exam 4 med surg

How does a superficial thickness burn presentlike

sunburn

what layer of skin is involved with a superficial thickness burn

epidermis

tx for superficial thickness burn

aloe, mild analgesics

How does a superficial partial thickness burn present

blister, red, moist glisten

How does a deep partial thickness burn present

waxy, may be moist or white

How does a full thickness burn present

hard, leathery eschar

define eschar

dead tissue

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

the entire epidermis, potentially the dermis

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

the entire epidermis, the dermis

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

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

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

Are full thickness burns painful?

no because of the nerve damage

how long do full thickness burns take to heal?

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

How is the extent of a burn measured

rule of 9's

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%

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%

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%

most common complication of burns

fluid shift and loss

describe the fluid shift that occurs with burns

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

fluid shift r/t burns leads to

hypovolemia

s/sx of hypovolemia

thread pulse, tachycardia, hypotension

hypovolemia r/t burns is also called

burn shock

how long does burn shock usually last

can continue for up to 36 hours

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

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

Parkland (Baxter) formula for fluid replacement

4ml Kg %burn

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

50%

how to evaluate the effectiveness of fluid resuscitation

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

what is the priority with burns

protect airway, treat hypovolemia

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

what are some other complications of burns besides fluid loss

infection and compartment syndrome

what bacteria are usually at fault for infections with a burn

staph and strep

complication of infection in a burn

sepsis

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

penicillin's, cephalosporins

how to apply creams to a burn

with a sterile glove

define surgical debridement

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

define an escharotomy/fasciotomy

incision in the fascia to relieve pressure in compartment syndrome

how to evaluate the effectiveness of a fasciotomy

check distal pulses

describe skin grafts

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

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

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

can resume in area of graft

most common cause of SCI

trauma (MVA)

risk factors for SCI

male, young, alcohol or drug use

primary concern with a cervical injury

respiratory dysfunction

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

the higher the chance of respiratory dysfunction

what level of SCI is correlated with autonomic dysreflexia

T6 and above

what to check before your patient receives a CT with contrast

allergies to iodine, renal function

What to think about before your patient receives an MRI

metal on or in the patient, claustrophobia

tx for SCI

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

side effects of steriods

hyperglycemia, increased risk of infection

when does spinal cord shock occur

may begin with in 1 hour of injury

How long does spinal cord shock lasts

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

how do you know when spinal shock is over

when reflexes return

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

s/sx of neurogenic shock

bradycardia, hypotension, temperature dysregulation

tx of neurogenic shock

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

Describe autonomic dysreflexia

exaggerated sympathetic response

Result of Autonomic Dysreflexiamassive

severe vasoconstriction

S/Sx of autonomic dysreflexia

pounding headache, severe HTN, bradycardia, flushed skin,

complication of untreated autonomic dysreflexia

stroke, MI, seizures

common cause of autonomic dysreflexia

bowel or bladder problems

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

how to clean the pins of a halo

with a 1/4 strength hydrogen peroxide every 4 hours

ABCDE approach to primary survey

airway, breathing, circulation, disability, exposure/evaluation

FGHI approach to secondary survey

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

tx of traumatic shock

large bore IV, followed by crystalloids then blood

what to think about with pediatric trauma

smaller body sizegreater relative surface area, less subq fat

tx of blood loss in trauma

transfuse 1:1:1

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

1:1:1

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

Hbg +1 Hct +3

common cause of respiratory failure in trauma

rib fractures

presentation of pain with a rib fracture

pain increases with inspiration

Presentation of flail chest

paradoxical chest expansion, chest retractions

tx of flail chest

prepare for chest tube followed by intubation

cause of pneumothorax in terms of trauma

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

tx of pneumothorax

chest tube

complications of untreated pneumothorax

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

s/sx of ARDS

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

first sign of ARDS

profound hypoxemia

tx of ARDSr

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

diagnostics for ARDS

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

CPAP is comparable to

PEEP, only improves oxygenation

uses for CPAP

sleep apnea, cardiogenic pulmonary edema

describe IPAP

pressure for inhalation for BIPAP ventilation

describe EPAP

lower pressure for exhalation oxygenation

what does the IPAP do

decrease work of breathing or ventilation

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

the top number (10)

what does the EPAP correct

oxygenation

what is EPAP similar to

PEEP

what is a requirement for BIPAP

the patient must be able to spontaneously breath

define tidal volume

volume of air the patient receives with each breath

how much tidal volume for a mechanically ventilated adult

6-8L/kg

Ventilation is reflected by what values

ETCO2, PCO2, RR

Oxygenation is reflected by which values

FiO2, PEEP

describe PEEP

positive pressure exerted during the expiratory phrase that is prevents atelectasis

what is the result of too much tidal volume

barotrauma

describe PIP

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

Good value for PIP

under 30 cmH2O

what is the PIP reflective of

pulmonary resistance in the upper airway

describe pPlat

pressure applied to lower airway during positive pressure ventilation

How to measure pPlat

measure during an inspiratory pause on the ventilator