the resuscitation phase of burn injury occur?

A

From the time of injury to 24-48 hours after.

36
Q

What % of weight loss in a burn patient is considered important?

A

10% or more.

37
Q

What happens to acid/base balance with severe burns?

A

Metabolic acidosis

38
Q

What is a major threat during the acute burn phase?

A

Infection/sepsis.

39
Q

What is Silvadene used for, and don’t just say “burns”!!! What are its advantages?

A

Silver sulfadiazine (Silvadene/Thermazene) is a silver salt that binds to bacterial membranes and interferes with DNA synthesis. It is painless, does not cause kidney disease or electrolyte imbalances, is wide spectrum, and has a long shelf life.

40
Q

What are some disadvantages of Silvadene?

A

Not absorbed into eschar well, not effective against pseudomonas, may cause rash/pruritus and leukopenia.

41
Q

Why might you use gentamycin cream instead of Silvadene?

A

It is effective against pseudomonas.

42
Q

What are some detriments to gentamycin usage?

A

It may have ototoxic and nephrotoxic effects.

43
Q

What would you monitor closely if using gentamycin cream on a burned patient?

A

Serum creatinine and creatinine clearance.

44
Q

When does the rehabilitative phase of burn recovery start?

A

From wound closure until patient achieves highest level of functioning possible.

45
Q

What is the difference between a homograph and a heterograph? ( no, homographs are NOT from gay people!)

A

A homograph is from a human donor (usually a cadaver cause living people don’t sit still well for skin peeling). Heterographs are from other animals. Soooo, if they used animal foreskin on someones burned head, that would make them a what? (Yes, I had to go there!)

46
Q

What level of CO is normal? Mild poisoning? Moderate? Severe? (coma)

A

1-10% is normal. 11-20 is mild. 21-40 is moderate. 41-60=coma and if its over 60 you are dead!

47
Q

When are colloid solutions given?

A

According to several publications found in the National Library of Medicine, colloids are given in the second 24 hrs post injury.

48
Q

When should blood products be given to burn patients?

A

According to the World Health organization, there is no reason to give blood in the first 24 hours of burn treatment, unless there are other injuries that warrant its use or S/S of inadequate oxygen delivery.

49
Q

What is the best indicator of fluid resuscitation in a burn patient?

A

Urine output.

50
Q

What pain meds are given for severe burns?

A

Opioids via IV.

51
Q

If a patient is brought in to your ER with deep partial burns covering 25% + of his body, or full thickness burns covering 10%, or any burns involving the eyes/ears/face/hands/feet/ perineum, or electrical or inhalation injury, is over 60 (John, you’re on your own in this category), or has complications ( EG: fractures) or other serious chronic conditions, what would you do?

A

Transfer (the patient) as soon as possible to a burn unit.

52
Q

What is an actinic keratosis? What can they turn into?

A

It is a premalignant lesion of the epidermis. Metastasis is rare and usually caused by UV exposure. They become squamous cell carcinoma if left untreated.

53
Q

Describe squamous cell carcinoma.

A

Cancer of the epidermis. Most likely to spread if on the lips/ears/genitals.

54
Q

Tell me something about basil cell carcinoma.

A

Arise from the basil layer. Rarely metastasize.

55
Q

What type of bone malignancy is most common? How painful is it?

A

Osteosarcoma. Sharp pain and warm to the touch.

56
Q

Where do osteosarcomas usually metastasize to?

A

The lung within 2 years.

57
Q

Tell me about chondrosarcomas.

A

Dull pain and swelling for a long time. Pelvis and proximal femur. Not as deadly as osteosarcoma. Affects middle age and older (gulp), predominantly males.

58
Q

What can you tell me about fibrosarcomas?

A

Gradual onset without specific symptoms. Malignant Fibrous Histiocytoma (MFH) is the most deadly. Occurs in the long bones of the lower extremities.

59
Q

What manifestations accompany Ewing’s sarcoma?

A

Systemic manifestations include fever, leukocytosis, and anemia. Local tenderness and swelling also occur.

60
Q

What are bright, cherry red lips an indication of?

A

CO poisoning.

61
Q

What temp can skin tolerate without injury?

A

104 degrees.

62
Q

In extensive and severe burns, what may damage kidneys even though there is no direct trauma?

A

Myoglobin is released from damaged muscle tissue and may damage the kidneys.

Complex Med Surg - Nrsg 200 (10 decks)

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