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373 Cards in this Set

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If a client were to have his head crash into the windshield during an MVA, what type of Neck Injury would be seen?
Hyperflexion
Forward Dislocation with Ruptured Posterior Ligaments
If a client were to fall onto a coffee table, hitting his chin with blunt force, what type of Neck Injury would be been?
Hyperextension
Ruptured anterior Ligaments
If a client were to dive into a pool, hitting his head with blunt force against the bottom of the pool, what type of Neck Injury would be been?
Compression
Spinal Cord Compressed
Vertebrae Fractured
What is a Odontoid Fracture?
The odontoid Process fractures, with a toothlike fracture.
What is a Hangmans Fracture?
The Hangman's fracture consists of bilateral pedicle or pars fractures involving the C2 vertebral body. Associated with this fracture is anterior subluxation or dislocation of the C2 vertebral body. It results from a severe extension injury such as from an automobile accident where the face forcibly strikes the dashboard or from hanging.
What is one of the first things that happens during a spinal cord injury?
Edema forms, which causes nervious system dysfunction.
Name Five Things that happen during a spinal cord injury?
-Microscopic Bleeding
-Cord Edema, causing more temporary dysfunction.
-GI Ulceration
-Spasticity after Flacidity
-Reflex Emptying of Bowl/Bladder.
Is dysfunction from Cord Emema Permenant?
No, there might be some improvement after the edema subsides.
In what type of Spinal Cord Injury, is Reflex Bowel/Bladder emptying seem most often?
Cervical.
How many vertebrae are there, and how are they divided?
33 Total
7 Cervical
12 Thoracic
5 Lumbar
5 Sacral
4 Coccygeal
What differentiates Partial vs Complete injury of the spinal cord.
Complete is severed, Partial is damage, or compression.
What spine segments are generally fatal?
C1-C3
Beyond C3, what type of problems are usually seen with Cervical damage?
Quadraplegia
What type of problems are usually seen with Thoracic and Lumbar Damage?
Paraplegia
What happens to reflexes during Spinal Shock Phase?
Reflexes are Absent.
When reflexes return, what happens with cutaneous stimulation to the anogenital area?
It would cause reflex bladder and bowel emptying.
In spinal cord injury, what are some triggers for muscle spasm?
-Emotion
-Full Bladder
-Cold
-Prolonged Sitting
What is Autonomic Dysreflexia?
The state in which an individual with a spinal cord injury at T-6 or above experiences a life-threatening uninhibited sympathetic response of the nervous system to a noxious stimulus.
What are some stimuli that could trigger Autonomic Dysreflexia?
Bowel, Bladder, Rectal Stimulation, Tight Shoe Laces, Pain, Cold, Spasms, Ingrown Toenails
What are some manifestations of Autonomic Dysreflexia?
Severe Hypertension, H/A, Bradycardia, Dilated Pupils, Blurred VIsion, Diaphoresis.
If a client exhibits autonomic dysreflexia, where is the stimulis normally applied?
Below the injury.
If a client exhibits autonomic dysreflexia with diaphoresis, where is the sweating usually observed?
Above the injury.
What is Brown-Séquard's syndrome?
Hemisection of the spinal cord with the following neurological changes: paralysis on the same side as the lesion, loss of position and vibratory sense, and ataxia; loss of pain and temperature sensitivity on the side opposite the lesion.
In Brown-Séquard's syndrome, what is seen on the opposite side of the injury?
Loss of Pain, Temperature and Light Touch.
In Brown-Séquard's syndrome, what is seen on the same side of the cord damage?
Loss of Motor Function, Vibration, Position and Deep Touch sensation.
What is Conus Medullaris Syndrome?
Flacidity of the Lower Extremities.
What is Cuada Equina Syndrome?
Loss of sensation in the Sacral Area from the waist to the knee.
How long does Spinal Shock last?
Upto Six Weeks.
What is seen with Body Temperature in Spinal Shock?
It is cool below the level of injury.
What happens to reflexes when Spinal Shock resolves?
Client becomes Hyper-Reflexic and Spastic.
Cervical Spinal Cord Injuries generally result in this type of paralysis.
Quadraplegia.
If a client has HTN, H/A, Bradycardia, especially with a SCI above T6, what might the nurse suspect?
Autonomic Dysreflexia.
What can cause Automomic Dysreflexia?
Tight Shoe Laces, Full Bladders, Catherization, Ingrown Toenails, Cold, etc.
What is the most serious complication of a C1 to C3 injury?
Respiratory Failure
If you are asked to remove a Cervical Collar, what should you be sure of?
That a physician or neurosurgeon is handeling the head and neck.
What is Gardner Wells traction?
Tongs that reduce cervical spine fractures or dislocations, maintain alignment of reduced spine fractures or dislocations, immobilise the spine and prevent cord injury
Why is NS IV given to a new SCI?
Client will most likely experience neurogenic shock, which will cause HTN. Giving NS, will help increase the volume to keep pressures up.
Why is an NG inserted in a SCI patient?
Shock will cause bloodflow to be shunted away from the GI system and may result in Paralytic Illius. As well, decompression of the stomach contents will help prevent vomiting.
What is a Miami J collar?
Provides immobilization without traction.
What is Pin Care for Gardner Wells Tongs.
H2O2 or NS.
If a client exhibits autonomic dysreflexia, where is the stimulis normally applied?
Below the injury.
If a client exhibits autonomic dysreflexia with diaphoresis, where is the sweating usually observed?
Above the injury.
What is Brown-Séquard's syndrome?
Hemisection of the spinal cord with the following neurological changes: paralysis on the same side as the lesion, loss of position and vibratory sense, and ataxia; loss of pain and temperature sensitivity on the side opposite the lesion.
In Brown-Séquard's syndrome, what is seen on the opposite side of the injury?
Loss of Pain, Temperature and Light Touch.
In Brown-Séquard's syndrome, what is seen on the same side of the cord damage?
Loss of Motor Function, Vibration, Position and Deep Touch sensation.
What is Conus Medullaris Syndrome?
Flacidity of the Lower Extremities.
What is Cuada Equina Syndrome?
Loss of sensation in the Sacral Area from the waist to the knee.
How long does Spinal Shock last?
Upto Six Weeks.
What is seen with Body Temperature in Spinal Shock?
It is cool below the level of injury.
What happens to reflexes when Spinal Shock resolves?
Client becomes Hyper-Reflexic and Spastic.
What is another name for Gardner-Wells Tongs?
J Tongs
What is a common problem associated with Pins in a Halo Vest?
Pins are actually more painful when they are taken out, or become loose, and as such the pins are tightened weekly.
http://www.spineuniverse.com/displayarticle.php/article1480.html
What are three benefits of a Kinetic Bed?
-Increase Ventilation
-Decrease Complications of Mobility
-Reduces Skin Ulceration
Why are H2 Receptor Blockers given in SCI?
Reduce Stomach Ulcers.
What meds might be given to an SCI patient who is cathaterized?
Urinary Antiseptics to reduce UTI.
Other than Urinary Antiseptics, what three meds might be given prophylactically in SCI?
-Anticoagulants
-Laxatives
-Antispasmodics
What is the Most Important Nursing Assessment in SCI?
Neurological and Respiratory
What can the Vasodilation after an SCI cause?
Neurogenic Shock
What two interventions are necessary because of the Risk for Aspiration seen in SCI?
-Assess Breath Sounds Frequently
-Have Suction readily available.
What level cord injuries is Thermoregulation usually an issue?
More seen above T6.
In clients with SCI above T6 will they be Hot or Cold?
They will be cold, and need to be kept warm
When treating SCI the first order of business are the ABC's, but what is the fourth C in this type of Injury?
Cervical Spine
To open the airway of a SCI client with a Cervical Spine Injury, is a Head Tilt and Neck Lift used?
No....Use the Jaw Thrust.
To open the airway of a SCI client with a Cervical Spine Injury, is a Head Tilt and Neck Lift used?
No....Use the Jaw Thrust.
What is a Laminectomy?
The excision of a vertebral posterior arch, usually to remove a lesion or herniated disk.
What is Surgical Fusion?
Taking a piece of bone from somewhere such as the Iliac Crest, and fusing it in the spine to help stabalize the spine.
What is Internal Fixation?
The use of internal wires, screws, or pins applied directly to fractured bone segments to keep them in place.
Rods and Pins may be used to repair an unstable spinal fracture. What is this procedure called?
Internal Fixation.
How might a SCI be immobilized and decompressed without the use of a kinetic bed?
Halo Traction
This surgical procedure removes a part of the vertebra to access the cord and spinal nerves, allowing for decompression.
Laminectomy
In this procedure, a graft is taken from the Iliac Crest and placed between the vertebrae.
Fusion
What is Baclofen?
Muscle Relaxant and Antispastic Agent.
What is Diaphragmatic Breathing?
AKA abdominal respiration.
Respiration in which chiefly the diaphragm exerts itself while the chest wall muscles are nearly at rest; used in normal, quiet breathing—and in pathological conditions such as pleurisy, pericarditis, and rib fracture.
What is glossopharyngeal breathing?
A technique of breathing in which the patient with inspiratory muscle weakness increases the volume of air breathed in by taking several “gulps” of air, closing the mouth, and forcing air into the lungs.
Why are high Top Tennis Shoes used in SCI?
Prevent Plantar Flexion.
What is Quad Assisted Coughing?
Place the fist of one hand, immediately below the breastbone, and the heel of the other hand on top of the breastbone. The hands need to be over the diaphragm area.

The hands must be below the ribs.

Take a breath and cough as you exhale the air. Your assistant should push inward and upwards as you cough. NOTE: If you are on a ventilator, your assistant should push during inhalation. An ambu-bag may be substituted for the ventilator for a stronger cough.

Repeat, as necessary, with rest periods, as needed, between efforts
What is GPB?
Glossopharengeal Breathing or Gulping in Air.
In SCI, why are anesthetic Lubricants used for Cath and Digital stimulation?
To prevent the risk of Autonomic Dysreflexia.
If you suspect Autonomic Dysreflexia, should you elevate the Head of the Bed?
Yes.
What is Prerenal ARF?
Acute Renal Failure that is based on something before the Kidney, such as hypovolumia, which does not allow for enough blood to be pumped through the Kidneys.
Name Five Causes of Prerenal ARF.
-Dehydration
-Hemorrhage
-GI Fluid Loss
-Third Spacing Fluid Loss
-Excessive Diuresis
How might surgery contribute to ARF?
Interruptions of blood flow during a surgery can cause the kidney to not function properly.
How might DMI and DMII contriubte to ARF?
Vascular obstruction can cause prerenal ARF by inhibiting blood from reaching the Kidneys.
How might HTN contribute to ARF?
Increased vascular resistance might prevent blood from reaching the Kidneys.
What are some causes of Intrerenal ARF?
-A prolonged Prerenal Period
-Nephrotoxins
-Intratubular Obstruction
-Infection
-Renal Injury
What is a Nephrotoxin?
nephrotoxin (nĕf″rō-tŏk′sĭn) [″ + toxikon, poison] A toxic substance that damages kidney tissues.
Name some Nephrotoxins.
Kanamycin, Gentamycin, Penicillin, Tetracycline
Rifampin
What are three heavy metals that are nephrotoxic?
Lead, Arsenic, Mercury
What is a solvent that is nephrotoxic?
Ethylene Glycol
Why should radiographic dyes be avoided if possible?
They are nephrtoxic.
What kind of ARF would intratubular obstruction cause?
Intrarenal.
What are four types of renal obstruction?
-Uric Acid Crystals
-Calculi
-Hemolytic Reactios (Blood Xfusion)
-Myoglobinuria/hemoglobinuria
What is Glomerulonephritis?
A form of nephritis in which the lesions involve primarily the glomeruli.
What is Nephritis?
Inflammation of the kidneys caused by bacteria or their toxins (e.g., pyelonephritis), autoimmune disorders (e.g., poststreptococcal glomerulonephritis, lupus nephritis), or toxic chemicals (e.g., mercury, arsenic, alcohol, nonsteroidal anti-inflammatory drugs).
What is pyelonephritis?
Inflammation of the kidney and renal pelvis, usually as a result of a bacterial infection that has ascended from the urinary bladder.
What are two causes of postrenal ARF?
-Ureteral Obstruction
-Bladder Neck Obstruction
What are two causes of ureteral obstruction?
-Calculi
-Tumors
Name three causes of Bladder Neck Obstruction.
-Strictures
-Calculi
-Prostatic Hypertrophy
What is Azotemia?
Presence of increased amounts of nitrogenous waste products, esp. urea, in the blood.
What would you suspect if you saw:
–elevated BUN/Creatinine ratio
–oliguria
–high urine specific gravity with minimal sodium
–microalbuminuria (in IDDM)
Prerenal ARF.
If you found elevated protein, epithelial cells, and casts in urine, what might you suspect?
Intrerenal ARF.
What type of ARF has High Sodium Excretion?
Intrarenal
If a client has Anuric and polyuric fluctuations, what type ARF?
Postrenal
When type ARF shows hematuria and pyuria?
Postrenal
What classifies someone as being polyuric?
More than 5L/Day
What will ABGs show in ARF?
Metabolic Acidosis.
What will RBC and HgB show in ARF?
Low values
How will Potassium present in ARF?
High
What are some Emergency Measures for Hyperkalemia?
•Large bore IV
•EKG monitoring
•Calcium Gluconate IV
•Potassium reduction
What is Kayexalate?
Sodium polystyrene sulfonate is an ion-exchange resin. It loses a sodium ion, that is replaced by a potassium ion. This reduces potassium in the blood.
• Sodium polystyrene sulfonate is used to treat hyperkalemia (high levels of potassium in the blood).
What are the treatments in the Oliguric Phase of ARF?
•Restore Fluid and electrolyte balance
•Mouth care
•Prevent infection
•Intake=previous day output + 500ml
•If u/o increases to diuretic stage, increase fluids
•Protein maximum 1Gm/kg/day
What changes in the Diuretic Phase of ARF from the Oliguric phase?
Urine output might incrase to 3-5 L per day and IV Fluids might be necessary.
What are some dietary interventions in ARF?
Keep Protein and K Low
What is the calculation for protein consumption during ARF?
1G/kg/day....slighly more if on dialysis
What is a major contributor of Potassium in the diet?
Fresh Fruits and Vegetables, and as such should be avoided in ARF.
How is Aluminum Hydroxide used in ARF?
It binds to the phosphorus, and prevents absorption.
Since RBC might be affected by ARF, what two medications might be given?
EPO and Fe
What are two diuretics that might be used in ARF?
Lasix and Dopamine
What is Kayexalate used for?
It is an exchange resin that helps remove potassium
Namre two types of Dialysis.
Hemodialysis and Peritoneal Dialysis.
What is CRRT?
Continuous renal replacement therapy.
In all types, blood is removed continuously for 24 hr and passed through a chamber containing a semipermeable filter. Excess fluid is removed slowly and, as a result, there is decreased risk of hemodynamic instability when compared to hemodialysis.
What is the prime age and Sex of Stone Patients?
Men 30-50
Name five non-dietary risk factors for Urinary Calculi.
Obstruction
Immobilization
Infection
Dehydration
UTI
What dietary supplement in high doses should be avoided in clients pronte to urinary calculi?
Vitamin C
Where is the Stone Belt?
South Eastern US
What is the most common type of Stone?
Calcium
What is a Staghorn?
Resembling the horns of a stag, these stones get their name from the shape they form by filling the pelvis or drainage system of the kidney (at the top of the ureter). Staghorn stones are linked to urinary tract infections. Despite the fact that they can grow large, they are often overlooked by patients because they cause minimal or even no pain. But a staghorn stone can lead to deterioration of kidney function, even without blocking the passage.
What is the second most common stone?
Oxalate
What are some other type of stones than Calcium Oxalate?
•Struvite
•Triple phosphate
•Uric Acid
•Cystine
•Xanthine
How is fatigue treated?
With Bedrest
What is ESWL?
Treatment with shock waves to break up a stone.
If your client was going to have a paracentisis or be treated with a LaVeen Shunt, what symptom might the be experiencing?
Ascites
This is treated with a hight CHO and low fat diet.
Anorexia
What is an important nursing intervention for a client with stones when they urinate?
Strain
What does increased amonia from protein absorbption cause?
Encephalopathy.
What is a liathiasis?
Another name for a stone.
What are two dietary treatments in ARF?
Reduce Potassium and Protein.
What is Icterus?
Jaundice
What is the name for the sharp, severe, sudden pain in a Kidney Stone?
Colic
These cause GI Bleeding and need to be banded or sclerosed.
Varices
This medication is used to decrease the bacteria in the GI tract and help absorb protein.
Neomycin
What kind of dietary interventions can be made for a client with Uric Acid Stones?
Reduce Purines
What is a common trade name for a diuretic which can cause ARF?
Lasix
Differentiate between Renal and Ureteral Colic.
Renal originates in the lumbar area and radiates to the testicles or bladder in women. Ureteral Colic radiates toward genitalia and thigh.
What are some assoicated symptoms of stones?
N/V
Pallor
Grunting Respirations
Increased BP/Pulse
Diaphoresis
Anxiety
Paralytic Ileus
What are some urinary specifics of a stone?
Urgency or Frequency
Hematuria
Cystitis
Decreased Bladder Capacity
Intermittent Urine Stream
Why is pain intermittent with a Kidney Stone.
Pain is usually seen when stone gets lodged and parastalsis tries to move.
What two typical infection assessments are seen with kidney stones?
Increased Fever and WBC Count
What is a KUB?
Xray of the Kidney, Ureter and Bladder.
Can Uric Acid stones be seen on an Xray?
No, they are not radiopaque.
What is the size that a stone will normally pass without surgical intervention?
4-5mm
What is Hydronephrosis?
Stretching of the renal pelvis as a result of obstruction to urinary outflow.
What is hydroureter?
The distention of the ureter with fluid owing to obstruction.
How much fluid should be consumed each day with a stone?
3-4L
Why is fluid important?
Helps Pass Stone
Stops Size from Increasing
Prevents Infection
Decreases Pain
What percentage of daily fluids needs to be water?
At lease 50%
What is Ditropan?
An antispasmodic.
What is the Generic name for ditropan?
Oxybutrin
Purines should be limited with Kidney Stones. What are some sources?
Aged Cheeses, Wine, Bony Fish, Organ Meats.
What is the recommended Calcium Level per day?
Limit to 800mg QD
What are some foods with high oxylates?
Black Tea, Tomatoes, Instant Coffee, Cola Drinks, Beer, rhubarb, green beans, asparagus, spinach, cabbage, celery, chocolate, citrus, apples, grapes, cranberries, peanuts, large doses of vitamin C
What are the medical interventions for Uric Acid Stones?
Allopurinol, sodium bicarb or citrate to raise pH
What are some medication interventions of Calcium oxylate stones
•Vitamin B6
•Magnesium oxide
•Cholestyramine
What are three types of Urin Diagnostic Tests that might be used?
UA
C&S
24 Hour Urine
How often should you urinate?
At least q2h
What is a nephrostomy?
The formation of an artificial fistula into the renal pelvis, for example, to drain an obstructed kidney or relieve hydronephrosis.
What is Lithotripsy?
The application of the physical force of sound waves to crush a stone in the bladder or urethra. 2. The production of shock waves by use of an external energy source in order to crush renal stones.
What is Percutaneous Lithotripsy?
Guide is inserted through the skin under fluoroscopy and ultrasound waves are applied.
What is ESWL?
Extracorporeal Shock Wave Lithotripsy.
How are the sound waves aimed with ESWL?
Fluroscopy
Why is an EKG used during lithotripsy?
To synchronize shock waves with R wave.
Why is a stent places prior to ESWL?
To keep fragments from clogging distal ureter.
How is a stent placed?
Stent may be placed prior to ESWL, with cystoscopy,
How long after ESWL might it take for stone fragments to pass?
Upto 3 months.
What is Ureterolithotomy
Surgical incision for removal of a stone from the ureter.
What is Cystolithotomy
Surgical removal of a urinary calculus from the bladder through an incision in its wall. Also called cystolithectomy.
What is pyelolithotomy?
The removal of a stone from the pelvis of a kidney through an incision.
What is Nephrolithotomy
Renal incision for removal of kidney stones.
What are characteristics of a 1st Degree Burn?
–Epidermis only
–Painful
–pink or red, dry, slight edema
–No blisters
–Blanches with pressure
–Sunburn
What is the title of a 1st degree burn?
Superficial Partial Thickness.
What is the title for a 2nd Degree Burn?
Deep Partial Thickness.
What are the characteristics of a 2nd degree burn?
–all of epidermis and part of dermis involved
–blisters
–red, blanches and refills
–pain
–edema local unless a large burn
–heals in 2-3 weeks without surgery
–no scar unless infected or traumatized
–skin grafting only for deeper 2nd degree burns
Where are two areas where second degree burns might recieve a skin graft?
Cosmetic Areas such as face and hands.
What is the title of a 3rd degree burn?
Full Thickness Burn
What are some characteristics of a 3rd degree burn?
–destroys all of the epidermis and dermis layers
–no regeneration of skin, so grafting is required
–can involve fat, fascia, tendon, bone
–white, black, red without blanching, charred, dry leathery eschar (dead tissue)
–wound is not painful except around the edges
What makes a 4th degree burn?
Full thickness into tendons and bone.
What causes a burn to be classified as "Major"?
20-25% or Larger
Electical
Hands, Face, eyes, ears, feet, genitalia
Inhalation burn
How does chronic disease affect burn classification?
Becomes major with DM, COPD, CRF,CAD, etc.
What is TBSA?
Total Burn Surface Area.
What might be done for compartment syndrome in a burn?
an Escharotomy.
What is Escharotomy?
Removal of the eschar formed on the skin and underlying tissue of severely burned areas. 2. Excision of dense necrotic skin about a decubitus or ischemic ulcer.
What is the term for removing the top of a blister?
Deroofing.
What happens if a blister bursts without having been deroofed?
Becomes infected.
Is the Rule of Nines Gross or Fine?
Gross
Do the rule of Nines
Head - 9
Each Arm - 9
Chest - 18
Back - 18
Each Leg - 18
Peri Area - 1
What is the more accurage burn assessment tool?
Lund Browder Chart
How does pain exhibit in a 3rd Degree Burn?
3rd degree itself is not painful, but edges (which are 1st and 2nd degree) are painful.
Is the extent of an electrical burn assessable externally.
No, There will be an Entry, Exit, burn, but there will also be the damage from the heat along the path on the bone, muscles, and internal organs.
What is the cutaneous burn in an electircal burn?
The area on the surface, sometimes called Flash which resembles defibrulator burns.
Which is more dangerous Alkaline or Acid Burns?
Alkaline is more damaging.
Is it "Usually" safe to irrigate a chemical burn with water?
Yes. Never try and neutralize unless done carefully with a known agent.
What is one metal that you would not irrigate with water?
Sodium Metal.
What are two resources for chemical burns?
MSDS or Poisen Control.
How does location of a client during a pulmonary burn correlate with the severity of the burn?
The smaller area the client was in, the worse the burn will be due to concentration of heat and smoke.
When does Maximum Edema usually present in a burn?
About 24 hours.
Why is hypovolemic shock seen in burn clients?
Fluids leaves the blood stream and move out into the tissues.
Is edema only seen at the burn site?
No, in massive burns it can be seen in the chest, next, and extremities.
How long does it take for the edmema to return back to the circulitory system?
48 hours.
What problems might be seen in a burn patient at 48 hours?
FLE, Hypertension, JVD, Preload Increase, thin sputum, Adventitous sounds.
Why is there renal failure with burns?
RBC destruction resutls in acute tubular necrosis and Myoglobinuria causes problems.
What is myoglobinuria?
Myoglobin in the urine.
What hematology changes would be seen in the first 48 hours of a burn?
High HCT
Low pH
Hgh K+
What hematology changes would be seen after the first 48 hours of a burn?
Low HCT
Low pH
K+ Normalizes or goes low
Na+ is low with diuresis
What is a Curlings Ulcer?
A peptic ulcer that sometimes occurs following severe burns to the body; a form of stress ulcer.
What are some factors affecting the risk for infection in a burn patient?
Decreased Albumin
Decreased serum trasferrin
Respiratory injury/inactivity
Anemia
Name four phases of phychological impact of a burn.
 Impact
 Retreat
 Acknowledgement
 Reconstructive period
What happens during the Impact Phase?
 Impact
– Shock, disbelief, feelings of being overwhelmed
What happens during the Retreat Phase?
 Retreat
– Repression, withdrawal, denial, suppression
What happens during the Acknowledgement phase?
Begins to mourn the lass
What happens during the reconstructive period.
Begins to plan for the future.
Why is the most serious damage internal in an electriical burn?
There is potential muscle, nerve and organ damage.
Why is Pulse Oximetry not useful in pulmonary injuries?
Because of anemia and the strong affinity of CO for the hemoglobin molecules.
When might you see CHF in a burn patient?
After 48 hours when the fluids leave the tissues and return to the circulation.
This complication causes the urine to become brown or black because of the muscle damage.
Myoglobinuria.
How are pain meds given in a burn?
Always IV not IM.
Why is early intubation with an ET tube important in a burn client?
Because there will be pressure from edema around the neck and head which could close the airway.
What might need to be done to O2 in a burn client?
Provide humidity.
Why are IV meds given over IM in a burn client?
Because as with any shock, the IM medication might sit in the tissue due to poor perfusion.
What is the general Parkland Formula?
4 ml LR X kg wt. X% burn (2nd, 3rd)=ml in first 24 hrs
What is the breakdown of IV fluids in the 1st 24 hours of a burn?
1/2 given in first 8 hours
1/2 Given of balance of 16 hours.
What happens in fluid during the 2nd 24 hours?
Colloids given with D5W to maintin urine output.
What are some expected outcomes of the Parkland formula?
Client will be:
-Alert
-HR < 120
-BP Normal
-Pulses Normal
-No Dyshythmias
What are two urine output targets?
75-100ml per hour
or
1ml per kg per hour
When oxygen by mask is applied to a burn client it is also important to provide.
Humidity.
Respiratory failure in a burn patient is most likely when?
In the First 48 Hours
(Per Johns Vanna slide 50 3/5)
What is the name of the formula to estimate the initial fluid rate in the hypovolemic phase of a burn?
Parkland Formulamy
What characteristics will urine have when adequate fluid resuscitation is achieved?
It will be free of pigment.
How should the limbs be placed in the ER?
Extended (not Hyperextended) to prevent problems with contratures that might be seen with flexion.
Why should two burn surfaces never touch?
They will "Web Over" and heal together.
When should cool water be used in a burn client?
Small 2nd degree only. Larger burns will cause hypothermia problems.
What is a tubbing room?
A room with a table and water source where debridement happens.
How long do tubbing sessions usually last?
30 Minutes or Less.
How often should you change gloves when tubbing?
Between each wound, to prevent cross contamination.
Why are elasic garments worn after a burn?
It keeps the skin flat, and prevents the scars from bulging and growing.
What are some interventions to minimize scarring?
Apply Splints
Elastic Pressure Garments
ROM Exercises
Whirlpool (If no multiple wounds)
What are the pros and cons of an open wound care method in burns?
No dressing, just ABX ointment.
Able to see well, but looses heat.
What are the pros and cons of an closed wound care method in burns?
–gauze or transparent dressing with or without antibiotic ointment
–anaerobes may grow
–not always possible in large burns
–decrease scarring and pain
How are grafts used in temporary wound covering.
They are placed on the wound not as a graft, but as a temporary covering. They eventually sluff off.
What are Biobrane and Integra?
Biosynthetic dressings.
Describe Integra, including the layers.
The top layer is a nylon material containing gelatin that intereacts with the clotting factors and helps it adhere better. The bottom layer contains a mesh that promotes a foundation for skin regrowth.
Name two broad spectrum Antimicrobial Otinments.
Silver Sulfadiazene (Silvadene)
Mafenide (Sulfamylon)
Which broad spectrum Antimicrobial Ointment is used most commonly. Why?
Silver Sulfadiazene (Silvadene) because Mafenide is used only when wounds are resistant. It is painful, and used cautiously in renal failure.
What Antimicrobial ointment is used for Gram positive wounds?
Bacitracin
What Antimicrobial ointment is used for Gram negative wounds?
Neosporin
When is autograft required?
-Some 2nd Degree
-All 3rd Degree greater postage stamp size.
-Face and Hands
How long should an autograft remain free of movement?

How is this done?
Seven Days.

With Splinting.
What is specific about Autograft Dressing Changes?
Usually done by the physician.
How might fluid be removed from an autograft?
Small needle incision and roll fluid out with a Q-Tip.
What is the name of the tool to remove a donor skin graft?
Dermatome.
Who often might one patch of skin be harvested?
Every several weeks
7-14 Days
Are autograft donor sites painful?
Yes, often times more painful than the original burn site.
What kind of wound is an autograft donor site?
2nd Degree
Name some types of dressings for an autograft donor site.
Xeroform
Opsite
Tegaderm
What is the Curreri Formula?
(25kcal * kg)+(40 * % Burn)
Is the number of kcal Expended each day.
How are calories added to a burn patient?
Fat & Protein
How long scar tissue metabolicly active?
18 Months
Who is sweating affected after a burn?
Scar tissue does not sweat, so non scar areas will sweat more, and run a risk of heatstroke.
Why is scar massage important?
-Moistureize
-More pliable
-Applies pressure to collegen fibers to help realign them
-Nerves regenerate unmylenated so massage desentizies them.
Using sterile gloves, scissors and sterile forecepts to remove dead tissue daily is called.
Debridement
What usually happens to blisters in deeper thickness burns to prevent them from becoming infected?
They are removed. Deroofing.
What are two preventative measures used to prevent ulcers of the GI System?
Histamine Antagonists
and
Proton Pump Inhibitors
What is a broad spectrum antimicrobial ointment that is used cautiously because of Pain and Renal Problems.
Mafenide
When an autograft is placed, no movement should occur for how many days?
Seven
What is the name of the soft gelatinous material in the center of a disk?
Nucleus Pulposus. It is a cushion between the vertabrae.
What causes low back back?
Bulging out of the nucleus pulposus.
Where do most low back pain injuries occur?
L4-5 or L5-S1
What causes the discus pulbosus to weaken?
Activity, Age, and Trauma
What type of pain does low back pain usually exhbit as?
Sharp
What are some stressors that can cause low back stress?
Sneezing, Coughing, Driving or Standing.
When does the pain usually exhibit in a low back injury.
Not at the time of injury......later.
What relieves low back pain?
Walking, laying on back with legs elevated, side lying with knees flexed.
What path does low back pain follow?
Usually along one dermatome.
Why is lordosis often seen in Low back pain?
The hips are swayed back and are in spasam.
What is Diathermy?
The therapeutic use of a high-frequency current to generate heat within some part of the body.
What is TENS?
transcutaneous electrical nerve stimulation.
Is a firm mattress indicated in low back pain?
Yes, some people even sleep on the floor.
What is Carisoprodol?
Soma is a Muscle Relaxant.
What is Cyclobenzaprine?
Flexeril is a Muscle Relaxant
What is baclofen?
Lioresal is a muscle relaxant.
What is Dantrolene Sodium?
Dantrium
What is a Diskectomy?
Surgical removal of a herniated intervertebral disk.
What is a Laminectomy?
The excision of a vertebral posterior arch, usually to remove a lesion or herniated disk.
What is spinal fusion?
Stabalizing spine with a bone graft from the Iliac Crest.
What intervention might be taken to assure that operative area of back is kept flat?
Gatch the Knees
What are some elimination issues after spinal surgery?
Bowel and Bladder retention.
What is an important assessment to make while dangling a client for the first time after back surgery?
Postural Hypotension.
The Galationous substance inside a disk that presses on nerves is the
Nuculeous Propulsus.
Low back pain from a previous injury can be exaccerbated by this.
Sneezing or coughing
What is the portal vein?
Vein formed by the union of veins from the abdominal viscera, which then takes blood into the liver.
What does the portal vein do?
Drains blood from the spleen and bowel and cleanses it in the liver.
Why is Hepatitis difficult to diagnose?
Vague symptoms.
•flu like symptoms including low grade fever
•diarrhea, constipation
•dull pain in right upper quadrant
•incubation periods vary
What is the greatest hepatitis problem facing us today?
Hepatitis C
What is the Icteric stage of hepatitis?
The Jaundice Stage
What happens to PT and APTT in hepatitis?
They increase because the clotting factors are made in the liver, and disease slows down their production, resulting in an increased clotting time.
What are four liver specific enzymes?
ALT, AST, GGT, and LDH
How does hepatitis affect WBC and BGL?
Leukopenia and Hypoglycemia
How is Hepatitis A usually transmitted?
Sewage, Handwashing
What does Hepatits E Mimic?
Hepatitis A
What types of Hepatitis should care be taken with Razors, Toothbrush, cigaretets?
Hep B and Hep C
What kind of diet should a client have during hepatitis?
High Carb/Low Fat
2500-3000 kcal per day
Why is high fat diet discouraged?
Causes more liver inflamation.
How much fluid per day for hepatitis?
3000ml per day.
What are some liver toxic memdications?
APAP, ASA
What are some interventions to relieve pruritis with hepatitis?
Cool baths, lotions, bile acid sequestrant medications.
What type of medications are used to treat Hep C?
Antivirals
What nurtitional problems are seen with Hepatitis?
Anorexia.
Which is more dangerous Hepatitis or Cirrhosis?
Cirrhosis
WHat is Hepatic Encephalopathy?
Brain dysfunction present in patients with chronic liver disease and portal hypertension, in which chemicals (amonia) that the liver normally detoxifies are shunted past it and left to circulate in the blood
What are some interventions to relieve pruritis with hepatitis?
Cool baths, lotions, bile acid sequestrant medications.
What type of medications are used to treat Hep C?
Antivirals
What nurtitional problems are seen with Hepatitis?
Anorexia.
Which is more dangerous Hepatitis or Cirrhosis?
Cirrhosis
WHat is Hepatic Encephalopathy?
Brain dysfunction present in patients with chronic liver disease and portal hypertension, in which chemicals (amonia) that the liver normally detoxifies are shunted past it and left to circulate in the blood
What is asterixis?
Abnormal muscle tremor consisting of involuntary jerking movements, esp. in the hands, but also seen in the tongue and feet.
What is Hepatic Encephalopathy
Brain dysfunction present in patients with chronic liver disease and portal hypertension, in which chemicals that the liver normally detoxifies are shunted past it and left to circulate in the blood. Some patients are asymptomatic; others have mild impairments in memory, calculation, speech, affect, or judgment. Severely affected patients may lapse into coma.
What is an esophageal varix?
A tortuous dilatation of an esophageal vein, esp. in the distal portion.
(An esophgus hemorrhoid)
What is splenomegaly?
Enlargement of the spleen.
What is the normal weight of a spleen?
300grams or less. It can swell to 500-1000grams with poortal hypertension which causes backup of fluid.
What is a spider angioma?
A branched growth of dilated capillaries on the skin, resembling a spider.
What is fetor hepaticus?
A mousy odor in the breath of persons with severe liver impairment
What is caput medusae?
A plexus of dilated veins around the umbilicus, seen in patients with portal hypertension (usually as a result of cirrhosis of the liver).
What is a LeVeen Shunt?
A shunt from the peritoneal cavity to the venous circulation used to help control ascites by allowing ascitic fluid to enter the venous circulation.
What is an intervention to take before a paracentesis?
Have the client void in order to shrink the urinary bladder to prevent it from being pricked.
What is a problem with a LaVeen Shunt?
Can cause CHF, SEPSIS or DIC.
Why would you measer abdominal girth in a cirrhosis patient?
To see if their abdomin is shrinking.
What is the problem with esophogeal varices?
Quickly GI bleed out, and also cause NH3 from GI system from breakdown of blood.
What is an ABX that is used in Cirrhosis to kill normal flora to prevent NH3?
Neomycin.
What is an example of a cathartic used to remove blood from the GI tract to prevent it from being absorbed, and later broken down into NH3?
Lactulose?
What is a cathartic?
An active purgative, producing bowel movements.
What medication might be given to help reduce problems from varices?
Vasopressin
What are some interventions to prevent rupture of varices?
Keep normotensive. No Valsalva.
If a varices ruptures, what interventions might be necessary.
Large Bore NG to remove blood before absorbption and Gastric Lavage with cool or room temperature NS.
How can varicees be repaired?
Injection scleropathy, thrombosis or banding
The problem caused by increased levels of NH3 due to increased absorption of amino acids and protein. Can be blood or food.
Hepaitc Encephalopathy
When is Cancer usually seen?
In Hep B and Hep C
A major cause of death in patients with cirrhosis.
Hemorrhage.
This drug is an antibiotic that is used to decrease thenormaol flora of the GI system, so that less prtein (ammonia) is absorbed.
Neomycin.
Varices can be treated with this systemic drug.
Vasopressin
What is seen in cervical spine injuries, after spinal shock resolves, and is caused by cutaneous stimuli?
Reflex evacuation of bowel and bladder
What occurs in spinal shock with cervical injuries?
Loss of bowel and bladder reflexes.
What interventions are needed for autonomic dysreflexia?
Check catheter, elevate HOB, keep warm, and check for constipation.
What assessments are seen in autonomic dysreflexia?
Severe HTN, bradycardia, visual disturbances, and headache.
Describe Back Pain.
Occurs much later that the injury, is along a dermatome, is sharp and severe, and is aggravated by coughing and sneezing.
If your assessment showed pH < 7.35, pCO2 normal or decreased, and HCO3 low, seen in shock and fluid overload phases of a burn, what would you suspect?
Metabolic Acidosis.
What are indications for an ET tube and ventilator in the shock phase?
Neck edema, carbonaceous sputum, singed nasal hairs, smoke inhalation.
What are 25 Kcal / kg) + (40 Kcal X % burn) and (4 ml LR X kg wt. X% 2nd & 3rd degree burn = 24 hr. amount)
The Curreri and Parkland formulas?
This sulfa drug causes No pain, broad spectrum, no electrolyte imbalances, and is white.
silver sulfadiazine
What type of wound is caused by harvesting skin for an autograft?
Scond degree
What assessments are seen in hepatitis?
Low grade fever, dull RUQ abdominal pain, constipation or diarrhea, and hypoglycemia.
What interventions are important for hepatitis?
Bedrest, low fat and high calorie diet, and increased fluids.
What is the cause of hepatic encephalopathy?
Increased ammonia levels.
What is done to prevent and treat esophageal bleeding?
NG, gastric lavage, banding, vasopressin, and sclerotherapy.
What medications are used to prevent and treat hepatic encephalopathy?
Lactulose, neomycin, and less protein.
What is given to reduce phosphorus (keep Ca++ in the bones), reduce anemia, and reduce potassium?
Aluminum hydroxide, EPO, insulin and dextrose, sodium bicarbonate, and kayexalate .
What interventions are needed for renal calculi?
Increase activity and fluids while reducing purines, oxylates, or calcium.
What is lithotripsy?
Fragmenting lithiasis or calculi with shock waves.
What are causes of acute renal failure in burn patients?
Myoglobinuria, hemoglobinuria, hypovolemia or shock, decreased cardiac output, and increased ADH.
What is Seen early in IDDM diabetics with prerenal ARF.
Microalbuminuria?
What is a treatment of fatigue from liver disease?
Bedrest
***Crossword***
This is treatment with shock waves to break up a kidney stone.
ESWL
***Crossword***
This can cause respiratory depressenion, and can be treated with a LaVeen Shunt.
Ascites
***Crossword***
This is Icterus caused by Bilirubin.
Jaundice
***Crossword***
This brain condition is caused by increased ammonia from protein absorption and metabolism.
Encephalopathy
***Crossword***