Flashcards in Unit 11 Deck (62)
What is Ewing's sarcoma?
It is a small round tumor found in bone and soft tissues. It is most often found in males 10-20 years old, and usually in the pelvis, femur, radius, ribs, or clavicle. It is usually very painful.
What does the ABCD method of evaluating skin lesions entail?
A= asymmetry B=border irregular C= color variations D= diameter > 5mm
With a stage 1 pressure ulcer, the skin is intact/not intact, is red, and blanches/does not blanch.
Intact. Blanches (because the blood supply is still intact)
With a stage 2 pressure ulcer there is partial thickness loss of the _____ and _____.
How deep is a stage 3 pressure ulcer?
Through the epidermis and dermis and into the sub Q tissue, but not through the fascia.
After a skin graft, is the affected area kept immobilized or exercised regularly?
It is kept immobile for 3-5 days.
What part of the skin does a superficial burn damage? How long does it take to heal?
The epidermis. 3-6 days.
What part of the skin does a superficial-partial thickness burn include? How long does it take to heal?
All of the epidermis and some of the dermis. 10-21 days
What part of the skin does a deep partial thickness burn include? How long does this take to heal?
All of the epidermis and deep into the dermis. 2-6 weeks.
Pertaining to partial thickness burns, which type blanches easily? Which type has blisters? Has the most pain?
Superficial partial thickness blanches, has blisters, and is painful.
What does a deep partial thickness burn look like?
Blanches slowly, if at all, is red/dry with white areas where burn is deeper.
What does a full thickness burn look like?
Covered in hard, dry, leathery eschar, waxy white, yellow, deep red, brown, black, with thrombosed vessels visible.
What happens to blood vessels after a severe burn?
Initially they constrict, but they quickly dilate and permeability increases causing capillary leak of plasma (proteins). As proteins leak into the interstitial spaces, fluid follows.
What electrolyte imbalances occur with a severe burn?
Hyperkalemia due to dying cells releasing potassium. Hyponatremia, due to sodium shift into the interstitial spaces.
What happens to the blood after a severe burn?
Due to dehydration, HGB/HCT/osmolarity↑.
After a severe burn, when does fluid begin to shift back to the vessels?
It starts at about 24 hours after.
After a severe burn, when does capillary leak stop?
About 48-72 hours after injury.
When fluids shift back into the cells and vessels after a burn, what happens to sodium and potassium levels?
Hypokalemia may occur due to its moving back into the cells and being excreted by the kidneys. Hyponatremia may remain or get worse due to kidney excretion and wound losses.
What happens to cardiac output after a severe burn?
It drops for 18-36 hours after injury, then returns to normal.
What happens to the gastrointestinal tract after a severe burn?
Blood flow is decreased to the area slowing peristalsis. Curling’s ulcers may develop due to reduced mucosal production. Give Zantac/Nexium, etc.
What happens to body temp after a severe burn?
Temp may reset to a higher level due to hypermetabolic state.
What happens to blood glucose after a burn? Heart rate? Respirations?
What are the S/S of pulmonary injury from burns?
Hoarseness, brassy cough, drool, difficulty swallowing, wheezing/stridor.
If you are treating a burn patient and his wheezing suddenly stops, what do you do?
Prepare to intubate, the airway is closing off.
According to the rule of 9’s, what % of total area is burned if a patient has burns covering an entire arm, his face and chest, and half his abdomen?
Explain the rule of nines.
Legs=18% each. Arms=9% each. Chest/upper back=18% each. Head =9%
What is the Parkland formula?
The formula for determining how much crystalloid fluid (lactated ringers) to give a burn patient over 24 hours. 4 mL/kg/% TBSA burned.
If a patient weighed 200 pounds, and had burns covering the fronts of his arms, his chest and abdomen, and the front of both legs from the knee up, how much fluid would he need in the first 24 hours?
14,727 mL. Double check me on this one and let me know if you get the same answer!
If a patient needs 24,000 mL of fluid in the first 24 hours, is it given in boluses, or do you just divide 24000 by 24 and set the drip rate?
Half is given in the first 8 hours from the time of injury, NOT from the time the entered the facility! The second half is given over the remaining 16 hours.