Nu 341 Med/surg - Sci & Burns

Front 1

most common cause of SCI

Back 1

trauma - mva, mca, falls, etc

Front 2

3 major risk factors for SCI

Back 2

age
gender
alcohol/drug abuse

Front 3

describe hyperflexion

Back 3

sudden forceful acceleration of head FORWARD

Front 4

describe hyperextension

Back 4

sudden forceful movement of head BACKWARD

Front 5

describe axial loading

Back 5

blow to top of head - diving accidents

Front 6

differentiate btw complete/incomplete SCI

Back 6

complete - severed
incomplete - some fxn remains

Front 7

name 4 types of incomplete SCI

Back 7

anterior cord syndrome
posterior cord syndrome
brown-sequard syndrome
central cord syndrome

Front 8

describe anterior cord syndrome

Back 8

- damage to ant gray/white SC matter
- result of decreased blood supply
- motor fxn, pain & temp lost
- touch, position & vibration intact

Front 9

describe posterior syndrome

Back 9

- damage to post gray/white SC matter
- motor fxn intact
- loss of vibe, crude touch, position sensation

Front 10

describe brown-sequard syndrome

Back 10

- from penetrating injury affecting 1/2 SC
- motor fxn, vibe, proprioception & deep touch lost on side of injury
- pain, temp & light touch affected on opposite side of injury

Front 11

describe central cord syndrome

Back 11

- more loss of fxn in upper extremities than in lower
- some sensation remains

Front 12

describe paraplegia

Back 12

- only lower extrem
- thoracic/lumbosacral SCI

Front 13

describe quadriplegia

Back 13

- all extrem
- cervical SCI

Front 14

what SCI is usually fatal secondary to resp death

Back 14

C2-3

Front 15

what SCI innervates diaphragm

Back 15

C4

Front 16

what SCI affects shoulders

Back 16

C5

Front 17

what SCI affects elbows, wrist and hand

Back 17

C6

Front 18

what SCI affects finger sensation

Back 18

C7

Front 19

what vertebra is at the nipple line

Back 19

T4

Front 20

what vertebra affects intercostal muscles

Back 20

T6

Front 21

what vertebra affects abd muscles

Back 21

L2

Front 22

what vertebra affects bladder control

Back 22

S3

Front 23

what vertebra affects ejaculation

Back 23

S2

Front 24

describe autonomic dysreflexia

Back 24

- most common w/ SCI above T6
- severe involuntary nervous system response to pain/stimuli
- extreme hi BP
- bradycardia
- severe sweating
- intense HA

Front 25

what SCI may require intubation

Back 25

C3-5

Front 26

what meds are used for early SCI tx

Back 26

steroids

Front 27

why are steroids used to tx SCI

Back 27

to decrease edema/inflamm that can lead to ischemia

Front 28

what meds used for SCI tx

Back 28

- corticosteroids
- vasopressors (atropine, dopamine, dobutrex)
- antispasmodics
- analgesics/NSAIDs
- PPIs
- Lovenox (prevent DVT)
- stool softeners

Front 29

describe SC shock

Back 29

- may begin 1 hr post injury
- lasts mins-mos
- usually lasts 1-6 wks
- SC shock ends when reflex returns

Front 30

s/s of SC shock

Back 30

- flaccid paralysis below injury
- loss of touch, temp, pressure, pain
- loss of bowel/bladder fxn
- loss of ability to perspire
- neurogenic shock

Front 31

describe neurogenic shock

Back 31

- shock that persists after SC shock ends
- bradycardia & hypotension

Front 32

what causes AD

Back 32

- lack of control of nervous system
- stimuli unable to ascend SC
- mass reflex stimulation of sympathetic nerves below injury
- massive vasoconstriction triggered

Front 33

name some common causes of AD

Back 33

- any noxious stim below injury
- constipation/bowel impaction
- skin irritant, burns, sores
- UTI/ urine retention

Front 34

tx for AD

Back 34

- remove noxious stim
- nifedipine 10mg oral
- nitro Sl
- hydralazine IM/IV
- nitroprusside IF drip

Front 35

how common is AD

Back 35

85% of SCI pts will get AD at least once

Front 36

what is traction used for

Back 36

- realign vertebrae
- facilitate bone healing
- prevent further injury

Front 37

what are most common traction devices

Back 37

- gardner-wells
- crutchfield tongs

Front 38

what is halo used for

Back 38

- provide stabilization
- allow pt more mobility

Front 39

describe superficial burn

Back 39

- least amt of drainage
- only epidermis
- sunburn, UV light, mild radiation
- heals 3-6 days
- no scar
- tx: aloe, mild analgesics

Front 40

describe partial thickness burn

Back 40

- 2 categories

Front 41

describe superficial partial thickness burn

Back 41

- entire dermis
- bright red, moist, glistening
- blister formation
- heals in 21 days

Front 42

causes of superficial partial thickness burn

Back 42

flash-flame, dilute chemicals, contact w/ hot surface

Front 43

describe deep partial thickness burns

Back 43

- entire dermis
- waxy, moist or dry appearance
- less painful
- heals in 3-6 wks
- scar formation

Front 44

describe full thickness burns

Back 44

- all layers of skin
- may extend into subcut fat, conn tiss, muscle and bone
- hard dry leathery scar
- no pain sensation b/c nerve endings destroyed
- heals in months
- skin graft needed

Front 45

describe the rule of 9s for burns

Back 45

- arms = 9 each
- legs = 18 each
- trunk = 36
- head/neck = 9
- perineum = 1

Front 46

why do burns cause vasoconstriction

Back 46

huge amounts of catecholemines released

Front 47

why are burn pts hypovolemic

Back 47

- burn shock
- fluid shifts from intracellular/intravascular to institium

Front 48

how long does burn shock last

Back 48

- first 12 hours
- can continue 24-36 hrs

Front 49

important labs to consider for burns

Back 49

- HYPERKALEMIA b/c large amounts of K released from injured cells
- HYPONATREMIA

Front 50

describe the parkland-baxter formula

Back 50

- 4ml of LR/kg body wt X % TBSA = ml LR for 24 hrs

Front 51

what pulm changes are considered for burn pts

Back 51

- superheated air injures lungs
- look for dyspnea, carbonaceous sputum, wheezing, hoarse

Front 52

what GI considerations for burn pts

Back 52

- fluid shift and decreased CO the GI has decreased perfusion
- decreased gastric mucosal integrity
- paralytic ileus
- abd dist
- curlings ulcer

Front 53

how are burns managed/tx

Back 53

- fluid replacement
- resp management
- cardiac support: vasopressors, dysrhythmias
- pain control
- antibiotics

Front 54

what surgeries are used for burns

Back 54

- escharotomy
- surg debride
- skin graft

Front 55

what are the major SE of steroid use

Back 55

hyperglycemia

Front 56

how do steroids cause hyperglycemia

Back 56

cortisol goes to the liver and causes extreme gluconeogenesis

Front 57

what corticosteroids are used for SCI

Back 57

- solumedrol - methylprednisone (most common)
- decadron (good for SC injuries)

Front 58

why are SCI pts hypotensive

Back 58

b/c BVs are dilated b/c of lack of motor response

Front 59

why is atropine the FIRST choice for SCI

Back 59

to increase HR so that circulation will increase and raise BP

Front 60

if pt has low HR and low BP what med will you give

Back 60

atropine

Front 61

if pt has good HR and low BP what med will you give

Back 61

- IV fluids
- levafed

Front 62

what is a common antispasmodic used in hospitals

Back 62

robaxin
dantrylene

Front 63

what NSAID is used IV to tx SCI

Back 63

toredol

Front 64

what is a common PPI used to tx SCI

Back 64

protonix

Front 65

why are PPIs given to SCI pts

Back 65

high possibility for peptic ulcer

Front 66

when is spinal shock OVER?

Back 66

when reflexes return

Front 67

what can often PERSIST after spinal shock ends

Back 67

bradycardia

Front 68

what is the ONLY shock where bradycardia is involved

Back 68

neurogenic shock - AFTER spinal shock ends

Front 69

know the appearance of the different burn categories

Back 69

SUPERFICIAL - red, no blisters
SUPERFICIAL PARTIAL - red, blisters, moist
DEEP PARTIAL - waxy, dry/moist, usually white
FULL THICKNESS - hard, dry, leathery eschar

Front 70

why do burn pts develop HYPOnatremia?

Back 70

aldosterone levels increase b/c of stress, which leads to increased sodium, but it quickly passes OUT of blood and into interstitium

Front 71

what labs MUST be considered for burn pts

Back 71

HYPERkalemia - damaged cells

HYPOnatremia - Na leaks out

Front 72

calculate fluid rate using parkland/barker formula for burn pt weighing 75kg w/ 25% burns

Back 72

4ml LR X 75kg X 25% TBSA = 7500ml/24 hrs

50% 1st 8 hrs = 3750 ml
25% 2nd 8 hrs = 1875 ml
25% 3rd 8 hrs = 1875 ml

Front 73

what is the drug of choice for burn pain control

Back 73

morphine

Front 74

what is a normal morphine pain regimen for an adult burn pt

Back 74

3-5 mg IV q5-10 mins

Front 75

what is important to monitor on adult burn pts recieving morphine pain regimens

Back 75

RR & BP

Front 76

how do we know if an escharotomy is effective

Back 76

check distal pulses and perfusion - cap refil

Front 77

what kind of cream is used for burns

Back 77

superficial - aloe
deep - silvadine

Front 78

what is best used to spread silvadine into burns

Back 78

sterile gloved hand/finger

Front 79

what nursing interventions are important to remember for crutchfield traction

Back 79

- NEVER remove weights even while moving pt
- keep weights suspended in air for max performance

Front 80

at/above what SC level is AD a problem

Back 80

T6

Front 81

how could the nurse PREVENT AD

Back 81

- stool softeners
- watch for urinary retention

Front 82

s/s of AD

Back 82

- pounding HA
- super hi BP

Front 83

meds for AD

Back 83

nipride
nifedipine
nitro
VASODILATORS

Front 84

differences btw spinal shock and normal shock

Back 84

bradycardia

Front 85

what type of diet is best for burn pts

Back 85

HI PROTEIN - 6000 cals/day