TEST 3 NUR 254

The nurse is providing discharge instructions to a patient and his family after a diagnosis of diabetes insipidus (DI). Which instructions should be included? Select all that apply. "Check body weight daily at the same time and on the same scale." "Report weight changes of more than 5 pounds per day." "Drink plenty of fluids." "Maintain adequate mouth care." "Know that overuse of desmopressin may lead to dehydration."

"Check body weight daily at the same time and on the same scale." "Drink plenty of fluids." "Maintain adequate mouth care."

A patient with osteoporosis and a recent fracture asks the nurse what the provider meant by saying it could be caused by hormone deficiency. How should the nurse reply? "Growth hormone, when low, can decrease bone density" "LH is important in strengthening bones" "FSH allows for the stimulation of strong bone formation" "ACTH reacts on the bones making them stronger"

"Growth hormone, when low, can decrease bone density"

Posterior pituitary gland

(Vasopressin)ADH and oxytocin

Yellow tags -

(delayed) for those who require observation. They do have life threatening injuries, but their condition is stable for the moment and, they are not in immediate danger of death.

Black tags -

(expectant) are used for the deceased and for those whose injuries are so extensive that they will not be able to survive given the care that is available.

Red tags -

(immediate) are used to label those who cannot survive without immediate treatment but who have a chance of survival. Includes compromises to patients ABC's

Green tags -

(minor) are reserved for the "walking wounded" who will need medical care at some point, after more critical injuries have been treated.

Chemical Burn

- Direct skin contact with acids/base agents, or organic compounds. can lead to renal/liver failure. Can be caused by lye, bleach, dishwasher detergent

Electrical Burns

- Exposure to direct current or alternating current (internal damage more severe than what external damage may lead you to suspect) Patient will require EKG and Cardiac monitoring

Thermal Burn

- Exposure to dry heat (flames) or moist heat (steam and hot liquids). most common in children and older adults

Inhalation injury

- most frequent and often lethal complication of burns. Due to Exposure to heat, asphyxiates, and smoke (suspect any burns of head, neck or chest to have inhalation injury

Diagnostics in emergent burn phase

Pulse oximetry Carboxyhemoglobin Serial ABG's 12 Lead EKG Chest x-ray Urinalysis CBC & electrolytes - Na decrease, K+ increase Total protein & albumin Creatinine phosphokinase Blood glucose

Adrenal crisis/Addisonian crisis

- severe hypovolemia and hypotension. Risk factors: underlying adrenal insufficiency who then undergo stress such as trauma, surgery, infection. Will require additional doses of glucocorticoids during periods of stress (surgery, trauma or infection). BE SURE TO TAPER IF TAKING STEROIDS FOR 2 OR MORE WEEKS!

Emergent (Immediate)

-Life threatening issues that require prompt treatment and care. Stabilization of the patient's condition is critical

Using the Parkland formula, the nurse determines that a patient requires a total of 12 L of fluid in the first 24 hours post injury. How much of the total volume needs to be given within the first 8 hours? A. 4,000 mL lactated Ringer's B. 6,000 mL lactated Ringer's C. 8,000 mL lactated Ringer's D. 10,000 mL lactated Ringer's

B. 6,000 mL lactated Ringer's

What medication is used for tx of an addisonian crisis

Corticosteroids

Radiation Burns

- Usually associated with sunburn or radiation treatment. peeling skin blisters

Inflammatory phase of wound healing

- imnmediately followiung injury, increases capillary permeability

Proliferative phase of wound healing

2-3 days post burn until complete re epitheliation or SX

Pt upper back, back of head, and both posterior arms are burned, calculate TBSA of injury

22.5

Female patient 36 years old with burns to her entire Right arm, her Right anterior leg, and her upper posterior trunk = ? Male patient 22 years old with burns to his face and Left anterior arm portion only = ? Elderly patient with burns to both arms, and Left anterior portion of her trunk= ?

27 9 27

NURSES ROLE IN DISASTERS

Disaster preparedness, response, and recovery Mass casualty triage, helping to ensure patients get the most appropriate level of care Putting disaster response plans into action Evacuation Decontamination NURSES MAY ALSO BECOME LEADERS AS THEIR COMMUNITIES PREPARE FOR POTENTIAL DISASTERS BY CREATING OR REVISING EMERGENCY PREPAREDNESS AND CONTINGENCY PLANS

Three goals for hospital decontamination

: 1) Hospitals must not allow contaminated patients to enter the facility, if the patient cannot be decontaminated at the on-incident scene a decontamination site should be set up just outside of ED 2) hospitals should decontaminate patients as rapidly as possible 3) hospitals must plan to protect the decontamination team from secondary exposure and injury.

RPMs: Respirations

: Is your patient breathing? If not, use jaw thrust method, or insert an oral airway. If you have an open airway and no breathing, that victim is tagged BLACK. If the victim breathes once an airway is restored or is breathing more than 30 times a minute, tag RED. If the victim is breathing normally, move to perfusion.

When hemodynamic status is monitored in a patient with a burn injury, what amount of urine output indicates adequate fluid resuscitation? A. 0.5 mL/kg/hr B. 1 mL/kg/hr C. 2 mL/kg/hr D. 3 mL/kg/hr

A. 0.5 mL/kg/hr

The nurse correlates which clinical manifestations to the possibility of an inhalation injury? (Select all that apply.) A. Facial burns B. Singed nasal hairs C. Soot in the sputum D. Hoarseness E. Eschar

A. Facial burns B. Singed nasal hairs C. Soot in the sputum D. Hoarseness

The nurse correlates which zone of burn injury as the most susceptible to sustained injury because of insufficient fluid resuscitation? A. Zone of stasis B. Zone of conversion C. Zone of hyperemia D. Zone of coagulation

A. Zone of stasis

INDICATIONS OF ADEQUATE FLUID RESUSUSITATION

ADEQUATE URINE OUTPUT SYSTOLIC BP >100 HEART RATE <120 CENTRAL VENOUS PRESSURE0 BETWEEN 5-10 MMHG LUNGS CLEAR ABDOMEN SOFT A & 0 X 4

A nurse is comparing the hormones of the pituitary gland in preparation for care of a patient undergoing a posterior lobe removal. Which hormone is secreted through the posterior lobe of the pituitary gland? ADH ACTH FSH GSH

ADH

Nursing Management of inhalation injury

ADMINSITER 100% humidified o2 Cxr Abg VALUES MAINTAIN EMERGENCY AIRWAY IE INTUBATION/TRACH high fowlers POSITION tcdb hourly frequent respiratory assessments

What is the medical management and tax for SIADH

Diuretics fluid restriction

Care of superficial burn

Do not apply ice or submerge in ice water May apply a cool compress, or run under cool water Should not require dressing as there are no open blisters Lotion (Aloe based) should be applied liberally 1-2 x day Over the counter pain medications can be taken Drink plenty of water and rest No oil , oil holds heat in

In which burn stage is the most common cause of infection to result in death

Acute stage/intermediate

Treatment of Hyperparathyroidism

Acute: large volumes of IV fluids, diuretics to increase excretion Subacute: oral fluids, avoid calcium containing antacids and vitamin D. May need calcitonin & dialysis in emergency situations to decrease serum calcium levels quickly. May also require a parathyroidectomy (if this is the cause)

Rule of Nines (adult)

Add posterior and anterior sides of the body separately Perineum 1%, entire arm is 9%, entire head is 9%, entire leg is 18%, entire torso is 36% Can be revised after edema resolves

When a client is experiencing a lack of cortisol, which glands could be the cause? Select all that apply. Adrenal gland Parathyroid gland Hypothalamus Pituitary gland Thyroid gland

Adrenal gland hypothalamus pituitary gland

Life span and cultural considerations for burns

Age has a significant impact on an individual's response to burn injury Older adults at greatest risk for death Older adults more likely to suffer a greater % of Total body surface area (tbsa), due to thinner skin. Older adults tend to experience inhalation injury Also likely to have pre-existing conditions which increase their risk of complications

Triage and acuity are based on ABCDE priorities

Airway with C-spine precautions- airway is inspected for obstruction or injuries Breathing- assess for ineffective breathing patterns Circulation with hemorrhage control- include pulses, heart rate, skin color, blood pressure, capillary refill, and any obvious signs of bleeding Disability and resource management- includes a brief neurological assessment that measures the patients LOC. Exposure/Environment- complete assessment of the patient; prevent hypothermia

The laboratory test results of a patient show a significant hyponatremia. What hormone imbalance should the nurse consider as the cause? Cortisol Aldosterone Growth hormone Follicle-stimulating hormone (FSH)

Aldosterone

PHARMACOLGY for burns

Analgesics (iv route best) Until client has resumed hemodynamic stability and normal gastric emptying. No im pain meds Antimicrobials may use topical silver sulfadiazine (silvadene) Antibiotics Tetanus prophylaxis (IM) antacids

American Burn Assoc. burn center referral criteria

Any patient with burns and concomitant trauma (e.g., fractures) in whom the burn injury poses the greatest risk of morbidity or death Burns in children at hospitals without qualified personnel or equipment for the care of children Burns in patients who will require special social, emotional, or rehabilitative intervention Burns in patients with preexisting medical disorders that could complicate management, prolong recovery, or affect mortality Burns that involve the face, hands, feet, genitalia, perineum, or major joints CHEMICAL BURNS, Electrical burns, including lightning injuries Inhalation injuries Partial-thickness burns on more than 10 percent of the total body surface area. full-thickness burns in any age group

Integumentary care of burns

Assess for circumferential injury, prevent infection, ASSESS FOR COMPARTMENT SYNDROME Clean and gently debride to remove necrotic skin Elevate burned extremities

Pain Management of Burn Pt.

Assess pain with consistent measurement tool Medicate before dressing changing procedures Explain all procedures to patient and family Can be difficulty to control Intense & long-lasting Use combination of non-narcotic pain control such as relaxation therapy Allow verbalization of pain

Interventions FOR SIADH

Assess: Neuro, I&O, Visual acuity, Serum Na/osmolality/Urine specific gravity/osmolality Do: Restrict fluids, Administer hypertonic saline IV (3%) via CL, seizure precautions Teach Disease process, FVE, fluid restriction

Nursing Interventions Diabetes Insipidus

Assess: VS, weight, I&O, Visual acuity, Serum Na/osmolality/Urine specific gravity Do: Administer DDAVP, IVFs, p.o. fluids, mouth care Teach: Daily weights, Manifestations, FVE, Medications

A fireman is brought to the ED after a flash explosion of chemicals in a garage fire. He is conscious but his eyes are swollen shut, he has singed nasal hair and eyelashes, and his voice is hoarse. The nurse determines which is the most important intervention? A. Initiation of an IV line B. Insertion of an endotracheal tube C. Irrigation of the eyes with normal saline D. Introduction of a method to communicate

B

The nurse recognizes that burns to which body areas meet the criteria for referral to a burn center because of the increased risk of functional changes? (Select all that apply.) A. Chest B. Perineum C. Elbows D. Face E. Hands

B,C,D,E

The nurse caring for a patient who has been involved in a high-speed MVC understands that the priorities of care include which of the following? A. Securing the airway, applying O2, undressing the patient, stopping excessive bleeding, performing a quick neurological assessment B. Securing the airway, applying O2, stopping excessive bleeding, performing a quick neurological assessment, undressing the patient C. Undressing the patient, securing the airway, applying O2, stopping excessive bleeding, performing a quick neurological assessment D. Stopping excessive bleeding, securing the airway, applying O2, performing a quick neurological assessment, undressing the patient

B. Securing the airway, applying O2, stopping excessive bleeding, performing a quick neurological assessment, undressing the patient

bioterrorism agents

BACILLUS ANTHRACIS (ANTHRAX) CLOSTRIDIUM BOTULINUM TOXIN (BOTULISM) YERSINIA PESTIS (PLAGUE) VIRAL HEMORRHAGIC FEVERS VARIOLA MAJOR (SMALLPOX) FRANCISELLA TULARENSIS (TULAREMIA

Trousseau's sign:

BP cuff is placed around the arm and inflated to a pressure greater than the systolic BP and held in place for 3 minutes, a carpal spasm if positive

Remodeling and maturation phase of wound healing

Begins after several weeks and normally complete in 2 years. Continuation of cellular differentiation. Scar formation and scar remodeling occur. Tissue regeneration and wound contraction continue keloids go beyond the boundary of the wound. Pt. W/ darker skin are at greater risk for scarring

Body Image Restoration Burns

Begins immediately after the burn occurs Major impact on quality of life Assess patient's psychological state Referral to psychological counseling Encourage support groups Promote self care & mobility as much as possible

Intermediate Phase Burns

Begins with start of diuresis and ends with closure of burn wound (begins 48-72 hours post burn injury and may last weeks to months) NURSING PRIORITIES SHIFY TO FOCUS ON: WOUND HEALING AND CLOSURE PAIN MANAGEMENT ENSURING OPTIMAL NUTRITION CONTINUED PREVENTION OF INFECTION

Pathophysiology of the emergent/resuscitative phase

Burn injury occurs and increases blood flow to area and a release of vasoactive substances occurs, which then increase capillary permeability. Water, sodium, plasma proteins shift to interstitial and surrounding tissues. Decreased intravascular volume occurs which can cause BURN shock. Patients can have insensible losses (evaporation) of up to 400ml/hr Electrolyte/fluid imbalance occur decreased sodium, increased potassium and increased hematocrit Iv fluids have to be administered to restore capillary permeability and prevent shock

Complications of the emergent phase

Burn shock (COMBO OF DISTRIBUTIVE AND HYPOVOLEMIC SHOCK)- CAN OCCUR SECONDARY TO massive fluid shift, continues until capillary integrity restored (within 24-36 hours of the injury) Treat with fluid replacement Vasoconstriction Dysrhythmias Intravascular hypovolemia and edema results in necrosis this can cause (Circulation impairment) Compartment syndrome

The nurse is caring for a patient who sustained second and third-degree burns on the anterior lower legs and anterior thorax. Which of the following does the nurse expect to note during the emergent phase of the burn injury? a. Decreased heart rate b. Increased blood pressure c. Elevated hematocrit level d. Increased urinary output

C

Michael works as a triage nurse, and four clients arrive at the emergency department at the same time. List the order in which he will assess these clients from first to last. A 50-year-old female with moderate abdominal pain and occasional vomiting. 2. A 35-year-old jogger with a twisted ankle, having a pedal pulse and no deformity. 3. An ambulatory dazed 25-year-old male with a bandaged head wound. 4. An irritable infant with a fever, petechiae, and nuchal rigidity. A) 1, 2, 3, 4 B) 2, 1, 3, 4 C) 4, 3, 1, 2 D) 3, 4, 2, 1

C) 4, 3, 1, 2

The nurse correlates which clinical manifestation to superficial partial-thickness burns? A. Eschar B. Dry, leathery appearance C. Blisters D. Waxy appearance

C. Blisters

3 TYPES OF AIRWAY/INHALATION INJURIES

C02 POISONING INJURY ABOVE THE GLOTTIS INJURY BELOW THE GLOTTIS

RPMs, Mental Status:

Can the victim follow simple commands ("open your eyes", "what's your name")? If the patient is breathing <30/minute and has normal perfusion but is unconscious or can't follow your commands, tag RED. If your breathing, normally perfused victim can follow commands, tag YELLOW if they can't get up or GREEN if they can.

The nursing student asks the nurse how central diabetes insipidus (DI) is different from nephrogenic DI. How should the nurse respond? Central DI occurs because the kidneys are resistant to ADH. Central DI is caused by decreased secretion of ADH. Central DI is observed in patients with chronic renal insufficiency. Central DI occurs when the kidneys are unable to concentrate urine.

Central DI is caused by decreased secretion of ADH.

RPMs Perfusion:

Check for a radial pulse and/or capillary refill. If no radial pulse or it takes longer than 2 seconds for nail bed color to return to pink, tag RED. If a pulse is present and CRT is normal, move to mental status.

After serum testing, it is determined that a patient has a deficiency of adrenocorticotropic hormone (ACTH)? What concern should the nurse be aware of? Dwarfism Osteoporosis Circulatory collapse Ventricular tachyarrhythmias

Circulatory collapse

Immediate tax for liquid chemical burn

Clothes off and shower for 20 mins

Pt has circumferential burn with no distal pulses, what is this called, and what is tx

Compartment syndrome, and escharotomy, if that fails fasciotomy

Which interventions should the nurse implement when caring for the patient who has undergone a transsphenoidal hypophysectomy? Select all that apply. Conduct a neurological assessment. Maintain the head of the bed at a 30° angle. Provide frequent mouth care. Monitor the nasal drainage pad. Obtain urine-specific gravity every hour.

Conduct a neurological assessment. Provide frequent mouth care. Monitor the nasal drainage pad. Obtain urine-specific gravity every hour.

Nursing Management of Rehabilitative Stage of Burns

Continue to monitor for infection, nutritional status, and pain Promote greater flexibility, comfort, and psychosocial health Nurse to observe for: Pain/discomfort Contractures Scarring Disfigurement Limited mobility Decreased mood, flat affect, fear, anxiety

Diagnostics for Adrenal cortex Hyperfunction

Cortisol levels drawn in afternoon (normally lower as the day progresses). Elevated (>16 mcg/dL) is diagnostic. Serum aldosterone levels (elevated with hyperaldosteronism) May also do: 24 hour urine for free-cortisol level Dexamethasone suppression test Serum electrolytes: hyperglycemia (with hypercortisolism) hypernatremia and hypokalemia (with hyperaldosteronism) Imaging tests-CT/MRI-to show the shape and size of pituitary and adrenal glands

Gastrointestinal Complications Intermediate Phase

Curling's ulcers (Stress ulcers) can occur due to ischemia Constipation due to narcotics and immobility Diarrhea due to feedings/antibiotics use antacids to prevent stress ulcers

The nurse is preparing to care for a patient scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn. The nurse understands that the anticipated therapeutic outcome of the escharotomy is? a. Brisk bleeding from the site b. Formation of granulation tissue c. Decreasing edema formation d. Return of distal pulses

D

The nurse understands priority prehospital interventions include which of the following? A. Transporting the patient as quickly as possible to the nearest trauma center B. Treating all injuries found on primary survey and then transporting the patient C. Notifying the local hospital of the transport of a trauma patient and transporting the patient quickly D. Assessing the patient using ABCs, treating life-threatening conditions, then transport to the hospital

D. Assessing the patient using ABCs, treating life-threatening conditions, then transport to the hospital

gastrointestinal consequences, burns

DUE TO A DECREASE IN NUTRIENT ABSORPTION AND GASTROINTESTINAL ABSORPTION Paralytic ileus: s/s absent bowel sounds, Gastric distention, nausea, vomiting, hematemesis. Tx: ng tube, monitor bowel sounds

The nurse monitors for which effects of daily cortisol therapy on a patient's circulating levels of adrenocorticotropic hormone (ACTH) and aldosterone? Decreased ACTH, decreased aldosterone Decreased ACTH, increased aldosterone Increased ACTH, decreased aldosterone Increased ACTH, increased aldosterone

Decreased ACTH, decreased aldosterone

A patient with hypercortisolism is hospitalized after experiencing a fall from orthostatic hypotension. Which additional symptom will be present? Decreased bone density Decreased blood pressure Decreased blood glucose level Decreased blood potassium level

Decreased blood glucose

Clinical manifestations of addisons

Decreased cortisol (can't stimulate gluconeogenesis and fat synthesis) → low BG, weakness, weight loss, fatigue, nausea, abdominal pain, gastroenteritis, and emotional lability. Decreased aldosterone (can't reabsorb NA or excrete K)→ leads to water loss, dehydration and hypotension. ACTH increases (related to MSH) → hyperpigmentation of the skin and mucous membranes Androgen & estrogen decreased → decreased pubic and axillary hair.

Renal/Urinary consequences, burns

Decreased renal blood flow due to hypovolemia Renal obstruction Myoglobin (from muscle breakdown) and hemoglobin can occlude renal tubules causing Acute TUBULAR NECROSIS Maintain urine output at 30-50ml hour, watch bun, creatinine, na levels

Regardless of the type of diabetes insipidus, what is the primary pathophysiological mechanism? Abnormal glycemic control Decreased secretion of antidiuretic hormone Increased plaque formation Abnormal demyelination

Decreased secretion of antidiuretic hormone

diabetes insipidus

Decreased secretion of antidiuretic hormone (ADH, vasopressin) from posterior pituitary Secondary to: Brain tumors Neuorsurgery Head trauma

Complications of diabetes insipidus

Dehydration/hypovolemia/circulatory collapse Hypernatremia w/CNS dysfunction (seizures, confusion, coma, etc.)

The nursing is caring for a patient with newly diagnosed idiopathic diabetes insipidus (DI). Which of the following should the nurse include in patient teaching? Pineal tumor is commonly the cause. Destruction of the cells of the hypothalamus lead to the condition. Traditional craniotomy is the reason for this. Head trauma often causes the condition.

Destruction of the cells of the hypothalamus lead to the condition.

Wound management

Dressing Wounds: use of antimicrobial such as silvadene Open: wound remains open to the air, covered only by topical antimicrobial agent. Allows easy access to wound, it also increase the risk for hypothermia. closed: a topical antimicrobial agent is applied and wound is covered with gauze and wrapped with roll bandage. Changed twice a day. It decrease heat loss, but may impair rom.

The nurse monitors the calcium levels closely in the patient taking digoxin (Lanoxin) because hypocalcemia may lead to which complication? Elevated heart rate Dysrhythmias Increased cardiac contractility Hypertension

Dysrhythmias

Diagnostics of Hyperparathyroidism

Elevated calcium/ionized calcium and PTH levels

Which burn stage are hematocrit levels elevated

Emergent/resusitative

TX Electrical-

Ensure electrical source is disconnected, move patient to safety, abc's, c-spine precautions, exit/entry sites, assess for injuries

Full thickness burn

Entire epidermis and dermis have been destroyed; may involve subcutaneous fat, muscle and/or bone Appears dry, leathery, pale, white, brown, tan or black, mottled, charred, or non-blanching red firm to touch Will not blanch when pressure is applied Pain sensation is absent at burn site, but may be sensitive to pressure Requires skin grafting for healing, application of topical agents, use of skin substitutes, excision of eschar.

Surgical Tx of Burns

Escharotomy Faciaotomy Debridement Surgical-excision is made cutting away necrotic tissue Enzymatic-involves using a topical agent to dissolve and remove the necrotic tissue. Examples are collagenase (santyl).

hyperparathyroidism

Excess PTH (hypercalcemia & hypophosphatemia)

Syndrome of Inappropriate Antidiuretic Hormone (SIADH)

Excessive amount of ADH → kidney reabsorbs too much H2O → decreases urine output (urine concentrated) → water overload → hemodilution (hyponatremia, decreased serum osmolality, decreased hematocrit).

Adrenal Cortex Hyperfunction

Excessive circulating glucocorticoid (cortisol) is the pathophysiologic process associated with primary hypercortisolism. Additionally, excessive secretion of ACTH from anterior pituitary leads to hypercortisolism.

Nursing Diagnosis Diabetes Insipidus

FVD, Risk for ineff therap regimen

Nursing Diagnoses SIADH

FVE, Risk injury, Knowledge deficit

These are indicators that the patient has an inhalation injury

Facial burns Singed facial or nose hairs Carbon in sputum (Soot) HOARSENESS

What type of burns result in the most significant anatomical skin changes.

Full thickness burns

Medical Management Of Hypoparathyroidism

Goal: Increase serum calcium level to 9—10 mg/dL Acute hypocalcemia: Calcium gluconate or calcium chloride IV, followed by oral calcium and vitamin D when stable. May also use sedatives such as pentobarbital to decrease neuromuscular irritability Environment free of noise, drafts, bright lights, sudden movement May need trach/mechanical ventilation or bronchodilators for respiratory distress Diet high in calcium and low in phosphorus Phosphorus binders (calcium acetate/Phoslo or sevelamer hydrochloride/Renagel

Homografts/aloegrafts

Harvested from cadavers

The nurse is caring for a patient after a transsphenoidal hypophysectomy. Which assessment changes are most concerning? Heart rate is increased. Pulse is full and bounding. Blood pressure is increased. Serum osmolality is decreased.

Heart rate is increased.

Decellularized homograft

Heart valves

Pathophysiology of hyperparathyroidism

High PTH levels → osteoclasts release calcium from bones into the blood (hypercalcemia and weak bones). PTH also causes intestine absorb more calcium from food, adding to the excess calcium in the blood. Due to high blood calcium levels, the kidneys excrete more calcium in the urine, which can lead to kidney stones.

Level A PPE

Highest level Offers the most skin, eye, mucous, and respiratory protections

Posterior pituitary disorders

Hormone: ADH (Antidiuretic hormone) Target: Distal tubules and collecting ducts of kidneys Action: Increases water reabsorption

Disorders of the Parathyroid Gland

Hormone: Parathyroid hormone (PTH) Target: bones, kidneys, small intestines Action: pull calcium from bones, conserve calcium in kidneys, absorb calcium in small intestine

Level D PPE

Hospital grade. Gown, mask, and gloves

What is an effective indicator of fluid resucitation in the emergent phase

Hurly urine output b/t 30 and 50 ml

superficial partial thickness burn

Involves epidermis and upper layers of dermis Blisters are open and weeping; pink or red; mild edema, blanches easily Touch and pain present and can be severe due to nerve endings Heals within 1-2 weeks with minimal to no scarring but pigment changes are common Administer analgesics, skin substitutes may be used.

Medical Management Of Adrenal Cortex Hyperfunction

Hypercortisolism Aminoglutethimide - Medication to decrease cortisol production Cyproheptadine - Medication to decrease ACTH production Pasireotide - Medication inhibits release of ACTH (new med) When administering these be sure to watch for adrenal supression/insufficiency (hypoglycemia, hyponatremia) Treat causative factor (Pituitary tumor - transphenoidal hypophysectomy (to remove tumor, Adrenal tumor: adrenalectomy). Post-op may need hormone replacement to avoid adrenal insufficiency (symptoms of Addisons). If bilateral adrenalectomy will require lifetime replacement Hyperaldosteronism Control HTN and manage hypokalemia Treat causative factor (usually tumors)

The nursing diagnosis Acute pain r/t ureteral pressure and obstruction secondary to renal lithiasis is most appropriate for the patient with which endocrine disorder? Hypothyroidism Hypoparathyroidism Hyperthyroidism Hyperparathyroidism

Hyperparathyroidism

What are typical lab values in a pt with cushings and what would be an app. Diet for this pt.

Hypo kalemia hypernatremia hyperglycemia lowfat/cal/sugar diet, with fluid rest

The nurse is caring for a patient who has had this gland removed. What hormone imbalance will be experienced? Hypoaldosteronism Hyperthyroidism Hypoparathyroidism Hyperpituitarism

Hypoaldosteronism

The nurse correlates which clinical manifestation to the pathophysiology of adrenal insufficiency? Heat intolerance Weight gain Peripheral edema Hypoglycemia

Hypoglycemia

What lab value do you see in pt, with SIADH

Hyponatremia

Complications Of SIADH

Hyponatremia resulting in cerebral edema and IICP Early - confusion/irritability Later - seizures coma

Adrenal Gland Disorders

Hypothalamus secretes CRH → anterior pituitary secretes ACTH (bound to MSH) → Adrenal cortex to secrete: *Glucocorticoids (cortisol) *Mineralocorticoids (aldosterone) *Sex hormones (androgens & estrogens) Adrenal cortex: Addison's disease - low cortisol and aldosterone Primary hyperaldosteronism (Conn's syndrome), Cushing's disease, and Cushing's syndrome. Can be increased aldosterone, or cortisol, or both

A patient has been receiving doses of prednisone for treatment of rheumatoid arthritis for the past three months. If this medication is suddenly discontinued, for which complication is the patient at risk (due to acute adrenal crisis)? Hypovolemia Hypernatremia Hypokalemia Hyperglycemia

Hypovolemia

Hypoparathyroidism

Idiopathic (autoimmune is suspected), acquired (most commonly d/t removal of parathyroids during total thyroidectomy or resection of cancer of head and neck) or reversible (too much iodine therapy for hyperthyroidism).

Clinical Manifestations of Adrenal Cortex Hyperfunction

Increased cortisol → hyperglycemia (d/t gluconeogenesis) leading to poor wound healing, abnormal fat distribution (d/t fat synthesis), muscle mass decreased (d/t protein breakdown), decreases inflammatory/immune response (risk for infection), easily bruised, osteoporosis (d/t effects on bone metabolism) Increased aldosterone→ hypernatremia, fluid retention, hypertension & hypokalemia (cardiac irregularities) Increased androgen and estrogen → male sex hormone characteristics in women (decreased breast size, amenorrhea, deep voice, hirsutism) and female ones in men (gynecomastia, erectile dysfunction).

Complications of the Intermediate burn phase

Infection is the most common cause of death Extreme disorientation High risk for contractures nutritional therapy & pain management

What is required for pt that has burns of face, chest, neck

Intubation

Nursing Interventions during emergent burn phase/Airway and ventilator Management

Intubation is required for all burns of the chest, face, or neck Treatment focused on preventing atelectasis and maintaining alveolar o2 exchange HOB 30 degrees & turn Q 2H 100 % Humidified O2 Bronchodilators & mucolytic agents Arterial line for continuous assessment of abg's Pain medications

deep partial thickness burn

Involves the entire epidermis and deeper layers of dermis Blisters that appear waxy, light pink or cherry red, mottled, or pale in the center; edema, sluggish or no blanching Capillary refill decreased/ absent Hypersensitive around wound edges, but may be sensitive to pressure only in center healing can take 3-6 weeks, may leave scarring May have to be excised and skin grafting. Contractures possible

The physician may order a replacement antidiuretic hormone such as desmopressin. How can this be administered? Select all that apply. It can be administered via intranasal route. It can be given orally. It can be given in an IV. It can be given subcutaneously. It can be given transdermally.

It can be administered via intranasal route. It can be given orally. It can be given subcutaneously.

Diagnostics of hypoparathyroidism

Low serum PTH levels Serum calcium <8.0 (normal 8.5-10.5 mg/dL) Ionized calcium <4.5 (normal 4.5-5.5 mg/dL) (required is serum albumin low, as binds with Ca) Magnesium - <1.5 (normal 1.5-2.5 mg/dL) Phosphorous >4.5 (normal 2.5-4.5 mg/dL) ECG - detect dysrhythmias Xray/bone density tests Albumin - if low will have low serum calcium, need ionized Ca

FOUR PHASES OF EMERGENCY RESPONSE (Disasters)

MITIGATION BOTH BEFORE AND AFTER EMERGENCY OCCURS WARNING SYSTEMS, INSURANCE PREPAREDNESS BEFORE EMERGENCY OCCURS NURSES GAIN UNDERSTANDING OF EXPECTED ROLES IN EMERGENCY DEVELOP EMERGENCY PLAN DESIGNATE MEETING PLACES EMERGENCY RESPONSE IMPLEMENTATION OF PREPAREDNESS PLANS VICTIMS TRIAGED, TREATED AS SOON AS POSSIBLE SEARCH AND RESCUE OPERATIONS, SHELTER FOR SURVIVORS, REPAIRING UTILITY INFRASTRUCTURES RECOVERY DESIGNED TO RETURN COMMUNITY TO NORMAL OR CREATE NEW, SAFER NORMAL REBUILDING, REEMPLOYMENT, REPAIR, RECONSTITUTION OF GOVERNMENT OPERATIONS

The nurse is caring for a patient with adrenocorticotropic hormone (ACTH) deficiency. What should be included in the plan of care? Preventing the risk for injury Providing a diet rich in calcium Increasing the intake of vitamin D Maintaining adequate volume of fluid intake

Maintain adequate fluid volume

Risk factors for burn

Males (69% of all burn center admissions were male clients) AGE- Older adults 65 and older Children age 4 and younger Socioeconomic status Rural areas Drug, alcohol, and/or tobacco use Physical or mental disabilities occupation

Clinical Manifestations of hyperparathyroidism

May be asymptomatic Polyuria Bone decalcification and bone pain Renal calculi Fatigue, muscle weakness Nausea, vomiting, constipation Hypertension & cardiac dysrhythmias

Non-urgent (Minor)-

Minor issues that do not require prompt care. Can ambulate and are stable in their conditions. Usually are seen within 120 mins

hyperparathyroidism

Most frequently parathyroid adenomas are cause by secreting Elevated levels of PTH hormone. Incidence greatest in women over age 50

Parkland Burn Formula

Mr. Duke is 60 kg and is burned at 30% TBSA 4mL X 60 X 30 = 7200 mL 7200mL / 2= 3600 mL 3600 mL will need to infuse in the first 8 hours (50%), so the pump will be programmed for 450mL/hr After the first 8 hours (remaining 50%), the pump will need to be programmed for 225mL/hr.

What is tetany, what is it caused by, and what disorders

Muscle twitching in hands, arms mouth, hypocalcemia, hypoparathyroidism

The functioning of the endocrine system works on what type of system? Negative feedback system Positive feedback system Alternating negative and positive feedback system Closed loop system

Negative feedback system

Manifestations Of hypoparathyroidism

Numbness and tingling in fingertips, toes and lips Muscle aches/cramps in legs, feet, abdomen and face Tetany, twitching muscles, particularly around your mouth, but also in your hands, arms and throat Bronchospasm, laryngeal spasm ECG changes

Nursing Management Of Hypoparathyroidism

Nursing Diagnoses Risk for ineffective airway clearance r/t laryngospasm Decreased cardiac output r/t supressed myocardial contractility Nursing Interventions Assess - VS (hypotension or dysrhythmia), Serum labs (ionized Ca, magnesium, albumin, calcium, phosphorus), Cardiac monitoring, Neuromuscular activity (Trousseau/Chvosteks) Do - Administer calcium replacement (IV calcium, slow IVP), administer vitamin D Teach - Calcium supplementation, diet rich in calcium/low in phosphorus, signs of hypocalcemia

Nursing Management of Addisons

Nursing Diagnoses (FVD, Risk for unstable BG, Risk for decreased CO, Body image r/t hyperpig) Interventions Assess I&O, VS, Serum Na/glucose/potassium, Hct/BUN (fluid status), Serum cortisol levels. Do IV access/fluids, administer corticosteroids (IV if acute adrenal crisis), Safety precautions d/t hypotension Teach Daily hormone replacement, Medical alert bracelet, Manifestations of adrenal crisis, Signs of too much corticosteroid (weight gain, osteoporosis)

Nursing management of Hyperparathyroidism

Nursing Diagnoses: Acute pain (renal tubules/renal calculi), High risk for falls (r/t bone demineralization) Nursing Interventions: Assess - VS, I&O, Serum ionized calcium, PTH, phosphorous, ECG Do - Increase fluid intake to 3L/day. NS IV fluid of choice if necessary, diuretic (furosemide), oral phosphate medications, lift sheets to prevent injury, strain urine (suspected calculi) Teach - s/s of hypercalcemia,, Low calcium diet, increase fluids and fiber to decrease complication of constipation

Nursing Management of Adrenal Cortex Hyperfunction

Nursing Diagnoses: Hypercortisolism - FVE, body image disturbance, risk for infection, deficient knowledge Hyperaldosteronism - FVE, Risk for decreased CO, deficient knowledge Interventions: Assess - VS (suppressed immune function/fever, HTN/FVE), Daily wt (FVE), I&O, Serum electrolytes (K, Glucose, Na), Skin, Fat distribution, Muscle mass, wound healing Do - Administer cortisol inhibitors, HOB up d/t work of breathing (FVE), Turn frequently Teach- Disease process, low sodium diet

Level B PPE

Offers respiratory protection but not as much skin

Complications Of Adrenal Cortex Hyperfunction

Osteoporosis, bone loss and fractures (d/t elevated cortisol) Hyperglycemia, decreased wound healing (d/t elevated cortisol) GI bleeding (d/t elevated HCL acid d/t cortisol) Hypertension and effects on vessels, kidneys, and eyes (d/t elevated aldosterone) Hypokalemia and dysrhythmias (d/t elevated aldosterone)

3 clinical manifestations of Hyperparathyroidism

Osteoporosis, renal calculi, polyuria, n/v, constipation, dysrythmias

Hypo and Hyperparathyroidism, what hormone is associated

PTH

What hormone is associated with disorders of pituitary gland

PTH

Hypoparathyroidism

PTH Insufficiency (hypocalcemia& hyperphosphatemia)

The client is experiencing problems with reabsorption of calcium. Which endocrine gland requires evaluation? Parathyroid gland Pancreas Hypothalamus Anterior pituitary

Parathyroid gland

The nurse correlates a positive Chvostek's sign to hyposecretion of which hormone? Thyroxin (T4) Thyrocalcitonin Parathyroid hormone (PTH) Triiodothyronine (T3)

Parathyroid hormone (PTH)

Which Type of burn is more painful full thickness or partial thickness

Partial thickness

The nurse is receiving hand-off reports for four patients. Which patient presents with a serum sodium level consistent with diabetes insipidus (DI)? Patient A -148 Patient B -140 Patient C -136 Patient D -128

Patient A -148

Emergent/Resuscitative Phase

Phase during which immediate problems are addressed and resolved. Fluid loss/edema formation until fluid mobilization/diuresis Lasts from Onset of injury through successful fluid resuscitation first 24-48 (up to 72 hours) Assess extent of burn injury Goal is to Resolve immediate life-threatening problems, secure airway, maintain temperature, and prevent hypovolemic shock Shock is the most common cause of death

The nurse is caring for a client at risk for developing diabetes insipidus. What is the initial assessment change the nurse should anticipate? Polyuria Hypotension Polydipsia Polyphagia

Polyuria

The nursing is admitting a patient from home. Which presenting symptom causes the nurse to be concerned that the patient has developed diabetes insipidus (DI)? Hypertension Bradycardia Polyuria Decreased serum sodium

Polyuria

Two manifestations of diabetes insipidus

Polyuria polydipsia

Clinical Manifestations Of Diabetes Insipidus

Polyuria - Enormous output of "water-like urine" w/ urine specific gravity < 1.005 (normally 1.010-1.030). ℅ nocturia. Polydipsia - Intense thirst Hemoconcentration - Elevated serum sodium (>145 mEq/L) and hematocrit (>50%) Volume deficit - hypotension, tachycardia, tenting turgor, fatigue, prolonged capillary refill

The patient presents to the emergency department with 1-week symptoms of polyuria, polydipsia, hypernatremia, and tachycardia. The patient has an elevate serum osmolality. A malfunction in which area of the brain is most likely causing these symptoms? Hypothalamus Anterior lobe of the pituitary Posterior pituitary gland Sella turcica

Posterior pituitary gland

Clinical manifestations SIADH

Primarily related to hyponatremia: Early (Na <135): Anorexia, nausea and malaise Moderate (Na <125): HA, irritability, confusion, and weakness) Severe (Na <120): Seizures and coma Neurologic signs d/t cerebral edema secondary to water intoxication resulting in increased ICP Other manifestations: Weight gain Intake > output - Urine is concentrated (elevated SG, but no other s/s of dehydration. No peripheral edema (excess fluid in vascular system not interstitial space)

What is it referred to when an endocrine gland itself causes the hypersecretion or hyposecretion of a hormone? Primary disorder Secondary disorder Tertiary disorder Organ disorder

Primary disorder

Causes of Addison's disease

Primary: autoimmune, infectious, cancerous or traumatic processes that lead to direct insult of adrenal cortex Secondary: disorders of anterior pituitary Tertiary: disorders of hypothalamus

Causes Of Adrenal Cortex Hyperfunction

Primary: direct oversecretion from adrenal cortex (often a tumor) Secondary: oversecretion of ACTH from anterior pituitary (often a tumor) Tertiary: oversecretion of CRH from hypothalamus

The nurse is concerned about high sodium levels in her patient experiencing diabetes insipidus. Which is the priority nursing action? Supplement the reciprocal hypokalemia. Complete hourly neurological assessments. Provide safety precautions for seizures. Monitor hourly urine output.

Provide safety precautions for seizures.

Circulatory/fluid resuscitation

Rapid fluid replacement is the Cornerstone of modern burn treatment Maintains tissue perfusion Monitor I & O's and VS Hemodynamic monitoring INSERT 2 LARGE-BORE IV CATHETERS Lactated Ringers (crystalloid) in the first 24 hours----warmed Use Parkland Burn Formula: 4mL X kg X % TBSA burn Fluid needs in 1st 24 hours 50% of fluid in 1st 8 hours followed by remaining in the next 16 hours Second 24 hours: administer colloids no formula for this

Pt has bleeding head wound, RR 32, UNABLE to ambulate, what category do u place them

Red

Pts RR is less than thirty and radial pulse is absent, what color would you tag them?

Red

Pathophysiology of adrenocortical insufficiency

Related to a decrease in one of the following: Glucocorticoid (cortisol) & mineralcorticoid (aldosterone) (primary insufficiency/ Addison's/adrenal cortex) ACTH (secondary insufficiency/ant pituitary) CRH (tertiary insufficiency/hypothalamus)

Management of Diabetes Insipidus

Replace Fluids: P.O. water Hypotonic IV fluids if unable to take p.o. (D5W) Monitor for hyperglycemia, volume overload and slowly decreasing the serum sodium Replace ADH: Desmopressin (DDAVP) or Vasopressin (Pitressin) - synthetic ADH (SQ, IN, or oral). Monitor U/O, serum electrolytes, fluid status (skin turgor, cap refill, daily weight)

Medical Management of Addisons

Replacement of cortisol IV hydrocortisone sodium succinate (Solu-Cortef) 50 to 100 mg (contains both glucocorticoid/cortisol and mineralcorticoid/aldosterone). If chronic, will need a corticosteroid (replaces cortisol) like prednisone, and a mineralcorticoid (replaces aldosterone) like fludrocortisone/Florinef. Fluid replacement IVFs with glucose Monitor frequently VS LOC Labs (sodium, glucose and potassium) If hyperkalemic Potassium binding or excreting agents (Kayexalate) If hypotension persists Vasopressors (dopamine)

Pt has RR of 19, A&O, and suddenly stops breathing, what would you do to assess this category

Reposition airway and assess for spontaneous breathing

Rehabilitative Stage Burns

Restorative, may overlap with acute stage and continues after discharge, as early as 2 weeks or up to 7-8 months Begins with wound closure and ends when patient returns to highest level of restoration Goals are to achieve maximal function, have psychological adjustment, and gain independence Due to new tissue growth needs rom is needed to prevent contractures, keep body parts extended

Adrenocortical Insufficiency (ADDISONS)

Results from destruction of adrenals (primary insufficiency), decreases ACTH from anterior pituitary (secondary insufficiency) or dysfunction of hypothalamus (tertiary insufficiency) Most common among females 30 to 50 years old

Level C PPE

Same skin as level b but lowers levels of respiratory protection as compared to levels A & B

Anterior pituitary gland

Secretes tropic hormones such as thyroid stimulating hormone (TSH), ACTH, growth hormone (somatotropic hormone), and the gonadotropins, prolactin, melanocyte stimulating hormone

Urgent (Delayed)-

Serious health conditions in which delay of treatment and care would result in life-threatening situations. NEED TO BE SEEN WITH IN 30 MINS

A client is suspected of having diabetes insipidus and is admitted to the medical-surgical nursing unit. Which diagnostic tests does the nurse anticipate the physician will order? Select all that apply. Serum and urine electrolytes CT scan Osmolality Urine-specific gravity Lumbar puncture

Serum and urine electrolytes Osmolality Urine-specific gravity

Diagnostics of Addison's disease

Serum cortisol levels (collected in a.m. d/t dec during day) Low with <5 mcg/dL with disease (normally 5-25 mcg/dL). Serum electrolytes affected: Hyponatremia (<135 mEq/L) d/t low aldosterone. Hyperkalemia (>5.0 mEq/L) d/t low aldosterone. Hypoglycemia (<60 mg/dL) d/t low cortisol Imaging studies: CT/MRI - to assess size and morphology of adrenal glands. Small adrenal associated with autoimmune destruction. Enlarged with infection.

Diagnostic tests SIADH

Serum: Na <135 mEq/L & Osmolality <270 mOsm/kg Urine: SG >1.030 & Urine Osmolality >290 mOsm/kg Diagnose underlying cause

What is main concern for patient in addisonian crisis

Shock

What is the basis of fluid therapy replacement for the treatment of diabetes insipidus? Serum osmolality is decreased as fluids are replaced rapidly. A fluid challenge is used to restore fluid volume. Additional fluids are needed in the intravascular space to maintain adequate fluid volume. Slowly decreasing the serum sodium decreases rapid correction of hypernatremia

Slowly decreasing the serum sodium decreases rapid correction of hypernatremia

What type of burn includes the entire epidermis and upper layer of the dermis

Superficial partial thickness

Which hormones of the body function to maintain the metabolism of the body? Select all that apply. T3 PTH T4 FSH CRH

T3 t4

REVERSE TRIAGE

THE MOST SEVERELY INJURED OR ILL VICTIMS ARE TREATED LAST TO ALLOW THE GREATEST NUMBER OF VICTIMS TO ALLOW FOR MEDICAL TREATMENT DESIGNED TO BE COMPLETED IN 60 SECONDS OR LESS. BASED ON THREE OBSERVATIONS: RESPIRATIONS, PERFUSION, AND MENTAL STATUS

Triage

TO ENSURE EARLY ASSESSMENT OF CLIENTS AND PRIORITIZE CARE BASED ON SEVERITY OF SYMPTOMS

INHALATION INJURY ASSESSMENT FINDINGS

Tachypnea, intercostal retractions, flaring nostrils Excessive agitation/anxiety, CONFUSION HORSENESS RALES, RHONCHI, DIMINSHED BREATH SOUNDS NASO- OR OROPHARYNX ERYTHEMA ELEVATED CARBOXYHEMOGLOBIN LEVELS HA, NAUSEA, VOMITTING, DIZZINESS

Surge Capacity

The ability of a healthcare facility or system to expand its operations to safely treat an abnormally large influx of patients.

pituitary gland

The endocrine system's most influential gland. Under the influence of the hypothalamus, the pituitary regulates growth and controls other endocrine glands.

Pathophysiology of Hypoparathyroidism

The low production of PTH results in hypocalcaemia (accompanied by hypomagnesemia)and hyperphosphatemia. Calcium plays a major role in appropriate muscle contraction. In low amounts it can lead to muscular rigidity and if severe tetany which can result in laryngospasm. (trach tray at bedside after thyroidectomy)

Which is true regarding the pituitary gland? Select all that apply. The pituitary gland is located in the sella turcica. The anterior pituitary gland secretes prolactin. The posterior pituitary gland synthesizes oxytocin. The posterior pituitary gland is responsible for the The anterior lobe of the pituitary is called adenohypophysis.

The pituitary gland is located in the sella turcica. The anterior pituitary gland secretes prolactin. The anterior lobe of the pituitary is called adenohypophysis.

ADDISONS dx corisol and aldosterone are too low or too high?

Too low

Medical Management SIADH

Treat hyponatremia Fluid restriction <1000ml/day Severe: IV Hypertonic saline (3%) Must be central line, careful monitoring for volume overload Diuretic (furosemide) - increase U/O

Name two tests to check for tetany

Trousseaus chovesteks

Pain management emergent phase burns

USE OF iv NARCOTIC MEDS; MORPHINE, FENTANYL, DILAUDID AVOID IM PAIN MEDICATIONS AS THERE MAY BE IMPAIRED DRUG ABSORPTION

INJURY ABOVE THE GLOTTIS:

USUALLY THERMAL OR CHEMICAL INJURY. MAY NEED INTUBATION DUE TO SWELLING OF AIRWAY

Diagnostics of diabetes insipidus?

Urine-Decreased urine osmolality (<200 mOsm/kg) and urine specific gravity <1.005 Serum -Hypernatremia (Na >145 mEq/L) Hematocrit increased (Hct >50%) Osmolality increased (>300 mOsm/kg) Water (fluid) deprivation test-All water withheld Measure urine osmolality and body weight hourly Normally urine osmolality increases to 2 to 4 times the serum. With DI the urine osmolality doesn't increase and the serum osmolality continues to increase CT or MRI to assess for cause (if not apparent)

A patient is admitted with severe dehydration and hypotension. Which hormone, when delivered, increases water reabsorption? Oxytocin Vasopressin Luteinizing hormone Adrenocorticotropic hormone

Vasopressin

Pharm tx for diabetes insipidus

Vasopressin

Nutritional management of burns

Weigh daily Parenteral nutrition Enteral nutrition Oral Tube feeding Monitor for nausea, vomiting or diarrhea High carbohydrate, high caloric - to offset energy expenditure High protein for tissue repair Feed patient early and aggressively, high protein high calorie, need 5,000 calories/day Enteral feedings preferred

autograft

a graft removed from the patient's own skin

Zone of coagulation

area that had the most contact with heat source and the location of the most damage. Eschar is often present here. no pain here b/c nerve cells are destroyed

Hypothalamus

brain region controlling the pituitary gland. Secrets CRH, GN-RH, GHRH, SOMATSTATIN GHIH, PROLACTIN-INHIBITING HORMONE, AND TRH

Patients will require a Referral to a burn center with the following injuries sites:

burns to face, hands, feet genitalia, perineum and burns over major joints are always considered serious.

Posterior pituitary disorders

diabetes insipidus SIADH

TX Thermal-

if caused by dry heat: Smother inflamed clothing. (stop, drop, and roll) If caused by moist heat: lavage with cool water. Do not use ice can cause vasoconstriction. Assess Abc's Cover body to prevent hypothermia

TX Chemical-

immediately remove clothing & use hose/shower for at least 20 minutes for liquid chemicals. Powder chemicals need to be removed prior to being rinsed with water

zone of stasis

immediately surrounds the zone of coagulation. characterized by damaged cells and impaired circulation. area most at risk for conversion if pt does not receive adequate fluid resuscitation. susceptible to limited blood flow and at risk for converting to zone of coagulation.

superficial burn

includes only the epidermal layer of skin Characterized by mild erythema and hypersensitivity Normal skin barriers remain intact Results from sunburn, UV light, or minor flash injuries (sudden ignition or explosion) Observe dryness and peeling of outer layer of skin without scar formation Typically heal in 3-7 days Cleaning products, battery acid, chlorine, tanning beds

Integumentary complications intermediate phase

infection, sepsis Use ppe when caring for patient Keep room warm Keep wounds covered

Phases of wound healing

inflammatory, proliferative, maturation/remodeling

INJURY BELOW THE GLOTTIS:

is more rare is associated with inhalation of steam or explosive gases or aspiration of hot liquids.

TX Radiation-

limit time of exposure, Establish distance, & shielding

mechanical debridement

nurse does so by applying and removing gauze dressings, or by using hydrotherapy, irrigation, or scissors and tweezers.

adrenal cortex

outer section of each adrenal gland; secretes (gluticocorticoids) cortisol, (mineralcortocoids) aldosterone, and sex hormones

The zone of hyperemia:

outermost zone; generally area of increased blood flow in an effort to bring key nutrients for tissue recovery.

Acute adrenal crisis

patient receiving exogenous corticosteroids for >2 weeks are at risk if abruptly discontinued

C02 poisoning:

results when toxic gases deposit on pulmonary mucosa. client will be red in color (like a cherry), other ss include ha, nausea, DYSPNEA, dizziness to coma and death.

adrenal medulla

secretes (catecholamines) epinephrine and norepinephrine

heterograft (xenograft)

skin transplant taken from a species other than the patient's, usually a pig

parathyroid glands

small pea-like organs that secretes parathyroid hormone (PTH) to regulate calcium and phosphate balance in blood, bones, and other tissues

Chvostek's sign:

spasm of the facial muscles elicited by tapping the facial nerve

Why are older adults more at risk for burns?

thinner skin, likely to suffer greater tbsa, more likely to have inhalation injury, and underlying conditions

Pressure garments for burns

wear over healed wounds-leave on at all times except during bathing 24hrs/day for 12-24 months