What are the 3 phases of burn therapy?
emergent, acute, and rehabilitation
What color is a 22 gauge IV?
Blue
How do we check for Trousseau sign?
Inflate blood pressure cuff
A patient with a respiratory rate of 30 would be at risk for what acid-base imbalance?
Respiratory alkalosis
What is infiltration?
IV fluid leaking into the tissue
A burned area that is red, has blisters, and is very painful should be categorized as which type?
Partial thickness (2nd degree)
What signs and symptoms are seen with fluid volume excess?
Dyspnea, Edema, HTN, Weakness/Fatigue
Which two electrolytes cause positive Chvostek’s & Trousseau’s signs?
HYPOmagnesemia
HYPOcalcemia
A patient experiencing frequent vomiting is at risk for which acid-base imbalance?
Metabolic alkalosis
What is phlebitis?
Inflammation of a vein
Aclient who has third degree burns on 40% of his body is at risk of developing which serious electrolyte imbalance?
Hyperkalemia
a blood clot that has broken free from the vessel wall is known as an ______?
embolus
Which electrolyte imbalance can lead to dry mucous membranes, decreased skin turgor, & intense thirst?
Hypernatremia
The first compensatory mechanism to correct acid-base imbalances is known as what system?
The buffer system
What will the BP, HR, & RR be in a patient with fluid volume deficit?
Low BP, High HR, High RR
What causes swelling in burn patients with a significant amount of damage?
The loss of plasma proteins known as albumin in the vasculature due to the significant damage to the epidermis, dermis, and subcutaneous tissue.
Ions equalize their concentration by the passive transport process of
diffusion
Which electrolyte imbalance can lead to a paralytic ileus & distended abdomen?
HYPOkalemia
pH 7.20 PaCO2 78 HCO3 49
Name the imbalance & compensation
partially compensated Respiratory acidosis
Which fluid-volume imbalance could lead to increased body temperature?
Fluid volume deficit
A patient with burns on the entire right leg, front of the right arm, and one half of the front torso. The nurse, using the “rule of nines,” assesses the burn as ____%.
31.5
The nurse explains that the compensatory reabsorption of water is controlled by ______ located in the _______?
antidiuretic hormone (ADH) in the posterior pituitary
Which electrolyte imbalance is the medication Kayexalate (sodium polystyrene sulfonate) used to treat?
Hyperkalemia
pH 7.36 PaCO2 83 HCO3 48
Name the imbalance & compensation
fully compensated Respiratory acidosis
A patient with severe hyponatremia may benefit from which category of IV fluid? (hypotonic, hypertonic, or isotonic)
Hypertonic