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Medical-Surgical Nursing, 10th Ed., Lewis, Dirksen, Heitkemper & Bucher | Registered Nurse (RN) School Study Aid

Burns Assessment

Stage and Extent of Burn

Dyspnea

Singed Nasal Hairs

Pain

Initial Decrease Urinary Output

Paralytic Ileus

Signs of Inadequate Hydration

Shock

Hypothermia

Hyperkalemia

2 mins

Types of Burns

Superficial Thickness

Sunburn

Superficial Partial Thickness

Blisters

Blanching

Deep Partial Thickness

Little or Non-blanching

Full Thickness

Waxy White, Yellow or Black

Decreased Pain

2 mins

Rule of 9's for Burns

Total Body Surface Area (TBSA)

Head

Chest

Abdomen

Upper Back

Lower Back

Posterior Leg (each)

Anterior Leg (each)

Each Arm

Genitalia 1%

2 mins

Burns Considerations

Maintain Body Temperature

Increased Risk of Infection

Venous Thromboembolism (VTE) Prophylaxis

Curling's Ulcer

Excision and Grafting

Adequate Nutrition

Contractures

2 mins

Stages of Burn Care

Resuscitative/Emergent Phase

Injury to Return of Capillary Permeability

48-72 hours

IV Fluid Replacement

Acute Phase

Diuresis to Near Wound Closure

Wound Closure to Return of Optimal Level

2 mins

Burns Interventions

Ensure Airway Patency

IV Fluid Replacement

Dry Sterile Dressing

Debridement

Elevate Burned Limbs

Analgesics

Silver Sulfadiazine

Escharotomy

2 mins

IV Solutions

Hypotonic (< 280 mOsm/L)

1/4 Normal Saline (0.225% NaCl)

1/2 Normal Saline (0.45% NaCl)

Isotonic (280-300 mOsm)

Normal Saline (0.9% NaCl)

Lactated Ringer's (LR)

Dextrose 5% in Water (D5W)

Hypertonic (> 300 mOsm)

3% or 5% NaCl

Dextrose 5% in 0.45% NaCl

Dextrose 10% in Water (D10W)

3 mins

Parkland Formula

Burn victims

24 hours

TBSA %

x Weight (kg)

x 4

= Fluid Requirement (in first 24 hrs)

1/2 of fluid given in first 8 hours

1 min

Mannitol (Osmitrol)

Osmotic Diuresis

Reducing Intracranial Pressure

Reducing Intraocular Pressure

Renal Failure Prophylaxis

Edema

Fluid and Electrolyte Imbalance

Avoid Use in Cardiac Patients

IV Administration

2 mins

Nystatin

Candidiasis

Vaginal

Oral

Cutaneous

Polyene

Binds Ergosterol

Forms Membrane Pores

Topical form of Amphotericin B

Rash

1 min

Diazepam (Valium)

Anxiety

Seizures and Status Epilepticus

Muscle Spasms

Alcohol Withdrawal

Dizziness/Vision Changes

Confusion/Amnesia

Urinary Incontinence

Behavioral Changes

Respiratory Depression

Flumazenil (Romazicon)

Fall Precaution

Do Not Stop Abruptly

2 mins

Zolpidem (Ambien)

Hypnotic

Insomnia

Daytime Drowsiness

Bizarre Sleep Behaviors

Sleep Driving

Angioedema

Short Term Administration

Take Immediately Before Bedtime

1 min

Enoxaparin (Lovenox)

Inhibits Clotting Factors

Factor Xa

Clot Formation Prevention

Heparin Induced Thrombocytopenia (HIT)

Bleeding

Medication Education

Subcutaneous Injection

2 Inches from Umbilicus or Incisions

Protamine Sulfate

2 mins

Morphine

Opioid Receptor Agonist

Pain

Myocardial Infarction

Nausea and Vomiting

CNS Depression

Biliary Colic

Constipation

Increased Intracranial Pressure (ICP)

Pupillary Constriction

Hypotension

2 mins

Heparin (Unfractionated)

Suppresses Coagulation

Deep Vein Thrombosis (DVT)

Pulmonary Embolism

Hemorrhage

Heparin-Induced Thrombocytopenia (HIT)

Monitor aPTT

Preferred (Safe) During Pregnancy

Protamine Sulfate

2 mins

Selective Serotonin Reuptake Inhibitor (SSRI) Overview

Depression

Anxiety

Selective Serotonin Reuptake Inhibitors

Paroxetine

Sertraline

Escitalopram

Fluoxetine

Sexual Dysfunction

Serotonin Syndrome

Treat with Cyproheptadine

2 mins

Venous Thromboembolism (DVT) Interventions

Anticoagulants

Prevention Education

Frequent Ambulation

Leg Exercises

Compression Stockings or SCD's

Avoid Nicotine and Oral Contraceptives

Surgery

1 min

Hypernatremia

> 145 mEq/L Na+

Change in LOC

Extreme Thirst

Orthostatic Hypotension

Dry Flushed Skin

Muscle Twitching

Seizures

Treat and Prevent Dehydration

Hypotonic Solutions (0.225% or 0.45% NaCl)

Sodium Restriction

Diuretics

2 mins

Hyponatremia

< 135 mEq Na+

Nausea and Vomiting

Decreased LOC

Confusion / Lethargy

Seizures

Assess Airway

Reduce Diuretic Dosage

Mannitol (Osmitrol)

Fluid Restriction

Hypertonic Solution (3% or 5% NaCl)

2 mins

Hypokalemia

< 3.5 mEq/L

Muscle Weakness

Arrhythmia

U Wave

Ileus

Hyporeflexia

IV K+ Infusion at 5-10 mEq/hr

Give Orally with Food

Monitor Respiratory Status

3 mins

Hyperkalemia

> 5.0 mEq/L K+

Abdominal Cramps

Muscle Weakness

Diarrhea

Arrhythmia

Tall, Peaked T Waves

IV Calcium

Infusion of Glucose and Insulin

Loop or Thiazide Diuretics

Kayexalate

Dialysis

Prevention Education

2 mins

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