OH NO, WHAT FIRST
This tag is considered the "walking wounded".
What is the green tag under mass casualty
Give the 5 Different causes of burns
thermal, chemical, electrical, radioactive,inhalation
True or false: When an unconscious patient comes in to the ER, medical personnel need permission before starting treatment.
False
Versed Fentanyl Succinylcholine
What are medications for Intubation
A nurse is planning care for a client going to surgery. Who is responsible for informing the client about the surgery along with possible risks, complications, and benefits?
The Surgeon
A nurse cares for a dying patient. Which manifestation of dying does the nurse treat first?
a. Anorexia
b. Pain
c. Nausea
d. Hair loss
Pain
When does fluid mobilization happen?
48-72 hours after burn injury
A patient arrives in the emergency department after being in a car crash with fatalities. The patient has a nearly amputated leg that is bleeding profusely. What action by the nurse takes priority?
a. Apply direct pressure to the bleeding.
b. Ensure that the patient has a patent airway.
c. Obtain consent for emergency surgery.
d. Start two large-bore IV catheters.
B
Airway is the priority, followed by breathing and circulation (IVs and direct pressure). Obtaining consent is done by the physician.
Increase in Peak airway pressures Ascultation of adventitious breath sounds increase respiratory rate and sustained coughing Sudden or gradual decrease in SpO2
What are indications for suctioning a ventilated patient
You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first?
Call the nursing supervisor to discuss the situation
A nurse is field-triaging patients after an industrial accident. Which patient condition would the nurse triage with a red tag?
a. Dislocated right hip and an open fracture of the right lower leg
b. Large contusion to the forehead and a bloody nose
c. Closed fracture of the right clavicle and arm numbness
d. Multiple fractured ribs and shortness of breath
D
Patients who have an immediate threat to life are given the highest priority, are placed in the emergent or class I category, and are given a red triage tag. The patient with multiple rib fractures and shortness of breath most likely has developed a pneumothorax, which may be fatal if not treated immediately. The patient with the hip and leg problem and the patient with the clavicle fracture would be classified as class II; these major but stable injuries can wait for 30 minutes to 2 hours for definitive care. The patient with facial wounds would be considered the “walking wounded” and classified as nonurgent.
A nurse uses the rule of nines to assess a patient with burn injuries to the entire back region and left arm. How would the nurse document the percentage of the patient’s body that sustained burns?
a. 9%
b. 18%
c. 27%
d. 36%
C
According to the rule of nines, the posterior trunk, anterior trunk, and legs each make up 18% of the total body surface. The head, neck, and arms each make up 9% of total body surface, and the perineum makes up 1%. In this case, the patient received burns to the back (18%) and one arm (9%), totaling 27% of the body.
In the deteriorating patient with shock, this class of medications is often used to support circulation
What are adrenergics
These drugs stimulate smooth muscle contraction in the blood vessels. This causes your blood vessels to become narrow. This effect also causes your blood pressure to increase. Increasing blood pressure can help treat shock. Dopamine and dobutamine are the drugs of choice to improve cardiac contractility, with dopamine the preferred agent in patients with hypotension.
Finding that leads you to suspect flail chest for a patient with several traumatic injuries after a multiple-vehicle accident?
a) Chest-tube draining bright red blood
b) Tracheal deviation to the unaffected side
c) Paradoxical chest movement during respiration
d) Little to no movement of the involved chest wall
What is c
A nurse received a bedside report at the change of shift with the night shift nurse and the client. The nursing student assigned to the client asks to review the client’s medical record. The nurse lists clients’ medical diagnoses on the message boards in the clients’ rooms. Later in the day, the nurse discusses the plan of care for a client who is dying with the client’s family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)?
Posting medical information about the client on a message board in the client’s room
A nurse reviews the laboratory results for a patient who was burned 24 hours ago. Which laboratory result would the nurse report to the healthcare provider immediately?
a. Arterial pH: 7.32
b. Hematocrit: 52%
c. Serum potassium: 6.5 mEq/L (6.5 mmol/L)
d. Serum sodium: 131 mEq/L (131 mmol/L)
C
The serum potassium level is changed to the degree that serious life-threatening responses could result. With such a rapid rise in potassium level, the patient is at high risk for experiencing severe cardiac dysrhythmias and death. All the other findings are abnormal but do not show the same degree of severity; they would be expected in the emergent phase after a burn injury.
An emergency room nurse assesses a patient who was rescued from a home fire. The patient suddenly develops a loud cough and shortness of breath and wheezing. What action would the nurse take first?
a. Apply oxygen and continuous pulse oximetry.
b. Provide small quantities of ice chips and sips of water.
c. Request a prescription for an antitussive medication.
d. Ask the respiratory therapist to provide humidified air.
A
Brassy cough and wheezing are some of the signs seen with inhalation injury. The first action by the nurse is to give the patient oxygen. Patients with possible inhalation injury also need continuous pulse oximetry. Ice chips and humidified room air will not help the problem, and antitussives are not warranted.
A nurse assesses a patient admitted with deep partial-thickness and full-thickness burns on the face, arms, and chest. Which assessment finding would alert the nurse to a potential complication?
a. Partial pressure of arterial oxygen (PaO2) of 80 mm Hg
b. Urine output of 20 mL/hr
c. Productive cough with white pulmonary secretions
d. Core temperature of 100.6 F (38 C)
B
A significant loss of fluid occurs with burn injuries, and fluids must be replaced to maintain hemodynamics. If fluid replacement is not adequate, the patient may become hypotensive and have decreased perfusion of organs, including the brain and kidneys. A low urine output is an indication of poor kidney perfusion.
Most common early manifestations of ARDS
What is dyspnea & tachypnea
A woman has severe life-threatening injuries, is unresponsive, and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman’s anemia. The woman’s husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse’s responsibility?
Gather more information about the wife’s preferences and determine whether the husband is her power of attorney for health care.
An emergency room nurse is triaging victims of a multi-casualty event. Which patient would receive care first?
a. A 30-year-old distraught mother holding her crying child
b. A 65-year-old conscious male with a head laceration
c. A 26-year-old male who has pale, cool, clammy skin
d. A 48-year-old with a simple fracture of the lower leg
C
The patient with pale, cool, clammy skin may be in shock and needs immediate medical attention. The mother does not have injuries and so would be the lowest priority. The other two people need medical attention soon, but not at the expense of a person in shock.
A nurse assesses a patient who has burn injuries and notes crackles in bilateral lung bases, a respiratory rate of 40 breaths/min, and a productive cough with blood-tinged sputum. What action would the nurse take next?
a. Administer furosemide (Lasix).
b. Perform chest physiotherapy.
c. Document and reassess in an hour.
d. Place the patient in an upright position.
ANS: D
Pulmonary edema can result from fluid resuscitation given for burn treatment. This can occur even in a young healthy person. Placing the patient in an upright position can relieve lung congestion immediately before other measures can be carried out. Although Lasix may be used to treat pulmonary edema in patients who are fluid overloaded, a patient with a burn injury will lose a significant amount of fluid through the broken skin; therefore, Lasix would not be appropriate. Chest physiotherapy will not get rid of fluid.
A patient presents with burns covering 40% of his body. He weighs 100 kg. He arrived in the emergency room at 0400 and had not received any IVF. Determine the amount of IVF to be administered in the first 24 hours. What type of IVF will be used?
What is 4ml X kg X % burn 4 X 100 X 40= 16,000 total ml to be infused Give ½ of IVF in first 8 hours= 8,000 ml from 0400 to 1200= 1,000 ml/hr Give ½ of IVF in next 16 hours= 8,000 from 1200 to 0400= 500 ml/hr
Occurs when air enters the pleural space but cannot escape. Tracheal deviation is a very late sign of this.
What is a tension pneumothorax
. A man who is homeless enters the emergency department seeking health care. The healthcare provider indicates that the client needs to be transferred to the city hospital for care before assessing the client. This action is most likely a violation of which of the following laws?
Emergency Medical Treatment and Active Labor Act (EMTALA)