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NURS 3512 acute & chronic > Week 8 burns > Flashcards

Week 8 burns Flashcards

1
Q

The 3 priorities in emergent stage

A

Airway- respiration
Circulation - Fluid status
Kidneys - dysuria/anuria

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2
Q

On a pathalogical level, what specifically makes HIV a problem?

A

It enters CD4+ T-cells and stops them from being a part of the immune response

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3
Q

What are the 4 ways HIV is transmitted?

A
  1. Blood
  2. Semen
  3. Vaginal secretions
  4. Breast milk
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4
Q

What CD4 level are HIV infections asymptomatic and can fight infection?

A

> 500

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5
Q

What are the characteristics of stage 1 HIV?

A
  1. acute stage
  2. CD4 count >500
  3. Maybe has viral symptoms
  4. short lasting
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6
Q

What are the characteristics of stage 2 HIV?

A

1.long stage (can last 10+ yrs untreated)
2. Few symptoms
3. CD4 count 200-499

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7
Q

What stage of HIV do we most commonly see in hospital?

A

Stage 2- early chronic stage

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8
Q

What are the characteristics of stage 3 HIV?

A
  1. late chronic infection
  2. CD4 count <200
  3. profound reduction in immunity
  4. susceptible to opportunistic infections and malignancies
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9
Q

What stage of HIV is considered AIDS and what is the CD4 count?

A

stage 3
<200 CD4

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10
Q

What stage of HIV is susceptible to opportunistic infections and malignancies?

A

Stage 3

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11
Q

What two interventions help when immune system is weakening in patients with HIV?

A
  1. prophylaxis - immunizations
  2. drug therapy for opportunistic diseases
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12
Q

What are the 6 opportunistic infections/diseases for someone with HIV?

A
  1. Oropharyngeal candidiasis
  2. Shingles
  3. Pneumonia
  4. Tuberculosis (TB)
    5.Kaposi sarcoma
  5. Cryptosporidiosis
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13
Q

What are the symptoms of PN?

A

fever
chills
productive cough
dyspnea

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14
Q

What is the treatment for PN?

A

Antibiotics (Septra)

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15
Q

What are the 3 things we can do/monitor for PN?

A
  1. resp assess
  2. DB & C
  3. supplimental O2
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16
Q

What are the symptoms of TB?

A

fatigue
malaise
anorexia
night sweats
weight loss
crackles
cough- blood sputum

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17
Q

What is the treatment for TB?

A

isonizaid/rifampin/pyrazinabmide

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18
Q

What are the things we monitor/do for someone with TB?

A

Airborn pecuations
Good hand washing
proper soiled tisse disposal

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19
Q

What are the symptoms of oropharyngeal candidas- thrush?

A

White patches/cottage cheese
pain

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20
Q

What is the treatment for oral thrush?

A

antifungal - Nystatin swish or swallow

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21
Q

what are 3 ways to prevent getting oropharayngeal candidiasis?

A
  1. Rinse mouth after liquid antibitotics
  2. use spacer for inhalers
  3. Good hand washing
  4. good oral hygiene
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22
Q

What are the symptoms of cryptosporidiosis? (parasitic infection)

A

Diarrhea

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23
Q

What are the precautions for TB?

A

airborne - negative air room

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24
Q

What is the treatment for cryptospoidiosis?

A

Anti-protozoals

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25
Q

What are 3 things nurses can do/monitor for cryptospoidiosis?

A
  1. Monitor I &O
  2. Electrolytes
  3. nutritional status
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26
Q

What are the symptoms of karposi sarcoma?

A

small, purplish-brown lesions on skin and mucous membranes

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27
Q

What is the treatment for karposi sarcoma?

A

chemo
immunothearpy

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28
Q

What do we teach people with karposi sarcoma?

A
  1. elevate limbs if swollen
  2. compression stockings
  3. protect skin - like if gardening
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29
Q

What is the symptom of shingles- varicella zoster virus?

A

painful rash along a nerve pathway (often around torso)

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30
Q

What is the treatment for shingles?

A

antiviral (acyclovir)

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31
Q

What can nurses do for someone with shingles-varicella zoster?

A
  1. Manage pain & Itching
  2. Educate about virus transmission when blisters burst
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32
Q

What are the 6 things nurses should teach someone who is immunocompromised?

A
  1. Adequate nutrition (good protein & calories)
  2. Adequate fluid intake- avoid dehydration
  3. Rest & manage fatigue - naps
  4. Infection control - contact, airborne, aerosol, etc
  5. Skin integrity - protection from infection
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33
Q

What are the 3 questions to answer for “Classification of burn?”

A
  1. what kind of burn?
  2. How extensive?
  3. How deep ?
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34
Q

What are the 3 “stages of a burn?”

A
  1. emergent
  2. acute
  3. rehabilitative
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35
Q

What are the 5 kinds of burn?

A
  1. Thermal
  2. Chemical
  3. Electrical
  4. Smoke-related
  5. Radiation
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36
Q

What is the most common type of burn?

A

Thermal burns

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37
Q

How do we measure “extent of burn?”

A

%
TBSA (total body surface area)
rule of 9’s (%)

38
Q

What burn extent is considered a major burn?

A

partial or full thickness burn
>20% TBSA

39
Q

How many stages (classification) are there of burn and what are they called?

A

1st degree - superficial partial thickness
2nd degree- deep partial thickness
3rd & 4th degree- full thickness

40
Q

What stages can a person regenerate their skin when burned and what is the condition required for this?

A

Superficial partial thickness and deep partial thickness
IF there is some dermis left to regenerate

41
Q

What stage burn is skin glossy, red, blisters/swelling?

A

Deep partial- thickness burn

42
Q

what does Full thickness burn look like?

A

dry, dark skin
looks charred
no blisters
dermal layer is gone

43
Q

Which type of burn does not have pain and why?

A

Full thickness burn b/c nerve endings are destroyed

44
Q

What is escharotomy and why is it performed?

A

A cut through eschar tissue b/c of inflammation that causes compartment syndrome under the eschar
- circumferential burn (all the way a round a limb/torso)

45
Q

When we talk about burns, what is the difference between “extent”,”kind” , and “classification” ?

A

kind = thermal, chemical etc. (cause)
Extent = TBSA % burned
classification - degree

46
Q

How long is the emergent (resuscitation) phase of a burn?

A

24-48 hours

47
Q

What is the goal during the emergent burn phase?

A

Save their life

48
Q

What is the major problem in the emergent stage we are concered with?

A

capillary leak = fluid shifts
Leaks OUT of the vascular system so BP plummets = changes in vitals

49
Q

How long is the acute stage of burn?

A

48-72 hours

50
Q

What is the major problem in the acute stage we are concerned with?

A

Capillary leak stops = diuresis
- vital changes
- fluid overload (HF careful)
- lytes imbalance

51
Q

How long is the rehabilitative phase of burn?

A

2 weeks up to 7-8 months

52
Q

What is the major issue in rehabilitative burn?

A

Adjusting to living

53
Q

What is important to observe around the face of someone in the emergent phase and why?

A

-Soot/smoke around their face.
-singed facial hair
Respiratory can still be compromised

54
Q

What are 5 warning signs during emergent phase that there’s a change in resp.?

A

1.SOB
2. wheezing and/or stridor
3. voice change-hoarsness
4. drooling
5. swallowing difficulty

55
Q

Do we assess circulatory system first or Airway first and why in emergent stage?

A

Airway. b/c you can have blood circulating well but if there’s no gas exchange, we have useless blood

56
Q

what HR do we want to stay under in burns in emergent phase?

A

<120 bmp

57
Q

what systolic BP do we want to stay under in burns during emergent stage?

A

> 90

58
Q

during the emergent stage, will K+ be high or low and why?

A

High b/c of tissue damage
Put on heart monitor

59
Q

during emergent stage, will Na be high or low?

A

Na will be low because water leaves the vascular system and Na follows

60
Q

What are the priorities during the emergent stage?

A
  1. Airway
  2. fluid therapy
    3 &4. Wound care & analgesia & immunization tetanus
  3. infection
61
Q

What type of AKI can happen in burns and why?

A

intrarenal AKI d/t rabdo because of the intense tissue damage in the body

62
Q

What are the 2 goals of the acute stage of burn?

A
  1. fighting infection
  2. support wound healing (nutrition)
63
Q

Why is nutrition important for someone in the acute phase of burn ?

A

because they are hypermetabolic

64
Q

Which phase of burn can require multiple trips to the OR for debridement/grafting?

A

Acute phase

65
Q

In what phase do we get the burn patient moving to avoid contracture?

A

Acute phase

66
Q

What phase of burn is psychological care especially important?

A

Acute phase

67
Q

What phase is pain management very important?

A

acute phase

68
Q

What does acticoat have in it and how many days does it stay on?

A

Acticoat
has silver
Sterile water activates the silver and that kills broad spectrum of bacteria
3-7 days then change

68
Q

What do nurses focus on in the acute stage of burn?

A

Wound care:
prevent infection
promote healing
Clean/debride
take care of donor site

69
Q

What is Flamazine?

A

An anti-microbial cream that is sometimes used

69
Q

What is the gold standard for burn dressing?

A

Acticoat

70
Q

What two dressings are most used for burns?

A
  1. Acticoat
  2. Adaptic
71
Q

What is debridement?

A

removing necrotic tissue

72
Q

What are the 5 types of skin grafts?

A
  1. *autograft
  2. CEA (cultured epithelian grafts - slow, 8-12 weeks)
  3. artificial skin
  4. Allograft (human cadaver skin)
  5. Xenograft (animal)
73
Q

What is used in the rehabilitation phase to help prevent lifting and scaring?

A

compression garment

73
Q

What dressing are donor sites covered with?

A

Hydrophillic foam dressing after harvesting

74
Q

What type of nutrition is required in the rehabilitation phase of burn?

A

normal diet as tolerated

75
Q

How long should people keep their grafts out of the sun for?

A

at least the first year

76
Q

What are the primary goals of rehabilitation phase?

A
  1. wound care as required
  2. functional support
77
Q

What disease affects wound healing for those with burns?

A

Diabetes melitis

78
Q

What disease affects fluid status for those with burns?

A

heart issues - fluid overload

79
Q

What are the 5 things we do for frostbite?

A
  1. soak in lukewarm bath slowly
  2. Analgesics
  3. Elevate affected limb - b/c inflammation
  4. monitor for compartment syndrome
  5. Antibiotics - if infection/tetanus shot
80
Q

What 2 things do we not do for frost bite?

A
  1. do not rub the skin
  2. no heavy blankets or hot water
80
Q

What is demarcate?

A

the end of healthy tissue and the beginning of dead tissue

81
Q

What is sepsis?

A

An extreme response to infection that can cause tissue damage, organ failure and death if not treated quickly

82
Q

What can sepsis lead to if not treated quickly?

A

septic shock

83
Q

What are the possible signs of sepsis?

A

low O2
Fast RR
dysuria/anuria
cognition and affect changes
Fever
signs of infection
BP drops b/c fluid shifts out of cells = lack of tissue perfusion = shut down

84
Q

Who are 5 patients at high risk for septic shock?

A
  1. Immunocompromised
  2. Large open wound- burns
  3. Invasive procedures- burns
  4. Age over 80
  5. Chronic illness
85
Q

what is the MAIN problem in septic shock?

A

Low perfusion = organ ischemia = organ shut down

86
Q

What are early signs of septic shock?

A

Elevated HR, decreased BP
Skin warm and flushed – body is trying to compensate by increasing CO
Restless, confused

87
Q

What are the late signs of septic shock?

A

Cold, clammy
Mottled- purple dusky colour
Bradycardia and decreased BP
Lactate increase (anaerobic metabolism that kidneys can’t deal with) = acidosis
Anuria = no urine output

88
Q

What are the 5 things we do for someone in septic shock in the first hour?

A

1.Measure Lactate level
2.Obtain blood cultures
3.Administer broad-spectrum antibiotics
4. Rapid administration of IV crystalloid fluid for hypotension
5. Vasopressor if blood pressure low after fluid resuscitation

NURS 3512 acute & chronic (29 decks)

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