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Capstone Quiz 2
Burns Considerations
Maintain Body Temperature
Increased Risk of Infection
Venous Thromboembolism (VTE) Prophylaxis
Curling's Ulcer
Excision and Grafting
Adequate Nutrition
Contractures
2 mins
Burns Interventions
Ensure Airway Patency
O2
IV Fluid Replacement
Dry Sterile Dressing
Debridement
Elevate Burned Limbs
Analgesics
Silver Sulfadiazine
Escharotomy
2 mins
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
Stages of Burn Care
Phase / Stage 1
Resuscitative/Emergent Phase
Injury to Return of Capillary Permeability
48-72 hours
IV Fluid Replacement
Phase / Stage 2
Acute Phase
Diuresis to Near Wound Closure
Phase / Stage 3
Wound Closure to Return of Optimal Level
2 mins
Rule of 9's for Burns
Total Body Surface Area (TBSA)
Head
Anterior Torso (18%)
Chest
Abdomen
Posterior Torso (18%)
Upper Back
Lower Back
Extremities
Posterior Leg (each)
Anterior Leg (each)
Each Arm
Genitalia 1%
2 mins
Parkland Formula
Burn victims
24 hours
TBSA% x Weight x 4 = Fluids
TBSA %
x Weight (kg)
x 4
= Fluid Requirement (in first 24 hrs)
Fluids in first 8 hours
1/2 of fluid given in first 8 hours
1 min
Morphine
Mechanism
Opioid Receptor Agonist
Indications
Pain
Myocardial Infarction
Side Effects
Nausea and Vomiting
CNS Depression
Biliary Colic
Constipation
Increased Intracranial Pressure (ICP)
Pupillary Constriction
Hypotension
2 mins
Tramadol
Indications
Chronic Pain
Mechanism of Action
Weak Opioid
Inhibit Serotonin and NE reuptake
Side Effect
Increased Risk of Seizure
48 secs
IV Anesthetics
Barbiturates
Benzodiazepines
Respiratory Depression
Hypotension
Ketamine
NMDA Receptor Antagonist
Hallucinations
Opioids
Propofol
Potentiates GABA-A
2 mins
Codeine
Mechanism
Opioid Receptor Agonist
Indications
Mild to Moderate Pain
Cough Suppressant
Side Effects
Sedation
Constipation
Miosis
Considerations
Close Monitoring When Breast Feeding
Often Combined with Non-Opioids
2 mins
Standard Precautions
Hand Hygiene
Wash In / Wash Out
Alcohol-Based Hand Rub
Hand Washing
Personal Protective Equipment (PPE)
Gown
Face Mask
Goggles/Face Shield
Gloves
Donning and Removing PPE
Discard Sharps in Puncture-Resistant Container
Cough Etiquette
2 mins
Contact Precautions
Private Room
Wash In / Wash Out
Personal Protective Equipment (PPE)
Gloves
Gown
Limit Time Patient Leaves Room
Leave Equipment In Room
Special Linen Handling
Same Pathogen, Same Room
History of Contact Isolation
Preventative Education
2 mins
Aseptic Technique
Invasive Procedures
Skin Integrity Broken
Sterility
Hands Up for Scrubbing
Keep Objects in View
Only Sterile Objects in Field
Only Sterile Touches Sterile
Contamination
Edges of Sterile Field
If Sterility Questioned
If Wet or Prolonged Exposure to Air
Considerations
Never Leave Sterile Area
PPE Order
2 mins
Compartment Syndrome Assessment
Mechanism
Trauma
Increased Pressure
Compressed Nerves and Blood Vessels
Assessment
1 or more of 6 P's
Ankle-Brachial Index (ABI)
Considerations
May take Days to develop
Early Detection
Ischemia
Damage often Irreversible
2 mins
Compartment Syndrome Interventions
Interventions
Frequent Neurovascular Assessments
Evaluate Pain
Do Not Elevate Extremity
Remove or Loosen Restrictive Items
Fasciotomy
Amputation
Considerations
Infection
Monitor Urine Output
2 mins
Types of Shock
Hypovolemic
Depleted Volume
Cardiogenic
Pump Failure
Obstructive
Indirect Pump Failure
Distributive
Lost Vascular Tone
Neurogenic
Anaphylactic
Septic
2 mins
Severe Sepsis and Septic Shock Assessment
Microthrombi
DIC
Decreased Oxygen Saturation
Decreased WBC
Oliguria
High Output Heart Failure
Multiple Organ Failure
2 mins
WBC Differential Lab Value
White Blood Cells (WBC)
5-10 (5,000-10,000)
Leukocyte Differential
Neutrophils (50%-70%)
Bands (2%-5%)
Segs (50%-70%)
Lymphocytes (20%-40%)
Monocytes (4%-8%)
Eosinophils (2%-4%)
Basophils (0.5%-1.5%)
2 mins
Tacrolimus (Prograf) Overview
Mechanisms
Immunosuppressant
Inhibits Calcineurin, Decreasing IL-2
Indications
Transplant Rejection
Atopic Dermatitis
Considerations
Increased Lymphoma Risk
Avoid Grapefruit Juice
1 min
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