Shock
What happens in the early stage of shock?
-BP: stays the same or slight decrease (10-15 MAP decrease)
-RAAS activated
-blood shunted to vital organs
What electrolyte is released when the cell is damaged?
Potassium
Most common fracture area in children...
Clavicle or forearm
0-20
Most common cause of septic shock?
UTI (gram negative bacteria)
What vital sign abnormalities will be seen in hypovolemic shock?
>HR
>RR
<BP
<peripheral pulse
<u/o
<stroke volume
Name the staging of burns and how they appear.
Superficial-sunburn
Partial thicknes- (superficial:pink/blistered) (deep: red/moist/blister)
Full thickness- all layers
What is osteogeneis imperfecta and name 2 nursing interventions.
Brittle bone disease
-gentle handling
-braces/casting/splinting
-high vit d, ca, biphosh
-decrease calorie intake
What abnormal labs would you see with a fat embolism?
>Lipase, >ESR
<RBC/Plt, <Ca
What is the 3rd stage of shock, and what happens during this stage?
Irreversible, tissue death--->organ death-->death.
Name 3 medications that could be given in shock?
Vasoconstrictors-epi, norepi
Pressers-dopamine, vasopressin
Fluid replacement-PRBC, FFP, Albumin, PLT's
Pain medication
02
Fluids-NS, LR
What happens with the "fluid shift" and what electrolyte disturbances will you see.
Initial vasoconstriction--->vasodilation and leaking of fluid & proteins (third spacing), decrease in blood volume and BP leads to edema in the interstitial space---->profound fluid, electrolytes and acid-base imbalances (hypovolemia, metabolic acidosis, hyperkalemia, hyponatremia, hemo-concentration)
What are the 3 levels of scoliosis and what do we do for each?
Mild(10-20)-exercises
Moderate(20-40)-Milwaukee/Boston brace 23hrs/day
Severe(40-50)-Fusion w. shell
A patient comes in with suspected PE, what lab would we test and what number indicates a positive?
D-Dimer, >500
What is DIC?
Serious bleeding disorder resulting from abnormally initiated and accelerated clotting. Subsequent decreases in clotting factors and platelets ensue, which may lead to uncontrollable hemorrhage
PE, Tamponade, Pneumothorax
What is the equation for fluid replacement for burns?
2-4ml x kg x total burn % (first 1/2 over 8hrs, second over 16hrs)
What is the most common type of Muscular Dystrophy, and what are 2 nursing interventions?
Duchenne.
-disease prevention
-nutrition according to height/weight
-ADL's
-Injury prevention
-physical therapy (water)
What 2 labs are monitored during antibiotic treatment of osteomyelitis?
Sed Rate, WBC
diag: abg, chest x-ray
tx: antibiotics, ventilator
Which type of shock would you see bradycardia?
A child comes into the ED with burns to his anterior trunk, right arm, red leg and perineum. Use the rule of nine's to determine the % burned...
46%
A child fractured his leg 3 weeks ago playing soccer, he comes home from school complaining of continued pain and tenderness. He feels warm to the touch. What is his diagnosis and anticipated treatment?
What are the ranges for CVP, MAP and Swanz Ganz
MAP 70-90
CVP 2-6 (8)
Swans 25/10
Who is going to pass this test!?
EVERY FRICKEN ONE OF US