Tissue Trauma

Question 1

Cryosurgery- what is normal for the wound?

What is not normal?

Answer 1

Normal: looks like a burn, with swelling, blistering and tenderness

Infection: Oozing and pain

Question 2

What is Pityriasis rosea?

Answer 2

rash that usually begins as a large circular or oval spot on chest, abdomen or back.
Called a “herald patch”, this spot can be up to 4 inches across.

The herald patch is typically followed by smaller spots that sweep out from the middle of your body in a shape that resembles drooping pine-tree branches.

Question 3

Burns over ______% is considered critical and possibly deadly.

Answer 3

30%

Question 4

List 5 major categories of tissue trauma

Answer 4

Physical 
Thermal
Chemical
Inflammatory 
Surgical

Question 5

List the 3 category of burns

Answer 5

Thermal
Chemical
Radiation

Question 6

What are 3 zones of every burn injury?

Answer 6

Zone of coagulation (inner)
Zone of stasis (middle)
Zone of hyperemia (outer)

Question 7

How is lead poisoning treated?

Answer 7

Chelation

Question 8

3 methods of healing wounds

Answer 8

First intention healing: surgical incision, no granulation, minimal scar.

Second intention healing: “healing by granulation”. Involves tissue loss.

Third intention: delayed healing- my need to stay open for drainage. Deep wounds.

Question 9

Dehiscence

Answer 9

Disruption of wound healing

Question 10

What is a Curling’s ulcer

Answer 10

acute gastric erosion to the duodenum, which is part of the small intestine. Result of large amounts of stress: severe burns or injuries sustained in a car accident.

Complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis (sloughing) of the gastric mucosa.

Question 11

Clinical signs of renal hemorrhage

Answer 11

Palpable flank mass with ecchymosis and tenderness.

Question 12

Hiatal hernia is caused by

Answer 12

weak diaphragm allows stomach to slide into esophagus
and caused by increased intra-abdominal pressure
Obesity

(NOT intrathoracic pressure and Not esophagus weakness)

Question 13

Symptoms of hiatal hernia

Answer 13

Esophageal reflux
Heartburn
Chest pain
Abdominal pain

Question 14

Pain with appendicitis

Answer 14

Moderate to severe
Begins in epigastrium or periumbilical then shift to rlq and becomes steady.

Lying flat or sitting helps. Knees drawn toward chest helps.

Question 15

Gastric resection

Answer 15

Bowel sounds may not be heard for 72 hours post op.

Monitor for hemorrhage: bright red blood from NG tube, tachycardia, hypotension.

Question 16

What lab is helpful in diagnosing pancreatitis

Answer 16

Amylase

Question 17

What happens to blood sugar with pancreatitis

Answer 17

Elevates due to reduced insulin production

Question 18

Melena

Answer 18

Dark tarry stool

Question 19

Post liver biopsy position

Answer 19

Lie on right side to splint and slow bleeding

Question 20

3 types of integumentary glands and functions

Answer 20

*Eccrine glands - secrete sweat through pores found in the palms of hands, soles of feet, and forehead

• Sebaceous glands - secrete oily sebum and are found on the chest, back, scalp, face, and forehead
• Apocrine glands - secrete sweat via canals along hair follicles in the underarms, pubic area, anus, and nipple are

Question 21

Stages of pressure ulcers

Answer 21

• Stage 1: may be painful, no breaks or tears. reddened and does not blanch.
• stage 2: open skin.tender and painful. The sore expands into deeper layers of the skin. It can look like a scrape (abrasion), blister, or a shallow crater in the skin. Sometimes a blister filled with clear fluid.
• stage 3: tissue beneath the skin, forming a small crater. Fat may show in the sore, but not muscle, tendon, or bone. May have tunneling.
• stage 4: very deep, reaching into muscle and bone and causing extensive damage. Damage to deeper tissues, tendons, and joints may occur. Possible eschar, slough, tunneling.

In stages 3 and 4 there may be little or no pain due to significant tissue damage. Serious complications, such as infection of the bone (osteomyelitis) or blood (sepsis), can occur if pressure injuries progress.

Sometimes a pressure injury does not fit into one of these stages- called unstagable.

Question 22

Stages of burns

Answer 22

• First-degree (superficial) burns: affect only the outer layer of skin, the epidermis. The burn site is red, painful, dry, no blisters. Mild sunburn is an example. Long-term tissue damage is rare and often consists of an increase or decrease in the skin color.
• Second-degree (partial thickness) burns. involve epidermis and dermis. Looks red, blistered, and may be swollen and painful.
• Third-degree (full thickness) burns. destroy the epidermis and dermis. They may go into the innermost layer of skin, the subcutaneous tissue. The burn site may look white or blackened and charred.

Fourth-degree burns. go through both layers of the skin and underlying tissue as well as deeper tissue, possibly involving muscle and bone. There is no feeling in the area since the nerve endings are destroyed.

Question 23

What does potassium do with burns?

What do fluids do with burns?

Answer 23

Potassium leaks from cells into plasma, causing hyperkalemia.

During first 49 hours after burn, capillary permeability increases allowing fluids to shift from plasma to interstitial spaces.

Question 24

Which body system is most affected by plumbism?

Answer 24

Lead poisoning

CNS: interferes with neurotransmitter function and can lead to encephalopathy, deceased intellectual function and behavior problems.

Question 25

Reason for poor wound healing with obesity?

Answer 25

Adipose has inadequate circulation

Question 26

Why does a person with wound get a tetanus shot?

Answer 26

Stimulate antibody production

Question 27

Best h2 receptor antagonist for critically ill patient s with peptic ulcer?

Answer 27

Famotidine

Question 28

What allergies checked before giving chelating agent?

Answer 28

Penicillin

Question 29

Gastric lavage patient position.

And what is it used for and not used for?

Answer 29

Position left side.

Lavage is done for poisoning.

Contraindication for acid, alkaline or hydrocarbon are ingested.

Question 30

How much iv fluid is needed for first 24 hours after a full thickness burn?

Answer 30

3-5 liters in 24 hours

Because of increased capillary permeability, AKA third spacing or capillary leak.

Question 31

Crohn’s disease –

Answer 31

Regional enteritis, most common areas are the distal ileum and colon.
two times more often in patients who smoke.
onset of symptoms is usually insidious, with prominent lower right quadrant pain and diarrhea unrelieved by defecation.
Because eating stimulates peristalsis, the crampy pains occur after meals. To avoid these bouts of crampy pain, patient tends to limit food intake.
intestine may perforate, leading to abscesses.
Fever and leukocytosis.
Chronic symptoms: diarrhea, abdominal pain, steatorrhea, anorexia, weight loss, nutritional deficiencies. Abscesses, fistulas, and fissures are common.
Symptoms extend beyond the GI tract and commonly include joint involvement (arthritis), skin lesions (erythema nodosum), ocular disorders (conjunctivitis), and oral ulcers.

Question 32

ulcerative colitis

Answer 32

recurrent disease of the mucosal and submucosal layers of the colon and rectum.
systemic complications and high mortality rate. Eventually, 10% to 15% develop carcinoma of colon.
predominant symptoms of ulcerative colitis are diarrhea, LLQ pain, intermittent tenesmus, rectal bleeding. may have anorexia, weight loss, fever, vomiting, dehydration, as well as cramping, the feeling of an urgent need to defecate, 10 to 20 liquid stools each day.
Hypocalcemia and anemia frequently develop. Rebound tenderness may occur in RLQ. Extraintestinal symptoms include skin lesions (erythema nodosum), eye lesions (uveitis), joint abnormalities (arthritis), and liver disease.

Question 33

Ileostomy

Answer 33

Long term usually means that all of the large intestine and rectum have been removed.

Question 34

Patient teaching for diverticulitis

Answer 34

Should be instructed to report symptoms of infection or acute exacerbation of diverticulitis such as constipation with narrowed stools (due to inflammation), mucus, pus, blood mixed in stool.
Fluids should be increased to at least two liters per day (if there is no sign of cardiac compromise).
Physical exercise may help relieve constipation.
A high fiber diet may be prescribed, but if diverticulitis is severe, may be NPO.

Question 35

Emergency treatment for aspirin poisoning

Answer 35

inducing vomiting. An emetic, such as syrup of ipecac, is usually given. Vomiting will stop the absorption of the drug by removing it from the stomach. Vomiting is not contraindicated with an overdose of aspirin because the drug causes no damage to tissues in the mouth, pharynx, esophagus.

Question 36

What is purpose of spica cast?

Answer 36

spica cast immobilizes both hips and legs in abducted position to maintain alignment.
Allows for healing of the repaired femoral head.

Question 37

A normal side effect of mannitol

Answer 37

increasing urine output.

As an osmotic diuretic, Mannitol (Osmitrol) reduces fluid cerebral edema by raising osmotic pressure and pulling fluid from edematous cerebral cells thus increasing urine output.

Question 38

Treatment for ingestion of drain cleaner

Answer 38

Drain cleaner almost always contains lye, which can burn the mouth, pharynx, and esophagus on ingestion. Be prepared to assist with a tracheostomy, which may be necessary because of swelling around the area of the larynx.
An emetic is contraindicated because, as the substance burns on ingestion, so too would it burn when vomiting. Additionally, the mucosa becomes necrotic and vomiting could lead to perforations.
Gastric lavage is contraindicated because the mucosa is burned from the ingestion of the caustic lye, causing necrosis. Gastric lavage also could lead to perforation of the necrotic mucosa.
As the burn from the lye ingestion heals, scar tissue develops and can lead to esophageal strictures, a common complication of lye ingestion. Tracheal stenosis would occur if the child had vomited and aspirated. Tracheal varices do not commonly occur after the ingestion of lye or other substances. Although very rare, esophageal diverticula may occur.

Question 39

Most serious complication of lead poisoning

Answer 39

Most of the pathologic effects of lead poisoning are reversible as long as the problem is diagnosed early. The most serious effects are those on the central nervous system (e.g., brain damage, mental retardation, behavior changes)
However, because of screening programs, many children with lead poisoning are diagnosed and treated early. As a result, little if any brain damage occurs that would require children to receive special schooling.

Question 40

Coronary Cardiogenic shock
Vs.
Noncoronary cardiogenic shock
Vs.
Neurogenic shock

Answer 40

Cardiogenic shock occurs as a result of inadequate supply of oxygen to the heart and tissues due to the heart’s inability to contract and pump blood.
Noncoronary cardiogenic shock results from conditions that stress the myocardium or result in ineffective myocardial function, such as dysrhythmias.
Coronary cardiogenic shock occurs when there is significant damage to the left ventricle such as from an anterior wall myocardial infarction. Though the client is taking warfarin, which can cause bleeding and hypovolemic shock from a decrease in intravascular volume, bleeding is not reported.
In neurogenic shock, vasodilatation occurs from a loss of balance between parasympathetic and sympathetic stimulation.