Adult Flashcards
Burns
- Assiss for airway patency
- Admin O2 as prescribed
- Obtain VS
- Assist to initiate an IV line and begin fluid replacement as prescribed (prevents hypovolemic shock)
- Elevate the extremities if no fractures are obvious
- Keep patient warm and maintain an NPO status
Extensive burns result in generalized body edema and a dec in circulating intravascular blood vol.
Fluid loss results in a dec in O2 perfusion
Urinary output is the most reliable and most sensitive noninvasive assessment parameter for cardiac output and tissue perfusion. (Report output of <30 mL/hr or >50 mL/hr)
Avoid IM and subcu med admin
Diuretics are not used
NPO until bowel sounds are heard. Start with clear liquids.
Wound closure is performed on day 5 to 21, depending on the extent of the burn
Autograft: immobilize and elevate graft site for 3 to 7 days
Phases of Care:
Resuscitation/Emergent- Begins at time of injury; Lasts 48-72 hrs
Resuscitative- Begins with the initation of fluids; Ends when capillary integrity returns to near-normal levels and large fluid shifts have dec
Acute- Begins when patient is hemodynamically stable, capillary permeability is restored, and diuresis has begun; Starts 48-72 hrs after time of injury
Rehabilitative- Overlaps acute phase; Extends beyond hospitalization
Rule of 9’s Adult
Head: 9% Anterior Torso: 18% Posterior Torso: 18% Arms: 9% each Legs: 18% each Perineum: 1%
Burn Location Complications
Head, Neck, Chest: Pulmonary complications
Face: Corneal abrasion
Ear: Auricular chondritis
Hands and Joints: Require intensive Tx to prevent disability
Perineal: Prone to autocontamination by urine and feces
Circumferential Burns on Extremities: Can produce a tourniquet-like effect and lead to vascular compromise (Compartment Syndrome)
Circumferential Burns on Thorax: Lead to inadequate chest wall expansion and pulmonary insufficiency
Direct Thermal Heat Injury
Inhalation of steam or explosive gases, ot the aspitation of scalding liquids.
Damage to upper or lower airway.
Topical Glucocorticoids
Can be absorbed into the systemic circulation; absorption is greater in permeable skin areas (scalp, axilla, face and neck, eyelids, perineum) and less in areas where permeability is poor (palms, soles, back).
Biopsy
The definitive means of diagnosing cancer and provides histological proof of malignancy.
Lymphoma
- Positive biopsy of lymph nodes, withe cervical nodes most often affected first.
- Presence of Reed-Sternberg cells in nodes
Hysterectomy
Vaginal bleeding post op: >1 saturated pad/hour may indicate excessive bleeding; report to RN
Colostomy
Pink stoma indicates low H&H
Oncological Emergencies
- Sepsis
- DIC (Disseminated Intravascular Coagulation)
- Syndrome of Inappropriate ADH (can lead to hyponatremia)
- Spinal Cord Compression
- Hypercalcemia
- Superior Vena Cava Syndrome (pressure from tumor blocks blood flow)
- Tumor Lysis Syndrome (Occurs during Tx; lots of tumor cells are destroyed leading to hyperkalemia or high uric acid in the blood)
Notify the RN and PHCP immediately if signs of an oncological emergency occur
Thyroid Scan
Contraindicated in: Pregnancy and Iodine Allergy
Diabetes Insipidus
Hyposecretion of ADH
Cause: Stroke, Surgery, Trauma, Idiopathic
Central DI: dec ADH production
Nephrogenic DI: Adequate ADH; kidneys not appropriately responsive
Addisons’s Disease
- Adrenal Cortex Insufficiency
- Cause: Autoimmune destruction (usually)
- Hyposecretion of glucocorticoids, mineralcorticoids, androgen
- Lethargy; Fatigue; Muscle weakness; Gastrointestinal disturbances; wt loss; Menstrual changes; Impotence; HYPOGLYCEMIA; HYPONATREMIA; HYPERkalemia; HYPERcalcemia; Postural hypotension; hyperpigmentation of the skin
- Diet: High protein, high carb
- Calcium and Vit D supplementation
- Lifelong glucocorticoid replacement
- Inc. Corticosteroids during times of stress
- Addisonian Crisis: Life-threatening; Precipitated by stress/infection/trauma/surgery/ubrupt withdrawal of exogenous corticosteroid use; Can cause hyponatremia, hyperkalemia, hypoglycemia, and shock
Cushing’s Disease and Syndrome
-Hypercortisolism
-Cause: Metabolic disorder from chronic and excessive production of cortisol (overstimulation of the adrenals by the pituitary gland)
OR
from the administration of glucocorticoids in large dose for several weeks (or longer).
-Generalized muscle wasting and weakness; Moon face; Buffalo hump; Truncal obesity with thin extremitites, supraclavicular fat pads; wt gain; Hirsutism; HYPERglycemia; HYPERnatremia; HYPOKALEMIA; HYPOCALCEMIA; HTN; Fagile skin that easily bruises; reddish-purple striae on the abdomen and upper thighs
Hypothyroidism
- Lethargy; Fatigue; Weakness; Muscle aches; Paresthesia; Cold intolerance; Wt gain; Dry skin/hair; Loss of body hair; Bradycardia; Constipation; Generalized puffiness and edema around the eyes/face; Forgetfulness; Memory loss; Menstrual disturbances; Cardiac enlargement/Tendency to develop heart failure; Goiter may or may not be present
- Low T4; High TSH
- Levothyroxine sodium: most common thyroid replacement med
- Cause: Thyroid is underproducing; Pituitary is not stimulating the thyroid
- Myxedema Coma: Results from persistently low thyroid production
