Medsurg III Exam 4 with complete solutions

whose most likely at risk for burns men 2x what percentage of burns occur at home 73 who is at isk for morbidity due to burns geriatrics pediatrics burn education monitor kids in bath outlet covers fireplace enclosures table clothes can cause easy spills first degree burn superficial sunburn second degree burn entire epidermis some dermis painful blisters third degree burn total destruction of epidermis, dermis, and underlying tissue lack of sensation fourth degree burn Deep burn necrosis extends into deep tissue, muscle, or bon Injuries that affect >20% ofTBSA are considered severe describe the placement and percentage of the rule of nines Head 9% anterior trunk 18% posterior trunk 18% genitalia 1% arms 9% legs 18% effects of major burns face neck upper extremity burns : inhalation of smoke / heat electrolyte shifts what test assess carbon monoxide poisoning carboxyhemoglobin whats CM of carbon monoxide poisoning fever headache dizzy NV bright pink lips "sut" black sputum Emergent or resuscitativephase onset of injury - fluid resuscitation how to ensure a patent airway in burn victim give humidified 100% O2 Acute or intermediate phase beginning or diuresis - wound closure 48-72 Management of shock: maintain BP, urine output 30-50mL, maintain serum sodium Rehabilitation phase wound closure - return to optimal phsyical / psychosocial what type of burn can cause hematuria electrical what must be continuously assessed in but pt continuously assess airway breathing what electrolytes are shifted in burn pt hyerkalemia -initial hyponatremia -later metabolic acidosis Elevated hematocrit -initial Decrease platelets and increased clotting time -initial What fluid resuscitation should be used for thermal or chemical burns 2mL LR /kg/% TBSA (only 2nd 3rd 4th degree burns) What fluid resuscitation should be used for electrical burns 4mL LR / kg/ %TBSA (only 2nd 3rd 4th degree burns) how are the infusions regulated on burn pts 1/2 of the vol within 8 hours of injury (injury time NOT who they got to hospital) rest within 16hours of injury How often must the patient' s response to fluid therapy be evaluated q1hr what topical agents are used in burn pt silvadine antibiotic ointment explain how the dressing should be applied to burn pt wrap each phalange single and then all together dont wrap tight what burns need graphs deep partial full thickness (decreases risk of infection, prevent further loss of protein fluid electrolytes) whats an Autograft ideal graph from pts own skin Homograft donated skin from deceased or living Xenograft skin from animals - usually a pig how long should the dressings be on the new graph until change? 3-5 days burn pt edu for prevention of infection limited visitors - may need full PPE no fresh fruit and flowers sterile procedures tubes /lines are only ok for 24hours - then need change whats the number 1 route for pain relief in burn pt IV Morphine & Fentanyl are commonly used in burn pt, what needs to be monitored respiratory and constipation A client with a superficial partial-thickness solar burn (sunburn)of the chest, back, face, and arms is seen in urgent care. Thenurse's primary concern should be pain management when should nutrition be administered to burn pt ASAP high protein high cal pt not eating well : ask what you like to eat nursing implementations for Psychosocial Support talk to how they feel promote body image talk to patient during dressing changes follow up care for burn pts early ambulation (prevent pneumonia and DVT) have family pt demonstrate wound care compression garments/wraps promotes circulation pain meds q 30 mins intact blisters average time between HIV + test and AIDS is 8-10 years period from infection of HIV and development of HIV antibodies for 3 months what cells does HIV target CD4 Reverse Transcriptase changes RNA to DNA who is at risk for HIV breastfed infants or birth of HIV+ mom Bisexual men IV drug users what edu should be given for prevention of HIV condoms needle exchange behavioral interventions avoid sharing needles antiviral medications within 72hours of exposure (2-3 rx for 28 days) if an RN has a needle stick, what should they do first inform their manager Antiretroviral medications aspostexposure prophylaxis forhealth care workers arestarted within how manyhours of exposure? 72 stage 0 HIV early HIV stage 1 of HIV Primary/acute Period from infection with HIV to the development of HIV-specific antibodies CD4+ T-cell counts normally 500 to1500 cells/mm3 of blood how many stages of HIV are there 5 Stage 2 HIV t lymphocytes between 200-499 Stage 3 HIV CD4 count below 200 cells considered to have AIDS stage unknown HIV no info on CD4 count how do we treat immune Reconstitution InflammatorySyndrome (IRIS) in HIV pt's steroids Kaposi's Sarcoma cancer caused by herpes virus TX: antibiotic or anti-tumor therapy (usually daunorubicin) what to monitor w pt on daunorubicin monitor liver labs so if liver enzymes are high: we cut dose in half CM of HIV asymptomatic in stage 1 or skin rash SOB dyspnea chest pain cough TB pneumonia NV anorexia dirrhea oral candidiasis