week 5 content Flashcards
Types of burns
__________
- Flame
- Flash
- Scald
- Contact with hot objects
____________
- Acid
- Alkaline
_______________
- oral/nasal injury
- esophageal injury
- direct parenchymal (functional part) of lung injury
___________
- conversion of electrical energy into heat
_________
- transfer of radiant energy to the body (radiation therapy for cancer)
_____________
- frost bite
- most common in children and OA r/t reduced ability to generate heat
Thermal – most common
cehmical
Inhalation
Electrical
Radiation
Extreme temperature
classification of burn injury:
severity determined by
(4)
- depth of burn
- extent of burn – based on % calculation of total body surface area
- location of burn
- age of patient, medical hx, any circumstances or complicating factors
depth of burn
1. superficial partial thickness = least damaging (1st degree)
2. deep partial thickness = medium damaging (2nd degree)
3. full thickness = most damaging (3rd degree)
- epidermis
- epidermis
- dermis
- epidermis
- dermis
- fat
- muscle
- bone
what do these tell you about the burn?
- lund-browder chart – more accurate b/c it considers patients age in proportion to relative body area size
- rule of nines chart
extent of burns
primary goal in burn emergency
(5)
- stop the burning by removing the source
- ABC’s
- Assessment of burns
- Transfer to burn center as needed
- Stabilization
3 phases of burn management
- Emergent/resuscitative phase
- Acute phase
- Rehabilitation phase
Emergent/resuscitative phase
how long
(up to 72 hours from event where burn occurred)
______________ phase
Time needed to resolve the immediate, life-threatening problems resulting from the burn injury
Emergent/resuscitative phase
Main concern in Emergent/resuscitative phase (2)
Main concern
- Hypovolemic shock – r/t fluid shift
- Edema formation - r/t capillary membrane – there’s no longer a semi-permeable membrane and fluid shifts
Patho of Emergent/resuscitative phase
- Massive F&E shift – r/t ___________
- Hypovolemic shock
main concern?
massive increase in permeability of capillaries
hypovolemic shock
Manifestations of Emergent/resuscitative phase
- Shock due to ________
- Pain - how does it vary by severity?
- which primary skin lesion?
hypovolemia
- full thickness burns (3rd) = less pain due to nerve damage
- Vesicle - blisters
3 main complications of Emergent/resuscitative phase
1. ____________ system
- __________system
3._________ system
cardiovascular
pulmonary
urinary
complications of Emergent/resuscitative phase
1. cardiovascular system
- shock + increased viscosity = ___ risk
- circumferential burns and edema = impaired ________
- treatment for circulation complication =
VTE
circulation
escharotomy (open eschar which allows perfusion and increased circulation)
complications of Emergent/resuscitative phase
2. if burn is inhaled…
which system is a concern for complications?
upper, lower, or both?
pulmonary system
upper and lower airway injury is a concern
complications of Emergent/resuscitative phase
3. why are we worried about the urinary system?
acute renal failure
d/t decrease blood flow to kidneys (w/ shock)
and excessive myoglobin and hemoglobin released
which can block renal tubules
nursing care Emergent/resuscitative phase
prioritize: airway and fluid therapy
- aggressive fluid resuscitation with 2 large bore IVs or Central Venous Access Device (CVAD)
- crystalloids (LR), colloids (albumin), or both?
- what will the fluids do?
- formulas based on location and extent of burns determine amount of fluids to give
- airway #1
- fluid therapy #2
crystalloids (LR), colloids (albumin), or both = increases intravascular volume, increases CO, decreases shock
wound care Emergent/resuscitative phase
1. necrotic tissue removed with ______?
2. escharotomies (open eschar) and fasciotomies (open fascia) performed to help with _________?
3. physically or mentally demanding on pt?
4. permanent or temporary skin coverage = goal?
5. with exposed wounds
PPE = ?
6. Sterile or clean gloves to apply ointments/dressings?
7. Keep room warm or cold?
1.debridement
2.circulation
3.both
4.permanent
5. hats, masks, gloves, gown
6. sterile
7. warm
Drug therapy Emergent/resuscitative phase
- ________ for analgesic and sedative – ATC, IV
- ________ immunization
- _______ antimicrobial agents
* Silver sulfadiazine (Silvadene) - Systemic or local only if concerns regarding sepsis – leading cause of death with burns?
- ___ prophylaxis – r/t increased viscosity
- Nutritional therapy enteral or parenteral feedings?
Opioids
Tetanus
Topical
systemic
VTE
enteral - use gut if working
Silver sulfadiazine (Silvadene)
Drug therapy Emergent/resuscitative phase
Topical antimicrobial agents
Systemic only if concerns regarding sepsis – leading cause of death with burns
Acute phase
how long
(3 weeks – months)
Acute phase
Begins = with mobilizations of _______ and subsequent__________
Ends = when partial thickness wounds are ______and full thickness burns are ________
Begins = with mobilizations of ECF and subsequent diuresis
Ends = when partial thickness wounds are healed and full thickness burns are covered by skin grafts
Acute phase
Partial thickness
- _______ formation: A crust or scab forms over the burned area, layer of dead tissue.
- Removal and re-epithelialization: The eschar can often be removed by medical professionals, allowing__________. This process is known as re-epithelialization
Partial thickness
- Eschar formation: A crust or scab forms over the burned area, layer of dead tissue.
- Removal and re-epithelialization: The eschar can often be removed by medical professionals, allowing new skin cells (epithelial cells) to grow and cover the wound. This process is known as re-epithelialization
Acute phase
Full thickness
T/F
- faster eschar separation compared to partial thickness?
- surgical debridement and skin grafting is common
F - slower because the damage extends deeper
T
_____________ phase
Goals
- working towards resuming functional role in society
- rehabilitate from any reconstructive surgery that may be needed
rehabilitation
rehabilitation phase
avoid ___________ and hypertrophic __________ by
- ROM
- Pressure garments – help keep scars flat
contractures
scarring
HIV is considered AIDS when 1 of 2 things occur (and Usually these occur at the same time)
_______
OR
_______
- CD4 count <200
OR - Developed specific opportunistic infection occurs (cancers, pneumocystis jirovecii, Kaposi’s sarcoma, wasting syndrome, pervasive candidiasis)
how many stages of HIV
3
HIV
stage 1
stage 1.5
Stage 1 = early/acute infection
- Rapid replication
- Undetectable with labs
- Asymptomatic
- Infectious
Stage 1.5 = seroconversion
- Detectable (antibodies)
- Flu like symptoms for several weeks
- Highly infectious!!
HIV
stage 2
stage 2.5
stage 2 = clinical latency/chronic
- Virus levels have stabilized
- Body is fighting infection
- Asymptomatic or mild symptoms
- With treatment = can be in this phase for decades
- Without treatment = can be in this phase for 3-12 years
Stage 2.5 = rapid virus production
- Antiviral fight is becoming less effective
- Viral load increases
- CD4 and T cell count decreases
HIV
stage 3
Stage 3 = AIDS
- Symptomatic HIV infection
which HIV stage?
- Rapid replication
- Undetectable with labs
- Asymptomatic
- Infectious
Stage 1 = early/acute infection
which HIV stage?
- Detectable (antibodies)
- Flu like symptoms for several weeks
- Highly infectious!!
Stage 1.5 = seroconversion
which HIV stage?
- Virus levels have stabilized
- Body is fighting infection
- Asymptomatic or mild symptoms
- With treatment = can be in this phase for decades
- Without treatment = can be in this phase for 3-12 years
stage 2 = clinical latency/chronic
which HIV stage?
- Antiviral fight is becoming less effective
- Viral load increases
- CD4 and T cell count decreases
Stage 2.5 = rapid virus production
which HIV stage?
- Symptomatic HIV infection
- CD4 count <200
- Developed specific opportunistic infection occurs (cancers, pneumocystis jirovecii, Kaposi’s sarcoma, wasting syndrome, pervasive candidiasis)
Stage 3 = AIDS
HIV Risky behaviors
SATA
- Men sex with men
- swimming with infected person
- Injection drug use
- Heterosexual contact
- Mother to child – perinatal
- Blood transfusion
- sharing food
- Men sex with men
X- swimming with infected person - Injection drug use
- Heterosexual contact
- Mother to child – perinatal
- Blood transfusion
X- sharing food
Transmission HIV
SATA
semen
vaginal secretions
Parenteral blood
pregnancy
birth
breastfeeding
all
- improve adherence outcome to ART
SATA - ensure pt is motivated
- social support
- make sure they can afford it
- negotiate treatment plan
- simple regimen
- anticipate s/e
- establish trust
- ensure pt is motivated
- social support
X* make sure they can afford it - negotiate treatment plan
- simple regimen
- anticipate s/e
- establish trust
Education for AIDS patient
SATA
r/t immunosuppression
- Avoid crowded areas
- Avoid traveling to countries with poor sanitation
- Avoid raw food or undercooked food
- Avoid cleaning litter boxes
- Keep home clean
- Don’t allow sick people to visit
- Don’t continue relationships with HIV infected people
Continue ART
Monitor CD4 and viral load
r/t immunosuppression
- Avoid crowded areas
- Avoid traveling to countries with poor sanitation
- Avoid raw food or undercooked food
- Avoid cleaning litter boxes
- Keep home clean
- Don’t allow sick people to visit
X- Avoid relationships with HIV infected people
Continue ART
Monitor CD4 and viral load
HIV Assessment
- Checking for cognitive changes – _____________
- _______ manifestations are common and associated with decreasing CD4 counts
- Types of infections - SATA
- Fungal
- Viral
- Bacterial
- Cancerous
AIDS dementia complex
Oral
all
HIV Prevention
- Avoid risk factors
- Talk about sensitive subjects
- Decrease risks r/t drug use – needle exchange program
- teach how to clean needles with soap
- Decrease risk of perinatal transmission
- Encourage routine HIV testing
- Decreasing work risk with Universal precautions
- universal precautions
- Post exposure prophylaxis
- Pre exposure prophylaxis
HIV Prevention
- Avoid risk factors
- Talk about sensitive subjects
- Decrease risks r/t drug use – needle exchange program
X- teach how to clean needles with soap
- Decrease risk of perinatal transmission
- Encourage routine HIV testing
- Decreasing work risk with Universal precautions
- universal precautions
- Post exposure prophylaxis
- Pre exposure prophylaxis
Universal precautions
potentially infectious HIV
SATA
- Blood
- CSF
- Synovial fluid
- Pleural fluid
- Amniotic fluid
- coughing
- Blood
- CSF
- Synovial fluid
- Pleural fluid
- Amniotic fluid
X- coughing
HIV Health care exposure
Exposure includes
SATA
- Need stick
- Cut with sharp object
- Mucous membrane contact
- Non-intact skin contact
- airborne droplets
- Need stick
- Cut with sharp object
- Mucous membrane contact
- Non-intact skin contact
X- airborne droplets
Post or pre exposure prophylaxis?
Recommendations based on risk of acquiring HIV
- Nature and severity of exposure
- HIV status of exposure source
Post exposure prophylaxis
Post exposure prophylaxis
Regimen ?
Follow up testing for HIV ?
- Combination therapy
- Start drug therapy ASAP – 1-2 hours ideal, max 72 hours
- 6 weeks
- 12 weeks
- 6 months
Pre or post exposure prophylaxis?
Daily med to lower chance of getting HIV
- Highly effective if used as prescribed
Preexposure prophylaxis
Preexposure prophylaxis
Doesn’t protect against other STIs?
Who qualifies? SATA
1. Anal or vaginal sex in last 6 months and Sexual partner has HIV with unknown viral load
2. Anal or vaginal sex in last 6 months and Sexual partner has HIV with known viral load
3. Anal or vaginal sex in last 6 months and uses condom consistently
4. Anal or vaginal sex in last 6 months and Have been diagnosed with STD in the last 6 months
5. men who have had sex with men in last 6 months
6. People who inject drugs
7. People who inject drugs and Injection partner had HIV
8. People who inject drugs and they share equipment to inject drugs
true - continue condom use
X 3. - Haven’t used condom consistently
X 5. men who have had sex with men in last 6 months AND…
X 6. People who inject drugs AND …
Anal or vaginal sex in last 6 months and
- Sexual partner has HIV – unknown or known viral load…OR
- Haven’t used condom consistently… OR
- Have been diagnosed with STD in the last 6 months
People who inject drugs and
- Injection partner had HIV… OR
- They share equipment to inject drugs
Routine screening - at least once
yearly screening - annual screen every year
based on risk factors
- Healthy adults, without risk factors, ages 13-75
- pregnant women, without risk factors, ages 13-75
- Men sex with men
- Injection drug use
- Exchange sex for money/drugs
- Sex partners have HIV, are bisexual, or injection drug users
- Sex partner has unknown HIV status
Routine screening
- Healthy adults, including pregnant women, without risk factors, ages 13-75
Yearly screening
- High risk
- Men sex with men
- Injection drug use
- Exchange sex for money/drugs
- Sex partners have HIV, are bisexual, or injection drug users
- Sex partner has unknown HIV status
HIV screening implications SATA
- Consent
- verify allergies - iodine
- Confidentiality
- Counseling
- Referral to care – if positive for HIV
- Consent
X- verify allergies - iodine - Confidentiality
- Counseling
- Referral to care – if positive for HIV
which generate of ELISA – enzyme linked immunosorbent assay, HIV testing is preferred? and why?
New tests – combination HIV antibody AND antigen tests (“4th generation”) = PREFERRED
- Specificity and sensitivity
- Identifies early/acute phase infections in most patients
- Rapid tests available
what is the Western blot used for?
HIV confirmatory follow up test
Viral load test – HIV RNA
- Quantitative or Qualitative – used as screening to identify HIV infect individuals. Ex: blood donors
- Quantitative or Qualitative – used to manage/monitor those who are infected, can also be used to diagnose
Viral load test – HIV RNA
- Qualitative – used as screening to identify HIV infect individuals. Ex: blood donors
- Quantitative – used to manage/monitor those who are infected, can also be used to diagnose
