Tissue Integrity, FE, Psychosocial

6 types of burns

fire, scald, contact, electrical, chemical, radiation

Burns classified by ___ and ___

depth and extent

First degree wound is superficial ___ thickness on outer layer of ___

partial, epidermis

Superficial heals in ___days, like a sunburn

3-10

1st degree burn tx

pain relief and fluid

second degree burn is partial thickness of ___x2___. Has brigh red, painful and moist ____ that you dont want to pop

epidermis and dermis. blisters

2nd degree takes ____ days to heal,

10-21

Full thickness (2nd degree) is entire ___ and ___. It is ___ with dry ___. Takes ___ to heal

epidermis and dermis. mottled, blisters. 1 month

3rd degree goes to ___, even muscle and bones.

sq

3rd degree appearance is white, yellow, brown, red, and black. It is ____ and ___ with extensive ____ but no pain bc nerves destroyed

dry, leathery, edema

if 3rd degree is wider than 1.5 inches you need a

skin graft

injury degree pic

extent of burn aka

tbsa

rule of nines chart

other factors for managing burns

age, location, other injuries, preexisting conditions

even if burns themselves are first degree, can be ____ as more severe if injury to hands, face, feet, inhalation, trauma, etc

reclassified

x burns almost always require hospitalization because edema causes ____ issues

genital, urination

Most immediate threat to burn survival is

hemodynamic instability

____ level can predict which people in burn shock will benefit from plasma exchange

lactate

K is usually ___ in burns from cell destruction K spewing out.

high

smoke or chemical inhalation can lead to

microscopic lung injury

Sudden increase in ___ means ARDS risk

rr

if any smoke or chemical inhalation need to ____ prophylactically bc we anticipate they will fail in 24-48 hrs

intubate

Smoke/chemical to resp dysfunction

inhaled reacts with mucous membranes, acids produced, ulcers spasms edema

resp dysfunction from burns ss

hacking cough, drooling, dyspnea, shallow breathing, horaseness, o2 drop

hypermetabolic response in burn is dt

tissue destruction and loss of skin that holds heat

how does hypermetabolic response happen in burns

catecholamine and cortisol release, heat production to balance heat loss from no skin

hypermetabolic response def

increased o2, glucose, protein use and fat wasting

most common cause of burn death is

sepsis

first priority to thermal injury

stop fire and provide relief

immediate ____ is more important than remove clothes

submersion

autograft is ___ homograft from ____, heterograft from ____

self, human, pig

circumferential burns

encircle body and act like tourniquets

Stress def

disruptive condition from change in environment that is perceived as damaging to balance or equilibrium

stress types

physical, physiologic, psychosocial

physiologic stress type

pain and fatigue

stressor sequence

series of stressful events from initial event

chronic intermittent stressors

everyday hassles

chronic enduring stressor

poverty

Selye’s GAS/theory of adaptation stages

alarm, resistance, exhaustion

alarm stage is ____ start, resistance is ____< exhaustion is when ____ effects happen with elevated endocrine activity

sns, adaptation, negative

local adaptation syndrome

inflammatory response to repair processes at local site of tissue injury

patho of stress

SNS/stress se

maladaptive responses to stress

goals not met, poor coping, distrurbed physiologic balance, increase illness susceptibility

psychoneuroimmunology

study of relationships of neuroendocrine system, cns, and immune system and how they affect overall health

OD risk factors

family hx, access, mental issue, peer pressure, lack of family, nature of substance, age of first use, stress, metabolism, social norms

acetaminophen tx

charcoal 4, acetylcysteine 48

acetaminophen OD steps

amphetamines effects (CNS and PNS)

increased catecholamines so hyperactive, increased dope so euphoria, sympathetic CV effects

Valium/diazepam amphetamines tx meds

sedatives and muscle relaxants, benzos HTN, charcoal for GI decontamination, defib/antidysrhythmics for dysrhythmias

Nursing Tx for amphetamines

high body heat from high metabolism so turn down temp

SSRI clinicals

AMS< ataxia, hyperpyrexia, hyperreflexia, tremor, myoclonus, ans effects, cv effects

SSRI drugs

maois, trazodone, snri, norepidope reuptake inhibitors, lithium, opioids, amphetamine/stimulants

alcohol od ss

drowsy, impaired coord, slurred speech, sudden mood change, aggression, gradiosity, stupor, coma

alcohol od tx nursing

head injury, hypoglycemia, hypoxia, hypovolemia, airway, let them sleep

suicide patho

more white matter, decreased serotonin

Biogenic amine theory

deficiency of nt (amines) in key areas of brain cause depression

top three biogenic amines

norepi, dope, serotonin

how can nt deficiecny happen

breakdown, rapid neuron firing, increased numbers/sensitivity of postsynaptic neurons

nursing tx for suicidals

suicidal 2 phase process

pt safety, underlying cause

pt safety suicide

never alone, no dangerous items

undelrying cause suicide

psych counseling

antidepressants increase norepi and serotonin in ___ membrane receptors by inhibiting serotonin reuptake in ___ space

post, pre

tricyclic antidepressants moa

block reuptake of serotonin and ne by pre

tricyclica anti (TCA) SE

CNS sedation, fatigue, suicide, visual disturbance, cv changes, dry mouth, constipation, fetal toxic, urinary retention, loss of libido

maoi moa

increase serotonin and ne concentration by reducing degredation of nt by MAO

ECT moa

artificial light to influence production of melatonin and function of catecholamine systems

ect is first line of defense for

seasonal depression