Critical Care Exam 3
Terms in this set (40)
What would be the percentage of burn injury of the entire surface of both arms, face, and anterior trunk using rule of nines?
both arms (9+9), face (4.5), anterior trunk (18) = 40.5%
What are the indications a patient may have sustained an injalation injury?
-singed nasal hair
-burns of the face, neck, and upper chest
-fire in an enclosed space
What is the required amount of fluid for resuscitation in the first 8 hours for a 75 kg pt with 50% thermal burn using ABA Formula?
3750mL/8hrs or 468.8 mL/hr
(75 x 50 x 2) = 7500 mL
7500/2 = 3750 mL
3750/8 = 468.8 mL
What are complications a burn patient may experience?
-loss of airway
-hemodynamic instability (hypovolemia due to capillary permeability into interstitium)
-electrolyte shifts (hyponatremia, hypoalbuminemia, hyperkalemia, increase Hct)
-loss of pulses (compartment syndrome)
What are the complications of electrical burns?
-hard to assess extent of cellular injury and death or internal damage
What are the indications a patient may have a basilar skull fracture?
-bruising behind the ear
-periorbital ecchymosis (raccoon eyes)
-CSF leakage from ear or nose (blood = test with halo sign, clear = test for sugar)
What are the treatments for increased ICP?
-elevated the HOB 30 degrees
-no hip flexion
-decrease coughing and sneexing
-limit care to short intervals
-hyperventilate (decrease CO2)
What are some of the long term complications of traumatic brain injuries?
-changes in personalities (in a coma 6 hrs or longer)
-altered cognitive and functional abilities
What is the treatment for a TBI pt with a BP 100/60 whose ICP is 15 mmHg?
Calculate CPP: (100 + 60 + 60)/3 = 73.33 - 15 = 58.33 mmHg (should be 70 mmHg)
So notify the HCP!
What are the manifestations of an epidural hematoma?
brief consciousness followed by sudden decompensation of neurological assessment
What are the prerenal causes of AKI?
Hypoperfusion (shock, HF)
-treat by increasing CO
What are the causes of intrarenal AKI?
-prolonged hypoperfusion (increase CO)
-myoglobinuria (tx:maintain positive fluid balance)
-aminoglycosides (tx: dose needs to decreased)
-chronic kidney infections
-NSAIDs (tx: use different medication)
What are the causes of postrenal AKI?
-kinked indwelling catheter
What are the complications of kidney disease?
-hyperkalemia (watch the EKG for peaked T waves, tx: kayexalate (if active bowel sounds found), calcium gluconate, insulin)
-hyperphosphatemia (tx: given calcium carbonate with meals, careful with iron)
-anemia (kidneys produce erythropietin, check hemoglobin)
-fluid overload (tx: dialysis)
What are the treatments for the oliguric phase of AKI?
-fluid restriction with daily weights (600 mL + UO in past 24hrs)
What are the treatments for the diuretic phase of AKI?
-monitor for hypokalemia, hyponatremia, hypovolemia
Whar are the complications of dialysis?
-hypotension (occurs in hemolytic dialysis, tx: slow down)
-muscle cramping (pull off sodium too fast, tx: fluid bolus of saline)
-infection & peritonitis (mainly in peritoneal dialysis)
-abd discomfort/cramping (because dialysate is too cold)
What are the manifestations of neurogenic shock?
-drop in SVR
What is the bladder/bowel managemnt for pts wth SCIs?
-bladder: intermittent catheterizations (every 4hrs)
-bowel: daily suppositories, digital stimulation (same time every day)
What is a pt experiencing when they have flaccid paralysi with absent reflexes that accompany the lack of sensation below the level of the spinal injury?
What are the signs and symptoms of autonomic dysreflexia or hyperreflexia?
-HTN (tx: raise HOB)
-HA (throbbing, pounding, pulsating)
-sweating above injury (forehead, upper extremities)
What are the complications a patient with a T6 spinal cord injury may experience?
-neurogenic and/or spinal shock
What are the steps of the primary assessment?
-while maintaining cervical spine immobilization
-assess (A) airway (intubated if needed)
-assess (B) breathing (use BVM if needed)
-assess (C) circulations (start IVS and give fluids if needed)
-assess (D) neuro status (get CT if needed)
What are the indications of compartment syndrome?
What are methods of preventing DVTs in a trauma patient?
-SCDs (if legs are intact)
-close assessment of extremities
What are the complications of chest trauma?
-pneumothorax (tx: chest tube)
-dysrhythmias (treat like a MI)
-elevated CK, troponin
-blunt cardiac injury
-diaphragmatic rupture (bowel sounds in thoracic cavity)
What are the complications of facial trauma?
-loss of airway
-basilar skull fractures
What are the types of rejection of transplanted organs?
-hyper acute: happens rapidly (witin first 24-48 hrs), pt got the wrong organ (tx: remove the organ)
-acute: common, within 2-4 weeks (tx: tweak immunosuppressants)
-chronic : over the years, the body will kill off the organ
What are the complications with organs transplants?
Who has the best chance of getting a transplant?
-the person with the highest medical need
What is the treatment for acute rejection of a transplant?
Administration of high dose immunosuppressant medications
What are the complications post kidney transplant?
-dehydration due to diuresis
What types of hepatitis can you contract from contaminated food?
Hep A and Hep E
What does a pt have to have before getting hepatitis D?
What are the nursing interventions for a patient with ascites?
-keeping pt in semi-Fowler's position
-assist with paracentesis
What are the prevention measures for a patient with esophageal varices (non-bleeding yet)?
Propanolol (decrease portal HTN)
What are the treatments for a patient with bleeding esophageal varices?
-Vasopressin (give with nitro if cardiac problems in pt)
What are the complications of hepatic failure?
-AMS (usually due to ammonia level)
-hemorrhaging esophageal varices
-elevated ammonia level
What lab results are important to monitor in patients with cirrhosis and bleeding varices?
What are the causes of edema in pts with hepatic failure?
-increase in serum aldosterone
-increased portal hypertension