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Burns:
Formally called first degree burn
Superficial thickness
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Formally called second degree burn
Partial thickness
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Formally called third degree burn
Full thickness
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What type of isolation do you use with a burn patient?
Reverse isolation or Protective
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DO NOT use Santyl...
On face
If pregnant
Over large nerves
If area is opened to a body cavity
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Hydrotherapy is used to
Debrid
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Silvadene
Soothing, apply directly, if rubs off apply more, can lower WBC, can cause a rash
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Sulfamylon
can cause acid base problems, stings, if it rubs off apply more
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Silver nitrate
keep these dressings wet; can cause electrolyte problems
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Betadine
Stings, stains, allergies, acid-base problems
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Why should burn drugs/cremes be rotated?
Different types of bacteria
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In burn patients, broad spectrum antibiotics are avoided to prevent?
Infection
-Broad spectrum antibiotics will be used until the wound cultures have returned
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If skin graft becomes blue or cool what would this mean?
No circulation
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Sometimes the MD will order you to roll sterile Q-tips over a graft with steady, gentle pressure from the center of the graft out to the edges. Why?
Smooths it down to touch the wound bed so it can adhere and gain circulation
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electrical burn-- 2 exits. Which is worse?
Entrance
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What is important with an electrical injury?
Heart monitor
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Electrical injury-- what arrythmia is patient at high risk for?
V-Fib
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With electrical burns ____ can build up and cause ______ ______.
Toxins build up and cause kidney damage
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Amputations are common in burns because_____
The circulatory system can be destroyed
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Complications of electrical wounds include:
cataracts, gait problems, and just about any type of neuro deficit.
Electricity loves blood!
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Alcohol + tobacco =
Cancer
Co-carcinogenic
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CAUTION stands for?
- Change in bowel/bladder habits
- A sore that does not heal
- Unusual bleeding/discharge
- Thickening or lump in breast or elsewhere
- Indigestion or difficulty swallowing
- Obvious change in wart or mole
- Nagging cough or hoarseness
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When cancer invades bone marrow it causes _____ and _______
Anemia and thrombocytopenia
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What is another name for internal radiation?
Brachytherapy
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With all brachytherapy, the radioactive source is inside the patient; radiation is being emitted.
What is the difference between Unsealed and Sealed or Solid?
- Unsealed: patient and body fluids emit radiation
- - isotope is given IV or PO
- - usually out of system in 48 hrs.
- Sealed or solid: patient emits radiation; body fluids are not radioactive
- - implanted close or in the tumor
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Radiation (brachytherapy) precautions
- -private room
- -restrict visitors
- -no visitors under 16
- -no pregnant visitors/nurses
- -mark the room
- -wear a film badge at all times
- -limit each visitor to 30 min per day
- -visitors must stay at least 6 feet from source
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How can you help prevent dislodgment of a radioactive implant?
- keep patient on bedrest
- prevent bladder distention
- decrease fiber in diet
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other names for External radiation are?
- teletherapy
- beam radiation
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Usual side effects of external radiation
- erythema
- shedding of skin
- altered taste
- fatigue
- Pancytopenia (all blood components are decreased)
- many signs and symptoms are location and dose related
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Protect an external radiation site from sun for how long after completion of therapy?
1 year
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Usual side effects of chemo
- aopecia,
- N/V
- mucositis
- immunosuppression
- anemia
- thrombocytopenia
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Patient's WBC count must be at least ____ before they can receive chemo
3,000
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A vesicant is a type of chemo drug that if it infiltrates (extravasates) will cause tissue ______.
When giving a vesicant the nurse must _______.
Necrosis
Stay with patient the whole time drug is being given
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Chemo works on the ___________
-usually schedualed every __________
Cell cycle
3-4 weeks
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Signs and symptoms of extravasation
- Pain
- redness
- swelling
- no blood return
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What do you do with extravasation?
- STOP infusion
- Ice packs
- Call MD
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What lab value is most important in preventing infection for an immunocomprimised patient?
Absolute Neutrophil count
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Classic symptom of invasive cervical cancer
painless vaginal bleeding
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general s/s of cervical cancer
- watery, blood tinged vaginal discharge
- leg pain along sciatic nerve
- back/flank pain
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Major symptom of uterine cancer
Post menopausal bleeding
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Diagnostic for uterine cancer to rule out ovarian involvment
CA-125 blood test
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Uterus and cervix only removed
Total abdominal hysterectomy
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may remove all of the pelvic organs
Patient may have colostomy, ileal conduit
Radical hysterectomy
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The greatest time for hemorrhage following a hysterectomy is
During the first 24 hrs
Why? Pelvic congestion of blood
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major complication with abdominal hysterectomy is _______
major complication with vaginal hysterectomy is ________
abd hemorrhage
vag infection
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bilateral oophorectomy =
ovaries
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bilateral salpingectomy =
tubes
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why do you want to prevent abd distention after abd surgery?
- Do not want tension on the suture line
- dehiscence and evisceration
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avoid high fowlers in post op abd surgery because
blood pools to suture
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S/S of lung cancer
- hemoptysis
- dyspnea
- hoarseness
- cough
- change in endurance
- chest pain
- pleuritic pain on inspiration
- displaced trach
*may metastasize to bone
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major difference between the S/S of lung cancer and that of tuberculosis
TB has night sweats too!
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After a bronchoscopy, watch for:
- resp. depression
- hoarseness
- dysphagia
- SQ emphysema (air in the tissues) Sounds like rice krispies
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Is it normal to have resp. depression after a bronchoscopy?
NO!
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Sputum specimen:
Best time to obtain?
Is this sterile?
What should patient do first?
First thing in the morning
yes it is sterile
patient should rinse mouth with water to decrease bacteria in mouth
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Diagnostic tests for lung cancer
- Bronchoscopy
- sputum specimen
- CT
- MRI
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Lobectomy
what is it?
How do you position pt after?
Part of the lung is removed
chest tubes and surgical side up
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Pneumonectomy:
What is it?
Pt care after?
total removal of lung
- Good lung up!
- position on affected side
- No chest tubes because there's no lung
Avoid severe lateral positioning becuase this could lead to a mediastinal shift!
- RR should always be perfect!!
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