Focus Points
NUR2790
Exam 2
Modules 3, 4, & 5
Module 3 Tissue Integrity
BURNS
➢ Review RN delegation of tasks: I&O, tracking, sterile
➢ Infection prevention: sterile dressing changes
➢ Understand how to support severely burned patients from resuscitation to discharge/rehab;
identify priority actions in each phase i.e. adequate fluid status and continuous monitor , airway!
during resuscitation phase; priority for burn patient coming to ED; priority for patient that has
been electrocuted: cardiac monitoring; what are potential consequences of burns: infection,
body image, contractures
➢ Treatment for patient that develops loud, brassy cough – what is going on here? Intubate
because about to lose airway due to laryngeal edema
➢ Understand common medications administered to burn patients and why the medications are
given i.e. for pain, prevention of ulcers. Morphine,
➢ Understand nursing assessment of burn patient – what is continuously monitored – s/s to watch
for i.e. drooling, difficulty swallowing, ABC – what does the nurse do first; psychosocial impact of
severe burn – would depression be normal? yes
➢ Parkland Formula: 4 mL x body surface area x weight in Kg. lactated ringers
➢ How to calculate BSA% - rule of nine’s
➢ Understand lab/ABG values for a burn patient i.e. what is typically seen in burn patients.
Metabolic acidosis, hyperkalemia, hyponatremia, hemoconcentration
➢ Describe the different layers of burns r/t involvement of dermis/epidermis i.e. which ones have
blisters, pain, etc. Superficial thick: SUNBURN only epidermis, least damage (peeling) Partial
thick: dermis and epidermis (sun, scald, grease) super-partial thick: 1/3 dermis damage, blisters,
good blood supply still, increased pain need pain meds before touching pt. deep partial thick: no
blisters-too deep, nerves destroyed
➢ Cardiac changes: Release of catecholamines, vasopressin, and angiotensin II causes intense
vasoconstriction and increased SVR
BP & HR elevated
Initial attempt to conserve fluid
Increased capillary force also promotes burn edema
CO decreased due to release of vasocontrictive agents and increased SVR and CO workload
Cardiac function continues to be depressed even after adequate fluid resuscitation
Myocardial depressant effects of inflammatory mediators
Tumor necrosis factor (inflammatory biochemical) released from burn wound
o DISASTER PREPAREDNESS
, Focus Points
NUR2790
Exam 2
➢ Understand colored tags and how would you educate others: black tag=low chance of survival
➢ Understand personal preparedness plan – what do you include or consider. 3 days. Food water.
➢ What does the RN need to do to be prepared on the floor? Chain of command
o Emergency Nursing/Mass casualty/Trauma Nursing
➢ Role of RN in ED when there is a mass casualty? Triage, delegating, pt care
➢ Understand critical incident stress debriefing how to prevent PTSD as a nurse? Talk to someone,
sleep, exercise, eat right, hydration
➢ Understand how you would triage incoming patients from mass casualty – examples know
difference between traditional and mass casualty? Treat stable first, traditional treat most sick
first.
➢ Mass casualty event – paramedic, Hospital incident commander, public information officer,
triage officer, medical command physician – hierarchy and roles
➢ Review RN delegation of tasks: LPNs and techs can collect info but RN charge for plan of care
➢ Specialty teams available in ER: trauma stroke resp.,cardiac, code rapid, anesthesia, forensic
➢ CPR – family presence
➢ Consider vulnerable populations – establishing trust
➢ Priority assessments i.e. which color would nurse focus on; patient arrives with O2 mask on
assess airway;
GAS EXCHANGE
➢ Understand Rapid Response Team role. Unstable pts
➢ Pulmonary embolus – patho, risk factors i.e. DVT, afib, immobility post surgical, preg, s/s you
may see: SOB, tachy, chest pain dyspnea, anxiety., anticipated treatment intervention to prevent
DVT anticoagulants. Monitor for bleeding, ptt
➢ Anticoagulants – monitoring, patient education. Electric razor, soft brush
➢ ABGs for respiratory issues i.e. COPD resp acidosis
➢ Common medications for intubated patients – what to monitor, patient education to prevent
ulcers.
➢ Mechanical ventilation – assessment (5-15) PEEP of 20cm means too high can cause pneumo,
treatment- prevent VAP ETT removed suction and oral care; low pressure alarm caused by losing
pressure could be cuff leak, disconnection; high pressure alarm mucus plug, kink, biting tube;
agitated patient what does the nurse assess for low O2, pain; dyspneic with normal O2 sat -ARDS
➢ Flail chest – anticipated interventions : pos. pressure, pain mngmt NO CHEST TUBE
➢ Understand refractory hypoxemia – wide spread inflammatory response seen in what disease
process? ARDS
CARDIAC
➢ Understand ECG complex – think about what is going on in the heart if there is no P wave with
every QRS, or if a segment lengthens i.e. what part of the conduction system of the heart
controls the rate-SA node; what wave is not normally seen on ECG- U wave not seen
➢ Common medications cardiac pt.– Beta blockers-tachy, anticoagulants-prevent clots and stroke
patient education- Take own pulse; what two meds will patient with afib have long term are
above.
NUR2790
Exam 2
Modules 3, 4, & 5
Module 3 Tissue Integrity
BURNS
➢ Review RN delegation of tasks: I&O, tracking, sterile
➢ Infection prevention: sterile dressing changes
➢ Understand how to support severely burned patients from resuscitation to discharge/rehab;
identify priority actions in each phase i.e. adequate fluid status and continuous monitor , airway!
during resuscitation phase; priority for burn patient coming to ED; priority for patient that has
been electrocuted: cardiac monitoring; what are potential consequences of burns: infection,
body image, contractures
➢ Treatment for patient that develops loud, brassy cough – what is going on here? Intubate
because about to lose airway due to laryngeal edema
➢ Understand common medications administered to burn patients and why the medications are
given i.e. for pain, prevention of ulcers. Morphine,
➢ Understand nursing assessment of burn patient – what is continuously monitored – s/s to watch
for i.e. drooling, difficulty swallowing, ABC – what does the nurse do first; psychosocial impact of
severe burn – would depression be normal? yes
➢ Parkland Formula: 4 mL x body surface area x weight in Kg. lactated ringers
➢ How to calculate BSA% - rule of nine’s
➢ Understand lab/ABG values for a burn patient i.e. what is typically seen in burn patients.
Metabolic acidosis, hyperkalemia, hyponatremia, hemoconcentration
➢ Describe the different layers of burns r/t involvement of dermis/epidermis i.e. which ones have
blisters, pain, etc. Superficial thick: SUNBURN only epidermis, least damage (peeling) Partial
thick: dermis and epidermis (sun, scald, grease) super-partial thick: 1/3 dermis damage, blisters,
good blood supply still, increased pain need pain meds before touching pt. deep partial thick: no
blisters-too deep, nerves destroyed
➢ Cardiac changes: Release of catecholamines, vasopressin, and angiotensin II causes intense
vasoconstriction and increased SVR
BP & HR elevated
Initial attempt to conserve fluid
Increased capillary force also promotes burn edema
CO decreased due to release of vasocontrictive agents and increased SVR and CO workload
Cardiac function continues to be depressed even after adequate fluid resuscitation
Myocardial depressant effects of inflammatory mediators
Tumor necrosis factor (inflammatory biochemical) released from burn wound
o DISASTER PREPAREDNESS
, Focus Points
NUR2790
Exam 2
➢ Understand colored tags and how would you educate others: black tag=low chance of survival
➢ Understand personal preparedness plan – what do you include or consider. 3 days. Food water.
➢ What does the RN need to do to be prepared on the floor? Chain of command
o Emergency Nursing/Mass casualty/Trauma Nursing
➢ Role of RN in ED when there is a mass casualty? Triage, delegating, pt care
➢ Understand critical incident stress debriefing how to prevent PTSD as a nurse? Talk to someone,
sleep, exercise, eat right, hydration
➢ Understand how you would triage incoming patients from mass casualty – examples know
difference between traditional and mass casualty? Treat stable first, traditional treat most sick
first.
➢ Mass casualty event – paramedic, Hospital incident commander, public information officer,
triage officer, medical command physician – hierarchy and roles
➢ Review RN delegation of tasks: LPNs and techs can collect info but RN charge for plan of care
➢ Specialty teams available in ER: trauma stroke resp.,cardiac, code rapid, anesthesia, forensic
➢ CPR – family presence
➢ Consider vulnerable populations – establishing trust
➢ Priority assessments i.e. which color would nurse focus on; patient arrives with O2 mask on
assess airway;
GAS EXCHANGE
➢ Understand Rapid Response Team role. Unstable pts
➢ Pulmonary embolus – patho, risk factors i.e. DVT, afib, immobility post surgical, preg, s/s you
may see: SOB, tachy, chest pain dyspnea, anxiety., anticipated treatment intervention to prevent
DVT anticoagulants. Monitor for bleeding, ptt
➢ Anticoagulants – monitoring, patient education. Electric razor, soft brush
➢ ABGs for respiratory issues i.e. COPD resp acidosis
➢ Common medications for intubated patients – what to monitor, patient education to prevent
ulcers.
➢ Mechanical ventilation – assessment (5-15) PEEP of 20cm means too high can cause pneumo,
treatment- prevent VAP ETT removed suction and oral care; low pressure alarm caused by losing
pressure could be cuff leak, disconnection; high pressure alarm mucus plug, kink, biting tube;
agitated patient what does the nurse assess for low O2, pain; dyspneic with normal O2 sat -ARDS
➢ Flail chest – anticipated interventions : pos. pressure, pain mngmt NO CHEST TUBE
➢ Understand refractory hypoxemia – wide spread inflammatory response seen in what disease
process? ARDS
CARDIAC
➢ Understand ECG complex – think about what is going on in the heart if there is no P wave with
every QRS, or if a segment lengthens i.e. what part of the conduction system of the heart
controls the rate-SA node; what wave is not normally seen on ECG- U wave not seen
➢ Common medications cardiac pt.– Beta blockers-tachy, anticoagulants-prevent clots and stroke
patient education- Take own pulse; what two meds will patient with afib have long term are
above.
