Rasmussen College :NUR 2755 MDC4 – Examination Blueprint – Exam 2_LATEST 2022
Burns
• Assessment – Expected laboratory values
... [Show More] – stages -
• Treatment – Fluids - skin grafts - Fluid overload S&S
• Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase
• Total body surface area (TBSA) – Rule of Nines
• Depth of burns
• Parkland Formula
• Urine Output 0.5ml/kg/hr
• Carbon monoxide poisoning
• Complication-eschar, burn shock, stridor, Infection, Curling Ulcers: treatment escharotomy
Respiratory Diseases (Assessment, Nursing interventions)
• Acute respiratory distress syndrome (ARDS) – Stridor – Risk Factors
o Clinical manifestations:….refractory hypoxemia, non-cardiac pulmonary edema
o Treatment: Prone, PEEP
• Hypoxemia
• Pulmonary embolism – Laboratory Values – Thrombophlebitis - Medications
• Pulmonary edema
• Pneumonia – Aspiration Pneumonia
• Flail chest - Paradoxical respiration – paralysis of the diaphragm – respiratory failure
• Pneumothorax – Signs and symptoms
o Chest tube management (watch Respiratory SR lecture)
• Treatment - endotracheal tube – tracheostomy - mechanical ventilation - bag-valve-mask device - pulse oximeter, Chest Tubes
• Mechanical Ventilators:
o Settings
o Complications
o Nursing interventions
o Low pressure and high-pressure alarms
o Ventilator Acquired Pneumonia (VAP) Protocol
• ABG Interpretation
Shock
• Hemodynamics: Central Venous pressure, Wedge pressure
• Meant Arterial Pressure Calculation MAP={SBP + 2(DBP)}/3. Usual Range 70-110
• Types, Cause, Risk factors
o Hypovolemic
o Cardiogenic
o Neurogenic
o Septic
o Anaphylactic
• Stages Progression
• Assessment/Clinical Manifestations/Labs and Diagnostics
• Interventions:
o ABC
o Specific interventions
• Client teaching/prevention
• Complications:
o DIC
o MODS
o ARDS
o SIRS
Medications: (Therapeutic Effect, Uses, Side effects, Nursing Considerations)
Drug Class: Anticoagulant
Heparin Clopidogrel Warfarin Ticlopidine Enoxaparin Drug Class: Anticoagulant antidote
• Protamine Sulfate
• Vitamin K Antiulcer Medication:
Proton Pump Inhibitors-prazole:
omeprazole lansoprazole esomeprazole pantoprazole
Histamine blockers: -dine:
famotidine ranitidine
cimetidine
Drug Class: Antibiotics Vancomycin Ciprofloxacin
Silver sulfadiazine
Penicillin V Drug Class: Thrombolytic
Alteplase Urokinase Reteplase Streptokinase Meds for anaphylaxis Epinephrine
Drug Class:
• Antihistamines
• Corticosteroids
Drug Class: Corticosteroids Methylprednisolone Hydrocortisone Prednisone
Cortisone Fludrocortisone Drug Class: Inotropes
Dobutamine Digoxin Volume Replacement Normal Saline Lactated Ringers Blood Products
• Consent, 20G, 2RNs, 4 hours max
Clotting Factors
Drug Class: Diuretic Furosemide Hydrochlorothiazide Spironolactone Drug Class: Vasopressors
Dopamine
Norepinephrine (Levophed) Vasopressin Drug Class: Vasodilators (afterload Reducers) Nitroglycerine Nitroprusside
Laboratory Values (Highlighted-MUST KNOW)
pH 7.35 – 7.45 mmol/L
Pa02 80 – 100 mm Hg
PaCO2 35-45 mm Hg
HCO3 22-26 mEq/L
SaO2 ➢ 95%
D-dimer 0.5 mg/l of blood or 500 ng/ml of
blood
Lactic Acid
(lactate) 3-7 mg/dL
0.3-0.8 mmol/L
WBC 5,000-10,000 cells/mcl
Hemoglobin
(Hgb) Men 14-18 g/100 ml,
Women 12-16 g/100 mL
Hematocrit
(Hct) Men 42-52%,
Women 37-47%
Sodium 136-145 mEq/L
Potassium 3.5-5 mEq/L
Laboratory Value Interpretation
Burns Resuscitative High K+ Hyponatremia
Increase WBC Acute Low K+
Hyponatremia
Increase WBC
Hypoxemia Low Pa02
Pulmonary embolism High D-Dimer High CO2 Low PaO2
Infection High WBC Increase temp
Fluid volume excess Decreased Serum Sodium <136 Decreased Urine Specific
Gravity Bounding pulse,
Increase BP
Hypovolemic Shock H/H high- dehydration
H/H low-bleeding Increased
Lactic Acid Increased K
Dosage and Calculation – (Know how to work these calculations.)
1. A client needs to receive vancomycin 500mg IV to treat pneumonia. The medication is supplied in a 100ml IV piggyback that is to be given over 1 hour. What rate in ml/hr should the nurse program into the IV pump?
mL/hr
2. Calculate the IV flow rate in drips per minute using a drip rate. Administer 2500ml Lactated Ringer's over 16 hours using a tubing with a drip factor of 15 drops/ml. Provide the answer in a whole number
gtt/min
3. Determine the infusion rate in milliliters per hour: The client has a vasoactive medication ordered to infuse at 5mcg/kg/min. The client is 188 lbs and the medication supply is 400mg in 250ml. The correct rate is
mL/hr
4. The order is to infuse Heparin 1000 u/hr from a solution of 20,000 u in 500 mL of D5W. What is the ml/hr flow rate? mL/hr
5. Order: diltiazem 30 mg PO BID. Available: diltiazem 60 mg per tablet. Dose: Tablets
6. Order: diphenhydramine 25 mg IM now. Available: diphenhydramine 50 mg/ml in a 10 ml vial. How much will you give? mL
Calculate the Mean Arterial Pressure (MAP) for a client with a BP of 90/48. Rule of 9s
1. The client has his entire left arm burnt, all of his front torso and the front of both legs. %
2. The client has his entire head burnt, entire back and back of the left leg. %
Parkland Formula
1. The client weighs 200 pounds and has burns to both his legs: %
2. Using the Parkland Formula determine the following:
a. Total fluid for the first 24 hours: mL
b. Fluid administered the first 8 hours mL.
c. How many mLs per hours will that be? mL/hr
d. IV rate for the next 16 hours: mL/hr
e. What would the IV rate be if the client waited 3 hours to come to the ED? mL/hr
f. Urine output: What would the minimum urine output be for the above client? mL/hr
Answers:
1. 100
2. 39
3. 16
4. 25
5. 0.5
6. 0.5
MAP=62
Rule of 9s
1. 45
2. 36
Parkland Formula
1. 36
a. 13,104
b. 6552
c. 819
d. 409.5
e. 1310.4
f. 45.5 [Show Less]