Unit 1 AH2

A set of 110 question and answer practice flashcards grounded strictly in the provided lecture notes, covering burn pathophysiology, shock critical care, emergency and trauma principles, environmental emergencies, and disaster preparedness.

What layer of the skin contains sweat and oil glands, hair follicles, and epidermal cells that line these structures?

The dermis (middle layer).

Under what condition can burned skin regrow naturally?

Skin can regrow if at least parts of the dermis containing epidermal cells are present.

Why is determining the percentage of Total Body Surface Area ($\text{TBSA}$) involved in a burn critical?

It helps determine fluid resuscitation rates, drug dosages, and the overall severity of the injury.

What causes blister formation in superficial partial-thickness burns?

Plasma leakage lifting up the destroyed epidermis.

How do full-thickness burn wounds heal naturally if skin grafting is not performed?

By contraction, a process where the wound edges slowly pull together.

What is the priority assessment for victims of electrical burn injuries?

Heart rate and rhythm.

What is the first emergency nursing action in the emergency department for a patient with dry chemical burns?

Brush off dry chemicals with protected hands, remove contaminated clothing, and then rinse.

How long should a fire burn be cooled with cool water during initial emergency management?

For at least 5 minutes (do not use cold water, and do not allow the patient to shiver).

To prevent home scald burns, water heaters should be set below what temperature?

Below $120^\circ\text{F}$.

What are the primary nursing priorities during the emergent (resuscitation) phase of a burn injury?

Secure the airway, support circulation and perfusion (fluid replacement), promote patient comfort (analgesia), maintain body temperature, and provide emotional support.

When does the rehabilitative (restorative) phase of burn care begin and end?

It begins with wound closure and ends when the patient returns to the highest possible level of functioning.

What causes hemoconcentration (thick blood) during the early stages of a major burn?

Leakage of fluid and electrolytes from the vascular space into the interstitial space (third spacing/capillary leak syndrome).

During which timeframe post-burn does the diuretic stage typically begin?

48 to 72 hours after injury.

What electrolyte imbalances occur during the early fluid shift (first 24 to 48 hours) of a burn injury?

Hyperkalemia and hyponatremia.

What electrolyte imbalances occur during the fluid remobilization/diuretic stage after 24 hours post-burn?

Hyponatremia and hypokalemia.

How should prescribed fluid volume be scheduled and administered during the first 24 hours post-burn?

Administer one-half of the total 24-hour prescribed volume within the first 8 hours post-burn, and the remaining half over the next 16 hours.

What is the target hourly urine output for fluid volume resuscitation in a burn patient?

$30\text{--}50\,\text{mL/h}$.

What are the normal adult SI ranges for total hemoglobin in females and males?

Females: $12\text{--}16\,\text{g/dL}$ ($7.4\text{--}9.9\,\text{mmol/L}$); Males: $14\text{--}18\,\text{g/dL}$ ($8.7\text{--}11.2\,\text{mmol/L}$).

Why are total protein and albumin levels decreased during the resuscitation phase of a burn injury?

Protein exudate is lost through open wounds, and increased vascular membrane permeability causes protein loss into the tissues.

What carboxyhemoglobin ($\text{COHb}$) saturation level is considered normal in a non-smoker?

$<3\%$ (smokers may normally have up to $12\%$).

How does carbon monoxide ($\text{CO}$) cause tissue hypoxia in burn patients?

Carbon monoxide binds to hemoglobin, displacing oxygen to form carboxyhemoglobin and reducing arterial oxygen content.

What key physical assessment findings indicate potential inhalation injury or airway obstruction in a burn patient?

Intraoral charcoal, singed nasal or scalp hairs, carbonaceous sputum, hoarseness or brassiness, accessory muscle use or stridor, and extensive facial burns.

What immediate nursing actions should be taken if a burn patient develops a brassy cough, drooling, or difficulty swallowing?

Position the patient upright, apply oxygen, and notify the Rapid Response Team immediately.

What clinical manifestations occur at a moderate carbon monoxide poisoning level ($21\%\text{--}40\%$)?

Headache, tinnitus, nausea, drowsiness, vertigo, altered mental state, confusion, stupor, irritability, decreased BP, increased/irregular HR, depressed ST segment, and pale/ash gray to reddish-purple skin.

Why are pressure dressings worn over grafted burn areas, and how long must they be worn daily?

They prevent contractures and hypertrophic scars and inhibit venous stasis and edema; they must be worn 23 hours/day until scar tissue matures.

What route of administration MUST be used for opioid pain medication during the resuscitation phase of a severe burn?

The intravenous ($\text{IV}$) route.

What is an autograft?

A permanent skin replacement using tissue harvested from an unburned site on the patient's own body.

What is the difference between an allograft and a xenograft?

An allograft uses tissue from another human, whereas a xenograft uses tissue from a nonhuman species (such as pig skin/porcine).

Using the Parkland formula ($4\,\text{mL} \times \text{kg} \times \%\text{TBSA}$), calculate the 24-hour fluid requirement for a patient weighing $154\,\text{lb}$ with a $50\%$ TBSA burn.

$14{,}000\,\text{mL}$ total ($70\,\text{kg} \times 4\,\text{mL} \times 50$); $7{,}000\,\text{mL}$ administered in the first 8 hours and $7{,}000\,\text{mL}$ over the remaining 16 hours.

What are the appearance, pain level, and healing time of a superficial second-degree (superficial partial thickness) burn?

Moist, red, blanching appearance with significant blistering, mild to moderate pain; heals via reepithelialization in about 2 weeks.

What are the appearance and physical characteristics of a third-degree (full thickness) burn?

Any color (black, red, yellow, brown, white), dry appearance, severe edema, no blistering, painless, and hard, inelastic eschar.

How is a minor burn classified regarding TBSA percentage?

Partial-thickness burns less than $10\%$ TBSA and full-thickness burns less than $2\%$ TBSA without high-risk involvement or complications.

What burn characteristics define a major burn injury requiring emergency care and burn center evaluation?

Partial-thickness burns $>10\%$ TBSA, full-thickness burns, involvement of face, hands, feet, genitalia, perineum, or major joints, electrical/chemical/inhalation injuries, or burns with major concomitant trauma.

What is the general physiological definition of shock?

A whole-body response to impaired oxygen delivery to tissues and organs, resulting in widespread abnormal cellular metabolism.

What Mean Arterial Pressure ($\text{MAP}$) range is required to maintain adequate perfusion to major body organs?

$60\text{--}70\,\text{mm\,Hg}$.

How does blood vessel constriction affect Mean Arterial Pressure ($\text{MAP}$)?

Constriction reduces the size of the vascular bed, which increases $\text{MAP}$.

What is the primary overall cause of hypovolemic shock?

Total body fluid is decreased across all fluid compartments.

What is the primary underlying cause of cardiogenic shock?

Direct heart muscle pump failure without alteration of fluid volume.

What causes distributive shock?

Fluid shifts from the central vascular space into interstitial tissues due to loss of sympathetic tone, vasodilation, or capillary leak.

What are the two most common underlying conditions causing obstructive shock?

Pericarditis and cardiac tamponade.

What physiological compensatory responses occur during the initial stage of shock?

Vascular constriction and increased heart rate, resulting in a slight increase in diastolic blood pressure.

What decrease in Mean Arterial Pressure ($\text{MAP}$) from baseline defines the compensatory stage of shock?

A decrease of $10\text{--}15\,\text{mm\,Hg}$ from baseline.

What clinical manifestations are characteristic of the compensatory stage of shock?

Thirst, anxiety, restlessness, tachycardia, increased respiratory rate, narrowing pulse pressure, decreased urine output, cool extremities, and a decrease in $O_2$ saturation.

Why must conditions causing the progressive stage of shock be corrected within 1 hour of onset?

To prevent permanent organ damage, Multiple Organ Dysfunction Syndrome ($\text{MODS}$), or death.

What clinical manifestations characterize the refractory (irreversible) stage of shock?

Rapid loss of consciousness, non-palpable pulses, cold/dusky extremities, slow/shallow respirations, and unmeasurable oxygen saturation.

What clinical manifestation is typically the earliest sign of hypovolemic shock?

An increased heart rate (tachycardia).

How long can kidney tissue tolerate anoxia during shock without experiencing permanent damage?

Up to 1 hour.

What is the first central nervous system ($\text{CNS}$) sign indicating hypovolemic shock?

Thirst (a compensatory mechanism to boost blood volume).

How do hemoglobin and hematocrit findings differ between hemorrhage and dehydration in hypovolemic shock?

Hemorrhage produces decreased hemoglobin and hematocrit, whereas dehydration produces elevated (concentrated) levels.

How should a patient in hypovolemic shock be positioned?

Elevate the patient's feet while keeping the head flat or elevated at no more than a $30\text{--}\text{degree}$ angle.

What is the purpose of administering vasoconstrictor drugs like norepinephrine or phenylephrine in shock?

To improve Mean Arterial Pressure ($\text{MAP}$) by increasing peripheral vascular resistance and venous return.

What critical assessment must be performed every 30 minutes when administering intravenous vasopressors?

Assess the infusion site for extravasation and check extremities for color and perfusion to prevent tissue ischemia and necrosis.

What diagnostic criteria define Systemic Inflammatory Response Syndrome ($\text{SIRS}$)?

Presence of at least two criteria: Temp $>38^\circ\text{C}$ or $<36^\circ\text{C}$, HR $>90\,\text{bpm}$, RR $>20\,\text{breaths/min}$ (or $\text{PaCO}_2 <32\,\text{mm\,Hg}$), and WBC $>12{,}000/\mu\text{L}$, $<4{,}000/\mu\text{L}$, or $>10\%$ immature bands.

What clinical presentation characterizes the hyperdynamic state seen in severe sepsis?

Increased heart rate, elevated systolic blood pressure, warm and pink skin, and increased cardiac output.

What severe hematologic clotting disorder develops during the progression of severe sepsis?

Disseminated Intravascular Coagulation ($\text{DIC}$).

What white blood cell differential changes are typically seen in advancing sepsis?

A low or normal total $\text{WBC}$ count with a decreasing segmented neutrophil level and a rising band neutrophil level ("left shift").

What are the five essential interventions in the Surviving Sepsis Campaign 1-Hour Bundle?

1) Measure lactate level, 2) Obtain blood cultures before antibiotics, 3) Administer broad-spectrum antibiotics, 4) Begin rapid infusion of $30\,\text{mL/kg}$ crystalloid for hypotension or lactate $\ge 4\,\text{mmol/L}$, 5) Apply vasopressors if hypotensive during/after fluid resuscitation to maintain $\text{MAP} \ge 65\,\text{mm\,Hg}$.

What is the single most common symptom for which individuals seek emergency care?

Pain.

What specialized emergency nursing role is trained to conduct exams on sexual assault victims?

Forensic Nurse Examiners ($\text{RN-FMEs}$), Sexual Assault Nurse Examiners ($\text{SANE}$), or Sexual Assault Forensic Examiners ($\text{SAFE}$).

In an ED SBAR handoff, what specific content belongs under the Assessment component?

Assessment and diagnostic findings, especially critical results and any isolation precautions.

What essential rule must ED nurses follow regarding invasive lines and tubes when a patient dies from trauma, suspected homicide, or abuse?

Leave all intravenous lines and indwelling tubes in place.

What are the key characteristics and requirements of a Level I Trauma Center?

Located in large teaching hospitals in densely populated areas, provides full continuum trauma care from prevention through rehabilitation, and is required to conduct research and scholarly activity.

What are the components of the Primary Survey in trauma assessment?

A (Airway/cervical spine), B (Breathing), C (Circulation), D (Disability), E (Exposure).

How can a nurse estimate a trauma patient's systolic blood pressure ($\text{SBP}$) using pulse palpation?

Radial pulse present: $\text{SBP} \ge 80\,\text{mm\,Hg}$; Femoral pulse present: $\text{SBP} \ge 70\,\text{mm\,Hg}$; Carotid pulse present: $\text{SBP} \ge 65\text{--}60\,\text{mm\,Hg}$ ($\ge 60\,\text{mm\,Hg}$).

What catheter size is ideal for establishing emergency intravenous access during primary trauma survey?

A large-bore catheter, ideally $16\,\text{gauge}$.

What clinical features indicate the development of a tension pneumothorax?

Decreased or absent breath sounds on affected side, respiratory distress, hypotension, jugular vein distention ($\text{JVD}$), and tracheal deviation to the opposite side.

What primary clinical boundary separates heat exhaustion from heat stroke?

Heat stroke involves failure of thermoregulation, body temperature exceeding $104^\circ\text{F}$ ($40^\circ\text{C}$), and central nervous system dysfunction.

What fluid rehydration practice should be avoided when treating heat exhaustion in the community?

Giving plain water alone (can worsen sodium deficit) and administering salt tablets (do not give).

What is the difference between exertional and non-exertional heat stroke?

Exertional has a sudden onset from strenuous activity in hot/humid conditions; non-exertional (classic) occurs from chronic exposure and is most common in ill or older adults.

What is the single best prehospital method for rapid cooling of a heat stroke victim?

Immediate immersion in cold water (while supporting the patient and protecting the airway).

At what core body temperature should active cooling interventions be stopped in a heat stroke patient?

When core body temperature is reduced to $102^\circ\text{F}$ ($39^\circ\text{C}$).

What anatomical features distinguish pit vipers from non-venomous snakes?

A depression or pit between each eye and nostril, a triangular head, split pupils, and curved fangs.

What pathophysiological effects are caused by coral snake venom?

Nerve and muscle toxins block neurotransmission, causing ascending paralysis, reduced pain perception, cranial nerve deficits, and respiratory paralysis.

How frequently should the circumference of a bitten extremity be measured following a snakebite?

Every $15\text{--}30\,\text{minutes}$.

What prehospital first-aid measures are strictly prohibited when caring for a pit viper snakebite?

Do not incise or suck the wound, apply ice, or use a tourniquet.

What classic skin sign is associated with severe Brown Recluse spider bites?

The "red, white, and blue" sign (a central bluish-purple necrotic center surrounded by ischemia and erythema).

What clinical syndrome is caused by Black Widow spider venom, and what are its manifestations?

Latrodectism; venom causes neurotransmitter release resulting in severe muscle spasms, abdominal rigidity, severe pain, hypertension, nausea, and vomiting.

What scorpion species in the United States produces potentially fatal neurotoxic stings, and what diagnostic sign increases pain?

The Bark scorpion (found in the southwestern US/Arizona); gentle tapping at the sting site causes increased pain.

What first-line emergency medication must be given immediately for an anaphylactic response to a bee or wasp sting?

Epinephrine (via autoinjector or injection).

How long should patients who sustain multiple bee stings (especially $>50$ stings) be observed in an emergency setting?

Observed for several hours to monitor for toxic venom effects.

What immediate posture should an individual assume outdoors if a lightning strike is imminent (hair stands on end, blue halo)?

Crouch on the balls of the feet and tuck the head down (do not lie flat on the ground or touch hands to the ground).

Why should land-line telephones and cell phones be avoided during a lightning storm?

Land-lines transmit lightning producing head/neck trauma or cataracts; cell phones transmit loud static causing acoustic damage.

What diagnostic tests are indicated in the emergency department for a patient struck by lightning?

ECG, head CT, and Creatine Kinase ($\text{CK}$) to detect skeletal muscle damage.

What clothing material should be strictly avoided in cold weather, and why?

Cotton, because it retains moisture next to the skin and speeds up body heat loss.

At what core body temperature threshold is hypothermia diagnosed?

Core body temperature less than $95^\circ\text{F}$ ($35^\circ\text{C}$).

What are the temperature ranges for mild, moderate, and severe hypothermia?

Mild: $90\text{--}95^\circ\text{F}$; Moderate: $82.4\text{--}90^\circ\text{F}$; Severe: $<82.4^\circ\text{F}$.

What is frostnip?

A superficial cold injury causing pain, numbness, and pallor that is easily reversed with rewarming without tissue loss.

What physical presentation defines Grade II frostbite?

Large, clear to milky fluid-filled blisters with partial-thickness skin necrosis.

What is the optimal water temperature for rapid rewarming of a frostbitten body part?

A warm bath of $104\text{--}108^\circ\text{F}$.

Why must a frostbitten extremity not touch the sides of the water container during rewarming?

To prevent mechanical tissue damage to the delicate freezing tissue.

What is acclimatization in altitude medicine?

The physiological process by which the body adapts to lower atmospheric pressure and decreased available oxygen.

What is the most common cause of death associated with high altitude?

High Altitude Pulmonary Edema ($\text{HAPE}$).

What clinical manifestations are typical of High Altitude Pulmonary Edema ($\text{HAPE}$)?

Poor exercise tolerance, persistent dry cough, lip and nail bed cyanosis, resting tachycardia and tachypnea, lung crackles, and pink frothy sputum.

What medication class is acetazolamide, and what essential allergy check must precede its administration for mountain sickness?

It is a sulfa drug (diuretic/carbonic anhydrase inhibitor); check for a known sulfa allergy.

What drug is specifically indicated for the management of High Altitude Cerebral Edema ($\text{HACE}$)?

Dexamethasone.

What physiological mechanism during drowning helps preserve blood flow to the brain and heart?

The diving reflex (lowered heart rate, reduced cardiac output, and peripheral vasoconstriction).

What defines the difference between an internal disaster and an external disaster?

An internal disaster occurs inside the healthcare facility or campus, whereas an external disaster occurs outside in the community.

How does a multi-casualty event differ from a mass casualty event?

A multi-casualty event can be managed by a hospital using local resources, whereas a mass casualty event overwhelms local capabilities and requires multi-agency collaboration.

How often does CMS require healthcare facilities to practice fire drills or actual fire responses?

At least once annually.

In disaster triage tagging, what does a RED tag indicate?

Class I: Emergent patients requiring immediate life-saving medical attention.