Exam 4: NSG233/ NSG 233 (Latest 2023/ 2024 Update) Med Surg 3 Exam| Questions and Verified Answers| 100% Correct| Grade A- Herzing
Exam 4: NSG233/ NSG 233 (Latest 2023/
2024 Update) Med Surg 3 Exam| Questions
and Verified Answers| 100% Correct| Grade
A- Herzing
Q: describe the placement and percentage of the rule of nines
Answer:
Head 9%
anterior trunk 18%
posterior trunk 18%
genitalia 1%
arms 9%
legs 18%
Q: effects of major burns
Answer:
face neck upper extremity burns : inhalation of smoke / heat
electrolyte shifts
Q: what test assess carbon monoxide poisoning
Answer:
carboxyhemoglobin
Q: whats CM of carbon monoxide poisoning
Answer:
fever
headache
dizzy
NV
bright pink lips
“sut” black sputum
Q: Emergent or resuscitativephase
Answer:
onset of injury – fluid resuscitation
Q: how to ensure a patent airway in burn victim
Answer:
give humidified 100% O2
Q: Acute or intermediate phase
Answer:
beginning or diuresis – wound closure
48-72
Management of shock: maintain BP, urine output 30-50mL, maintain serum sodium
Q: Rehabilitation phase
Answer:
wound closure – return to optimal phsyical / psychosocial
Q: what type of burn can cause hematuria
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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
what do we put TB pt on w/ HIV
rifampin
could be in combo w/ other drugs
what do we put pneumonia pt on w/ HIV
bactin
when does capos sarcoma usually occur
in stage 3
Tx of HIV AIDS
Antiretroviral therapy
combo of 2+ rx
who would be on mono therapy for HIV pt
pregnant woman
(zidovudine: hepatic toxic)
monitor clotting and bleeding: pancytopenia
what test can indicate the extent or stage of HIV
CD4
increase in CD4= getting better on RX
what do HIV pt need to avoid
no raw food
fully cooked steak
bird cages and cat litter
sick people
avoid bowl irritants – spicy food, alc, fried food, nuts
nutritional diet for HIV pt
ensure / boost
no raw food
well done stk
avoid bowl irritants – spicy food, alc, fried food, nuts
Which of the following is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result ofHIV infection?
HIV encephalopathy