| Burn baby, buuurrrn | Ache-y, Brake-y Heart | Urine Good Hands | Make up your mind (brain) | SHOCK and awe |
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What is second degree, partial thickness
The patient presents to the ED with burns to the arms and legs. Blisters are present, and he reports a pain rating of 9 out of 10. What level of burn does this patient have?
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What is Vagal maneuvers, adenosine
Synchronized cardioversion if persistent IV BB or CCB if adenosine doesn't work
Name the treatments used for sinus tachycardia
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Increased BUN
Increased Cr Decreased UO Increased Na (>40) Casts in urine Lower than normal specific gravity
Describe some characteristics that may be seen with intrarenal AKI.
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Flaccid paralysis
The nurse is evaluating the neurological signs of a client in spinal shock following spinal cord injury. Which observation indicates that spinal shock persists?
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Increase the rate of intravenous (IV) fluids
A client in shock develops a central venous pressure (CVP) of 2 mm Hg. Which prescribed intervention should the nurse implement first?
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What is within 4 hours
Name the amount of time it takes for edema to form in a superficial burn.
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What is a P wave
Depolarization of the atria will produce a
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Trauma to the bladder or abdomen
A client arrives at the emergency department with complaints of low abdominal pain and hematuria. The client is afebrile. The nurse next assesses the client to determine a history of which condition?
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Altered breathing pattern
A client with a spinal cord injury at the level of C5 has a weakened respiratory effort and ineffective cough and is using accessory neck muscles in breathing. The nurse carefully monitors the client and suspects the presence of which problem.
Altered breathing pattern 2. Increased likelihood of injury 3. Ineffective oxygen consumption 4. Increased susceptibility to aspiration |
Stage 2
A client at risk for shock secondary to pneumonia develops restlessness and is agitated and confused. Urinary output has decreased and the blood pressure is 92/68 mm Hg. The nurse minimally suspects which stage of shock based on this data?
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What is removal of eschar via escharotomy (decompression of edema formation), or fasciotomy (restore tissue perfusion).
Name the treatments for severe edema
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What is the total time for a ventricular depolarization and repolarization
The QT interval represents
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Check the level of the drainage bag.
Reposition the client to his or her side. Place the client in good body alignment. Check the peritoneal dialysis system for kinks.
The nurse monitoring a client receiving peritoneal dialysis notes that the client's outflow is less than the inflow. Which actions should the nurse take?
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Sit them upright
The nurse is caring for a client who sustained a spinal cord injury. During administration of morning care, the client begins to exhibit signs and symptoms of autonomic dysreflexia. Which initial nursing action should the nurse take? |
Rapid ID and elimination of the cause of infection
Retrieve specimens of blood, sputum, urine, wound drainage, and tips of invasive catheters using aseptic technique Remove IV lines and reinsert at alternate sites Remove urinary catheters Drain abscesses Antibiotics within 1st hour Aggressive fluid resuscitation
What are the current treatments of sepsis and septic shock?
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Systemic inflammation causes release of free oxygen radicals that increase capillary permeability, this causes increased plasma loss and subsequent peripheral edema->increased vasoconstriction and decreased tissue perfusion. this in turn causes increased work load of the heart and O2 demand increases.
When a burn injury occurs, what happens to the cardiac output and why? (Patho)
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Ensure airway/give O2
Amiodorone 150mg IVP over 10min Procainamide until arrhythmia suppressed Adenosine W/out pulse= SHOCK
A patients heart monitor shows ventricular tachycardia with a pulse; what should you the nurse do in this situation? What should they do if they do not have a pulse?
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Those with heart failure or cirrhosis with ascites
Which patients are at an increased risk of developing NSAID induced kidney disease?
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Ipsilateral paralysis and loss of touch and vibration
The nurse is performing an assessment on a client with the diagnosis of Brown-Séquard syndrome. The nurse would expect to note which assessment finding?
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Toward the end of the continuum of septic shock when tissue perfusion cannot be effectively restored
When does MODS typically occur and why?
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Albumin loss
Hyperkalemia from massive cell destruction (hypoK later with fluid shifts) Hyponatremia (can also occur in 1st week of acute phase as water shifts from interstitial to vascular space)
Name the different fluid and electrolyte alterations that occur immediately after a burn.
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What is a QRS complex
Depolarization of a ventricle will produce a
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1000ml/day
Usually the fluid allowance per day for patients who receive in-center HD who are anuric is about
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Mannitol and hypertonic saline (3%)
What medications may be used to decrease cerebral edema?
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Distributive shock
Anaphylactic and neurogenic shock are both a type of
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