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Parkland Formula a) 4ml x % BSA x weight (kg)= volume of fluid that needs to be infused b) ½ of the total volume of fluid in first 8 hours c) Last half in 16 hours MAP Calculation a) MAP= 1/3 * SBP + 2/3 * DBP Treatment for frostbite a) Rewarming the skin a. Rewarm the area using a warm-water bath for 15 to 30 minutes b. Skin may turn soft and look red or purple c. You may be encouraged to gently move the affected area as it rewarms. b) Oral pain medicine a. The rewarming process can be painful c) Protecting the injury a. Once the skin thaws, loosely wrap the area with sterile sheets, towels, or dressing to protect the skin. b. May have to protect fingers and toes as they thaw by gently separating them from each other c. You may need to elevate the affected area to reduce swelling d) Debridement (removal of damaged tissue) a. To heal properly, frostbitten skin needs to be free of damaged, dead or infected tissue. e) Whirlpool therapy or physical therapy a. Hydrotherapy can aid healing by keeping skin clean and naturally removing dead tissue b. Pt may be encouraged to move the affected area f) Antibiotics a. If the skin or blisters appear to be infected, the doctor may prescribe oral antibiotics g) TPA a. IV injection of a drug that helps restore blood flow (thrombolytic) such as TPA. b. TPA lowers the risk of amputation c. These drugs can cause serious bleeding and are typically used only in the most serious situations and within 24 hours of exposure. h) Wound care i) Surgery a. Severe frostbite patients may need surgery or amputation to remove dead or decaying tissue. j) Hyperbaric oxygen therapy a. Some patients show improved symptoms after this therapy, but more study is needed.
Treatment and differences of heat stroke and heat exhaustion a) Heat exhaustion a. Symptoms i. General weakness, increased heavy sweating, a weak but faster HR, N/V, possible fainting, pale/cold/clammy skin b. Treatment i. Stop physical activity, transfer to cool space ii. Cooling measures (ice water bath, mist skin with water, ice packs, special cooling blanket) iii. Rehydration therapy b) Heat stroke a. Symptoms i. Elevated body temperature above 103 F (39.4 C), rapid and strong HR, loss or change of consciousness, hot, red, dry, or moist skin b. Treatment i. Oxygen therapy, IV lines, urinary catheter, continuous cooling (Ice bath, mist skin with water, ice packs, special cooling blanket), benzodiazepine if shivering occurs, monitor for multi system organ dysfunction syndrome and electrolyte imbalances. Priority assessment in triage a) ABC’s Temperature reduction strategies a) Ice bath, mist skin with water, ice packs, special cooling blanket Skin injury related to frostbite a) Frostbite occurs in several stages: a. Frostnip i. Mild form of frostbite- does not permanently damage the skin ii. Continued exposure leads to numbness in the affected area iii. As the skin warms, the patient may feel pain and tingling. b. Superficial Frostbite i. Appears as reddened skin that turns white or pale ii. The skin may begin to feel warm- a sign of serious skin involvement iii. If you treat frostbite with rewarming at this stage, the surface of skin may appear mottled and you may notice stinging, burning, and swelling iv. Fluid-filled blisters may appear 12 to 36 hours after rewarming the skin c. Deep (Severe) Frostbite i. Skin turns white or bluish grey, and the patient may experience numbness, losing all sensation of cold, pain, or discomfort in the affected area. ii. Joints/muscles may no longer work
Addressing ventilator alarms a) Should never be turned off or ignored during mechanical ventilation b) The major alarms on the ventilator indicate either a high pressure or low exhaled volume c) If the alarm cannot be determined, ventilate the patient manually with a resuscitation bag until the problem is corrected by another health care professional Fractured ribs and flail chest a) Rib fracture a. Important info i. The most common cause is blunt trauma from a fall or car accident. Trauma can increase your risk for organ damage when your rib is fractured. ii. Older age, osteoporosis, or a tumor can increase your risk for rib fractures. iii. A stress fracture can happen in your upper or middle ribs. Stress fractures can happen when you have a forceful long-term cough. They can also be caused by forceful athletic movements, such as in golf, throwing, or rowing. iv. A condition called flail chest occurs if 3 or more of your ribs are broken in 2 or more places. This condition may make it hard for you to breathe. b. Signs and symptoms i. Chest wall pain that worsens when you breathe, move, or cough ii. Bruising or swelling near your injury iii. Shortness of breath or difficulty taking a deep breath c. Treatment i. Medications
- NSAIDs , such as ibuprofen, help decrease swelling, pain, and fever.
- Prescription pain medicine may be given.
- Intercostal nerve block may be given to numb the injured area for about 6 hours. It is given as a shot between 2 of your ribs in the fractured area. You may need this if your pain continues or is getting worse even after you take oral pain medicines. ii. Surgery may be needed if your rib fracture is severe or several ribs are badly broken. Surgery is often needed for a flail chest. d. Management of symptoms i. Take deep breaths and cough 10 times each hour. This will decrease your risk for a lung infection. Hug a pillow on your injured side to decrease pain while you take deep breaths. Take a deep breath and hold it for as long as you can. Let the air out and then cough. Deep breaths help open your airway. You may be given an incentive spirometer to help you take deep breaths. Put the plastic piece in your mouth and take a slow, deep breath, then let the air out and cough. Repeat these steps 10 times every hour. ii. Rest and limit activity as directed. Do not pull, push, or lift objects. Start to do more as your pain decreases. iii. Apply ice on your chest near your fractured rib for 15 to 20 minutes every hour or as directed. Use an ice pack, or put crushed ice in a plastic
bag.
i. Small air blisters (blebs) can develop on the top of the lungs. These blebs sometimes burst — allowing air to leak into the space that surrounds the lungs. d. Mechanical ventilation. i. A severe type of pneumothorax can occur in people who need mechanical assistance to breathe. The ventilator can create an imbalance of air pressure within the chest. The lung may collapse completely. d) Diagnosis a. chest X-ray. In some cases, a computerized tomography (CT) scan may be needed to provide more-detailed images. Ultrasound imaging also may be used to identify a pneumothorax. e) Treatment a. Observation i. If only a small portion of your lung is collapsed, your doctor may simply monitor your condition with a series of chest X-rays until the excess air is completely absorbed and your lung has re-expanded. This may take several weeks. b. Needle aspiration or chest tube insertion c. Nonsurgical repair: i. Using a substance to irritate the tissues around the lung so that they'll stick together and seal any leaks. This can be done through the chest tube, but may be done during surgery. ii. Drawing blood from your arm and placing it into the chest tube. The blood creates a fibrinous patch on the lung (autologous blood patch), sealing the air leak. iii. Passing a thin tube (bronchoscope) down your throat and into your lungs to look at your lungs and air passages and place a one-way valve. The valve allows the lung to re-expand and the air leak to heal. d. Surgery: i. Sometimes surgery may be necessary to close the air leak. In most cases, the surgery can be performed through small incisions, using a tiny fiber- optic camera and narrow, long-handled surgical tools. The surgeon will look for the leaking area or ruptured bleb and close it off. ii. Rarely, the surgeon will have to make a larger incision between the ribs to get better access to multiple or larger air leaks. ARDs a) Overview a. Acute respiratory distress syndrome (ARDS) occurs when fluid builds up in the tiny, elastic air sacs (alveoli) in your lungs. The fluid keeps your lungs from filling with enough air, which means less oxygen reaches your bloodstream. This deprives your organs of the oxygen they need to function. b) Symptoms a. Severe shortness of breath
b. Labored and unusually rapid breathing c. Low blood pressure d. Confusion and extreme tiredness c) Treatment a. Oxygen i. Supplemental oxygen. For milder symptoms or as a temporary measure, oxygen may be delivered through a mask that fits tightly over your nose and mouth. ii. Mechanical ventilation. Most people with ARDS will need the help of a machine to breathe. b. Fluids i. Carefully managing the amount of intravenous fluids is crucial. Too much fluid can increase fluid buildup in the lungs. Too little fluid can put a strain on your heart and other organs and lead to shock. c. Medication i. People with ARDS usually are given medication to:
- Prevent and treat infections, Relieve pain and discomfort, Prevent blood clots in the legs and lungs, Minimize gastric reflux, and Sedate d. pulmonary rehabilitation. i. Many medical centers now offer pulmonary rehabilitation programs, which incorporate exercise training, education and counseling to help you learn how to return to your normal activities and achieve your ideal weight. Pulmonary Embolism a) Overview a. a blockage in one of the pulmonary arteries in your lungs. In most cases, pulmonary embolism is caused by blood clots that travel to the lungs from deep veins in the legs or, rarely, from veins in other parts of the body (deep vein thrombosis). b) Symptoms a. Common signs and symptoms include: i. Shortness of breath. This symptom typically appears suddenly and always gets worse with exertion. ii. Chest pain. You may feel like you're having a heart attack. The pain is often sharp and felt when you breathe in deeply, often stopping you from being able to take a deep breath. It can also be felt when you cough, bend or stoop. iii. Cough. The cough may produce bloody or blood-streaked sputum. b. Other signs and symptoms that can occur with pulmonary embolism include: i. Rapid or irregular heartbeat, Lightheadedness or dizziness, Excessive sweating, Fever, Leg pain or swelling, or both, usually in the calf caused by a deep vein thrombosis, and Clammy or discolored skin (cyanosis) c) Prevention a. Blood thinners (anticoagulants).
Ways to minimize the risk of autonomic dysreflexia a) a syndrome that leads to a sudden onset of high blood pressure and can be accompanied by low heartbeats, is not uncommon. a. In fact, about fifty percent of individuals with a spinal cord injury get it. It is most common in individuals with spinal cord injuries, at, or above the thoracic (T6) nerves of the spine or above. b) When the skin or bladder is irritated, signals are sent to the spinal cord, which triggers a reflex action. This reflex tightens blood vessels below the injury, causing blood pressure to rise. c) Prevention a. Sit up when possible i. Sitting up helps blood move to lower parts of the body and helps ease blood pressure. b. Take off tight clothes i. At times, autonomic dysreflexia can be caused by skin conditions. c. Medications i. The most commonly used drugs are nifedipine (immediate release form) as well as nitrates. Other commonly used agents are prazosin, captopril, terazosin, mecamylamine, diazoxide, and phenoxybenzamine. d. Use the bathroom regularly i. While an individual's bladder will still store urine from their kidneys, their brain may not be able to control their bladder because of the injury. This can make patients more susceptible to urinary tract infections. e. Watch for bladder infection signs i. An autonomic dysreflexia episode that remains unexplained by most of the other causes can also be due to a urinary tract infection. Spinal shock injuries and how to assess
a) characterized by the temporary reduction or loss of reflexes following a spinal cord injury. b) Symptoms a. Altered body temperature b. Skin color and moisture changes (such as dry and pale skin) c. Abnormal perspiration function (decreased or increased sweating, flushing) d. Increased blood pressure and slowed heart rate e. Irregularities in the musculoskeletal system f. Altered sensory response g. Unusual urinary bladder and GI tract functions (overflow and incontinence) h. Irregular vasomotor response i. Depressed genital reflexes Seizure care a) Mark the seizure start time. b) If a patient is standing, lay them to the ground and roll them to the side. If the patient is in bed, roll them to the side c) The patient can never swallow their tongue. Never place anything in patient mouth or try to open their mouth. This can compromise the airway or cause more harm to the patient. d) Never hold the patient down or try to stop their movements. This can cause injury to the patient. Instead, protect the patient from hitting hard surfaces with soft puddings like pillows. e) By rolling the patient to the sides, you may achieve a patent airway. f) Administer 100% oxygen g) Check oxygen saturation. It may be below 90 due to apnea. The patient may turn blue on the lips and fingers. Do not panic! h) Patient will have oral secretions. Suction at bedside to keep the airway patent. i) If help is available, establish an IV- line for possible IV medication administration if the seizure continues for a long time (Status epilepticus). You do not have to have a physician order to start an IV line in this case. j) Put the side rails up to prevent falls k) Pad the bed of any patient expected to get seizures. Injuries caused by unpadded bed can count against you. l) Your drug of choice during seizure is Ativan IV push. Homonymous hemianopsia and how to deal with deficit a) a condition in which a person sees only one side -- right or left -- of the visual world of each eye and results from a problem in brain function rather than a disorder of the eyes themselves. b) Treatment a. Strategies to improve reading ability: i. Use a straight edge to direct the eyes to the next line of text. ii. Work on willingly increasing the size of small eye movements as words are read along the line of text. The goal is to capture each word in the field of vision and to recognize it as a whole before reading it.
i. weight loss, difficulty speaking or breathing, trouble chewing, trouble swallowing, a weak cough with increased secretions (saliva or mucus), weak tongue, feeling unrested during the day, daytime fatigue, frequent nighttime awakenings, morning headaches, and the skin around your neck, between your ribs, or on your abdomen pulls in when you breathe. c. Prevention i. Take anticholinesterase medication as prescribed ii. Avoid respiratory infections iii. Maintain strength and weight with proper nutrition iv. When exercising, plan intermittent rest periods v. Reduce emotional stress vi. All currently used medications should be disclosed to your doctor to help avoid medications that interfere with myasthenia gravis treatment b) Cholinergic crisis a. also referred to as mnemonic “SLUDGE syndrome,” is a clinical condition that occurs as a result of the overstimulation of muscarinic and nicotinic receptors at the neuromuscular synapses and junctions due to an excess of acetylcholine. b. Symptoms i. stimulation of skeletal muscle (due to nicotinic acetylcholine receptor stimulation), stimulation of the salivary glands, stimulation of the pupillary constrictor muscles, vomiting, smooth muscle tone changes causing gastrointestinal problems, like cramping, contraction of the detrusor muscles, relaxation of the internal sphincter muscle of urethra, stimulation of the lacrimal glands. c. Risks (Prevention= reducing the risks) i. sufferers after general anesthesia who received high doses of acetylcholinesterase inhibitors (a chemical which inhibits the acetylcholinesterase enzyme from breaking down acetylcholine) to reverse the effects of neuromuscular blocking agents ii. people with myasthenia gravis on the medical treatment with high dose acetylcholinesterase inhibitors. iii. exposure to a chemical substance that causes inactivation of acetylcholinesterase (the primary cholinesterase in the human body). Examples of such substances are nerve gas such as – tabun (the first nerve agent chemical weapon to be discovered), sarin (a highly toxic synthetic organophosphorus compound), soman and other organophosphates including insecticides and pesticides; Parkinson’s and mobility interventions a) nursing interventions a. Assess neurological status. b. Assess ability to swallow and chew. c. Provide high-calorie, high-protien, high-fiber soft diet with small, frequent feedings. d. Increase fluid intake to 2000 mL/day.
e. Monitor for constipation. f. Promote independence along with safety measures. g. Avoid rushing the client with activities. h. Assist with ambulation and provide assistive devices. i. Instruct client to rock back and forth to initiate movement. j. Instruct the client to wear low-heeled shoes. k. Encourage the client to lift feet when walking and avoid prolonged sitting. l. Provide a firm mattress, and position the client prone, without a pillow, to facilitate proper posture. m. Instruct in proper posture by teaching the client to hold the hands behind the back to keep the spine and neck erect. n. Promote physical therapy and rehabilitation. o. Administer anticholinergic medications as prescribed to treat tremors and rigidity and to inhibit the action of acetylcholine. p. Administer antiparkinsonian medications to increase the level of dopamine in the CNS. q. Instruct the client to avoid foods high in vitamin B6 because they block the effects of antiparkinsonian medications. r. Instruct the client to avoid monoamine oxidase inhibitors because they will precipitate hypertensive crisis. Management of Guillain-Barre syndrome a) an autoimmune disease in which there is an acute inflammation of the spinal and cranial nerves manifested by motor dysfunction that predominates over sensory dysfunction. b) Symptoms a. often begins with tingling and weakness starting in your feet and legs and spreading to your upper body and arms b. Prickling, pins and needles sensations in your fingers, toes, ankles, or wrists c. Weakness in your legs that spreads to your upper body d. Unsteady walking or inability to walk or climb stairs e. Difficulty with facial movements, including speaking, chewing, or swallowing f. Double vision or inability to move eyes g. Severe pain that may feel achy, shooting or cramp like and may be worse at night h. Difficulty with bladder control or bowel function i. Rapid heart rate j. Low or high blood pressure k. Difficulty breathing c) Treatment a. Plasma exchange (plasmapheresis) i. The liquid portion of part of your blood (plasma) is removed and separated from your blood cells. The blood cells are then put back into your body, which manufactures more plasma to make up for what was removed. Plasmapheresis may work by ridding plasma of certain antibodies that contribute to the immune system's attack on the peripheral nerves.
c) Encourage your child to be as active as allowed. a. Your child will be asked to move around in bed and to sit up as much as he/she can. The head of the bed can be raised to help your child breathe better. Turning your child from side to side helps to prevent secretions from staying in one place in the lungs. Sometimes chest physiotherapy (CPT) may be ordered for your child. d) Encourage your child to get out of bed and walk as soon as allowed by the doctor. Different types of wound drainage and wound assessment a) Types a. Serous Drainage i. A pale yellow or transparent fluid found most frequently inside the body’s cavities
- Examplesblisters, Seromucous inflammation, and Serous pulmonary alveolitis b. Sanguineous drainage i. involves solely blood that comes from a fresh wound. It usually is of a bright red color seen in partial -thickness and full-thickness wounds c. Serosanguineous drainage i. pink exudate d. Seropulent drainage i. It is also commonly named ‘’seropus’’ that is similar to serum when it comes to consistency but a bit more cloudier, yellowish in color. e. Purulent drainage i. It is often yellow, green or even brown in color, has unpleasing smell and is a sure sign that there is an infection b) Assessment a. Size, width, length and depth i. important to be measured and documented so that the progress of the wound can be measured over time. b. Undermining and tunnelling c. Wound bed tissue type i. A wound can consist of different tissue types, which can be categorized by name and/or colour. Record the percentages of the differing tissue types. d. Wound edge (margin) i. can indicate the stage of healing and provide information as to the wound aetiology. The margin type that is good to see is skin that is smooth and adheres firmly to the wound bed. Lab values of note: Sodium, Hgb, Platlet, Creatinine a) Sodium 1 35- 145 a. Low: use of diuretics, diarrhea, adrenal insufficiency b. High: kidney disease, dehydration, Cushing’s syndrome b) HgbF: 1 2. 1 -15. 1 M: 13 .8-1 7. a. Low: Iron, vit D3, or folate deficiency, bone marrow damage
b. High: dehydration, kidney or heart disease c) Platelet 150 , 000 -4 00 , 000 a. Low: viral infection, lupus, pernicious anemia (B12 deficiency), leukemia, chemo b. High: leukemia, bone marrow abnormalities, inflammatory conditions d) Creatinine 0 .8-1. 4 a. Low: low muscle mass, malnutrition b. High: low kidney function Understand the role of the Medical Reserve Corp a) a national network of volunteers, organized locally to improve the health and safety of their communities. b) MRC volunteers include medical and public health professionals, as well as other community members without healthcare backgrounds c) MRC units prepare for and respond to natural disasters, such as wildfires, hurricanes, tornados, blizzards, and floods, as well as other emergencies affecting public health, such as disease outbreaks. Understand the role of DMAT a) Disaster Medical Assistance Teams b) staffed with medical professionals and para-professionals who can help area health systems respond by providing expert patient care. c) members may be called on to help hospitals and healthcare facilities serve the needs of their patients, support medical sites and shelters, and more. Medication, use of Tagamet in burn injury a) pain medication, antibiotics, anti-anxiety medication, topical products for wound healing, such as bacitracin and silver sulfadiazine (Silvadene), and fluids for hydration b) tagametincrease cell immunity after injury Informed consent, know who can sign and who can sign if there is a change in capacity without an informed consent a) Doctor must explain the details of the procedure. The nurse can only clarify and watch the patient sign the informed consent after the doctor has spoke with the patient. Risk for those with latex allergies, who is at greatest risk? a) Risk factors a. People with spina bifida. The risk of latex allergy is highest in people with spina bifida — a birth defect that affects the development of the spine. People with this disorder often are exposed to latex products through early and frequent health care. b. People who undergo multiple surgeries or medical procedures. c. Health care workers. d. Rubber industry workers.
a. The Sims' position is a variation of the left lateral position. The patient is usually awake and helps with the positioning. The patient will roll to his or her left side. Body restraints are used to safely secure the patient to the operating table. Keeping the left leg straight, the patient will slide the left hip back and bend the right leg. This position allows access to the anus. j) Lateral a. A patient may be positioned in Lateral position during back, colorectal, kidney, and hip surgeries. It's also commonly used during thoracic and ENT surgeries, and neurosurgery. k) Trendelenburg a. typically used for lower abdominal, colorectal, gynecology, and genitourinary surgeries, cardioversion, and central venous catheter placement. b. In this position, the patient's arms should be tucked at their sides, and the patient must be secured to avoid sliding on the surgical table. l) Reverse Trendelenburg a. typically used for laparoscopic, gallbladder, stomach, prostrate, gynecology, bariatric and head and neck surgeries. Observations for same day surgical discharge a) must be met before the patient is discharged b) if the patient experiences ongoing issues related to unstable vital signs, poor gas exchange, excessive nausea and vomiting, or unmanageable alterations in comfort, admission to an cute care setting or extended-care facility may be necessary Surgical Drains a) Gravity drains such as the penrose and the T-tube drain directly through a tube from the surgical area. b) In closed=-wound drainage systems such as the JP and Hemovac drainage collects in a collecting vessel by means of compression and re-expansion of the system. Review Parkinson’s a) overview a. a progressive nervous system disorder that affects movement. b) Symptoms through stages
a. c) Complications: a. Thinking difficulties. i. You may experience cognitive problems (dementia) and thinking difficulties. These usually occur in the later stages of Parkinson's disease. Such cognitive problems aren't very responsive to medications. b. Depression and emotional changes. i. You may experience depression, sometimes in the very early stages. You may also experience other emotional changes, such as fear, anxiety or loss of motivation. Doctors may give you medications to treat these symptoms. c. Swallowing problems. i. You may develop difficulties with swallowing as your condition progresses. Saliva may accumulate in your mouth due to slowed swallowing, leading to drooling. d. Chewing and eating problems. i. Late-stage Parkinson's disease affects the muscles in your mouth, making chewing difficult. This can lead to choking and poor nutrition. e. Sleep problems and sleep disorders. i. People with Parkinson's disease often have sleep problems, including waking up frequently throughout the night, waking up early or falling asleep during the day. People may also experience rapid eye movement sleep behavior disorder, which involves acting out your dreams. Medications may help your sleep problems. f. Bladder problems. i. Parkinson's disease may cause bladder problems, including being unable to control urine or having difficulty urinating.
