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Complex exam 2 Flashcards

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1
Q

What does too much ADH cause? *

A

Fluid overload

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2
Q

another name for ADH *

A

vasopressin

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3
Q

What does SIADH present as

A

*michelin man
-puffy, holds water

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4
Q

Best way to measure fluid retention

A

daily weight bc pt can at home as well

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5
Q

What defines DKA

A

ketones in blood/urine

*a severe insulin deficiency–>body burns fat–>produces ketones (usually T1DM)

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6
Q

Testing for DKA but no ketones and SUPER HIGH SUGAR

A

*Hyperosmolar nonketotic syndrome
-HHNS (nonketotic hyperglycemia)

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7
Q

HHNS

A

*extreme hyperglycemia without ketones (NO ACIDOSIS
*usually T2DM

-normal pH
-600-1000+ glucose
-from severe dehydration

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8
Q

DKA s/s

A

*usually T1DM

-LOW ph
-250-600 glucose
-from fat breakdown
-kussmaul breathing
-FRUIT BREATH

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9
Q

HHNS Tx

A

*“wash them out”
-insulin and AGGRESSIVE hydration

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10
Q

what degree of burns DO NOT require abx

A

first degree

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11
Q

Rule of 9

A

-head/neck= 9%
-EACH arm= 9%
-EACH Leg= 18%
-Front trunk= 18%
-Back Trunk= 18%
-genitals= 1%

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12
Q

First degree burns characteristics

A

*Superficial
-epidermis
-red, dry, no blisters
-painful
(sunburn is example)

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13
Q

2nd degree burns characteristics

A

*Patial-thickness
*Epidermis + dermis

-BLISTERS
-moist
-red/pink
-skin peeling (slight sloughing)
-blanchable
-very painful

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14
Q

What are 2nd degree burns at higher risk for?

A

*INFECTION–>bc of no top skin layer

-hypovolemia d/t fluid shifts

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15
Q

2nd degree burn tx

A

*silver ointment–>can damage healthy tissue so only apply on damaged skin

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16
Q

3rd degree burn characteristics

A

*FULL THICKNESS
*Epidermis + dermis + subcutaneous tissue

-white, leathery, waxy
-no pain
-no circulation
-no sloughing
-CANNOT regenerate skin

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17
Q

3rd degree burn tx

A

-Skin grafts (could cause inflammation)
-Abx
-sterile leeches

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18
Q

Initial intervention with burns

A

*STOP BURN PROCESS

-ABC’s*
-remove clothing
-wrap in CLEAN DRY SHEETS
-humidified oxygen
-IV access (do not delay transport)

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19
Q

What is the most life threatening early complication of burns?

A

Airway obstruction from inhalation injury which causes edema –> closes airway

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20
Q

What is most common cause of death in closed-space fires?

A

inhalation injury

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21
Q

burned lungs respiratory complication

A

decreased gas exchange

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22
Q

What happens if pt w. burn to head, neck, an/or chest has wheezing disappear.

A

*no air movement–> INTUBATE!

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23
Q

what is the best indicator of adequate perfusion

A

urine output
-30-55 cc/hr
-100cc/hr for electrical burns

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24
Q

How to know if fluid resus is good

A

50ml/hr UO

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25
Choice of IV fluid for burn pt
lactated ringers
26
fluid resuscitation formula
2-4cc(mL) x Kg x %TBSA burned = fluid (mL) *after you calculate the total you do: -1/2 in first 8 hours -1/4 in next 8 hours -1/4 in last 8 hours *DOUBLE fluid resuscitation FOR ELECTRICAL BURNS
27
why not give fluid bolus for burn pt?
worsens edema by increasing capillary presure
28
what unusual therapy is used for 3rd degree burns
sterile leeches
29
Whats a brassy cough seen in
Inhalation injury
30
in Electrical burn pts, what do you do before fluid resuscitation?
FIRST check cardiac function and circulation
31
Eletrical burn pt s/s
*assess for 2 wounds (entrance and exit) -Altered LOC -cardiac dysthrythmias -possible myoglobinuria
32
Whats biggest worry in circumferential burns
*Oxygenation and circulation -is it around chest or back-->check breathing pattern
33
What to worry about when circumferential burns go around an extremity
*swelling + tight eschar = cuts off blood flow leading to: -weak/absent pulses -numbness/tingles -tissue death (ischemia
34
Tx for circumferential burn
escharotomy
35
why do electrical burn pts get double fluid resuscitation?
cant see internal damage
36
FIRST priority with electrical burns?
cardiac function (hrt rhythm)
37
pt was in a house fire and presents with productive cough and singed nasal hair. What is the priority concern?
airway compromise
38
S/S of upper airway injury
-singed nasal hair -hoarseness -facial burns -cant swallow -throat edema -stridor
39
Upper airway injury tx
*cool humidified O2 -possibly ET
40
Interventions for pulmonary injury
-high flow oxygen via nonrebreather -possible ET
41
Carbon monoxide poisoning test
carboxyhemoglobin level
42
burn fluid formula
2-4 cc x kg x %tbsa
43
Burn fluid formula districution timing
-1/2 first 8 hrs -1/4 second 8 hrs -1/4 last 8 hrs
44
Normal ICP
0-15 mmHg
45
when should ICP be tx
>15
46
is ICP related to BP
NOOO
47
tx for ICP
3% mannitol--> pulls fluid back into circulation-->improves brain function
48
Pre-renal failure cause
decreased cardiac output
49
CHF is which renal failure
pre-renal
50
pyelonophritis is which renal failure
inter-renal
51
Renal stones (calculi or nephrolith) are which renal failure
post-renal aka blockage after kidney
52
NSAIDS cause what
nephrotoxic kidney damage
53
W/ nephrotoxic pt what is the nurse plan
potential for acute renal failure
54
at home with renal failure, what do you monitor
Weight and BP
55
w/ peritoneal dialysis, what should urine look like?
clear/slightly yellow
56
what if the dialysate has brown flakes or blood?
*STOP and call provider -brown is stool -If it looks bad just stop and call
57
You put in 2000 cc in peritoneal dialysis pt but you don't get it all back, what do you do
* probably Shift in the abdomen--> Reposition and check for kinks **If you think peritoneal tube is clogged--> call doc and DO NOT FLUSH -->can cause infection/damage
58
Renal failure pt has crackles b/l, what does it mean
*fluid in lungs-->fluid overload/pulmonary edema
59
Which lab would you be concerned with in liver failure
*elevated ammonia liver cant detoxify--> ammonia build up
60
liver failure pt with elevated ammonia tx
LACTULOSE--> makes pt poop out ammonia
61
3 major problems from liver failure
-ascites -varices -encephalopathy
62
Pt w/ hepatic encephalopathy and elevated ammonia lvl present w/
*excitability--> DO NOT let them walk around by selves
63
What electrolyte do we worry about with kidneys
*Potassium -we worry about potassium overload-->dangerous for heart
64
potassium overload tx
Kayexalate
65
What imbalance does chronic renal failure cause
*metabolic acidosis -kidneys cant eliminate acids-->lower bicarb--> metabolic acidosis
66
What are the 2 main problems in chronic pancreatitis
*the pancrease isnt making: -digestive enzymes -insulin
67
what do we give for chronic pancreatitis?
*-ASE ending -pancrealipASE *DO NOT GIVE: -vitamins, morphine, lactulose
68
Best way to reduce pancreatitis pain/discomfort
*NPO to decrease stomachache workload *worry first about replacing enzymes then once need for replacement stops, can worry about pain meds
69
Pt has esophageal bleeding/tube w/ SOB, what do you do?
*cut tube and GET IT OUT OF PT --> if not will asphyxiate
70
can you place catheter in trauma place?
NO-->call doc to
71
What should you assess w/ AV fistula?
-do they have good distal pulses -do they have bruits/thrills
72
Fistule pt education
*check fistula at home but ASSESS not access
73
Cervical spine immobilization needs
-assess/stabilize effective airway -immobilize to prevent further damage -maintain airway patency/effective breathing -Administer IV fluids JUDICIOUSLY -High dose steroids to reduce swelling -warmth
74
What is the ABCDEF-H for?
*trauma assessment priorities 1. A/B/C= KEEP ALIVE 2. D= brain function 3. E= find hidden injuries 4. F/H= gather data and complete assessment
75
A. trauma assess
*airway "can the pt breath, is the airway open" *Immobilization is priority in neck trauma-->protect c-spine at all times -jaw thrust (NOT head tilt if trauma) -suction -insert airway (OPA, ET tube if needed
76
B. trauma assess
*breathing "are they actually ventilating"--> assess: -chest rise -breath sounds -O2 sats *Interventions: -oxygen (nonrebreather) -bag-valve mask -Chest tube if needed
77
C. trauma assess
*circulation "are they perfusing/bleeding?" *interventions: -control bleeding -2 large bore IVs -give fluids *DO NOT WASTE TIME ON BP-->Check pulse
78
D. trauma assess
*Disability (neuro status) "does this pt have enough brain function to live"--> assess: -GCS -Alert, voice, pain, unresponsive (AVPU) -pupil response
79
E. trauma assess
*Exposure/environmental control "what injuries are hidden" -fully undress and check entire body -PREVENT SHIVERING AND OVERHEATING-->shivering increased O2 demand
80
F. trauma assess
*full set of vitals/focused adjuncts: -full VS -exhaled co2 = 35-45 -Watch I/Os--> should you give foley -If they vomit, can you protect airway-->hyperventilate
81
H. trauma assess
*head-to-toe/history "what happened, what else is injured"
82
What does D. assess for
neuro function
83
What does E assess
environment/temp control (prevent shivering)
84
What does F include?
-vitals -35-45 CO2 -I&O -Airway protection
85
Who must authorize transfer
PCP has to authorize-->call admitting team 1.stabilize pt 2.MD authorizes 4. accepting facility
86
What must happen before transfer
must be stable
87
EMTALA regulations
*requires that pt is stable before transfer 1.all pts need medical screening 2. pt must be stable unless transfer benefits outweigh risk 3. appropriate transfer aka all things met 4. pt consent
88
autonomic dysreflexia
*SCI at T-6 or higher--> DAMAGE ABOVE the lesion-->body notices pain but cant pinpoint it which leads to: -HTN -Anxiety -sweating -blurred vision -HA
89
hyperreflexia tx/intervention
*FIRST elevated HOB to drain -THEN notify MD asap to get antihypertensives -loosen tight clothes -check catheter for obstruction -check for distenstion/impaction -cool room -BP q10-15 min *VASODILATORS AFTER
90
woman w/ neck laceration, what is priority assessment
ABC
91
Sequence of care of trauma
1. jaw thrust 2. assess spon vent 3. O2 4. large bore IVs 5. remove clothing 6. VS 7. foley cath
92
Which assessment finding may mean inhalation injury
brassy cough
93
renal disease causes high what?
creatinine
94
What is the best way to check patency in AV fistula?
palpate the fistula throughout its length to assess for a thrill
95
Pt has T5 spinal injury with flushed skin, diaphoresis, BP is 162/96, HA. what is priority interventions.
-Elevate HOB 90 -loosen clothing -assess for bladder/bowel distention -give antihypertensives
96
Early IICP s/s
-HA -N/V -amnesia for events -altered LOC -restlessness/drowsiness -changes in speech -loss of judgement
97
Late s/s IICP
-dilated, nonreactive pupil -unresponsiveness to verbal or painful stimuli -abnormal posturing patterns -changes in respiratory pattern
98
Very late s/s IICP
*CUSHING TRIADS -changes in body temperature -herniation and death
99
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