Exam 3 Sem 3 Complete

What are the top 2 burn etiologies?

Flame and Scald

Where do 73% of burns occur?

In the home

What are the top 2 complications of burns?

Pneumonia and UTI

What are the most common injuries associated with burns?

Fractures and soft tissue injuries

What are 3 risk factors of getting burns?

Alcohol/smoking/substance abuse, Cultural practices, socioeconomic status, Violence/abuse, psych hx, age, disabilities

When should a burn be referred to a burn center?

Greater than 10% TBSA partial thickness, 3rd degree burns, Involve sensitive areas, Preexisting medical conditions, Psychological trauma

What are the 3 main functions of the skin?

Defense, Sensory, Social

What percent of TBSA is the anterior chest?

9%

What percent TBSA are both arms combined?

18%

What percent TBSA is the front of the L leg, entire R leg and genitalia?

28%

What level of burn presents red to pink with mild edema?

Superficial burn

What level of burn is through the epithelium and most of the dermis, often requiring grafting?

Deep Partial Thickness burn

What level of burn often appears as blisters and are wet and soft?

Superficial Partial Thickness burn

What level of burn presents as dry, leathery and rigid often with eschar present?

Full Thickness burn

What level of burn is usually black, charred and painless?

Deep Full Thickness burn

What is the deepest of the 3 regions of a burn?

Zone of coagulation

Where is the zone of hyperemia in a burn?

The farthest region from the burn that is still affected (better perfusion)

What layer of the skin is a split thickness graft of?

Epidermis

A graft that uses both the epidermis and the dermis is considered what?

Full thickness graft

"The position of comfort is the position of ______________"

Contracture

Your 2pm patient in the burn unit is a 43 year old celebrity chef with scald burns on his anterior neck and left chest s/p losing in Hell's Kitchen 3 days ago. What interventions would be most helpful for preventing future issues?

Neck and Shoulder A/PROM, Positioning in supine with neck and shoulder in slight extension. Compression garment and splint on neck. Extension/Abduction splint on L arm.

What is the usual ratio of patients to nurses in the ICU?

1-2 pts: 1 nurse

What is the usual ratio of patients to nurses in the medical/surgical unit?

4-6 pts: 1 nurse

What would you call if there was a patient decompensating, having chest pain, having a seizure or severe HR,BP,RR changes?

Rapid Response

What does the AMPAC 6 Click entail?

6 questions scored 1-4 on PT basics like bed mobility, transfers, gait and stairs

When does discharge planning begin for pts entering the ED?

As soon as they arrive

How much treatment time do acute rehab patients get?

3 hours a day 5-7 days a week

How much treatment time do subacute rehab patients get?

1 hour a day 5 days a week

What does hematocrit show and what is normal?

Percent red blood cells in blood, ~40-50%

Your burn pt is on Morphine and Vecuronium, why might they be prescribed these?

Morphine for pain and sedation, vecuronium for muscle relaxant

During what stage of skin graft healing does revascularization occur and what color does the skin turn?

Third stage, pinks up

In the first stage of skin graft healing, the graft absorbs moisture and _________________.

Fibrinogen

What is a pulmonary diagnosis related to decreased surface tension in the alveoli?

Atelectasis

What is a pulmonary diagnosis associated with a large and acute increase in intrapleural pressure?

Pneumothorax

What comprises the gas exchange pump of the pulmonary system?

Lung tissue and airways

What comprises the musculoskeletal ventilatory pump of the pulmonary system?

Rib cage, spine, pelvic region (provide protection and muscle attachment sites)

Central chemoreceptors sense a change in _______ and ________ in blood and stimulate change in RR and depth of breathing

CO2 and pH

What is the primary and secondary stimulus for breathing?

CO2 then O2

What patients rely on the secondary stimulus in the peripheral chemoreceptors for breathing?

COPD (hypercapnic pts)

Which mainstem bronchi is positioned more vertically and therefore is more likely to have aspiration occur?

Right

What is the unit of gas exchange?

Single alveolus and capillary

Where in the lungs experiences laminar flow?

Farther down the bronchioles

(Obstructive/Restrictive) lung disease has decreased compliance

Obstructive

(Obstructive/Restrictive) lung disease has increased resistance

Restrictive

Alveoli at the apex of the lungs in standing are generally ______________

Overventilated

Alveoli at the base of the lungs in standing are generally _____________

Overperfused

What pathology (Obstructive/Restrictive) generally has an artificially high FEV1/FVC ratio?

Restrictive (getting little air they do have out quickly)

An infant in the NICU presents with respiratory rate over 60, nasal flaring, peripheral edema and cyanosis. What condition might they have?

Respiratory distress syndrome (caused by immature lungs and decr surfactant) (ground glass appearance)

What is the name of the condition that can result from RDS in infants and is considered a chronic respiratory disorder featuring scarring lung tissue and barotrauma?

Bronchopulmonary dysplasia (fibrotic changes)

What positioning should the wrist, hand and fingers be in for splinting?

Lego Hands! (Slight wrist Ext, MCP Flx, IP Ext, Thumb Abd)

What type of stretching is most beneficial for burn pts or other pts at a high risk of scarring/contractures?

Low Load Long Duration

What are 3 primary ways that tissue extensibility throughout healing is managed in burn patients?

Compression garments, Massage, Surgical Releases

What outcome measure is used to assess scars?

POSAS (Patient and Observer Scar Assessment Scale)

How is the MMRC Dyspnea scale scored?

0-4 relative to real life activities

What does the term orthopnea refer to?

Difficulty breathing when laying down

What is the normal range for blood pH?

7.35-7.45

What ABG value displays alveolar ventilation?

PaCO2

What are the 3 steps of interpreting ABGs?

Above or below 7.4 (acid/base), Respiratory (PaCO2 40mmHg) or Metabolic (CO2/HCO3), Compensated or Uncompensated?

What does an FIO2 of 21% correspond to?

Room air O2 content

How do PaO2 and SpO2 correlate?

At 40, 50, 60, PaO2 it is 70, 80, 90 SpO2

Severe hypoxemia causes pulmonary ______________, requiring increased ______________ heart work, which is called _____________

Hypertension, Right, Cor Pulmonale

What percent of normal TLC is considered severe restrictive?

Less than 50%

What is the term for a very severe asthma attack?

Status Asthmaticus

Which has better imaging of the lungs, CT Scan or MRI?

CT scan

What direction is a chest Xray taken from and what position is the patient in? Is there any particular bone that needs to be moved out of the way?

Posterior to anterior in standing. Scapula abducted

On an XRay the darkest areas are the densest (T/F)

False, Lighter is denser as it absorbs more X rays!

What is a silhouette sign on an Xray?

A gray area in the lungs due to fluid or mass

What are air bronchograms on an Xray?

Well defined pathway of bronchioles due to fluid or inflammation

What does pneumothorax look like on Xray?

Very black region with smaller denser lung next to it

What are the two main goals of mechanical ventilation?

To correct hypoxemia and improve cardiac function

What is the name of the tube that is used in mechanical ventilation to reach down to the trachea?

Endotracheal tube

What is the name of the tube used in long term mechanical ventilation (many weeks to years)?

Tracheostomy tube

This type of respiratory failure is considered Type 1 and consists of a PaO2 less than 60mmHg due to a failure in oxygen exchange

Hypoxemia

This type of respiratory failure is considered Type 2 and consists of low pH, PaCO2 less than 50 and is due to failure to remove CO2

Hypercapnia

What is the biggest difference between CPAP and CMV?

CPAP gives a set pressure to keep airways open, CMV requires no muscles of respiration and does it all for you

What is the difference between BiPAP and CPAP?

CPAP has constant pressure, BiPAP has different inspiratory and expiratory pressures so the pt doesnt need to breathe out against resistance

Why might the high inspiratory pressure alarm go off on the vent?

Secretions, Bronchospasm, Kinking of tube, Decr lung compliance

Why might the low inspiratory pressure alarm go off on the vent?

Leak or disconnect of vent tube system

What is an easy way to guesstimate the available PaO2 from any given FiO2?

Multiply by 5 (21% O2 in room air = 100mmHg PaO2)

For a patient that requires some supplemental oxygen, especially with exertion, what type of device should be used?

Low Flow Oxygen Device

For a patient with a specific FiO2 requirement at all times of day what type of device should be used?

High Flow Oxygen Device

What is the 20-30-40 rule for ventilation?

less than 20ml/kg FVC, 30cmH2O MIP, 40cmH20 MEP

What is Guillan Barre characterized by?

PNS Autoimmune disorder w/ demyelination, sometimes set off by infection

What are the two primary medical managements for GBS?

IV Immunoglobulin, Plasmaphoresis

What are the specific signs and symptoms of respiratory distress?

RR > 30, SpO2 <90, incr in HR/BP, Paradoxical Breathing

If a patient seems ready to be weaned off a ventilator, what is one of the first things the respirator team will try?

Spontaneous breathing trials

What is another term for paradoxical breathing?

Thoracoabdominal breathing

What PEEP shows readiness for mobility in the ICU?

Less than 10

What SpO2 and RR are needed to show readiness for mobility?

Over 90%, 10-30 RR

What HR, MAP and SBP are necessary to show readiness for mobility?

HR>60 <120, MAP >55 <140, SBP >90 <180

Your patient has SpO2 of 94%, RR of 15, PEEP of 5, Afib that started yesterday, HR of 110 and SBP of 150. Are they ready for mobility yet or not and why?

No because of the new onset dysrhythmia. Everything else is within acceptable values

Your patient's eyes open to you voicing "hello", but they do not make any eye contact. Are they ready for mobility work today?

Yes! Anything -3 to +2 is gucci

What does the PERME examine and how is it scored?

Mobility and command following for critically ill pts, 0-32 pts

What system does the med Aldactone act on?

RAAS

What does Jardiance do for the heart?

Reduce preload, promote vasodilation

What is considered a normal BNP lab value?

0-100

How hard should post exertion malaise patients be working during treatment?

55% AAMHR or RHR+15

What directions does the thoracic cavity expand for inspiration?

A/P, Lateral, Cephalocaudal

What are the 3 primary muscles of inspiration?

Diaphragm, external intercostals, scalenes

What are the accessory muscles of inspiration?

Pec Minor, Serratus Ant, SCM, Pec Major Sternal, Levator Costarum, Seratus Posterior Superior