Med-Surg 3 ATI/NCLEX Study Guide: Burns & Shock

A comprehensive set of vocabulary flashcards covering burn classifications, emergency management, fluid resuscitation, and the various stages and types of shock for shock according to ATI/NCLEX standards.

Burn First Priority

Airway, especially in the presence of facial burns, singed nasal hairs, soot in the mouth/nose, hoarseness, drooling, wheezing, or stridor.

Thermal Burns

Burns caused by flame, hot liquids, steam, or hot surfaces.

Electrical Burns High Risks

Potential for dysrhythmias, cardiac arrest, compartment syndrome, rhabdomyolysis, and spinal injuries.

Electrical Burn Interventions

Cardiac monitoring, checking CK/myoglobin levels, monitoring urine output, and maintaining spinal precautions.

Chemical Burn Priority Treatment

Flush the area with water immediately for $20+$ minutes; never apply creams immediately or attempt to neutralize chemicals.

1st Degree (Superficial) Burn

Involves only the epidermis; characterized by red, blanchable, painful, and dry skin with no blisters.

2nd Degree Superficial Partial Thickness Burn

Involves the upper dermis; characterized by blisters, wet/shiny appearance, pink/red color, and intense pain.

2nd Degree Deep Partial Thickness Burn

Involves the lower dermis; characterized by a pale, drier, cherry red appearance where blisters may or may not exist.

3rd Degree Full Thickness Burn

Entire dermis is destroyed; characterized by white, brown, black, leathery, or waxy appearance with eschar present and no pain due to nerve destruction.

4th Degree Burn

Burn extending into the muscle, bone, and tendons, often resulting in a mummified appearance.

Adult Rule of Nines: Head/Neck

$9\%$ of Total Body Surface Area (TBSA).

Adult Rule of Nines: Arms

Each arm accounts for $9\%$ of Total Body Surface Area (TBSA).

Adult Rule of Nines: Trunk

Anterior trunk is $18\%$ and posterior trunk is $18\%$ of Total Body Surface Area (TBSA).

Adult Rule of Nines: Legs

Each leg accounts for $18\%$ of Total Body Surface Area (TBSA).

ATI TBSA Calculation Tip

Only 2nd and 3rd degree burns count toward Total Body Surface Area (TBSA); 1st degree burns are excluded.

Parkland Formula

$4\,mL \times kg \times \text{\%TBSA}$ used to determine fluid replacement for the first $24$ hours.

Parkland Fluid Administration Schedule

Give $1/2$ of total fluids in the first $8$ hours, $1/4$ in the second $8$ hours, and $1/4$ in the third $8$ hours.

Lactated Ringer’s (LR)

The fluid of choice for fluid resuscitation in burn patients.

Burn Emergent Phase

Occurs $0–48$ hours post-burn; characterized by fluid shifts out of vessels into tissues, leadings to hypovolemia, shock, and edema.

Emergent Phase Electrolyte Finding

Hyperkalemia due to damaged cells releasing potassium into the bloodstream.

Hemoconcentration

An increase in Hematocrit (Hct) occurring during the emergent phase of a burn.

Burn Acute Phase

Occurs from $48$ hours to weeks; characterized by fluid returning to vessels resulting in diuresis.

Acute Phase Electrolyte Findings

Hypokalemia and hyponatremia as fluids and electrolytes shift back and are excreted.

Burn Nutrition Requirements

High calorie, high protein, and high carbohydrate diet to support a hypermetabolic state.

Silver Sulfadiazine (Silvadene)

A topical antibiotic used in burn wound care to prevent infection.

Escharotomy

A surgical procedure that cuts through eschar to restore circulation and prevent necrosis.

Carbon Monoxide Poisoning Sign

Cherry-red skin color, accompanied by headache, dizziness, and confusion; treated with $100\%$ oxygen.

Shock Definition

Inadequate tissue perfusion leading to organ hypoxia.

Early Shock Signs

Tachycardia, restlessness, cool skin, and delayed capillary refill; blood pressure may still be normal.

Stage 2 (Progressive) Shock

Stage where perfusion worsens, characterized by hypotension, organ dysfunction, and acidosis.

Cardiogenic Shock Treatment

Nitroprusside to decrease workload (vasodilation) and Dobutamine to increase contractility (positive inotrope).

Hypovolemic Shock Priority

Fluid replacement using Normal Saline (NS), Lactated Ringer's (LR), or blood, typically via two large-bore IVs.

Neurogenic Shock Unique Finding

Bradycardia combined with hypotension, caused by the loss of sympathetic nervous system tone.

SIRS Criteria

Need $2+$ of: Temp $>100.4^{\circ}F$ or $<96.8^{\circ}F$, HR $>90$, RR $>20$, or WBC $>12,000$ or $<4,000$.

Septic Shock Bundle Priorities

1. Lactate level, 2. Blood cultures, 3. Broad-spectrum antibiotics, 4. $30\,mL/kg$ isotonic fluids, 5. Vasopressors if still hypotensive.

Norepinephrine (Levophed)

The vasopressor of choice in septic shock to maintain a MAP $>65\,mmHg$.

MODS (Multiple Organ Dysfunction Syndrome)

The failure of two or more organ systems (e.g., ARDS in lungs, low urine output in kidneys) during refractory shock.