Acute Phase Electrolyte Imbalances Quiz

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)

Prolonged GI suction and IV therapy without potassium Signup and view all the answers

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

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

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

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

What are the types of burns?

All of the above Signup and view all the answers

What determines the result effect of the burn?

Temperature, duration of contact, type of tissue involved Signup and view all the answers

How are thermal injuries caused?

Flame, flash, scald, contact with hot object Signup and view all the answers

How do chemicals cause a burn?

Acids, alkalis, organic compounds contacting the tissues Signup and view all the answers

Why are alkali burns so hard to manage?

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

What are the types of burn injury?

All of the above Signup and view all the answers

What are some ways to prevent burn injuries?

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

How do inhalation injuries occur?

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

What are the types of inhalation burn injuries?

All of the above Signup and view all the answers

How does carbon monoxide cause poisoning?

Displaces oxygen in the hemoglobin, causing carboxyhemoglobinemia, hypoxia, death Signup and view all the answers

How is CO poisoning treated?

Supplement 100% oxygen Signup and view all the answers

What are the manifestations of CO poisoning?

Skin color is cherry red Signup and view all the answers

What are the manifestations of upper airway injury?

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

What are the manifestations of lower airway injury?

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

What does the severity of electrical burns depend on?

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

What are the manifestations of electrical burns?

Dysrhythmias, severe metabolic acidosis, myoglobinuria, bone fracture Signup and view all the answers

Where should an electrical burn patient go immediately?

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

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

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

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

Fat and bone Signup and view all the answers

How does cold cause damage to cells?

Forms ice crystals, vasoconstriction, vascular stasis Signup and view all the answers

What determines the severity of frostbite?

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

What is superficial frostbite?

Ice crystals forming in the upper layers of the skin Signup and view all the answers

What are some treatments for superficial frostbite?

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

What is deep frostbite?

Ice crystals forming deeper, affecting muscle, bone, and tendons Signup and view all the answers

What are the manifestations of deep frostbite?

Skin is white, hard, no sensation, complete necrosis Signup and view all the answers

What are the treatments of deep frostbite?

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

How are the severity of burns classified?

Depth, extent, location, patient's risk factors Signup and view all the answers

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

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

How is the extent of the burn classified?

Lund-Browder chart, Rule of Nines Signup and view all the answers

What degree of burn is not classified by extent?

Superficial (1st degree) Signup and view all the answers

Why is the Lund-Browder chart more accurate?

Takes patient age into account Signup and view all the answers

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

1% Signup and view all the answers

When is the extent of the burn reassessed?

After the edema has subsided Signup and view all the answers

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

Respiratory obstruction and circulatory compromise Signup and view all the answers

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

Self-care deficits Signup and view all the answers

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

Risk for infection Signup and view all the answers

What is compartment syndrome?

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

What is an escharotomy?

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

What are some client risk factors to consider?

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

What are the 4 phases of burn management?

All of the above Signup and view all the answers

What is the main priority during prehospital care?

Removing the person from the source of burn Signup and view all the answers

Prehospital treatment of small thermal burns?

Cover with clean cloth soaked in cold water Signup and view all the answers

Prehospital treatment of large thermal burns if unresponsive?

CAB - Circulation, Airway, Breathing Signup and view all the answers

Prehospital treatment of large thermal burns if responsive?

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

Prehospital treatment of electrical injuries?

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

Prehospital treatment of chemical injuries?

Brush off solid particles, flush with water Signup and view all the answers

Prehospital treatment of inhalation injuries?

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

What is the primary concern during the emergent phase?

Resolving immediate concerns of hypovolemic shock and edema formation Signup and view all the answers

When does the emergent phase begin?

When there is fluid loss Signup and view all the answers

When does the emergent phase end?

When fluid mobilization and diuresis begin Signup and view all the answers

What are the pathophysiological changes during the emergent phase?

Fluid and electrolyte shifts, inflammation and healing, immunological changes Signup and view all the answers

What is the greatest concern with electrolyte and fluid shifts?

Hypovolemic shock Signup and view all the answers

How does burn shock occur?

Increased capillary permeability resulting in edema and reduced blood volume Signup and view all the answers

How else is circulatory volume decreased during the emergent phase?

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

What type of necrosis occurs from burn injury?

Coagulative Signup and view all the answers

What are the main nursing priorities during the emergent phase?

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

How does healing occur in the emergent phase?

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

What are the immunological changes during the emergent phase?

Systemic impairment of immune system, circulating immune globulins decrease Signup and view all the answers

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

Shock, blisters, altered mental state Signup and view all the answers

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

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

What defines the end of the emergent phase?

Capillary membrane permeability restored, edema subsides Signup and view all the answers

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

Cardiovascular, respiratory, urinary Signup and view all the answers

What are the cardiovascular complications of the emergent phase?

Dysrhythmias, hypovolemic shock, sludging Signup and view all the answers

What is sludging and how does it get treated?

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

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

Telemetry Signup and view all the answers

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

Upper airway injury, lower airway injury, pneumonia Signup and view all the answers

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

12-24 hours Signup and view all the answers

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

Chest x-ray Signup and view all the answers

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

Renal ischemia, acute tubular necrosis Signup and view all the answers

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

Fluid replacement Signup and view all the answers

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

Airway management, fluid therapy, wound care Signup and view all the answers

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

Endotracheal intubation, escharotomy if needed Signup and view all the answers

What consists of fluid therapy during the emergent phase?

Begin IV fluid replacement with large bore IV lines Signup and view all the answers

What is the Parkland/Baxter formula?

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

How is the Parkland formula implemented?

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

When should the wound be treated during the emergent phase?

After ABCs and fluid replacement managed Signup and view all the answers

What consists of wound care during the emergent phase?

Daily cleansing and dressing changes, gentle or surgical debridement Signup and view all the answers

What are the two approaches to managing burn wounds?

Open and closed Signup and view all the answers

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

Wound is covered with antimicrobial ointment, infection prevention Signup and view all the answers

What is the closed method for wound management?

Multiple dressing changes applied with topical antibiotic Signup and view all the answers

When is sterile technique used for wound management?

Applying new ointments and dressings Signup and view all the answers

Why should the room be kept warm?

Reduce shivering Signup and view all the answers

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

Antibiotic ointment, eyedrops Signup and view all the answers

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

Analgesics, tetanus prophylaxis, antimicrobial agents Signup and view all the answers

Why are systemic IV antibiotics contraindicated in fresh burns?

Bacteria live in the eschar which is avascular Signup and view all the answers

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

Enteral feeding, assess gastric emptying Signup and view all the answers

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

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

When does the acute phase begin and end?

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

How long can the acute phase last?

Can last several weeks or months Signup and view all the answers

What are the pathophysiological changes during the acute phase?

Diuresis makes the patient less edematous, WBCs surround area Signup and view all the answers

What are clinical manifestations of the acute phase?

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

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

To maintain homeostasis of fluid and electrolytes 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.