Term
|
Definition
-Has OR on standby 24/7
-Has to have enough patient's necessitate this and give experience |
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Term
| Important information to get when a trauma patient is first admitted |
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Definition
Mechanism of injury
-Blunt, penetrating, MVA, fall, GSW, blast, burn, etc.
-Predict types of injury
-Helps plan for appropriate care adn equipment.
Allergies
Significant PMH |
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Term
| What do the ABCDE of the primary survey stand for? |
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Definition
Airway
Breathing
Circulation
Disability
Exposure |
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Term
|
Definition
| 0-4 with 0 being really bad and 4 being not as bad. |
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Term
|
Definition
| Scale that aims to give objective data on patient's consciousness. 3-15 with 3 being a deep coma. It assesses verbal response, verbal response, and motor response. |
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Term
| Primary survey: Circulation |
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Definition
-Check all peripheral pulses
-2 large-bore IVs
-NS or LR, PRBCs
-Assess for hemorrhagic shock (tennis scores, love, 15, 30, 40) |
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Term
| Primary survey: Disability |
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Definition
-Basic neuro exam
-Gross motor and sensory exam
-AVPU
Alert
Responsiveness to voice
Responsiveness to pain
Unresponsive
-Glasgow Coma Scale |
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Term
|
Definition
| One in which the number of people killed or injured in a single incident is large enough to strain or overwhelm the resources of local EMS providers |
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Term
| Homeostatic functions of skin |
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Definition
-Barriers to microorganisms
-Protections from injury via barrier and sensation
-Maintain F/E balance
-Regulate body temp
-Regenerate itself
-Provides personal identity |
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Term
| Local responses to burn: Zones of injury |
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Definition
-Zone of coagulation: irreversible tissue damage
-Zone of stasis: low perfusion, potentially salvageable tissue
-Zone of hyperemia: Increased perfusion r/t inflammatory response; will recover |
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Term
|
Definition
-Depth & degree of injury
-Extent of burn: percentage of body area
-Location |
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Term
| What criteria is essential for skin regrowth after a burn? |
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Definition
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Term
| Burns: Depth & degree of injury |
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Definition
-Different terminology but essentially the same criteria
-First, second, third degree burns
-Superficial-, partial-, full-, deep full-thickness
-Minor, moderate, major-ABA criteria
--Based on depth, extent, and location, type of burn
--Burn center referral criteria |
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Term
|
Definition
-Minor: Superficial: BSA < 50% (sunburns)
-Moderate: Superficial: BSA > 50%; Partial thickness: BSA <30 %; Full thickness: BSA <10%
-Major/Critical: Partial Thickness: BSA > 30%; Full Thickness: BSA >10%; Inhalation injury; Inhalation injury; Any partial or full thickness burn involving the hands, feet, joints, face, or genitals |
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Term
| Superficial Partial Thickness |
|
Definition
Superficial dermal burn
-Necrosis confined to upper third of dermis
-Zone of necrois lifted off viable wound by edema
-Small zone of injury |
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Term
|
Definition
Deep Dermal Burn
-Necrosis involving majority of skin layers
-Zone of necrosis adherent to zone of injury
-Smaller edema layer |
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Term
|
Definition
| No remaining viable dermis |
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Term
|
Definition
| Adult: 9% head, 9% arms, 18% legs, 18% chest 18% back; 1: perineum |
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Term
| Inflammatory response r/t burns |
|
Definition
-Increased capillary permeability
-Vasodilation
-Massive fluid shifts from blood vessels into tissue--capillary leak syndrome
-SIRS |
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Term
|
Definition
-Extensive burns may lead to massive edema: obstruction may result from upper airway swelling
-High risk of airway involvement: Burns on head, neck, chest or burned in an enclosed space; singed nasal hairs; Soot in nostrils or sputum
-Mechanisms of injury r/t heat or smoke: Direct injury and cellular damage (external)
-Inflammatory changes |
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Term
| Burns: Airway Obstruction |
|
Definition
-Damage may not show for 8-24
-Assessment:
Tachypnea, dyspnea, stridor or cough
Use of accessory muscles
Dry, reddened mucous membranes
Swollen uvula
Drooling
Hoarseness
Dry, reddened mucous membranes
-Treatment: 100% NRB, bronchodilators, suctioning, bronchoscopy
-Be prepared to intubate early |
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Term
|
Definition
In resuscitative or urgent phase: Gas exchange
-Hypoxia
-Carbon monoxide poisoning or toxic gases
-Smoke inhalation
-ARDS |
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Term
| Burns: Fluid Resuscitation |
|
Definition
-IVF: Lactated Ringers
-The lactate in LR is metabolized into bicarb by the liver, which can help correct metabolic acidosis |
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Term
| Parkland formula for burns |
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Definition
-Calculates fluid requirements for burn patients in first 24-hours
-4 X wt in kg X TBSA burned = 24 hr fluids
First half of fluid delivered in first 8 hrs
Second half delivered over 16 hrs
-Adust based on patient response to avoid overhydration and increased fluid overload |
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Term
|
Definition
-Maintenance fluids-usually changed to D5 1/2NS with KCL
-Basal rate + insensible fluidloss (both involve calculations)
-Complications of over-hydration:
Compartment syndromes: extremity, chest, abdominal
ARDS |
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Term
|
Definition
| Compartment syndrome is a serious condition that involves increased pressure in a muscle compartment. Lead to muscle and nerve damage and problems with blood flow |
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Term
|
Definition
-Hgb, Hct elevated as a result of fluid volume loss
-Serum elecrolytes: Na+ decreased (trapped in interstitial fluid (edema) and lost through plasma leakage; hyperkalemia at first due to cell injury/death, then hypokalemia
-BUN/Creatinine
-ABGs-Metabolic acidosis |
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Term
| Collaborative and nursing management goals |
|
Definition
-Maintain respiratory function
-Restore fluid balance
-Thermoregulation
-Prevent infection
-Restore skin integrity
-Adequate pain control
-Adequate nutrition
-Provide emotional support |
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Term
|
Definition
-Pain Management
-Monitor ECG
-IV access (multiple)
-Management perfusion needs (maintain hourly urine output 0.5mg/kg) |
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|
Term
| What are the most painful burns? |
|
Definition
| Superficial partial-thickness burns |
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Term
|
Definition
-Most common type of burns: heat transfer from external source
-Causes: Flames, Scalds from hot foods or liquids, including steam (70% of peds patients)
-Prevention: Home water heaters < 120 F
-Hot food, liquid out of children's reach |
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|
Term
|
Definition
-Most common cause: adults: occupational; children: household
-May not be much external damage (look for entrance and exit sites)
-Deeper wounds from current traveling through the body, course may be erratic through body
-Special precautions for electrical burns: EKG and cardiac monitoring; C-spine precautions |
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Term
|
Definition
Cause
-Overexposure to sun
-Radiation treatment for cancer
-Industrial accidents
Prevention
-Educate public to protect against UV exposure
-Educate about safety measure in industrial setting |
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Term
|
Definition
Cause
-Skin contact with caustic chemicals
Treatment
-Remove all contaminated clothing
-Thoroughly irrigate affected area
-May need specific counter-agent
Prevention
-Keep chemicals in a safe place
-Know how to neutralize chemicals
-Occupational training |
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|
Term
|
Definition
Cause
-Inhalation of heated air and smoke
Incidence
-More in elders, inability to escape fire
Prevalence
-20% to 30% of patients in burn centers
-Majority of burn injury deaths from smoke inhalation
-77% increased mortality rate with cutaneous injuries |
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Term
| Functions of the Nervous System |
|
Definition
-What: Direct all physiological, cognitive, and psychological activities
-Why: Coordinates homeostasis
-How: Gather sensory information, integrateit, and respond to it via motor activity |
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Term
| Diagnostics for spinal cord injury |
|
Definition
-CT is now standard--more sensitive and specific than regular x-rays
-Must assess entire spine
Labs:
CBC
ABG
UA
Lactate |
|
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Term
|
Definition
| An insult to the spinal cord resulting in a change, either temporary or permanent, in its normal motor, sensory, or autonomic function |
|
|
Term
|
Definition
Plegia: complete lesion
Paresis: some muscle strength is preserved |
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|
Term
| Tetraplegia (or quadriplegia) |
|
Definition
-Injury of teh cervical spinal cord
-Patient can usually still move his arms using the segments above the injury (e.g. in a C7 injury, the patient can still flex his forearms, using the C5 segment) |
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Term
|
Definition
| -Injury involving the thoracic or lumbo-sacral cord, or cauda equina (T1 and distal) |
|
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Term
|
Definition
-Paralysis of one half of the body
-Usually in brain injuries (e.g. stroke, TBI) |
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|
Term
| Complete vs. Incomplete SCI |
|
Definition
-Complete: no sensory, morot or autonomic funciton below the level of injury
-Incomplete: some sensory, motor or autonomic function below the level of injury
-Can't be determined until after spinal shock resolves |
|
|
Term
| Most common levels of SCI? |
|
Definition
-Tetraplegia: C5
-Paraplegia: T12 |
|
|
Term
|
Definition
-Transient physiological depression of cord function below the level of injury
Symptoms:
-Complete loss of all neurologic function (including reflexes and rectal tone)
-Initially hypertensive but then becomes hypotensive
-Flaccid Paralysis
Lasts several hours to days until reflex arcs below the level of injury recover |
|
|
Term
|
Definition
-Results from unapposed parasympathetic stimulation
-Most commonly seen with SCI above T6
-Classic Triad of symptoms: Hypotension, Bradycardia, Peripheral vasodilation
Differentiate from spinal shock, hemorrhagic shock, and hypovolemia shock-how? |
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Term
|
Definition
Can result from any noxious stimuli below the level of injury, which triggers limited sympathetic hyperactivity.
-Most commonly caused by:
-Bladder and bowel distention
-Any trauma or injury: blisters, burns, fractures, appendicitis
-Pregnancy
-Can cause HTN crisis which can lead to seizures, stroke, and death |
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|
Term
| Most common causes of death after acute phase of SCI |
|
Definition
-Pneumonia
-Pulmonary emboli
-Septicemia |
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|
Term
| Adrenal glands release which chemicals? |
|
Definition
-Cortisol
-Aldosterone
-Testosterone
-Epinephrine and norephinephrine |
|
|
Term
|
Definition
-Released under stress response
-Increases blood sugar
-Fat, protein, CHO metabolism
-Anti-inflammatory, anti-immune response |
|
|
Term
| Corticosteroid medication |
|
Definition
-Common cause of Cushing's and Addisons syndromes
-Do not suddenly stop, must be tapered off
-Monitor for:
-Emotional labile, may develop acute psychosis
-Risk for injury
-Risk for infection
-Skin integrity
-High blood glucose levels |
|
|
Term
|
Definition
-Tumor in adrenal medulla that causes increased catecholamines production
-Intermittent episodes of sympathetic overstimulation
-Treated by surgery |
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|
Term
|
Definition
-Common in brain cancer, neurosurgical and TBI patients
-Diagnostics: UO > 4L/24 hrs; USG <1.005
-Meds: DDAVP by inhaler (may be lifelong) |
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|
Term
|
Definition
-Treatment
Fluid restriction
Raise sodium steadily bu slowly (watch for pum edema)
Vasopressin antagonist |
|
|
Term
|
Definition
Hypothyroidism (autoimmune)
symptoms are the same as hypothyroid |
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|
Term
|
Definition
|
|
Term
|
Definition
|
|
Term
| What is the most common source of iodine? |
|
Definition
|
|
Term
| Implications of hyperthyroidism |
|
Definition
-Chest pain - Order TSH
-Nutrition
-Drug metabolism
-Post-Op thyroidectomy
-Anterior neck surgery
-Thyroid storm
-I-131 therapy |
|
|
Term
| Implications of hypothyroidism |
|
Definition
-Peri-Operative
-Drug Metabolism
-Increased risk of complications
-Poor energy level |
|
|
Term
|
Definition
-DKA has ketones, kussmaul respirations, develops rapidly, BS >300
-HHNS has hyperosmoloarity, no ketones, slower development, BS >500 |
|
|
Term
| Treatment priorities for DKA and HHNS |
|
Definition
First: fluid balance
-IVF rehydration started before insulin
-Start with NS 1-2 L in 1-2 hours
-Then complete rehydration over 24 hours
Hyperglycemia: controlled decrease via insulin infusion (not SQ)
-Electrolyte balance
-Watch for complications: seizures, cerebral edema |
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