exam 4 med surg

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How does a superficial thickness burn presentlike

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1

How does a superficial thickness burn presentlike

sunburn

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2

what layer of skin is involved with a superficial thickness burn

epidermis

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3

tx for superficial thickness burn

aloe, mild analgesics

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4

How does a superficial partial thickness burn present

blister, red, moist glisten

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5

How does a deep partial thickness burn present

waxy, may be moist or white

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6

How does a full thickness burn present

hard, leathery eschar

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7

define eschar

dead tissue

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8

what part of the skin is damaged in a superficial partial thickness burn

the entire epidermis, potentially the dermis

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9

what part of the skin is damaged in a deep partial thickness burn

the entire epidermis, the dermis

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10

what part of the skin is damaged in a full thickness burn

the entire epidermis, entire dermis and may extend to subcutaneous tissue

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11

your patient presents with a full thickness burn with lots of eschar, you know that for proper wound healing what needs to happen

debridement of the eschar

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12

Are full thickness burns painful?

no because of the nerve damage

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13

how long do full thickness burns take to heal?

depends on the restablishment of good blood supply to area of the burn

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14

How is the extent of a burn measured

rule of 9's

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15

A 25 year old female patient has sustained burns to the back of the right arm, posterior trunk, front of the left leg, anterior head and neck, and perineum. Using the Rule of Nines, calculate the total body surface area percentage that is burned?

*37%

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16

A 68 year old male patient has partial thickness burns to the front and back of the right and left leg, front of right arm, and anterior trunk. Using the Rule of Nines, calculate the total body surface area percentage that is burned?

*58.5%

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17

A 66 year old female patient has deep partial thickness burns to both of the legs on the back, front and back of the trunk, both arms on the front and back, and front and back of the head and neck. Using the Rule of Nines, calculate the total body surface area percentage that is burned?

81%

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18

most common complication of burns

fluid shift and loss

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19

describe the fluid shift that occurs with burns

fluid moves from the intracellular and intravascular space into the interstitial space

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20

fluid shift r/t burns leads to

hypovolemia

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21

s/sx of hypovolemia

thread pulse, tachycardia, hypotension

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22

hypovolemia r/t burns is also called

burn shock

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23

how long does burn shock usually last

can continue for up to 36 hours

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24

what labs should you be concerned if you have a burn patient

hyperkalemia, hyponatremia, H&H may be increased d/t fluid loss

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25

Parkland (Baxter) formula for fluid replacement

4ml Kg %burn

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26

how much fluid is given based off the parkland (baxter) formula for fluid replacement during the first 8 hours

50%

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27

how to evaluate the effectiveness of fluid resuscitation

increase in blood pressure, urine output should be relative to the amount of fluid received

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28

what is the priority with burns

protect airway, treat hypovolemia

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29

when should a burn patient be intubated

if there are burns to face, neck or chest, if there is any suspicion of inhalation injury such as dark sputum

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30

what are some other complications of burns besides fluid loss

infection and compartment syndrome

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31

what bacteria are usually at fault for infections with a burn

staph and strep

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32

complication of infection in a burn

sepsis

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33

what are some examples of antibiotics that can be used s/p infection in a burn

penicillin's, cephalosporins

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34

how to apply creams to a burn

with a sterile glove

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35

define surgical debridement

removal of eschar to level of healthy tissue, bleeding should occur

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36

define an escharotomy/fasciotomy

incision in the fascia to relieve pressure in compartment syndrome

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37

how to evaluate the effectiveness of a fasciotomy

check distal pulses

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38

describe skin grafts

skin is removed from a healthy part of the body and applied to the burn

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39

your patient is 3 days s/p skin grafting, what do you expect

immobilization of the area where the graft was supplied 4-5 days

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40

your patient is 5 days s/p skin grafting, what do you expect for ROM

can resume in area of graft

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41

most common cause of SCI

trauma (MVA)

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42

risk factors for SCI

male, young, alcohol or drug use

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43

primary concern with a cervical injury

respiratory dysfunction

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44

describe the relationship with level of SCI and respiratory dysfunctionthe higher the level (cervical vs thoracic)

the higher the chance of respiratory dysfunction

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45

what level of SCI is correlated with autonomic dysreflexia

T6 and above

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46

what to check before your patient receives a CT with contrast

allergies to iodine, renal function

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47

What to think about before your patient receives an MRI

metal on or in the patient, claustrophobia

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48

tx for SCI

assess airway, apply C collar for immobilization and stabilization of head and neck, potentially steroids'

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49

side effects of steriods

hyperglycemia, increased risk of infection

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50

when does spinal cord shock occur

may begin with in 1 hour of injury

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51

How long does spinal cord shock lasts

varies, could be minutes to months, usually lasts between 1-6 weeks

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52

how do you know when spinal shock is over

when reflexes return

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53

s/sx of spinal cord shock

flaccid paralysis below level of injury, loss of reflexes, loss of sensation of touch, temperature, pressure and pain, bowel and bladder dysfunction, loss of ability to perspire

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54

s/sx of neurogenic shock

bradycardia, hypotension, temperature dysregulation

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55

tx of neurogenic shock

fluids (usually 2L) then a vasopressor if still hypotensive

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56

Describe autonomic dysreflexia

exaggerated sympathetic response

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57

Result of Autonomic Dysreflexiamassive

severe vasoconstriction

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58

S/Sx of autonomic dysreflexia

pounding headache, severe HTN, bradycardia, flushed skin,

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59

complication of untreated autonomic dysreflexia

stroke, MI, seizures

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60

common cause of autonomic dysreflexia

bowel or bladder problems

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61

your patient is in a gardner wells device following a SCI, what is important to remember about this device

do not move device or change weights after the device has been applied

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62

how to clean the pins of a halo

with a 1/4 strength hydrogen peroxide every 4 hours

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63

ABCDE approach to primary survey

airway, breathing, circulation, disability, exposure/evaluation

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64

FGHI approach to secondary survey

full set of vitals, give comfort, head to toe assessment, identify all injuries

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65

tx of traumatic shock

large bore IV, followed by crystalloids then blood

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66

what to think about with pediatric trauma

smaller body sizegreater relative surface area, less subq fat

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67

tx of blood loss in trauma

transfuse 1:1:1

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68

what is the ratio for FFP:PRBCs:PLTS for resuscitation

1:1:1

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69

for 1 unit of blood you can expect the H&H to rise

Hbg +1 Hct +3

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70

common cause of respiratory failure in trauma

rib fractures

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71

presentation of pain with a rib fracture

pain increases with inspiration

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72

Presentation of flail chest

paradoxical chest expansion, chest retractions

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73

tx of flail chest

prepare for chest tube followed by intubation

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74

cause of pneumothorax in terms of trauma

any injury that lets air/blood/fluid into the pleural space

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75

tx of pneumothorax

chest tube

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76

complications of untreated pneumothorax

trapped air pushes on vena cava leading to decreased CO and eventually obstructive shock

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77

s/sx of ARDS

dyspnea, profound hypoxemia, decreased lung compliance, diffuse bilateral infiltrates

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78

first sign of ARDS

profound hypoxemia

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79

tx of ARDSr

apid O2 titration, BIPAP, mechanical ventilation, sedatives, analgesics, possibly paralytics

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80

diagnostics for ARDS

chest xray, will show diffuse infiltrates or "white out"

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81

CPAP is comparable to

PEEP, only improves oxygenation

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82

uses for CPAP

sleep apnea, cardiogenic pulmonary edema

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83

describe IPAP

pressure for inhalation for BIPAP ventilation

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84

describe EPAP

lower pressure for exhalation oxygenation

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85

what does the IPAP do

decrease work of breathing or ventilation

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86

Which number on a BIPAP represents the IPAP (ex 10/5)

the top number (10)

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87

what does the EPAP correct

oxygenation

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88

what is EPAP similar to

PEEP

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89

what is a requirement for BIPAP

the patient must be able to spontaneously breath

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90

define tidal volume

volume of air the patient receives with each breath

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91

how much tidal volume for a mechanically ventilated adult

6-8L/kg

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92

Ventilation is reflected by what values

ETCO2, PCO2, RR

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93

Oxygenation is reflected by which values

FiO2, PEEP

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94

describe PEEP

positive pressure exerted during the expiratory phrase that is prevents atelectasis

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95

what is the result of too much tidal volume

barotrauma

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96

describe PIP

pressure needed by the vent to deliver a set tidal volume, it is the highest pressure reached during the inspiratory phase

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97

Good value for PIP

under 30 cmH2O

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98

what is the PIP reflective of

pulmonary resistance in the upper airway

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99

describe pPlat

pressure applied to lower airway during positive pressure ventilation

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100

How to measure pPlat

measure during an inspiratory pause on the ventilator

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