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HURST > Burns & Oncology > Flashcards

Burns & Oncology Flashcards

1
Q

Burns ________ capillary permeability and ______ seeps out into the tissue.

A

increase

plasma

The majority of this occurs in the first 24 hrs and we need to worry about shock.

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2
Q

Burn victimes are in ____. The pulse _____. CO _____. UOP ____.

A

FVD due to massive fluid shifts bc the capillaries are leaking

pulse increases (compensation for lack of fluid in vascular space)

CO decreases (less volume less pressure)

UOP decreases (kidneys are either trying to hold on to flui or aren’t being perfused)

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3
Q

What all is secreted with burn victims?

A

Epinephrine and norepinephrine to make you peripherally vasoconstrict to shunt.

ADH and Aldosterone hold on to sodium and water to increase blood volume.

ADH just water.
Aldosterone water and sodium.

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4
Q

Anytime the ______ BP drops below __ the client will not have what?

A

Anytime the systolic BP drops below 90 the client will not have adequate organ perfusion.

ex. 85/60

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5
Q

Rule of 9’s

A

Measures % of BSA that is burned.

Head and Neck: 9%

Front of Truck: 18%
Back of Torso: 18%

Arm: 9% each
- Ex. Anterior arm: 4.5%

Leg: 18% each

Genital area: 1%

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6
Q

Partial-thickness burns vs. Full-thickness burns

A

Partial - first and second degree

Full - third and fourth

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7
Q

Examples of severe burns:

A

located on face, neck, or chest = interferes with breathing

hands, feet, joints, eyes = interferes with daily life

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8
Q

Risk Factors with Burns:

A

Heart, lung, kidney disease (less able to compensate or go without perfusion)

Healing issues (pre-existing diabetes or peripheral vascular disease)

Other injuries (falls, smoke inhalation)

Old and very young

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9
Q

A higher mortality is expected in ______ & ______ with burns. Why?

A

very young and very old

Skin is very thin and they have less subQ fat meaning burns can go deeper.

BSA is a lot less in the very young.

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10
Q

Treatment for Burns:

A

Stop burning process (blankets, cool water)
——- blankets hold in body heat and keep out germs.

Remove jewelry and non-adherent clothing and cover with dry clean cloth.

Check for inhalation injuries and treat

  • —– Carbon Monoxide - oxygen 100%
  • —– Hydrogen cyanide - oxygen 100%
  • ———– if you suspect inhalation injury = intubate BEFORE swelling occurs

Fluid replacement (LR and albumin)

Medication (albumin, opioids, tetanus toxoid, immune globulin

Infection Control (systemic antibiotics / topical meds)

Wound Care (debridement / grafting

Nutrition (protein and vit. C)

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11
Q

Carbon Monoxide Poisoning

A

Client will be hypoxic even with O2 sat measuring 100%.

treatment is 100% oxygen

watch for signs of hypoxia, not the O2 sat because it only counts bound hemoglobin, not hemoglobin boung specifically with oxygen.

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12
Q

Hydrogen cyanide

A

treatment 100% oxygen

antidote at hospital

determine if the burn occurred in an open or closed space

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13
Q

Indicators of inhalation injury:

A 
singed nose or facial hair
soot on face
coughing up secretions with dark specks
dysphagia
wheezing
blisters found on oral / pharyngeal mucousa
hoarseness
substernal / intercostal retractions and stridor

** if you see these, intubate in case their airway swells shut

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14
Q

Fluid Replacement with Burns:

A

Needs at least 2 large bore IV’s.

Crystalloids (LR) and colloids (albumin) are used for fluid replacement

Based on time injury occurred.

  • – total amount of fluid needed for first 24, then give half in first 8 hours.
  • – (2-4 mL of LR) x (kg) x (TBSA%) = total fluid requirements in first 24 hrs
    • 4 mL used for electrical burns to prevent renal damage
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15
Q

How do you tell if fluid replacement in burn victims is adequate?

A

measure urinary output

min of 0.5 to 1 mL/hg/hr (30-50 mL/hr)

75-100 mL/hr for electrical injuries

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16
Q

Restless burn victim? Think:

A

pain

hypoxia

inadequate fluid replacement

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17
Q

Albumin

A

colloid

  • administered after first 24 hrs once capillary permeability is normal
  • Helps to hold onto fluid in vascular space
  • increases vascular volume which increases renal perfusion, BP, and CO
  • increases workload of heart bc it’s increasing volume
  • WATCH FOR FVE / you’ll know if the CO begins to decrease, you hear crackles or wetness in the lungs
  • Measure CVP hourly to ensure you’re not overloading the client!
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18
Q

Why do we give IV pain meds to burn victims?

A

It’s faster!

IM won’t work if the muscle is damaged or not being perfused.

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19
Q

Immunizations with burns.

A

Tetanus Toxoid (active immunity) –> takes 2-4 wks to develop immunity

Immune globulin (passive immunity) –> immediate protection

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20
Q

Infection control with burns

A

Systemic Antibiotic Therapy

Topical Medications

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21
Q

Systemic Antibiotic Therapy with Burns

A

broad-spectrum avoided (superinfection, secondary infection, sepsis)

    • broad-spectrum used until wound cultures return.
    • COLLECT CULTURES BEFORE ADMINISTERING ANTIBIOTICS

-mycin durgs –> watch for BUN and creatinine increases (nephrotoxicity)
and for hearing loss (ototoxicity)

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22
Q

Topical Meds and Burns

A

Why? Reduced blood flow = IV meds may not get to tissues

Silver dressings are antimicrobial.
Left in place for 3-14 days

1) mafenide acetate - acid/base problems likely / stings / reapply if it rubs off
2) silver nitrate - keep wet / electrolyte problems likely
3) antimicrobial ointments - antibacterial coverage / promote moist wound

alternate methods so tolerance isn’t developed

*CHECK FOR SULFATE ALLERGY

How to apply? Thin layer w sterile gloves

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23
Q

Debridement

A

1 ) enzymatic debridement

  • —- sutilains or collagenase eat dead tissue
  • ——- don’t use on face (scarring)
  • ——- don’t use if pregnant
  • ——- don’t use over large nerves
  • ——- don’t use if open to body cavity

2 ) hydrotherapy

  • —- pain management before this therapy
  • —- immersion hydrotherapy (whirlpool) can cause cross-contamination bt injuries
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24
Q

Grafting

A

Autograft = own

surgeon can re-harvest from same donor site every 12-14 days

blue or cool skin graft = poor circulation
—- may use syringes or pressure to try and work any fluid or air out from under graft to help w adherence

Graft = cover w wet NS gauze
Donor site = dry gauze

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25
Q

Nutrition and burn victims

A

more caloric intake needed

should start 1-2 days postburn

PROTEIN & VITAMIN C to promote healing

Check Pre-Albumin to check for proper nutrition
— pre = more sensitive lab

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26
Q

Complications w Burns

A

Circulation

Renal system (watch for renal failure / anuria / FVE)

Electrolyte imbalances

GI system (stress ulcer / paralytic ileus / ascites)

Contractures

Infection

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27
Q

Circulation and Burns

A

Circ. Check: cap refill / pulses / color / temp

Elevation can reduce swelling.

escharotomy & fasciotomy - relieves pressure and restores circulation

fasciotomy is deeper

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28
Q

What is the renal system going to do in burn pts?

A

kidneys will try to retain fluid (or are not being perfused)
—– this means you may put in catheter and get no urine return or see brown or red urine

Mannitol can be used to flush out kidneys. When urine is clear, d/c drug.

anuria or oliguria = renal failure

After 48 hours, client will begin urinating again. Fluid is going back into vascular space (cap permeability normalizes / albumin pulls fluid into vasculature again)

NOW we worry about FVE and NEED kidneys to increase output.

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29
Q

Will potassium be high or low in burn victims?

A

HIGH!

Potassium is stored inside of cells, so when cells rupture, it leaks into the blood.

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30
Q

What is prescribed to treat stress ulcers?

A

magnesium carbonate

pantoprazole (protonix)

famotidine (Pepcid)

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31
Q

Another name for stress ulcer

A

curling’s ulcer

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32
Q

Antacids

A

aluminum hydroxide gel

magnesium hydroxide (milk of magnesia)

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33
Q

H2 Antagonists

A

famotidine (pepcid)

nizatidine

34
Q

Why do we have burn client NPO w NG tube hooked to suction?

A

prevent paralytic ileus

  • decreased vascular volume (GI is not gonna be perfused)
  • decreased GI motility
  • Hyperkalemia

===we don’t want food sitting in GI tract and rotting

with NG feedings CHECK RESIDUALS to make sure its moving

35
Q

Client w burn doesn’t have bowel sounds. What will happen?

A

increased abdominal girth / ascites

36
Q

Burn pt with NG tube will have it removed when?

A

we hear bowel sounds

37
Q

How to prevent contractures w burn pts

A

wrap each finger separately

splints

hyperextend neck (no pillows)

38
Q

Chemical Burns

A

remove chemical and flush for 15-30 min w cool water or sterile saline

brush powder chemicals off first and then flush

39
Q

electrical burns

A

2 wounds (entrance & exit)

First thing is continuous heart monitoring for 24 hrs.

At risk for V. FIB

myoglobin and hemoglobin can build up and cause renal damage

amputations common bc circulatory system is wrecked.

Other complications: cataracts, gait problems, neuro deficit.

40
Q

What is the number one cause of preventable cancer?

A

tobacco

41
Q

suspected dietary causes of cancer

A

low fiber diet (low residue)

increased red meat

increased animal fat

nitrites (processed sandwich meats)

alcohol

preservatives and additives

42
Q

Risk Factors of Cancer

A 
tobacco
alcohol
dietary causes 
--- low fiber diet
--- increased red meat and animal fat
--- nitrites (processed sandwich meat)
--- alcohol
--- preservatives and additives
obesity
physical inactivity
poor nutrition
immunosuppressed
AA
hereditary
UV radiation
carcinogens (diesel, exhaust, asbestos)
stress
chronic irritation (smoking, GERD)
hx of cancer or chemotherapy
43
Q

Primary prevention for cancer

A 
no smoking
exercise 
good nutrition
normal body wt
limit alcohol
vaccines for preventable (HPV and hep. B)
avoid known carcinogens
sunscreen
44
Q

What two cancers can be prevented by vaccines?

A

HPV and Hepatitis B

45
Q

Secondary Prevention Methods for Cancer (female)

A

monthly breast exams (day 7 through 12 of the menstrual cycle / right when period is about to end)
Clinical breast exams every year greater than age 40. (every 3 yrs for 20-39)
mammogram annually at 40 (no lotions, powder, deodorant)
pap swears starting at 21 and every 3 yrs
colonoscopy at 50 and every decade after
test for blood in stool yearly starting at 50

46
Q

Secondary Prevention Methods for Cancer (male)

A 
yearly clinical testicular exams
monthly testicular self-exams
digital rectal exam at age 50
colonoscopy at 50 and every decade after
fecal occult blood testing yearly after 50
47
Q

S/sx of cancer

A 
CAUTION
C - change in bowel / bladder habits
A - a sore that does not heal
U - unusual bleeding / discharge
T - thickening or lump in breast etc.
I - indigestion or difficulty swallowing
O - obvious change in wart or mole
N - nagging cough or hoarsness

anemia, leukopenia, thrombocytopenia –> bone marrow cancers

unexplained weight loss –> cachexia (extreme wasting and malnutrition)

fever –> blood cancers and lymphoma

fatigue (due to anemia / #1 symptom)

pain

48
Q

Blood Tests with Cancer

A 
Abnormal CBC and differential
---- worry about NEUTROPHIL count
Elevated liver enzymes (AST and ALT)
---- increases if liver is damaged
Tumor markers (biomarkers)
49
Q

Positive Diagnostic Studies

A 
Chest X-ray
CT scan
MRI
PET scan
Bone marrow biopsy
tissue biopsy
imaging studies
50
Q

Types of Cancer Treatment

A

Surgery (curative surgery & reconstructive surgery)

Radiation therapy

    • Internal Radiation (brachytherapy)
    • External Radiation (teletherapy, external beam radiotherapy)
51
Q

Why is surgery a treatment for cancer?

A

Prevention (removing pre-cancerous or benign masses)

Diagnosis (staging, biopsy, lymph node mapping)

Treatment (removal of tumor)

52
Q

Total laryngectomy. What is it? And how do we care for it post op?

A

removal of vocal cords, epiglottis, and thyroid cartilage

Since the whole larynx is removed (including epiglottis) they will have a permanent tracheostomy o.

Position post op? sitting up / semi-fowlers

NG feedings to protect suture line (don’t want peristalsis)

monitor drains

watch for carotid artery rupture or rupture of innominate artery (bleeds from trach)
—- if this happens, send back to surgery (emergency)

frequent oral care

NPO so watch for pneumonia

bib for trach to act as a filter (keep powder away from trach)

humidified environments help decrease secretions
— all breathing is done through stoma

53
Q

How does a client with total laryngectomy talk?

A

special devices (electrolarynx or blom-singer)

Can’t whistle, can’t drink through straw, not recommended to smoke or swim.

54
Q

Post op care following a mastectomy

What about if lymph nodes were removed?

A

bleeding –> check dressings front and back (pooling)

if reconstructive surgery uses their own tissue, they will have abdominal surgical site

Hemovac or Jackson Pratt drains

encourage use of that arm (brushing hair, squeeze tennis balls, wall climbing, flex and extend to promote circulation)

  • *If lymph nodes were removed:
      • avoid procedures on affected arm for the rest of their LIFE
        • —- no constriction (BP, tight sleeves, watch, or purses on that side)
        • —- no IV or injections
        • —- wear gloves when gardening, watch small cuts, no nail-biting and no sunburn
55
Q

Two types of Radiation Therapy

A

Internal Radiation (brachytherapy)

External Radiation (teletherapy, external beam radiotherapy)

56
Q

Internal Radiation (bracytherapy)

A

gets radiation close to the cancer or target tissue

internal radiation = INSIDE body

emits radiation and is a hazard to others for a time

It can be sealed or unsealed

General Precautions: time, distance, shielding

57
Q

Unsealed vs. Sealed or solid

A

Unsealed: client and body fluids emit radiation

- radioisotope given IV or PO
- radioactive for 24 to 48 hours

Sealed or solid: client emits radiation; body fluids are not radioactive
- temporary or permanent implants placed close to tumor
- ex. prostate cancer = implantable seeds
cervical cancer = vaginal implant

58
Q

Precautions with Internal Radiation

A

nursing assignments rotated daily

nurse should only have 1 client with radiation implant at a time

private room

film badge (tells you how much radiation you’re getting)

limit visitors to 30 min/day at 6 ft away

  • – no visitors less than 16 yrs
  • – no pregnant visitors / nurses

mark room with instructions on isotope

wear gloves

59
Q

How can you help prevent dislodgment of the implant?

A

keep client on bedrest
decrease fiber in diet
prevent bladder distention

60
Q

You see an implant become dislodged and you see it, what do you do?

A

gloves, use forceps to pick up dislodged implant, place in lead-lined container, leave in room, call radiation department

61
Q

Should patient with internal radiation sleep in same bed as their spouse? Use public transportation? Return to work immediately? Share utensils or cook for others? Only have to flush once after using bathroom?

A

no to all

62
Q

External radiation

A

teletherapy / external beam radiation

beam of high energy delivered OUTSIDE of body

client is NOT radioactive

don’t wash off, use lotion, or get sun exposure on markings for 1 year

63
Q

Side effects of external radiation

A

limited to exposed tissues

erythema (redness)
shedding of skin
fatiuge
pancytopenia (all blood components are decreased)

64
Q

Full Chemotherapy Precautions

A

chemotherapy gown - must be coated to prevent contamination / change immediately

two pairs of chemotherapy gloves that are thicker and longer than standard (one under gown, one over gown cuff)

goggles / mask if splashing or inhalation can occur

65
Q

Chemotherapy is excreted for ______ days after administration.

A

3 to 7 days

wear two pairs of gloves and a chemotherapy gown (face shield if splashing)

66
Q

disposal of chemotherapy

A

yellow, rigid chemotherapy waste container used for sharps and IV equipment

yellow chemotherapy waste bag used for gowns, gloves, disposables

wash w soap and water after removing gloves

67
Q

What to do if a chemo spill occurs?

A

wash hands w soap and water

get spill kit from wall in clients room

put on respirator mask

put on chemotherapy gown

put on 2 sets of gloves

put on goggles

use absorbent pads to wipe up spill

68
Q

Major complications with chemotherapy

A

Extravasation (vesicant is chemo drug that causes necrosis if infiltrated)

- s/sx of extravasation - pain, swelling, no blood return
- stop infusion ASAP / stay with client / send for extravasation kit
69
Q

Transplants

A

Bone marrow and stem cell transplants are used for hematologic cancers.

Stem Cell Transplant –> stem cells transplanted from blood stream

Bone Marrow Transplant –> stem cells transplanted from bone marrow

*stem cells are given IV and settle into bones later

70
Q

GI Side Effects of Cancer and/or Cancer Treatment

A

N/V - most common after tx / esp 24-48 hrs after treatment

* ondansetron (serotonin receptor antagonists) given for first wk after chemo
* netupitant / palonosetron (prevents acute and delayed N/V) only one dose / one pill / one hour before chemo    * ginger, aromatherapy, acupuncture, acupressure, distraction, relaxation

Stomatitis - oral cavity irritation

Diarrhea - nutrition and F&E imbalances

71
Q

Integumentary Side Effects of Cancer and/or Cancer Treatment

A

alopecia

mastectomy, amputation, scar

they need to look at the incision

72
Q

Hematopoietic System - Side Effects of Cancer and/or Cancer Treatment

A

bone marrow is supressed (decreased RBCs, WBCs, and platelets)

client is at risk for anemia, infection, and bleeding

Infection is #1 cause of cancer related deaths

73
Q

General Side Effects of Cancer and/or Cancer Treatment

A 
N/V
stomatitis
diarrhea
alopecia
scar
suppressed bone marrow (decreased RBCs, WBCs, and platelets)
fatigue
pain

***client at risk for anemia, infection, and bleeding

74
Q

Precautions to Prevent Infection in Cancer Patients

A

private room / limit visitors and nurses

client has own supplies

change dressings and IV tubing daily

cough and deep breath to prevent pneumonia

no gardening or cleaning up after pets

avoid crowds, wear mask

handwashing (after touching any animal)

drink only fresh water

avoid uncooked foods (meats, eggs)

brush teeth w soft toothbrush 4 times a day

no alcohol-based mouthwash

report temp 100.4 or higher

**** if neutropenic ***
prescribe antibiotics
VS q4hrs
private room w door closed
antimicrobial soap
no invasive procedures (IM, rectal)
Avoid catheters or NG tubes
limit acetaminophen
75
Q

Life-Threatening Complications of Cancer and/or Treatments

A

Neutropenia (tx w antibiotics and neutropenic precautions)
DVTs (2nd leading cause of death)
Thrombocytopenia

76
Q

How to calculate Neutropenia

A

ANC - absolute neutrophil count

2500 - 8000 cells/mm is normal

77
Q

Why are DVT’s prevalent in cancer patients?

A 
prolonged bedrest
surgery
use of central line
external compression of vessels by tumor
invasion of vessels by tumor
certain chemo drugs

DVT’s can lead to PE

78
Q

Thrombocytopenia in Cancer pts

A

decrease in platelets = bad clotting = bleed risk

you can give platelets

79
Q

Risk factor for Thrombocytopenia

A 
advanced metastatic disease
hematological malignancies
bleeding disorders (hemophilia, liver dz, ITP - idiopathic thrombocytopenia purpura)
bacterial infections
anticoagulant meds
result of cancer treatments
80
Q

Thrombocytopenia Assessment

A 
Hx
VS
pulse oximetry
change in LOC (headache, pupil changes, anything that makes you suspect intracranial bleed)
conjunctival hemorrhages
petechiae, ecchymosis, purpura
oozing
bleeding from rectum, ears, nose, mouth
81
Q

How to infuse Platelets?

A

never infuse them cold bc the spleen will reject them

82
Q

RBC transfusions are for clients with ?

A

symptomatic anemia

don’t want Hgb/Hct to drop below 8g/dL and 24%

HURST (15 decks)

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