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H & Illness 4: A & C illness > week 12 > Flashcards

week 12 Flashcards

1
Q

burn classificiation/assesment
what are the types :

superficial partial thickness (1st )

deep partial thickness burn

A

superficial partial thickness burn ( 1st degree )
- doesnt need to be hospitalized ( put dressing on to protect that skin )

deep partial thickness burn ( 2nd degree )
- size of a toonie , deep

partial thickness burn - can get away with dressing change to keep to clean - would heal but takes a whiee
but large area - entire hand ( doesn’t happen, bad infection ( will heal but have scar tissues 0

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2
Q

what is full thickness ( 3rd degree )

A

cut off all the dead tissue ( some type of dressing thing to act like skin )

full thickness burn ( 3rd degree ) smells like burn hair
eschar on it ( black stuff )
not soft and doesn’t feel human and its hard

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3
Q

needs to get grafted ( the photo)

full thickness ( within 48 hours, die from sepsis , ( burn dead skin )
what is this describing ?

A

full thickness ( 3rd degree ) – cut off all the dead skin ( some type of dressing thing to act like skin )

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4
Q

what is extent – the % tbsa burned ( estimate ) rule of nines

A

total burning surface area

the higher the total body surface area burn - the more serious it is and the more likely the pt will have roughly recovery and pass away

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5
Q

where is the location that could occur for burns ?

A

face, neck, chest
hands, feet, joints, eyes
ears
buttocks and perineum
circumferential – limb - perfusion ) chest ( inhalation , movmeent of chest wall )

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6
Q

what do we immediately worry about when they have a burn across their chest / neck/face

A

worry abt the airway
pulling hot air and they can have burn even in their esophagys

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7
Q

what do we worry abt when they have burn in their hands, feet, joints and eyes

A

we worry abt how they are able to live ( independence and work )
wr worry abt the contractures and eyes we worry abt the eye sight

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8
Q

why are ears hard to heal ?

A

alot of cartilgae and not a lot of blood, takes a long time to heal
the classic burn is when thwhat

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9
Q

what are the risk factos for burn

A

age
med/hx.chronic diseasae, lifestyle other injuries

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10
Q

in class she tlaked abt circumferencial ( expand on it )

A

the classic burn is when the older person get to a tub and do not realize and lower their backside and now have a burn - worry abt bowel movemnt, getting infection , diarrhea

circumferential - gets all the way around

( chest can epxand require escharotomy )

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11
Q

what undergoes age as a risk factor

A

organs are not working not as grat and have more diffuclty with rehab

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12
Q

what disease delays healing for burns ?

A

ms crohns , any type of disease ( diabetes, imapires healing , makes risk goes higher

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13
Q

true or false. sometimes they cut burns tissues, and let it expand ( releases pressure, emerg thing, has to be done )

A

true

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13
Q

poor kidney function, resp such as copd , huge risk they will die is this true amongst burns

A

yes this is true

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14
Q

what undergoes lifestyle, alcoholic , not good ability to heal and have liver problems or kidney

is this true

A

yes this is try

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15
Q

circumferenrail chst burn,,, chest cant expand , and may require what ?

A

escharotomy ( relieving pressure – there can be chest expansion )

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16
Q

what is the 3 distinct phases that a burn person goes through ?

A

emerg
acute
rehab

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17
Q

what is the emergency phase

A

remebeer abcs
resp
– airway
possible injury above glottis
et tube/ventilator
abg, give 02

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18
Q

how ong does a pt passes awya in the emergency phase

A

48 hours
right when the burns happens watch out fot 24 hours to 48

if they do [ass way usually because airway has closed in and couldnt intubate thwm

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19
Q

what is the first thing you’ll see in an emergency phase ?

A

usually when they die out of ariway problems its cardioasdcular low blood pressure second adn the first is airway

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20
Q

true or false. think abt airway, think abt injury in the glottis ( look for signs for burning for ae )
anu time of set burning of fac,e shotnnes of breat or whhezing and thinkin abt burnt hair

A

truew

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21
Q

waht type of asesemtn is important in emerg phase ?

A

chest assmsnet 0 asucualte an dpositioning

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22
Q

reclal that these are important an dundergoes emerg phase :

recall : remebeer abcs
resp
– airway
possible injury above glottis
et tube/ventilator
abg, give 02

what else ?

A

– Oropharynx
– Positioning
– DB & C, chest physio, suctioning – CXR, bronchoscopy
* Carbon monoxide (CO) poisoning – EMT treat

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23
Q

what type of position in emerg phase ?

A

hgih fowlers psoiton

lets ahve a good look isndie the tissue inside the bronchitis an dsee how bad it is how burn it is

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24
Q

why do we do a diagnsotics ?

A

to get a baseline

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25
Q

if we hear a wheezing what is this indiciating

A

everyhting is closing down

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26
Q

dont rlly deal with it in the hospital caused because of conbustable material in the air
breathing in their home but not actually getting oxygen connecting to red blood cells

this is what ?

A

emerg phase carbon monoxide co posiiojign emt trear

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27
Q

what is the treatment for carbon monoxide poisoning - emt trear

A

skin is cherry red - treatment : is get them outside, and give oxyegn for proabbaly 24 horurs
we have to make sure carbon monoxide is not in their body enough to stop carthe oxygen from getting hemoglobin

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28
Q

Presence of soot on face & mouth – signs of smoke inhalation….no S&S initially, then SOB, wheezing, hoarseness

A

its giving burnt ( remember the photo ) smoking inhalation

when they got to the hospital:nothing rlly and then suddely sob

upper airway is injured and alot of hot air went in and alot of that tissues to heat
they may look okay but actually not ( listen to talk and breathing )

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29
Q

Partial and full thickness burns, involves face (O2, high Fowlers position)

A

whole upper body , all the soot
the nurse has a mask on him ( 50 liters going in )
probably need to be intubated ( nurses are close by )

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30
Q

Facial burn involving lips and mouth. L/A fluid given. Edema develops to face & upper airway

A

*Protect airway *Intubate early p465
Burn to upper airway -hoarsness, stridor, -difficulty swallowing -++secretions

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31
Q

emergency phase: ng care/assessment

what is it ?

A

abc’s here is the c “ fluid resuscitation “ dr’s area figure out doing a formula

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32
Q

fluid theraphy– need to support BP
what is going on with interstitial spaces?

A

bp going down and starts hypovolemic and we see this when body surface area is over 15 percent

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33
Q

wha do we see in u/o and elctrolytes for fluid theraphy in emerg phase

A

low urine outout, we also see low sodium and high potassium

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34
Q

in emerg phase , what is the iv fluid and what is the formula

A

iv fluid ( parland formula )

— adequacy of fluid replacement, avoid hypovolemic shock

  • estbalish 2 large bore ivs or central line ( gieve alot of fluids )
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35
Q

what do have to check in emerg phase?

A

cicrulation : peripheral pulses, bp, heart rate, the other thign we are checking is urine output ( for perfsion )

urien otput , is telling us if they are getting enough perfusion to their kidneys

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36
Q

true or flase. in emrg phase: capillary seal is lost– so we get a lot of edema , we cannot stop the fluid shifting

A

true

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37
Q

what is the type of iv fluid do we give patients in emrhg phase?

A

ringers lactate or normal saline, avoiding hypovolemic shock

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38
Q

true or false. look at the urine output ( between 30 to 50 mls ) perh hour. we also want os sytolic greater than 90 and we want to keep heart rate less than 120

A

yes this is true

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38
Q

( 3 things we look at )
if these are not good enough then we probably need to revisit and give them more fluid : what are those 3 things

A

urijne output
heart rate
blood pressure

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39
Q

wound care, analgesia, and immunization is what we look at in emerg phase

A

yes we look at this too

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40
Q

is this true : wound care is delayed until airway is protected and bp is stable
analgesia - we are giving them stuff ( most time they are in shcok )
9 we give them concisous sedation, fentanyl,versant, mrphone , those type of drugs to help tehm relax

A

yes

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41
Q

what immunization do we looka t ?

A

tetanus toxoid

42
Q

these ppl ar eliekly to have anarobic infection development
we give a tetnaus immunizatin canhelp decrease teh chance

true or flae. during burns

A

true

43
Q

When monitoring initial fluid replacement for the patient with 40% TBSA deep partial-thickness and full-thickness burns caused by a car accident, which of the following findings is of most concern?
a. Urine output of 35 mL/hr
b. Serum K+ of 4.5 mmol/L
c. Decreased bowel sounds
d. BP 86/72 mm Hg

A

d

44
Q

what is the acute phase?

A

phase is so much more stable and each by

45
Q

when a pt dies in a cute phase, why does this occur

A

usually from overwhelming infection which then leads to sepsis )

46
Q

Acute Phase: Ng Care/Assessment

  • Pt is more ‘stable’ – ABC are all managed
  • Fluid mobilizes and pt is hypervolemic
    *Capillary leak sealed so pt will diurese
A

yes

47
Q

acute phas/ng care assesment

Goes for multiple ORs for debridement/grafting
* Fluids/nutrition
– Calories, protein – Ulcer protection
* Electrolytes

A

yes

48
Q

start tube feed early and grt them eating

electrolytes - sodium , potassium come down

A

true in acute

49
Q

what type of calories.protein are we giving pts in acut ephase

A

exxtra protein pweder ( body needs to repair )

giving them ulcer protection ( h2 blocker ) or ppi - large burn is stressful to the body

50
Q

edema goes down and sodium and potassium decrease
they are losing extra fluid ( it is coming out.

fluid and nutrition this is where they are hypermetbaollic - burninga. lot of clalroeis

A

yes

51
Q

decreasing their iv rate to more normal - no longer than fkuid resesatated
trying to get them back to eating and drinking

A

yes

52
Q

Acute Phase: Ng Care/Assessment
pain/symptom management

positioning of pt
pyschologicla care
peds consideration

what undergoes this

A

pain/symptpm mamagement
-analgesia- can develop tolerance
-anti anxieyy
-pruritis

53
Q

alot of analegsesi - often times we use
pca’s , catemine infusions when they have the dressing change ( can help decrease the nsrcotic they need )

what is the three common analgesia we use in acute phase

A

morphine, fentanyl , dilatin( 3 most common )

54
Q

what should we give right before a dressing change ina cute pjhase

A

ativan

55
Q

why is pruritis occuring ina cute phase?

A

the skin is trying to heal, betadron

56
Q

positioning of pt of acute phase

A

this is where we look closely with pt
be careful we are not over stretching the graft – but we also dont wnt them to develop contractures

57
Q

what undergoes peds considerations for acute phase

A

encourgae visitiors, and encourgae be able to decrease the akpount of narcotics they need
try to get narcotics when we do not need them for dressing change

hard for little kids- dressings in a prcedure room and look like a concisous sedation

58
Q

acute phase: ng care/assessment
what do u do?

A

read the dr’s orders to know the wounds
what are you doing? donor, grafted site, reinforce only, change dressing, what products to use

59
Q

acute phase : ng care/assesment
basic goals of wound care what undergoes it

A

cleans/debride it and promote wound healing

looking for signs of infection (infection and healing goes together for graft )

60
Q

true or false. if it is infected, graft does not want to adhere

A

true

61
Q

rehab phase what is it

A

has all been closed ( heal- done with operations )
fight scaring ( deal with contractures, scaring )

62
Q

wound care- acute phase
what do we want to prevent
how do we prevent that ?

A

prevent infection
sterile ns cleaning/debridement
( this isn done in the or ) get massive infection - if not taken off, and general anesthethic ( full thickness burn ) with leatherdy and hardly any blood

63
Q

what is escharotomy

A

maintain perfusion, cut ( relieve pressure ) kinda similar to compartment syndrome

64
Q

what is debridement of burned sin

A

cheese grater

65
Q

split thickness skin graft donor site mamagement ( takes a bit of time 2-3weeks to heal )
whats soemthing to consider

A
  • only ting abt donor site ( the redness from where they took the donor site , doesnt usually fade thtat much )
    something u can see
66
Q

wound care- acute phase
hydrotherpahy ( showers, tub )
sterile dressing
-open method
-multiple dressing changes ( OD, BID )

what undergoes open method ( show an example )

A

open method ( burn in their ear ) often times put ointment in their ear
leave it open to air ( do not put dressing to it )

multiple sterile changing - organizing ur care ( pain killer and visitor is coming, can relax for the rest of the day )

67
Q

separate room - hydrotherapy

A

make sure the water is not going to make the person sicker

washing them and putting them on a stretcher and doing dressing change in this room

68
Q

the pt gets very cold and also have pyxis machine and get narcotics and get supplies
seperate room hydrotherpahy

A

true

69
Q

traumatic of dressing changes happens there and goback to their rom
- some hospital uses them and some dont
- depends on the water athe hospital has, not using sterile and tap water
in terms of separate room-hydrotherpahy

A

this is true

70
Q

flamazine - silver sulfadiazine cream antimicrobial what is this

A

silver in it ( good antibiotic ) commonly used and what is does once again is help healing for infection

helps healing and prevent infection

71
Q

silver ( anticoat ) what activate the silver particles

A

sterile water activates the silver particles which act upon the wound base to kill a broad spectrum of bacteria

72
Q

what is this describing : this is expensive but works extremely well depends on how big these wounds are

A

silver

comes out its like a coat
u need a gown, mask, gloves, and hair cover

73
Q

this needs to be wet or damp
sterile water and acvate the anticoat to wor and out another dressing on it to keep in intanct : what is this

A

silver

74
Q

imagine the picture - covered with a hydrophillic foam dressing after harvesting

A

donor site: hands off 7 to 14 days , we do not pull it apart - just let it heal

75
Q

adaptic is what ?

A

non adhering dressing
commonly used for burns
to get moisture for the area that is healing , the skin is not going to stick to it

76
Q

skin graft what is our primary goal

A

to cover the burn wound this is the primary goal

77
Q

are these tru amongst skin grafts :
fre graft : does not maintain original blood suply. need to care for donor site also
- full thickness ( donor site closed surgically )
-partial/split thickness meshed or unmeshed sheet ( donot site regular drsg changes )

  • skin flap - moves skin and sc tissue, maintas original blood supply, vascular attachment is called a pedicle
A

yes

78
Q

what are the types of skin grafts

A

autograft
cea– cultured epithelial autograft
-allograft or homograft
heterograft or xenograft
-biobrane

79
Q

what is autograft

A

pts own skin ( this is the most common )

80
Q

what is cea-cultured epithelial autograft

A

takes skin and grow it ( they took off their skin and grow it in tge lab 0- very fragile )

81
Q

what is allograft or homoggraft

A

another persons skin (this is temp) usually on for three days to 2 weeks

82
Q

heterograft or xenograft

A

different species ( temp ) 3 days to 2 weeks
apig or a cow just for covered to buy time

83
Q

biobrane

A

temp
most common ( this is product that is bought, manufactured and known as artifical skin nyolon elasticity transparent material )

84
Q

thin blanket attatch to a machine , airport position ( so we don not get in contractures )
these ppl are typically cold
boot ( make sure when it heals it doesnt heal differently, antt hem to walk, splints to help contractures )
is this true amongst biobrane?

A

yes this is true

85
Q

operative debridement of full thickness burns is needed to prepare wound for grafting

A

yes
blood-maning good perfusion and prepare for good grafting -acut ephase

86
Q

rehabilitation phase: ng care/assesment

A

they take 6 months to 2 years to heal
newly grafted skin-remember that it is fragile

87
Q

true or false. during rehab phase, it is sensitive to touch to sunglight and any type of friction even pressure

A

yes true

88
Q

what undergoes rehabilitation phase

A

wounds healed/grafts adhered

compression garment/dressing

wound care maintenance ( skin , joint )

nutritional care

emotional support

89
Q

true or false. encourage water bases moisture and protect it from the sunlight

A

true

90
Q

what do we have to make sure in rehabilitation phase

A

make sure they do physio - range of motions and splints
what will start to happen, the skin will anturally go differntly, very early be with splints to make sure ti todsnt happen
contractures so bad they cannot even brush their teeth or hair so make sure to avoid this

91
Q

get the pts get level of self care
- getting themselves dressed
brushing teeth
lotion etc
( more back into lfie )

a big thing here is push against ( make the scars heal, encourage new skin to heal )
and compression garment and dressing is something these people use

yes this is in rehab phase

A

true

92
Q

in terms of nutrional care what happens

A

go back to normal diet ( apetite is improving, need to have normal levels of calories and protein

93
Q

in terms of wound care maintenance ( skin/joint ) what do we do?

A

keeps scars flat , jobst - compression garmenty encourage if not worn might buldge out
wear it 24 horus a day. tak them off when theya re having showering
put them on again
wear 1 to 2 years after their injury

94
Q

what is hypertrophic scar

A

this is something we want to avoid , thats why wear those garments

95
Q

what is a jobst?

A

compression grament

96
Q

what is a frostbitem ?

A

tissue freezng - ice crystals form in tissue and cells

all the way through, it’s just frozen and no perfusion, when a person is in this stafe ( drressing change )

97
Q

what is superficial or deep ( grade I to IV )
grade III and IV need )_____ and grade II might ?

A

hospital care

98
Q

what is monitoring wound-dressing changes
in superficial or deep ( grade I to IV )

A

dressing changes - on that wound from the freezing, but they will wait, demarcte couple of months once that happen, probably going to amputate

99
Q

being hospilized for fristbite is

A

pain
becuase of the wound ( very painful rewarming, these peiple will get narctoics for the pain )

100
Q

frostbite
for deep- wait to demarcate ( 2 weeks to 5 months ) then debridement and possible amputation

A

demarcate a time progresses - what ie means divider line injured skin to nromal skin overtime, often time several weeks u will then see a full extent of the damage

101
Q

true or false. gangrene may evolve after days to weeks after injury

A

true

102
Q

frostbite treatment
what to do

A

handle the area very carefully
these are injured tissues and easily damaged

103
Q
  • soak that extermity to warm water and be very careful , we do not want it too ho )

we do not want person to hit the base ( could damage it more )
- generally warming and good
clothing and jewelry remove from that site ( take it off ) oroabbly going to swell alot

very painful , analgesic ( mrphine and fentanyl ) and the pain these peoplehave can last several weeks to months

frostbite

A

yes

104
Q
  • What to NOT do? with frostbite
A

do not squeeze, massage or swueeze the area ( do ot wrap it ins oemting tight )

105
Q

what is frostbite treatment

A
  • Hyperbaric oxygen therapy (100% oxygen in a controlled setting) – mixed results
  • Thrombolytic therapy – needs to be started within 24 hrs of injury, dec need for amputation; risky & may be contraindicated

H & Illness 4: A & C illness (21 decks)

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