exam 2- musculoskeletal, shock, trauma, burns Flashcards
(336 cards)
1
Q
CT scan-
does what
uses what
A
provides 3d pictures to evaluate trauma
uses contrast dye
2
Q
Mri
uses what
watch for what
A
uses radioactive fields to visualize structures and diagnose-
wathc for metal stuff
3
Q
Duplex venous ultrasonography-
shows what
diagnosis what
A
shows how well blood moves in legs
diagnoses dvt
4
Q
Bone Scan-
what looks at
what does increased uptake mean
make sure
A
visualses bone
- uptake is increases in osteomyelitis, osteopsos, and cancers//
make sure pt is hydrated
5
Q
Arthroscopy
looks into what
A
–looks into diseases of the knee and may remove fluid
6
Q
Arthrocentesis-
does what\
after you do what
A
needle that obtains synovial fluid from joint-
after need to apply compression
7
Q
Serum Calcium lab value-
what does decreased mean
what does increased mean
A
decreased means malabsotpion,
increases means bone cancer/fractures
8
Q
CBC with diff.-
shows what
or what counts
A
show anemia, or platelet counts
9
Q
CMP (BUN, creatinine, sodium, glucose
assessing what
A
- assessing renal function
10
Q
Erythrocyte sedimentation rate (ESR)
detects what
what does high mean
A
- detects inflammation-
high means inflammation
11
Q
PT & INR / PTT-
why important to know
what does low mean- give what
what does high mean- give what
A
important to know for anticoagulant therapy-
low means its clotting fast- give hep/warfarin
high means takes longer to clot- give vit k/ protamine/ FFP
12
Q
Wound culture-
know what
A
know correct specimen for antibiotic
13
Q
Uric Acid-
diagnoses what when elevated
A
diagnoses gout when elevated
14
Q
D-Dimer – what does high diagnose
A
diagnoses dvt/pe
15
Q
Renal Labs-
what assessing
why
A
assessing renal function
- renal labs help in treatment of pt
16
Q
Osteogenesis Imperfecta (Brittle bone disease)
what type of disorder
what bones
A
Connective tissue disorder
fragile bones that are more likely to fracture
17
Q
Osteogenesis Imperfecta (Brittle bone disease)
Clinical Manifestations:
multiple
what sclera
what skin
increased
large
what height
lose what
A
multiple fractures
, blue sclera,
thin and soft skin,
increased joint hyper reflexibility,
large exterior fontanel,
and short height,
will lose hearing
18
Q
Osteogenesis Imperfecta (Brittle bone disease)
diet x2
A
calcium and vitamin d supplements
19
Q
Osteogenesis Imperfecta (Brittle bone disease)
how fast does it happen
who does it happen to
A
Progressive, and diagnosed as child ages
Genetic- affects males and females the same
20
Q
Osteogenesis Imperfecta (Brittle bone disease)
what education
no more what
consult who
A
Education on cast care
No contact sports/ playgrounds/ no tossing in air
Pt/ot consult
21
Q
Osteogenesis Imperfecta (Brittle bone disease)
what risk
manage what
A
fall risk
manage fracture
22
Q
Cast care
what assessment
inspect for
what in cast
keep it what
A
- nuero assessments,
inspect for hot spots,
nothing in cast,
keep clean and dry,
23
Q
Muscular Dystrophy
Types: Duchenne (most common childhood form-genetic-males)
Clinical Manifestations:
see when
difficulty
frequent
tire when
abnomral
positive
A
see around school age
Walking difficulty,
frequent falls,
tires easily with activity,
abnormal gait,
positive Gower’s maneuver
24
Q
Muscular Dystrophy
Medical Management:
is there a cure
what care
prevent what
or what
what care
A
No cure
Supportive care,
prevention of infection (respiratory due to weakness of respiratory muscles)
or spinal deformities
Self care deficits – support family- refer home caer
25
Muscular Dystrophy
weak heart-> leads to what
weak diaprhagm-> leads to what
Will have weakened heart muscle and lead to HF
And have weak diaphragm and lead to respiratory failure/infections
26
Muscular Dystrophy
loss of
chronic
f
Loss of muscle mass
Chronic inflammation
Fibrosis- scaring of tissue
27
Muscular Dystrophy
what chronic meds
Chronic corticosteroid usage to decease inflammation in resp
28
Muscular Dystrophy
may end up w what
will require what
May end up w vent and trach support
Will require a wheelchair
29
Scoliosis
what looks like
causes are what
Lateral S- or C-shaped curvature of the spine
Cause may be congenital, idiopathic, acquired
30
Scoliosis
when do you check
Check around kindergarten -10-12 age before puberty growth spurt
31
Scoliosis Clinical Manifestations
what pain
what back
how walk
what when walking
what gait
: back pain,
curved back,
walk uneven,
sway when walking,
wider gait
32
Scoliosis Mild treatment
pt/ot exercise to decrease the curvature
33
Scoliosis Moderate treatment
: brace (Milwaukee or Boston) to prevent further curvature
34
Scoliosis Severe treatment
: spinal fusion with tortious shell brace
(to prevent instability)
35
Paget’s Disease
what type of disease
affects how many bones
Progressive genetic disease = larger and softer bones
Can affect a single bone or multiple
36
Paget’s Disease
what type of disorder
increased
increased
Disorder with Bone Remodeling
Increased Bone Reabsorption
Increased Bone Growth
37
Paget’s Disease
skeletal
what bones
potential for what
Skeletal Deformities,
Fragile Bones,
potential fractures(risks for bleed , clot and infection)
38
Paget’s Disease
in what bones
how do bones look (L/S/U)
Excessive bone reabsorption and excessive bone formation in long bones like legs
Bones become large, soft and unstable
39
Paget’s Disease Complications
what pain
a
d
increased risk
- bone pain,
arthritis ,
deformaites,
inc fracture risk,
40
Paget’s Disease Diagnose w
bone scan,
xray
ct
mri
41
Paget’s Disease Draw what labs
serum alkaline phosphate
and a calcium
42
Paget’s Disease Treatment
what meds
how do those work
biphophates (aledronate) and also calcitonin –
increases strength of bone
By inhibiting bone reabsorption
43
Paget’s Disease
decreased what risk
by decreasing risk for what
Decrease risk for bleed by decreasing risk of fracture
44
Pagets disease- supplements x2
Supplements- calcium and vitamin d
45
Amputations
what is amputation
what is primary
what is secondary
Partial or total removal of extremity
primary- emergency event
secondary- chronic disease
46
Amputations
Can you think of any diseases and or risk factors for amputation?
o
d
p
h
hyper
c
osteosarcoma(bone tumor)
Diabetes,
peripheral vascular disease,
HTN,
hyperlipidemia,
cardiovascular disease
47
Amputations Are there any Health Promotions that can be utilized to aid in prevention?-
get what
increase what
education on what
get glucose under control,
increase exercise,
education on nutrition
48
Amputations Complications
I
d h
p p
c
infection
delayed healing
phantom pain
contractions
49
Amputations Infection s/s
d
r
f
what hr
what bp
– drainage,
redness,
fever,
high hr
low bp
50
Amputations
Delayed healing
s
decreased
what imbalances
–smoking,
decreased cardiac output,
electrolyte imbalances
51
Amputations Phantom pain
treat w what
t
m
p m
- treat w
tens,
mirror,
pain meds
52
Amputations Contractures
teach what
what excercises
- teach to extend joint to prevent,
rom excercises
53
below knee amputation
assessment
p
s
lab
wound
temp how often
pain
skin
wbc
wound-redness/edems
temp every 4-8 hrs
54
below knee amputation
pt teaching
do what appropriatly
stump what
positioning what
resume
wrap stump appropriately
stump exercises
positioning of stump
resume physical activity asap
55
Trauma associated Amputations -Save the digit if possible!
put on what
dont put where
keep it what
Put on ice but not in ice- like in plastic bag in ice
Don’t put in any liquid like water/milk- don’t want it to get mushy/ infection
Keep it cool if you can
56
When should a tourniquet be considered?
only when
if its small- then do what
Only if massive hemorrhage-
if its something small- wrap it and keep above head to decrease bleeding and hospital asap
57
Trasnverse fractures
linear fractures-
Transverse- fracture across bone
Linear- fractue long way
58
oblique nondisplaced-looks like
obloquy displaced- looks like
Oblique nondisplaced- looks like / and bone is intact
Oblique displaced looks like / bone split
59
Spiral fracture
- curves around bone
60
what does stable fracture mean
what does unstable fracture mean
Stable means bone maintains alignment
Unstable means bone moves out of alignment
61
if there's an open fracture
risk for what
need what
what support
penetrates skin- risk for infection
- needs antibiotics,
nutritional supports, vit c, diet
62
Closed
inc risk of what x2
- inc risk of hemorrhage and bleed
63
Fracture care in emergency
what to fracture
maintain
prevent
immobilize fracture,
maintaine perfusion
prevent infection
64
Fracture care - splint
maintains what
prevents what
maintain normal alignment
prevent dislocation
65
fractures
diagnosed w
what decreases pain
Diagnoses with x ray
Nsaids will decrease pain
66
fracture care-diet
high
high protein
high calcium
67
Traction fracture care
prevents what
do not do what
- prevents muscle spams by constantly pulling on fractured bones
, do not remove weights
68
Fractures nursing diagnosis
Manage acute pain
monitor
move pt how
put affected extremity where
encourage what
adminster what
-monitor vs
, move pt gently or slowly,
elevate above heart,
encourage adjuntive like deep breathing or relaxation
, administer meds as persribed
69
Fractures nursing diagnosis
Reduce risk for impaired peripheral neruoravasucal function-
assess what
monitor fr what
monitor what in cast
asses perfusion,
assess nail beds,
monitor for edema,
monitor tightness of cast
70
Fractures nursing diagnosis
Reduce risk of infection-
what technique
administer what
promite what
sterile technique,
administer antibiotics,
promote nutritional intake,
71
Fractures nursing diagnosis
Promote physical mobility-
turn how often
teach what
turn every2 hrs,
teach rom on limbs,
72
Rib fracture
Flail chest: -what looks like
impairs what
Fractures: Trauma related
fracture of 2 or more adjacent ribs in 2 or more places free-floating segment that moves in opposite direction of rib cage
impairs respirations
73
Rib fracture
what 2 complications
Fractures: Trauma related
pneumothorax and hemothorax
74
Pelvic fracture
montior for what
what is sign of that
Monitor for hemorrhage!
if blood is coming out of urethra could be sign of internal hemorrhage
75
pelvic fracture
pain where
cant use what/ until when
Might have pain to back or hip area(may signify internal bleed),
No foley catheters until all bladder/urethral trauma have been cleared-
76
pelvic fracture
how move them
keep what
how many people
can logroll for movement-
keep shoulders in line w hip
have multiple people help.
77
Femure fracture
monitor for what
monitor for what else
what to leg
frequent what
Monitor for hemorrhage!
Monitor for fat embolism,
stabilize leg,
frequent assessments
78
Very vascular in pelvis-
need to think how
what is priority
pelvic fractures
Need to think of bleed- they are a bleed until proven otherwise
Priority is bleeding and ruling out bleeding- because its very vascular in pelvis
79
pelvic fracture diagnostics
get what
what if bleeding
ct of abdomen and pelvis
ultrasound if bleed
80
Immobile and broke a big bone-
preventing what
how
pelvic fracture
prevent blood clots-
scd, compression socks, anticaogs
81
pelvic fracture
dont move unless what
no foley until when
also ned to watch what
Don’t move unless log role- improper movement can cause damage- shoulder in line with hip
No foley unless you’ve ruled out trauma
Also think about fat emboli- watch for s/s
82
when to get ultrasound in pelvic fracture
if complaining about
what pain
what other pain
what type of pelvic pain
pelvic fracture
Lower abdominal pain,
low back pain,
pelvic pain like cramping or shooting-
83
Rib Fractures -> Flail chest
is ti bad
occurs w what
Medical emergency- flair chest
Can occur w cpr, motor veihicle accident, fall, sport injury
84
Rib Fractures -> Flail chest
try not to do what
keep what
Try not to move unintentionally -
keep chest straight
85
Rib Fractures -> Flail chest
when do you give chest tube
Chest tube depends on if anything is in plueral space
86
Rib Fractures -> Flail chest
Its incredibly painful to breath, so they are
what breathers
risk for what x2
shallow breathers
puts them at risk for atelectasis and pneumonia
87
how to prevent pneumonia -what meds x2
make sure what
prevent w pain relief- opioids and nsaids
are sure to is on pain schedule
88
what do you give if they have pneumonia
s
f
may need what
steroids
fluids
maybe need intubation
89
Rib Fractures -> Flail chest
watch what x2
what means may need chest tube
watch symmetry and lung sounds
if one side isn’t moving then may need chest tube or x ray
90
Rib Fractures -> Flail chest
Rn after procedure of chest tube
assess how often
have pt do what//nurse do what as well
check system why
Assess respiration status every 4 hrs,
have patient take deep breathes (if painful pre-medicate)
check the system to ensure that drainage is patent and that the tubing is free of dependent loops or kinks
91
rn chest tube
make sure stays what
document what
risk for what
what do you do if chest tube comes out
make sure its sealed
document how much drainage
risk for clots
place sterile petroleum jelly over to prevent air from coming in
92
Chest tube management could be used for what
place for what x2
place for
pneumothorax (air in pleural space)
hemothorax ((blood in pleral space)
93
Femur (long bone) Fractures
Why are there higher risks for complications in a long bone fracture vs a small bone fracture?-
because the long bones are highly vascular and contain more blood
94
What are the surgical interventions for this fracture? (Procedures)
Femur (long bone) Fractures
normally, a metal rod is inserted into leg
95
What is the nurse’s role in management of this disorder? post op
assessing what w pt
Femur (long bone) Fractures
assess cap refill
pedal pulses
all vitals
96
What are the potential complications?
Femur (long bone) Fractures
Dvt/pe
97
Femur (long bone) Fractures
what is key
decreases what
Early stabilization of fracture is key
- Risk for fat emboli decreases when you put leg straight out Because bone marrow cant leak into system
98
Complications of musculoskeletal Trauma
pressure from what
f e
d
I
I h
disruption of what
Pressure from edema and hemorrhage
Fat emboli
Deep venous thrombosis (PE)
Infection
Impaired healing
Disruption of neural transmissio
99
compartment syndrome-
increased what
due to what
increase pressure
due to blood or fluids accumulation during musculoskeletal trauma
100
compartment syndrome- Usually in lower leg or forearm-
causes what
causes a
leads to what
causes pressure on nerve endings and pain-
causes a decrease in blood flow to area
And leads to ischemia
101
compartment syndrome-Manifestations-- inflammation around muscle constricting blood flow, builds up pressure-
a lot
decreased
what defecits
a lot of pain,
decreased palpable pulses
Circulatory and nuero deficits(cant feel or cant move things like toes)
102
compartment syndrome-
what happens if not releived
if not treated it can cause what x2
If not relieved the patient can go into rhabdo( intrinsic aki)
If not treated asap it can cause sepsis and irreversible muscle trauma
103
compartment syndrome- interventions
what immediately
remove any what
Alleviate pressure immediately!
Remove any tight fighting dressing, casts, or clothing
104
compartment syndrome- Fasciotomy
what is it
incision is left to what
surgical incision of the muscle fascia to relive pressure within the compartment.
Incision is then left open to heal.
105
compartment syndrome-
won't do what
put what on
Will not recast them-
put a splint on and let it heal
106
Interventions- compartment syndrome -What is patient at risk for?
I
o
n
additional
mostly 24-48 hrs after limb surgery
infection
osteomyelitis,
necrosis,
additional nerve damage,
107
fat embolism- how does it work
Fat globules released from the bone marrow into the bloodstream due to Fx lodge in pulmonary vascular bed or peripheral circulation →S/Sx of embolism respiratory failure or death due to pulmonary edema
108
fat embolism-
What is the difference between blood clot (PE) & fat embolism?
what only occurs in fat embolism
difference is that is not a clot , it is a bunch of bone marrow,
petechiae only occur w fat embolism (because of clotting cascade due to fracture)
109
fat embolism
cant give them what
will be on what
Never give these patients heparin- already have thrombocytopenia
Will be on corticosteroids to reduce inflammation and pulmonary edema
110
fat embolism- may need what available
What kind
may need blood products available
plasma and FFP- contain cloning factor
111
fat embolism Diagnosis Lab:
what
ESR
Ca
rbc/platelts
what lipase
what diagnostic
↑ESR,
↓ Ca+,
↓ RBC & platelets,
↑ lipase level
angiogram- diangostic
112
fat embolism
cant use foley until when
no foleys until identified that there is no internal bleed,
113
Interventions- fat emboli
prevention- early what
Early stabilization of long bone fracture
114
Interventions- fat emboli
similar to blood clot embolism except
need prompt what
anticoagulants are not indicated (oxygen)
Prompt identification
115
Interventions- fat emboli
may require what
May require intubation and mechanical ventilation
116
Pulmonary embolism
what is it
Obstruction of blood flow to pulmonary system due to clot
Fat emboli are most common nonthrombotic PE
117
Pulmonary embolism s/s-
d
s
what pain
c
what hr
what rr
what in lungs
what temp
dyspnea,
sob,
pluertic chest pain,
, cough,
tachycardia,
tachypnea,
crackles in lungs
low grade fever
118
Pulmonary embolism
Prevention
what meds
early
using
- prophylactic anticoags,
early ambulation
, using compress stockings,
119
Pulmonary embolism
Diagnoses w
d dimer
chest ct
120
Pulmonary embolism meds-
what med
what if massive pe
anticoagulant - heparin iv and oral warfarin
massive pe is throbolytics like tpa or streokpinase
121
if anticoagulants fail for pulmonary embolism then you get what
then you need surgery and umbrella filter will be inserted into vena cava to catch emboli
122
Pulmonary embolism
what is antidote for heparin
what is antidote for warfarin
protamine is antidore for herpain
vit k is antidote for warfarin
123
Pulmonary embolism nursing diagnosis-
Promote effective gas exchange-
assess what
record
place where
monitor what
assess resp status,
record loc,
place in high fowlers,
monitor abg,
124
Pulmonary embolism nursing diagnosis-Promote aqeuqute cadiac output-
listen to what
record
assess
monitor
admisnter
listen to heart sounds,
record i/o,
assess skin color,
monitor cardiac rhythm,
administer meds as ordered
125
Pulmonary embolism nursing diagnosis-Reduce risk for bleeding and hemorrhage-
assess
keep what
avoid what
maintain what
maintain
asses for bleeding,
keep antidotes at bedside,
avoid invasive procedures,
maintain firm pressure on injection sites,
maintain adequate fluid intake
126
Deep Vein Thrombosis
Indirect causes include
what blood flow
what injury
increased what
↓ blood flow
Blood vessel injury
Increased clotting due to reaction to blood loss
127
Deep Vein Thrombosis-Prevention measures
what to fracture
early what
Immobilization of fracture
early ambulation
128
Deep Vein Thrombosis-Interventions
need for what
what meds
what devices
need for assessment in fractures (checking neruo in legs, feet, pulses, check BIL) & immobility,
anticoagulants (also prophylactic),
compression stockings
129
Deep Vein Thrombosis-If pts are complaining of-
what pain
t
s
w
r
calf pain,
tenderness,
swelling ,
warmth,
redness
130
DVT
pt may do what
feels like what
what is tall tale sign
Pt may rub,
feels like Charlie horse in spot,
tall tale sign is very specific area of pain,
131
Deep Vein Thrombosis
stop what immediately
STOP rubbing/ DO NOT massage,
132
Deep Vein Thrombosis
diagnosis
get venous ultrasound
and d dimer to diagnose
133
Deep Vein Thrombosis Treat w/ what meds
Anticoagulants LMW heparins(enoxaparin) and oral warfarin or potneitnal surgery
134
Deep Vein Thrombosis-When taking anticoags-
report what
use what
what toothbrush
no what drink
no what food
no what med
report any bleeding
, use electric razor,
soft bristle toothbrush,
no alchohol,
no vit k,
no nsaids /aspirin
135
Deep Vein Thrombosis- how could it be avoided
increased
elevating
giving what
placing
Increased ambulation and movement
Elevating foot of bed
Give prescribed phrolactic meds – LMW heparins or oral
anticoagulants
Placing SCD and TEDS
136
DVT nursing diagnoses- Manage pain-
assess
measure
apply
assess pain,
measure calf,
apply warm heat,
137
DVT nursing diagnoses- Promote tissue perfusion-
assess p
assess s
what to extremities
knees what
what applainces
change positions how often
asses pulses,
assess skin,
elevate extremities,
knees slightly bent,
weight dispersion appliances, c
hange positions every 2 hrs
138
DVT nursing diagnoses-Reduce risk for bleeding-
report what
monitor what
report any bleeding,
monitor labs(inr, aptt),
139
DVT nursing diagnoses- Promote mobility-
encourage what
_ and _ _
increase what
assist w
encourage rom,
C and DB,
increased fluid intake
, assist w ambulation,
140
Infection (could lead to osteomyelitis)
inc risk when
more likely in what
↑ risk when blood supply is decreased
More likely in open than closed fractures because bone is exposed to enviroemnt
141
osteomyelitis may be caused by what
may lead to what x2
May be caused by contamination from injury or surgery
sepsis and tissue death & necrosis
142
Infection (could lead to osteomyelitis)-Most at risk are delayed healing
d
p
chronic
m o
-Diabetics,
peripheral vascular disease,
chronic neuropathy,
morbidly obese
143
Infection (could lead to osteomyelitis)-Antibiotics-
may need what
what ones are used
watch what
may need picc or iv
vanco/genta mycin is used or ceft drugs-
watch renal labs-
144
Infection (could lead to osteomyelitis)
Nutrition:
decrease want
offer what
possible what
what 2 vitamins
decrease sugar and complex carbs,
offer protein,
possible increae in calcium and zinc,
vit d and c_
145
Infection (could lead to osteomyelitis)
what environment
obtain what
watch for what
Get inro cool environment
Obatin vitals,
watch for s/s of sepsis
146
Infection (could lead to osteomyelitis)
diagnostics
(WBC) ,
pro calcitonin,
esr( sepsis and inflammation) ,
flat panneled x ray,
maybe mri,
bone scan
147
Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome
manifestations
what pain
s
b
changes in what
decreased what
(occurs after nerve or musculoskeletal trauma)
Persistent pain,
swelling,
burning,
changes in skin color and texture,
decreased motion r/t CNS or PNS damage
148
Treatment: what agent
Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome (occurs after nerve or musculoskeletal trauma)
sympathetic nervous system blocking agent
(local anesthetic)
149
meds:
n
t
g
c
Reflex Sympathetic Dystrophy/Complex Regional pain Syndrome
(occurs after nerve or musculoskeletal trauma)
NSAIDs,
Tramadol(narcotic),
Gabapentin(nerve pain),
Clonidine patch (antihypertensive)
150
Delayed union - what is it
(lack of healing after 6mths)
151
Nonunion- what is it
persistent what
(lack of healing) →
persistent pain and movement at the fracture site →
152
will need what in nonunion
need for surgical intervention for potential refusion or new screws put in
153
what happens if non union healing happens in elderly
may need palliative care
bed lift, bed ridden, may hospice- control pain
154
What are factors that negatively influencing healing?
a
h
what status
what diseases
s
- age,
health,
immune status
, chronic diseases,
smoking
155
nutrition in msk injury
increase what
p
c
f/v
what 2 vitamins
protien
calcium
fruits/vegtables
vitamin d/b12
156
what foods to avoid in MSK injury
complex carbs and high sugar
157
Types of Trauma
m v m
major vs minor
158
types of blunt trauma
d
a
s
c
c
Deceleration
Acceleration
Shearing
Compression
Crushing
159
what is penetrating trauma
Foreign object enters the body
160
I
b i
i_ _
types of trauma
inhlation
blast injury
Intimate partner violence
161
what is class 1
class 2
class 3
trauma
Class 1 Life-threatening
Class 2 Multiple injuries
Class 3 least severe
162
what is lethal trio
h
a
c
hypothermia
acidosis
coagulopathy
163
Trauma: primary survey (assessment)
a
b
c
d
e
A- Airway establishment, c-spine immobilization (hold neck straight)
B- Breathing – ventiallary indepedeance
C- Circulatory – cap refill, skin color, temp, pulses
D- Disability- Neuro checks, pupils, response to stimuli
E- Exposure/full body assessment to determine what happened
164
Trauma- will need what-preferably
what is golden hour
Need an iv- preferably as large as possible aSAP/
golden hour is when prompt treatment helps prevent against death
165
Secondary survey (subjective -SAMPLE)
F
G
H
I
F- Full set of vitals
G- Giving comfort, physical and emotional
H- Head to toe and H&P
I- Full Inspection
166
Trauma :: Head/Neck (airway obstruction) Highest PRIORITY ->
maintenance of what
stabilize what- when let it go
maintenance of airway
stabilization of cervical spine- c spine must be cleared before you can let go
167
Trauma :: Head/Neck (airway obstruction)
Jaw thrust-
if when
this will do what
if pt is unresponsive,
this will manually open airway
168
Trauma :: Head/Neck (airway obstruction)
always give what
maybe what
Always give high flow 02,
maybe Combitube or endotracheal intubation
169
Trauma :: Head/Neck (airway obstruction)
pts tend to do what when in trauma
Pts tend to hyperventilate when they are in trauma
170
Trauma :: Head/Neck (airway obstruction)
What else would you assess for the airway?
Look listen and feel
what depth
what chest
t d
check what
assess risk for what
Respiration depth
Symmetrical chest
Tracheal deviation
Check JVD and chest trauma
Assess risk for flail chest- cpr or rib
171
Trauma :: Thoracic Effects-
Pneumothorax (Tension) manifestations
j
severe
t d
JVD,
severe distress,
tracheal deviation/
172
what do you need immediately w tension pneumothorax
need immediate needle thoracostomy
(large bore needle into 2nd ICS @ MCL
then insert chest tube)
pulls out air so lungs can re-expand
173
Trauma :: Thoracic Effects
Flail Chest (on MSK trauma PP)-
see what s/s
and d
will require what
sinking w inspiration and protrusion w exhalation-
dyspnea-
will need surgery or mechanical vetntilation
174
Trauma :: Thoracic Effects-
Thoracic contusion-
what is it
impairs what
bruisding of thoracic tissue-
impairs gas exchange due to hemorrhage
175
Trauma :: Thoracic Effects-Diaphragmatic rupture-
what is it
causes what
herniation of abdominal contents into thoracic cavity
, causes respiratory comprimise
176
Trauma :: Thoracic Effects
Cardiac tamponade
what is it
will need what
blood in pericardial sac
need pericardiocentesis-
177
pericardiocentesis
large bore needle into pericardial sac into heart and remove fluid
178
Trauma :: Thoracic Effects
Aortic rupture (most likely fatal)- why fatal
by time they can get the treatment they need they died from hypovolemia
179
chest tubes are places where
always assess for what
chest tubes may be placed at bed side
Always assess for uneven inspirations
180
What is difference between placement from hemothorax and pnemothorax
h- bottom
p- on top
181
what is triss score
TRISS score Use age of pt., type of trauma, systolic BP, RR, injury severity score, and GCS to predict survival
182
Emergency Department Care
get a what
if pt. is conscious or bystanders –
try to figure out what
Thorough assessment,
if pt. is conscious or bystanders – need to get as much history and what happened as possible!
– try to figure out what type of injury it was- interview everyone
183
KNOW: in emergency department care
Blood type,
cross and match,
CBC,
ABGs,
alcohol level,
urine drug screen
, preg. test,
imaging (CT, MRI)
184
try to do what
also need to get what type of tests
Emergency Department Care diagnosis
Try to identify the pt/
get cbc, renal function and liver function because it can affect how you care for pt
185
Diagnostic peritoneal lavage–
what happens
what means a problem
Emergency Department Care diagnosis
large bore needle attached to syringe-
if flank blood is taken out then the pt is immediately taken back to or for laparotomy-
186
what is Diagnostic peritoneal lavage used to diagnose
Emergency Department Care diagnosis
used to determine if there is internal bleeding wherever the lavage is performed (
187
Medications trauma->Blood components & crystalloids
do what
Replace volume
188
Inotropic & vasopressive meds -dopamine- epinepherine-
purpose is to do what:
increase what:
causes what:
Medications trauma
purpose is to increase Cardiac output-
Increase myocardial contractility
Cause vasoconstriction so that blood stays in core and organs are perfused
189
remember what w inotropic meds
Remember ”you cannot squeeze a dry tank!” Give fluids first and in conjunction give the inotropics but do not give just inotropics. Meds won’t work without enough fluids.
190
Medications trauma-Opioids
used for what
use
need what first
used for pain
Be sure to use carefully,
need full assessment first-watch bp and respiratory
191
Medications trauma-Immunizations
give what
If unable to remember or not within the last 5 years – give a tetanus booster
192
meds- trauma
full of what
replaces what
what type of iv fluid
LR (ringer lactate, lactated ringers)
Electrolytes
Replaces fluid volume/Volume replacement
Isotonic
193
NS (0.9% sodium chloride)-meds
replaces what
what type of iv fluid
only fluid
trauma- meds
Replaces fluid volume/Volume replacement
Isotonic
Only fluid given w/ blood
194
Whole blood- meds trauma
replaces what
contains what
risks are what
Replaces blood volume & 02
Contains everything (RBCs, plasma, etc.)
Risks: incompatibility and FVO
195
Packed RBCs
replaces what
increases HGB by what
do what prior
no what
trauma meds
Replaces 02 carrying capacity
1 unit = increase of hgb by 1 g/dL
Warm prior to admin if indicated and ordered
No clotting factors
196
Platelets
used for what
raises by how much
trauma meds
Used for thrombocytopenia
1 infusion = raise platelets by 30,000-50,000
197
Albumin
is what
do not
can be used
trauma meds
Blood expander- Expands blood volume in shock
Do not substitute for whole blood
Can be used for diuresis
198
FFP (fresh frozen plasma)
used for what
what before
has what
used for when
trauma meds
Used for coagulopathy
Thaw before using
Has clothing factors
Use for pt. on coumadin involved in trauma to stop bleeding
199
Cryoprecipitate
used for what
w low
trauma meds
Used for coagulopathy
w/ low fibrinogen
200
blood typing
+ can receive
- can reive
what each letter can
+ = +,-
-= -
each letter can get its own letter
201
Transusion reactions-Febrile
causes what
- causes fever and chills in first 15 minutes
202
Transusion reactions-Hypersensitivity
u
i
- urticaria(reddeded wheals)
and itching
203
Transusion reactions
Hemolytic-clumping of rbc,
what in face
what in vein
h
what bp
what pain
flushing of face,
burning on vein,
Headache
, hypotension,
lumar pain
204
Other risks- transfusion reactions
c o
imbalances
I d
circulatory overload,
electrolyte imbalances,
infectious diseases
205
Manage airway clearance
might have
increased
monitor x2
Interventions (post initial trauma) A,B,C, I
Might have tracheostomy
Increased confusion = check 02!
Monitor loc and 02
206
Risk of infection
Clostridium (if laying out in field for awhile)
MRSA, necrotizing fasciitis, tetanus
h
what precaution
provide what x2
Interventions (post initial trauma) A,B,C, I
Hand hygiene,
standard precautions,
provide fluids and nutrition
207
Impaired mobility
provide what
_ and _ _
I s
want to prevent what
Interventions (post initial trauma) A,B,C, I
provide active or passive excercises,
Cough and deep breathing,
Incentive spirometry,
prevent DVT/PE, Fat emboli,
208
mental Interventions (post initial trauma) A,B,C, I
Grief & loss
New coping
Transition of care to home or other facility
209
trauma-emergency surgery
indicated when
despite
and there is
Indicated when patient remains in shock,
despite resuscitation
and there is no obvious external sign of bleeding
210
Organ Donation
Consent given by donor & another person
Encourage individuals to express what they want
211
Shock
what is it
lack
Systemic imbalance between oxygen supply and demand (O2 and/or perfusion issue)
Lack of oxygen to the cell
212
To maintain homeostatic regulation need:
sufficient
uncomprimised
sufficient
healthy
Sufficient CO (cardiac output)
Uncompromised vascular system
Sufficient volume of blood
Healthy tissues that use 02
213
what is cardiac output=
how calculate
amt. of blood pumped with each contraction
SV x HR
214
flow rate for nasal cannula
2-6
215
flow rate for simple face mask
6-10
216
flow rate for Ventura mask
3-10
217
flow rate for non rebreather
10-15
218
flow rate for high flow nasal cannula
30-60
219
SVR
resistance of peripheral circulation
220
map goal
goal
need what for perfusion
70-110
*need to be at 60 to have proper perfusion
221
MAP drop
how calculate
subtract top from bottom
then divide this number from the original top number
222
Stage 1 stage of shock
map drops how much
volume drops how much
MAP drops less than 10 mmHg from normal levels
(volume decreased by 500 ml)
223
Compensatory shock
map drops how much
volume how much
MAP falls to 10-15 mmHg from normal levels
(volume decreased by 25-35%)
224
Stage 2 stage of shock
map how much
volume drop how much
MAP of 20 mmHg from normal levels
(volume decreased by 35-50%)
225
Stage 3
what type of shock
what type of care
Refractory or Irreversible Shock (Death is imminent) –
comfort care- body is no longer compensating
226
Stage 1-Early, Reversible
what MAP
what decrease in blood volume
map drop less then 10
decrease less then 500 mls
227
Stage 1-Early, Reversible
Sympathetic nervous system
increases what x2
which does what
shock compensation
increases heart rate and the force of the cardiac contraction
which increases the cardiac output
228
Stage 1-Early, Reversible
Sympathetic stimulation also causes what
increases what
shock compensation
peripheral vasoconstriction
which increases MAP
229
Stage 1-Early, Reversible
symptoms:
what hr
what map
will see what lab
Slight increase in heart rate
Slight decrease in MAP
see an increase in lactic acid
230
Stage 1.5-Compensatory Shock
map drops how far
volume drops how far
MAP drops 10-15 below baseline
volume drops 1000
231
Stage 1.5-Compensatory Shock
what hr
what bp
slight what
Hr will be up,
bp slight down,
may have slight changes in loc- confusion and lethargic
232
Stage 1.5-Compensatory Shock
give pt what
because may need
Make sure to give pts fluids-
may need inotropic drugs and they need fluids to work-
233
Stage 1.5-Compensatory Shock
need what
need a detailed
Need to put 02 on pateitn
- need a detailed nuero assessment
234
Stage 1.5-Compensatory Shock
try to get what
replace what w what
try to get multiple large bore iv,
replace volume w whole blood, fluids
235
Stage 1.5-Compensatory Shock
labs
Cbc w diff,
want h/ h,
some electrolytes,
inflammatory like sed rate // esr//c reactive protein// pro cal/ lactic acid
236
Stage 1.5-Compensatory Shock
Sympathetic nervous system releases what x2
causes what
Compensatory mechanisms
epinephrine and norepinephrine
-causing vasoconstriction, increased cardiac output and increased peripheral perfusion
237
Stage 1.5-Compensatory Shock- The RAA system response occurs as perfusion to the kidneys decreases–
converts what
results in what
which does what
Compensatory mechanisms
this conversion of Angiotensin I to Angiotensin II
results in the kidneys absorbing water and sodium
which increases the blood volume…maintaining MAP
238
Stage 1.5-Compensatory Shock-The hypothalamus releases adrenocorticotropic hormone-
secretes what
retain what
Compensatory mechanisms
secretes aldosterone-
retains water and sodium
The posterior pituitary releases antidiuretic hormone
239
Stage 1.5-Compensatory Shock-
As MAP falls in this stage, a fluid shift from
where to where
does what
Compensatory mechanisms
interstitial space to the capillaries occur
raising blood volume
240
compensatory mechanisms do what
however......
stage 1.5- compensatory shock
Compensatory mechanisms are able to maintain blood pressure and thus tissue perfusion to vital organs, preventing cell damage
The compensatory mechanisms can only maintain MAP for a short period of time, if proper treatment is not provided shock will progress
241
Stage 2: Intermediate or Progressive Shock
map how far
blood volume how far
Begins after MAP falls 20mmHg below baseline
Blood volume loss of 35-50% ( 1800-2500mL of fluid)
242
Stage 2: Intermediate or Progressive Shock
what happens to compensatory mechanisms
but cant what
Compensatory mechanisms remain activated,
but can no longer maintain MAP for organ perfusion
243
Stage 2: Intermediate or Progressive Shock
what happens to cells
cells where become hypoxic
Cells become oxygen deficient from the sustained vasoconstriction
Cells in the heart and brain become hypoxic
244
Stage 2: Intermediate or Progressive Shock
Affected cells switch from
what to what
causes what to form
what is now present in body
aerobic to anerobic metabolism
causing the formation of lactic acid---
Acidotic State in the body is now present
245
Stage 2: Intermediate or Progressive Shock
fluid goes where
Then Fluid shifts back into the interstitial space
246
Stage 2: Intermediate or Progressive Shock
what is diminished
Perfusion
to skin, skeletal muscles, kidneys and GI organs are diminished
247
Stage 2: Intermediate or Progressive Shock
--General state of acidosis and hyperkalemia ensues that waht
If not treated RAPIDLY, the patient will become Stage 3 or Irreversible
248
Stage 2: Intermediate or Progressive Shock-Need to transfer to icu
pt feels how/ may not be
what rr
what bp
what hr
sense of what
what skin
Pt will feel horrible/ may not be respsonsive or not making snese
tachypnic,
bp down
hr up,
impending doom
cold clammy skin
249
what helps acidosos
what med
what else
sodium bicarbonate
fluids
250
Stage 3: Refractory or Irreversible Shock
what happens
Death of cells is followed by death of tissues, which results in death of organs
251
Stage 3: Refractory or Irreversible Shock
what is initiated
are in what
Comfort care is initiated- in patient hospice-
are in metabolic acidosis
252
Stage 3: Refractory or Irreversible Shock
may be what
can give what
Msy be intubated-
can give pain meds-
253
Hypovolemic shock
what type of problem
what decreases
happens from what
Volume problem
venous blood return decreases
Can happen from trauma, massive bleeding,
254
Hypovolemic shock s/s
what bp
what skin
what hr
what pulse
hypotensive
pale cool clammy skin
high hr
thready pulse
255
Hypovolemic shock
replace what- w what
what type of meds
what device
replace volume- replace blood and fluids
Vasopressers- dopamine
Intubation to hemodynamically stable
256
Hypovolemic shock- what happens if it is from a bleed
go to or and fix bleed
257
Cardiogenic shock
what isn't working
decrease in what
increase in what
Pumping mechanism is not working
decrease in cardiac output
increase in 02 demand
258
when do you see cariogenic shock
end stage CHF
end stage COPD
259
cardiogenic shock s.s
what bp
what hr
what rr
s
w
a I
c
what in lungs
what skin
hypotension
tachycardia
increased rr
SOB,
wheezing,
, activity intolerance,
cyanotic
, crackles in lungs
cool clammy skin
260
Treatment?
what iv
what therapy
v
cariogenic shock
iv fluids
02 theray
vasopressors
261
obstructive shock
what is it
from what
obstruction in heart or vessels
from tamponade, pneumothorax, PE
262
obstructive shock s/s
decreased
reduced
decreased cardiac output and bp-
reduced tissue perfusion
263
Obstructive shock
treat what
treat cause-
like anticoagulants,
oxygen,
treat effects of disease
264
what is septic shock
Pathogens entered in blood, ruptured cell membranes are toxic and disrupt vascular, coagulation, immune, inflammatory system
265
who does septic shock happen to
Immunocompromised pts are at risk-
chemo, imunosuppresents, chronic illness, traumatic injury, old adult, poor nutrition, smokers
266
Septic shock- s/s - warm stage
what temp
what rr
what bp
what hr
f
w/c
possible
increase body temp,
tachypnea,
hypotension,
tachycardia-thready
, flushed,
weakness/chills,
possible diarrhea
267
Septic shock-If not caught early it will progress to cool stage-
o
what temp
l
change
s
possible
Older adults may skip warm stage
oliguria,
decreased body temp,
lethargic,
change in loc,
shaking, possible anuria,
268
Septic shock
Treatment?
a
what drugs
v
a
c
f
Antibiotics- (mycin/ ceft- broad spectrum)
Inotropic drugs
Vasopressors,
Antivirals
Corticosteriods
Fluids
269
Septic shock
do what if change in loc
Make sure to do glascow coma scale if change in loc
270
Neurogenic shock
what is neurogenic shock
Imbalance between PSNS and SNS causes a dramatic reduction in systemic vascular resistance
271
who does neurogenic shock happen to
Neuro pts like head injury, spine injury, untreated pain, insulin reaction, severe heat exposure,
272
neurogenic shock s/s
change
what bp
what hr
L
o
what temp
change in loc,
hypotension,
bradycardia-pounding,
lethargic,
oliguria,
low core body temp
273
neurogenic shock treatment
do what
dont do what
identify cause and treat cayse
dont overload on fluids
274
potential meds for neurogenic shock
iv what
what therapy
what agents
what if severe bradycardia
iv fluids
02 therapy
intorpoic agents
atropine if severe bradycardia
275
Anaphylactic shock
exposure to what
causes what
Humoral mediated hypersensitivity reaction- vasodilation, pooling of blood leads to hypovolemia
Exposure to allergy
276
Anaphylactic shock
d
w
what appearance
r/a
imdending
p e
what bp
what tempature
what hr
dyspnea,
wheezing,
flushed appearance,
restless/ anxious
, impending doom,
pulmonary edema,
hypotensive,
high body temp,
high hr,
277
swelling where in anaphylactic shock
May have swelling on lips, on tongue, edema in lungs, angioedema,
278
treatment in analphatic shock
e
c
epi
corticosreiods
279
Shock interventions-labs
Hbg/Hct,
ABGs,
Electrolytes,
BUN,
serum creatinine,
blood cultures
, WBC w/ diff,
Cardiac enzymes
280
Shock interventions-meds
Depends on type…diuretics, calcium, antiarrhythmics, antibiotics, epi, antihistamines
281
Shock interventions- 02
ALL pt. need 02! Their 02 Saturation does not matter!
282
Shock interventions- replacing what
fluids and blood
283
Disseminated Intravascular Coagulation (DIC)
what causes thus
what look like
Severe cases of sepsis can lead to DIC
Widespread clotting and bleeding
284
Disseminated Intravascular Coagulation (DIC)
ranges from:
bleeding ranges from-
p
e
p
what bleed
Bleeding ranges from oozing to frank hemorrhage from every body orifice,
petechia,
ecchymosis,
purpura,
gi bleed
285
Disseminated Intravascular Coagulation (DIC)-labs
d dimer,
clotting factor,
h/h,
platelet count
286
Disseminated Intravascular Coagulation
what from where
b
c
d
what hr
what bp
changes
oozing from punctures,
bruising,
cyanosis,
dyspnea,
tachycardia,
hypotension,
mental status changes
287
treatment for DIC
h
f and p
potential
heparin,
ffp and platlets,
potential blood
288
Epidermis- what does it do
it is the protective layer
289
Dermis
houses what
houses nerves and blood vessels
290
subcutaneous
provides what
protects
provide insulation in fat and protects organs
291
Burns can cause what changes
Burns cause physiologic, metabolic, and psychological changes
292
Removal of skin -> changes in what
due to what
Burns
change in functioning of most body systems (metabolic, endocrine, respiratory, cardiac, hematologic, and immune functioning)
due to fluid losses and large inflammatory processes
293
Inhallation burns take priority- s/s
what hairs
what mucosa
what in mouth
what voice
what cough
signed nasal hairs,
excoriated oral mucosa,
soot or black in back of mouth,
horse voice,
frequent cough,
294
Always check mouth- why In burns
can do what
if suspect inhalation injury we will prophylactically intubate them
295
Types of Burns-Thermal
what from what
open
direct
- sclads from steam,
open flames,
direct contact w hot object
296
Types of Burns
Chemical
need to know what
- need to know chemical and antidote
297
Types of Burns
Electrical
l s
and what else
- lighting strike and high voltage electrical current
298
Types of Burns-Radiation
- uv radiation
299
Types of Burns-Inhalation- inhale what
–smoke inhalation
300
Superficial Burn-sunburn or minor injury-
only what is involved
how does skin look
only the epidermis layer of the skin is involved –
skin is pink, no scars
301
Partial Thickness Burn-
Superficial partial thickness-
involves what
what is given
involves upper 1/3 of dermis
– analgesics are given
302
Deep partial thickness-
extends where
needs what(e/G)
extends deeper into dermis – needs excision and grafting
303
Full-Thickness Burn
involves what
looks how
needs what to heal
-involves all layers of the skin-
looks all sorts of yellow/brown and dry,
needs skin grafting to heal
304
Rule of nine
anterior leg-
poster leg-
groin is
abdomen in
butt in
anterior chest is
posterior chest in
each anterior arm is
each posterior arm is
anterior head is
posterior head is
anterior leg- 9 each
poster leg- 9 each
groin is 1
abdomen in 9
butt in 9
anterior chest is 9
posterior chest in 9
each anterior arm is 4.5
each posterior arm is 4.5
anterior head is 4.5
posterior head is 4.5
305
Chest/face/throat burns = what issues
Airway/breathing issues
306
Major burns defined as:
what % in under 40
what % in over 40
what % full thickness burns
over 25% TBSA adults less than 40
> 20% TBSA adults more than 40
>10% TBSA full thickness burns
307
Major burns defined as:any burns where
ANY burns to face, eyes, ears, hands, feet or perineum
308
major burns -
what type of high injury
all what else
High voltage electrical injuries
All inhalation burns or involve major trauma
309
Nursing Interventions :Fluid Resuscitation
needed in what % or more burns
20
310
Nursing Interventions :Fluid Resuscitation- major burns
what type of fluid
through what
want that temp why
Crystalloids (warm LR)
through large bore IV catheters-
want warm because we don’t want them to lose cals through shivering
311
Consensus formula (Parkland formula)
what is formula
administer how mich in 8 hrs, then how much next 16
fluid resuscitation
LR: 2-4 mL x kg x TBSA burn
Administer ½ during first 8 hrs, then remaining for 16 hrs
312
Watch hourly urine – in parkland formula
should be 0.5 mL/kg/hr
313
Respiratory managment - burns
HOB where
what frequently
use what
place tube when
use what
Hob at 30 degrees
Sucction frequently
Use incentive spiroemty
Place a tube if impending airway obstruction
Use humidification in room
314
Medications- burns
-Topical antimicrobial agents
Silver nitrate / Silvadene cream
315
Medications- burns-Pain meds
intravenous what
what before wound care
use what else
keep pt on what
Intravenous narcotics – MSO4 3-5mg q 5-10 min, around the clock initially
benzos 1h B4 wound care
Non-pharm also…temp is good, distractions,
Keep pt on pain schedule
316
Medications- burns-Prevention of gastric hyperacidity (Curling/stress ulcers)
what meds
what else when bs are active
H2 blockers or PPI (Pantoprazole, etc)
Antacid, once BS active x 4 quadrants
317
why give lorazepam in burns
cant give what- what only
to decrease muscle spams from pain
no oral meds until they are stable- IV only
318
Medications- burns-Infection prevention
what vaccine
what meds
what field
what room
Tetanus vaccine
Antibiotics-cephalozolin,, ceftriaxone,
Sterile field all the time
Every room is negative pressure
319
Treatments- burns-Escharotomy
prevents what
how does it work
: prevents compartment syndrome-
make incisions through thickened dead skin to improve circulation
320
Treatments- burns-Pre- escharocotomy
try to get where
may need what x2
try to get them to surgery,
may need to be intubated, pain meds
321
Treatments- burns-Debridement
what is it
: removes dead tissue to allow healing
322
Treatments- burns-Autografting
how does it work
– transplant skin from one spot to over burn
323
Treatments- burns-Autografting
what for healing- risk for
daily assessment of what
elevate what
Immobilization for healing- risk for clots
Daily assessment and skin care as graft heals; mild soaps and lotion
Elevation of new graft sites
324
Health Promotion / Nutrition- burns - how much cals do they need per day
4000-6000 kcal/day
325
may need what for burns
start what to feed/ how fast
Health Promotion / Nutrition- burns
May need supplemental feedings-
Start NG tube feedings within 24-48 hr injury
326
when do you not use NG tube in burns and use TPN
c/s u
b o
other
Curling/stress ulcer,
bowel obstruction
other intolerances
327
TPN
must have what
monitor b g
monitor what levels
monitor what test
must have a CVAD
Monitor Blood Glucose
Monitor electrolyte and protein levels
Monitor kidney and liver blood tests
328
Small burns
clean w what
what tehcnique
apply what
what pain meds
Daily cleaning w mild soap and water
Steril technique for dressings
Apply topical agents
Mild analegiscs
329
Maintatin skin itnergrity-
provide what
elevate where
immobilize graft for how long
move pt how
clean what
Burns nursing interventions
provide wound care,
elevate wound above heart,
immobilize skin graft sites for 3-5 days,
move pt slowly,
clean burns,
330
Maintain fluid balance-
assess what
monitor what
what daily
test what
maintain what environment
Burns nursing interventions
assess bp/hr,
monitor i/o,
weigh daily,
test stools for blood,
maintain a warm eviroment,
331
Manage acute pain-
measure what
adminster what
explain what
Burns nursing interventions
measure pain,
administer analgesics as prescribed,
explain procedure
332
Reduce risk of infection-
daily what
monitor for what
maintain what
Burns nursing interventions
daily wbc counts,
monitor for s/s of infection,
maintain a aseptic enviroemnt,
333
Assist w physical motility-
perform what
apply what
Burns nursing interventions
perform rom, apply splints,
334
UAP can do what
LPN do what
UAP can do vs, urine output. I/o
LPN can give oral meds
335
administration of blood
hand
open
all
spike/and
prime w
prepare/invert
spike
close
prime/ attach
regulate
monitor for
hand hygiene,
open y tubing,
all clamps in off,
spike ns bag and put on iv pole,
prime with ns,
prepare blood-invert2-3 times,
spike blood,
close ns,
prime with blood, attach to vad,
regulate blood flow- initial 15 minutes (rate 60-120 ml/hr)
montor for reaction
336
normal levels
ph
hco3
pac02
ph-acid - 7.35-7.45 alk
hco3-(met acid )22- 26 (met alk)
pac02- (acid )45- 35(alkalosis)
