Professional Documents
Culture Documents
Burns, Environmental Emergencies, & Multisystem Shock
Burns, Environmental Emergencies, & Multisystem Shock
Burns, Environmental Emergencies, & Multisystem Shock
the radiator of the overheating truck he was driving. His anterior torso,
the anterior of both arms are the areas affected. What is the total body
surface area burned?
A. 9%
B. 18%
C. 27%
D. 36%
C. 27%
Rationale:
18% (anterior torso) + 4.5 (anterior 1st arm) + 4.5 (anterior 2nd arm)=
27% TBSA
Upon obtaining the TBSA, and with the patient weighing 145 lbs. how
many ml of fluid would the patient receive in a 24 hours fluid
rescucitation?
A. 7,128ml
b. 4,752ml
c. 9,504ml
d. 10,054ml
A. 7,128ml
Rationale:
Severe pain-Emergent phase
Nursing Care: ◎ Soaking the burn with cool H2O (relieves pain & limit
local tissue edema)
Rationale:
Second Degree
◎ Mottled, red, painful
◎ Heals in 14-20 days
◎ Superficial burn heals causing pigmentation
◎ Deep burn heals causing scarring & pigmentation
A patient has a burn in his chest & face and is having strider. What
would be your priority nursing action?
A. Obtain an IV line
b. Give 100% oxygen is a non-rebreather mask
c. Take history as to how the incident happened
d. Irrigate the would with saline solution
B. Give 100% oxygen is a non-rebreather mask
Rationale: The client has an inhalation burn injury during the emergent
phase. The focus for the client is to assess ABC's & if the patient is able
to breathe properly.
Dressing the wound of the burnt area is included in the plan of care of
the nurse caring for a burned client. What topical dressings would most
likely be applied on the burned area?
A. Betadine
B. 70% isopropyl alcohol
C. Silver sulfadizine (Silvadene)
D. Terramycin
C. Silver sulfadizine (Silvadene)
Rationale:
TBSA- posterior torso (18%), anterior + posterior of right arm (9%), and
anterior of both legs (18%).
18 + 9 + 18= 45 TBSA
Fluid resuscitation:
45% x 68kg x 4ml= 12,240ml/hr
What is the key factor in describing any type of the shock?
A. Hypoxemia
B. Hypotension
C. Vascular collapse
D. Inadequate tissue perfusion
d. inadequate tissue perfusion
Rationale:
During both the compensatory and progressive stages of shock, the
SNS is activated in an
attempt to maintain CO and SVR. In the refractory stage of shock, the
SNS can no longer
compensate to maintain homeostasis and a loss of vasomotor tone
leading to profound hypotension affects perfusion to all vital organs,
causing increasing cellular hypoxia, metabolic acidosis, and cellular
death. Respiratory alkalosis occurs in early shock. Unresponsiveness
and absent peripheral pulses can occur for many reasons and in earlier
shock.
A patient with acute pancreatitis is experiencing Hypovolemic shock.
Which invitations orders for the patients will the nurse implement
first?
A. Start 1000mL of normal saline at 500mL/hr
B. Obtain blood cultures before staring IV antibiotics.
C. Draw blood for hematology & coagulation factors
D. Administer high-flow oxygen (100%) with a non-rebreather mask
D. Administer high-flow oxygen (100%) with a non-rebreather mask
Rationale: Vasoactive drugs are those that can either dilate or constrict
blood vessels and are used in various stages of shock treatment. When
using either vasodilators or vasoconstrictors, it is important to maintain
a mean arterial pressure (MAP) of at least 65 mm Hg so that adequate
perfusion is maintained. The goal for urine output is ≥0.5 mL/kg/hr.
The other goals would be appropriate only with either vasodilators or
vasoconstrictors, not with all vasoactive drugs.
Identify two medical therapies that are specific to each of the following
types of shock: Cardiogenic
Thrombolytic therapy, angioplasty, emergency revascularization,
Increase CO with inotrope coming agents, reduce workout by dilating
coronary arteries, intra-aortic ballon pump, treat dysrhythmias
Identify two medical therapies that are specific to each of the following
types of shock: Hypovolemic
Fluid & blood replacement, control of bleeding with pressure, surgery
Identify two medical therapies that are specific to each of the following
types of shock: Septic
Fluid resuscitation, antimicrobial agents, inotropic agents with
vasopressors
Identify two medical therapies that are specific to each of the following
types of shock: Anaphlyactic
Epinephrine, inhaled bronchodilators, colloidal fluid replacement,
diphenhydramine, corticosteroids
Identify four drugs and their actions that are used in treatment of
cardiogenic shock but are not generally used for other types of shock:
Epinephrine (Adrenalin)
Increase contractility of heart & SVR by constricting blood vessels
Identify four drugs and their actions that are used in treatment of
cardiogenic shock but are not generally used for other types of shock:
Dobutamine (Dobutex)
Increase contractility of heart by binding onto beta adrenergic
receptors
Identify four drugs and their actions that are used in treatment of
cardiogenic shock but are not generally used for other types of shock:
Norepinephrine (Levophed)
Increase BP by binding to a & B adrenergic receptors for
vasoconstriction
Identify four drugs and their actions that are used in treatment of
cardiogenic shock but are not generally used for other types of shock:
Amrinone
Increase contractility of heart by inhibiting phosphodiesterase
What is the PRIORITY nursing responsibility In the prevention of
shock?
A. Frequently monitoring all patients' vital signs
B. Using aseptic technique for all invasive procedures
C. Being aware of the potential for shock in all patient at risk
D. Teaching patient health promotion activities to prevent shock
C. Being aware of the potential for shock in all patient at risk
A. Burns
B. Fungi
C. Viruses
D. Crush injuries
E. Surgical procedures
A, D, E
Rationale: Mechanical tissue trauma triggering of SIRS occurs with
burns, crush injuries & surgical procedures. Fungi, viruses, bacteria &
parasites cause microbial invasion triggering which is more likely in this
patient