week 7

Question 1

BP management during a stroke

Answer 1

you want to keep it around 160 to keep adequate CPP

Question 2

who is most commonly effected by thermal burns

Answer 2

1. kids
2. older adults
3. diabetics

Question 3

priorities for a chemical burn

Answer 3

1. remove cloths
   - chemical stay in the cloths
2. rinse skin dont but dont use cold b/c youll cause vasoconstriction

Question 4

what are the two types of smoke inhalation

Answer 4

1. above glottis

2. below glottis

Question 5

what does a below glottis injury indicate

Answer 5

longer exposure

Question 6

what is the main complication for smoke inhalation injury

Answer 6

carbon monoxie poisoning

Question 7

what are the main sources of smoke inhalation injuries

Answer 7

gas leak and old cars inside a garage

Question 8

why cannot we let go when we recieve an electrical shock

Answer 8

1. muscle contract

2. instant nerve damage

Question 9

what is the iceberg effect

Answer 9

extensive deep tissue damage

Question 10

what are the types of 2nd degree burns

Answer 10

superficial-the first part of the dermis

Deep-the whole dermis

Question 11

how can you tell you have a deep second degree burn

Answer 11

youll see blisters, this is automatically considered a 2nd stage wound and requires a wound consult

Question 12

3rd degree burn characteristics

Answer 12

you see open skin

Question 13

rule of 9s

Answer 13

chest is 18, face 9, thigh 9 etc

Question 14

priority for burns in the head neck or chest

Answer 14

ABC

Question 15

priority for burns in the hands feet, joint, eyes

Answer 15

self care

Question 16

priority for burns in the ears nose, butt, perinonium

Answer 16

infection

Question 17

what is the emergent phase

Answer 17

the phase right after the burn, strong inflammatory process happening, lasts 72 hours

Question 18

what do you do after intubation

Answer 18

bronchoscopy to see how bad the lung damage is

Question 19

what happens when the chest is burnt

Answer 19

any skin that is burnt gets hard (feels leathery) therefore lung expansion becomes very hard

Question 20

Escharotomies

Answer 20

removal of skin from the chest wall

Question 21

facial edema

Answer 21

is expected after a burn b/c of the fluid replacement

Question 22

complications after burns

Answer 22

dysrhthias due to electrolyte imbalances

Question 23

how do you do fluid therapy for burns patients

Answer 23

two large bore IVs for >15% TBSA

Question 24

parkland (baxter) formula

Answer 24

kg x 4mL x Body % burned

give first half in 8 hours then the rest over 16 hours

Question 25

how do you treat 3rd spacing

Answer 25

albumin and lasix

Question 26

how do you prevent ear pressure ulcer

Answer 26

put a towel under the heal to keep ears floated

Question 27

what is given to all burns patients

Answer 27

tetanus

Question 28

what is the goal for acute phase

Answer 28

start ambulation and fix the fluid shift. Also watch for ileus (no gas, no BMs, no Bowel sounds)

Question 29

what are the main causes of sepsis

Answer 29

1. UTI 2. pneumonia 3. pressure ulcers

Question 30

Vancomycin considerations

Answer 30

dont give faster then 1g/hr b/c you can cause acute tubular necrosis (ATN) this applys for all -mycin drugs (the aminoglycosides) -Contrast also puts patients at risk for ATN

Question 31

you suction a sepsis patient and get blood what does this indicate what should you do

Answer 31

DIC -> fresh frozen plasma

Question 32

what does low platelets indicate for burns patients

Answer 32

myelosuppression

Question 33

how do you diagnose DIC

Answer 33

all the clotting factors go up and D-Dimer is elevated

Question 34

how do you treat hyperkalemia in CKD

Answer 34

kaxelate with D5W and IV insulin. Try not to give lasixs b/c it can cause ATN. Give calcium gluconate, Bicarb and albuterol to move k+ into the cell

Question 35

3 phases of acute renal failure

Answer 35

1. diuretic 2. oliguric (less then 400 ml in 24 hours) 3. anuric (less then 40mL in 24 hours)

Question 36

when do you give blood transfusions for CKD patients

Answer 36

during dialysis

Question 37

what is the normal urine output

Answer 37

0.5 ml/kg/hr

Question 38

how do you diagnose CKD

Answer 38

GFR < 60 for 3 months | but really we diagnose using the albumin-creatinine ratio

Question 39

how do you diagnose ESKF

Answer 39

GFR <15 (normal is 125+)

Question 40

when do you give epogen

Answer 40

HgB less then 7

Question 41

magnesium considerations

Answer 41

dont give faster then 1g/hr or youll cause heart block

Question 42

potassium considerations

Answer 42

dont give faster then 10 mEq /hr

Question 43

what drug do you give for infiltration

Answer 43

Regitine

Question 44

how is the albumin-creatinine ratio done

Answer 44

use the first void of the morning b/c any exercise will effect the ratio

Question 45

who cannot recieve a kidney transplant

Answer 45

cardiomegaly patients b/c the BP will be to low and the kidney will fail

Question 46

what drug should patients recieving a kidney be on

Answer 46

steriods prior to transplant and antibiotics in the bladder prior too

Question 47

urine output post transplant

Answer 47

should be very high, higher then normal. Needs to be replaced 1:1 ratio.