Acute Phase Electrolyte Imbalances Quiz
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Questions and Answers

How can hyponatremia occur during the acute phase? (Select all that apply)

  • Excessive water intake (correct)
  • Diarrhea (correct)
  • Excessive GI suction (correct)
  • Excessive salt intake

    • How can hypernatremia occur during the acute phase? (Select all that apply)

  • Successful fluid replacement with hypertonic IV (correct)
  • Improper tube feeding and fluid administration (correct)
  • Excessive water intake
  • Excessive salt intake

    • How can hyperkalemia occur during the acute phase? (Select all that apply)

  • Massive muscle injury (correct)
  • Adrenocortical insufficiency (correct)
  • Excessive potassium intake
  • Renal failure (correct)

    • How can hypokalemia occur during the acute phase? (Select all that apply)

    <p>Prolonged GI suction and IV therapy without potassium</p> Signup and view all the answers

    How are the complications of the acute phase different from the emergent phase?

    <p>Complications can worsen, include systemic infection, neurological deterioration, decreased ROM, Curling's ulcer, and increased blood glucose.</p> Signup and view all the answers

    How does wound care differ in the emergent phase from the acute phase?

    <p>In the acute phase, it involves continuous monitoring, cleaning, debriding, grafting, and possibly enzymatic debridement.</p> Signup and view all the answers

    What are the types of burns?

    <p>All of the above</p> Signup and view all the answers

    What determines the result effect of the burn?

    <p>Temperature, duration of contact, type of tissue involved</p> Signup and view all the answers

    How are thermal injuries caused?

    <p>Flame, flash, scald, contact with hot object</p> Signup and view all the answers

    How do chemicals cause a burn?

    <p>Acids, alkalis, organic compounds contacting the tissues</p> Signup and view all the answers

    Why are alkali burns so hard to manage?

    <p>They adhere to tissue and lyse and liquefy proteins, thus they cannot be neutralized until removed</p> Signup and view all the answers

    What are the types of burn injury?

    <p>All of the above</p> Signup and view all the answers

    What are some ways to prevent burn injuries?

    <p>Use caution when cooking, smoking, bathing, handling chemicals, playing outside during lightning storms, have eye washing stations near</p> Signup and view all the answers

    How do inhalation injuries occur?

    <p>Breathing in smoke or hot air that damages tissues of the respiratory tract</p> Signup and view all the answers

    What are the types of inhalation burn injuries?

    <p>All of the above</p> Signup and view all the answers

    How does carbon monoxide cause poisoning?

    <p>Displaces oxygen in the hemoglobin, causing carboxyhemoglobinemia, hypoxia, death</p> Signup and view all the answers

    How is CO poisoning treated?

    <p>Supplement 100% oxygen</p> Signup and view all the answers

    What are the manifestations of CO poisoning?

    <p>Skin color is cherry red</p> Signup and view all the answers

    What are the manifestations of upper airway injury?

    <p>Edema, redness, blistering, hoarseness, carbonaceous secretions, mechanical airway obstruction, singed nasal hair</p> Signup and view all the answers

    What are the manifestations of lower airway injury?

    <p>Chemically related, pulmonary edema may not show for 12-24 hours</p> Signup and view all the answers

    What does the severity of electrical burns depend on?

    <p>Amount of voltage, tissue resistance, pathway of the current, surface area affected, duration of flow</p> Signup and view all the answers

    What are the manifestations of electrical burns?

    <p>Dysrhythmias, severe metabolic acidosis, myoglobinuria, bone fracture</p> Signup and view all the answers

    Where should an electrical burn patient go immediately?

    <p>The burn unit/trauma rooms</p> Signup and view all the answers

    Why is the severity of an electrical burn injury hard to determine?

    <p>The iceberg effect, where most of the damage is below the skin</p> Signup and view all the answers

    What type of tissue has the most resistance to electrical burns?

    <p>Fat and bone</p> Signup and view all the answers

    How does cold cause damage to cells?

    <p>Forms ice crystals, vasoconstriction, vascular stasis</p> Signup and view all the answers

    What determines the severity of frostbite?

    <p>Ambient temperature, length of exposure, condition of clothing, contact with metal, skin color, acclimatization</p> Signup and view all the answers

    What is superficial frostbite?

    <p>Ice crystals forming in the upper layers of the skin</p> Signup and view all the answers

    What are some treatments for superficial frostbite?

    <p>Water bath not too hot, drain and debride blisters, apply sterile dressings, avoid friction</p> Signup and view all the answers

    What is deep frostbite?

    <p>Ice crystals forming deeper, affecting muscle, bone, and tendons</p> Signup and view all the answers

    What are the manifestations of deep frostbite?

    <p>Skin is white, hard, no sensation, complete necrosis</p> Signup and view all the answers

    What are the treatments of deep frostbite?

    <p>Tetanus prophylaxis, amputation may be necessary, antibiotics if at risk for infection</p> Signup and view all the answers

    How are the severity of burns classified?

    <p>Depth, extent, location, patient's risk factors</p> Signup and view all the answers

    How is the depth (thickness) of a burn injury described?

    <p>Superficial partial (1st degree), deep partial (2nd degree), full (3rd + 4th degree)</p> Signup and view all the answers

    How is the extent of the burn classified?

    <p>Lund-Browder chart, Rule of Nines</p> Signup and view all the answers

    What degree of burn is not classified by extent?

    <p>Superficial (1st degree)</p> Signup and view all the answers

    Why is the Lund-Browder chart more accurate?

    <p>Takes patient age into account</p> Signup and view all the answers

    What is the percentage of a hand or irregular area burn considered?

    <p>1%</p> Signup and view all the answers

    When is the extent of the burn reassessed?

    <p>After the edema has subsided</p> Signup and view all the answers

    What does a burn to the face, neck, and chest/trunk indicate?

    <p>Respiratory obstruction and circulatory compromise</p> Signup and view all the answers

    What do burns to the hands, feet, joints, and eyes indicate?

    <p>Self-care deficits</p> Signup and view all the answers

    What do burns to the ears, nose, buttocks/perineal area indicate?

    <p>Risk for infection</p> Signup and view all the answers

    What is compartment syndrome?

    <p>Pressure building up in a specific area, can be caused by burns</p> Signup and view all the answers

    What is an escharotomy?

    <p>Surgical incision made through the burn eschar to allow expansion of the deeper tissue</p> Signup and view all the answers

    What are some client risk factors to consider?

    <p>Age, pre-existing conditions, diabetes mellitus, peripheral vascular disease, physical debilitation</p> Signup and view all the answers

    What are the 4 phases of burn management?

    <p>All of the above</p> Signup and view all the answers

    What is the main priority during prehospital care?

    <p>Removing the person from the source of burn</p> Signup and view all the answers

    Prehospital treatment of small thermal burns?

    <p>Cover with clean cloth soaked in cold water</p> Signup and view all the answers

    Prehospital treatment of large thermal burns if unresponsive?

    <p>CAB - Circulation, Airway, Breathing</p> Signup and view all the answers

    Prehospital treatment of large thermal burns if responsive?

    <p>ABC - Airway, Breathing, wrap in cool, clean, dry sheet</p> Signup and view all the answers

    Prehospital treatment of electrical injuries?

    <p>Remove person from source, CABC (cervical injury)</p> Signup and view all the answers

    Prehospital treatment of chemical injuries?

    <p>Brush off solid particles, flush with water</p> Signup and view all the answers

    Prehospital treatment of inhalation injuries?

    <p>Observe closely for respiratory distress, treat fast at the nearest burn unit</p> Signup and view all the answers

    What is the primary concern during the emergent phase?

    <p>Resolving immediate concerns of hypovolemic shock and edema formation</p> Signup and view all the answers

    When does the emergent phase begin?

    <p>When there is fluid loss</p> Signup and view all the answers

    When does the emergent phase end?

    <p>When fluid mobilization and diuresis begin</p> Signup and view all the answers

    What are the pathophysiological changes during the emergent phase?

    <p>Fluid and electrolyte shifts, inflammation and healing, immunological changes</p> Signup and view all the answers

    What is the greatest concern with electrolyte and fluid shifts?

    <p>Hypovolemic shock</p> Signup and view all the answers

    How does burn shock occur?

    <p>Increased capillary permeability resulting in edema and reduced blood volume</p> Signup and view all the answers

    How else is circulatory volume decreased during the emergent phase?

    <p>Increased insensible fluid loss, RBC hemolyzed by free radicals</p> Signup and view all the answers

    What type of necrosis occurs from burn injury?

    <p>Coagulative</p> Signup and view all the answers

    What are the main nursing priorities during the emergent phase?

    <p>Ongoing assessment of ABCs, vitals, cardiac rhythm, oxygen, LOC</p> Signup and view all the answers

    How does healing occur in the emergent phase?

    <p>WBCs move to the area to form clots within 6-12 hours</p> Signup and view all the answers

    What are the immunological changes during the emergent phase?

    <p>Systemic impairment of immune system, circulating immune globulins decrease</p> Signup and view all the answers

    What are the clinical manifestations of injury during the emergent phase?

    <p>Shock, blisters, altered mental state</p> Signup and view all the answers

    What fluid and electrolyte shift occurs during the early emergent phase?

    <p>Sodium and water shift to the interstitial space, decreases intravascular volume</p> Signup and view all the answers

    What defines the end of the emergent phase?

    <p>Capillary membrane permeability restored, edema subsides</p> Signup and view all the answers

    What are the systems involved in the complications during the emergent phase?

    <p>Cardiovascular, respiratory, urinary</p> Signup and view all the answers

    What are the cardiovascular complications of the emergent phase?

    <p>Dysrhythmias, hypovolemic shock, sludging</p> Signup and view all the answers

    What is sludging and how does it get treated?

    <p>Loss of fluid increases blood viscosity and impairs circulation, treated with fluid replacement</p> Signup and view all the answers

    What is recommended for monitoring cardiovascular complications during the emergent phase?

    <p>Telemetry</p> Signup and view all the answers

    What are the types of complications for the respiratory system during the emergent phase?

    <p>Upper airway injury, lower airway injury, pneumonia</p> Signup and view all the answers

    How long do the signs of lower airway injury take to manifest?

    <p>12-24 hours</p> Signup and view all the answers

    What is a recommended diagnostic test for respiratory complications of the emergent phase?

    <p>Chest x-ray</p> Signup and view all the answers

    What are the complications related to the urinary system during the emergent phase?

    <p>Renal ischemia, acute tubular necrosis</p> Signup and view all the answers

    What is the main form of treatment for urinary complications of the emergent phase?

    <p>Fluid replacement</p> Signup and view all the answers

    What are the predominant nursing and collaborative management activities during the emergent phase?

    <p>Airway management, fluid therapy, wound care</p> Signup and view all the answers

    What is first done to manage the airway during emergent care?

    <p>Endotracheal intubation, escharotomy if needed</p> Signup and view all the answers

    What consists of fluid therapy during the emergent phase?

    <p>Begin IV fluid replacement with large bore IV lines</p> Signup and view all the answers

    What is the Parkland/Baxter formula?

    <p>4mL of Ringers lactate solution x kg bodyweight x TBSA = 24hr care</p> Signup and view all the answers

    How is the Parkland formula implemented?

    <p>Give 1/2 total fluids over 1st 8 hours, then the rest over 16 hours</p> Signup and view all the answers

    When should the wound be treated during the emergent phase?

    <p>After ABCs and fluid replacement managed</p> Signup and view all the answers

    What consists of wound care during the emergent phase?

    <p>Daily cleansing and dressing changes, gentle or surgical debridement</p> Signup and view all the answers

    What are the two approaches to managing burn wounds?

    <p>Open and closed</p> Signup and view all the answers

    What is the open method of wound treatment and what is the main priority?

    <p>Wound is covered with antimicrobial ointment, infection prevention</p> Signup and view all the answers

    What is the closed method for wound management?

    <p>Multiple dressing changes applied with topical antibiotic</p> Signup and view all the answers

    When is sterile technique used for wound management?

    <p>Applying new ointments and dressings</p> Signup and view all the answers

    Why should the room be kept warm?

    <p>Reduce shivering</p> Signup and view all the answers

    What is used for the treatment of the eye for a facial burn?

    <p>Antibiotic ointment, eyedrops</p> Signup and view all the answers

    What are the main uses for drug therapy for burn wounds?

    <p>Analgesics, tetanus prophylaxis, antimicrobial agents</p> Signup and view all the answers

    Why are systemic IV antibiotics contraindicated in fresh burns?

    <p>Bacteria live in the eschar which is avascular</p> Signup and view all the answers

    How is nutritional therapy implemented for patients with less severe burns?

    <p>Enteral feeding, assess gastric emptying</p> Signup and view all the answers

    What is a hypermetabolic state and how is it treated with nutritional therapy?

    <p>Increased resting metabolic expenditure, treated with early enteral feeding</p> Signup and view all the answers

    When does the acute phase begin and end?

    <p>When fluid mobilization and diuresis begins, ends when wounds are healed or covered in grafts</p> Signup and view all the answers

    How long can the acute phase last?

    <p>Can last several weeks or months</p> Signup and view all the answers

    What are the pathophysiological changes during the acute phase?

    <p>Diuresis makes the patient less edematous, WBCs surround area</p> Signup and view all the answers

    What are clinical manifestations of the acute phase?

    <p>Partial thickness wounds form eschar, full thickness wounds require debridement and skin grafts</p> Signup and view all the answers

    Why must laboratory values be monitored closely during the acute phase?

    <p>To maintain homeostasis of fluid and electrolytes</p> Signup and view all the answers

    Study Notes

    Types of Burns

    • Thermal, electrical, chemical, and radiation burns exist, with thermal burns being the most common.
    • Chemical burns are caused by acids, alkalis, and organic compounds.

    Determinants of Burn Severity

    • The effects of burn injuries depend on temperature, duration of contact, and type of tissue affected.
    • Alkali burns are particularly severe because they can continue to damage tissues until they are fully removed.

    Burn Mechanisms

    • Thermal injuries can arise from flame, flash, scald (most common), or contact with hot objects.
    • Inhalation injuries damage respiratory tissues due to smoke or hot air.

    Inhalation Injuries

    • Types include carbon monoxide poisoning and injuries above or below the glottis.
    • Carbon monoxide displaces oxygen in hemoglobin, leading to hypoxia; treatment includes administering 100% oxygen.

    Manifestations of Injuries

    • Upper airway injuries present with edema, hoarseness, and singed nasal hair, while lower airway injuries may lead to pulmonary edema and delayed symptoms.
    • Electrical burns can cause dysrhythmias, acidosis, and require swift medical attention at trauma units.

    Frostbite and Cold Injuries

    • Frostbite severity hinges on temperature, exposure duration, and skin condition.
    • Superficial frostbite affects only the skin, presenting mottled, crunchy textures; deep frostbite damages underlying tissues and leads to necrosis.

    Classification of Burns

    • The severity classification is based on depth, extent (TBSA), location, and patient risk factors.
    • Lund-Browder chart considers age for more accurate TBSA assessment versus the Rule of Nines.

    Phases of Burn Management

    • Management occurs in prehospital, emergent, acute, and rehabilitative phases; early intervention is crucial.
    • The main priority during prehospital care is stopping the burn process, particularly for large burns.

    Fluid and Electrolyte Management

    • During the emergent phase, hypovolemic shock from fluid shifts is a key concern.
    • Parkland formula guides fluid replacement in acute burns, calculating needs based on TBSA and weight.

    Wound Care Techniques

    • Wound management approaches include open (antimicrobial ointments) and closed methods (topical dressings with antibiotics).
    • Continuous monitoring and dressing changes are vital during the acute phase to prevent infection and promote healing.

    Nutritional Support

    • Patients experience increased resting metabolic demands, necessitating enteral feeding and vitamin supplementation in the acute phase.
    • Monitoring laboratory values is critical for managing fluid and electrolyte imbalances during recovery.

    Complications and Monitoring

    • Acute phase complications can include systemic infection, neurological deterioration, and nutritional imbalances.
    • Regular assessments and interventions aim to maintain homeostasis and prevent deterioration in patient conditions.

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    Description

    Test your knowledge on electrolyte imbalances during the acute phase. Explore how conditions like hyponatremia and hypernatremia can arise due to various factors such as fluid intake and GI suction. This quiz helps reinforce important clinical signs to watch for.

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