HESI Remediation Info

• Arterial: intermittent claudication, cramping, numbness, tingling
• Aggravating symptoms: walking, elevation
• Relieving factors: rest, or dangling.
• Associated symptoms: cool pale skin-poor healing injuries to extremities
• Venous: aching, tiredness, feeling of fullness
• aggravating symptoms: prolonged standing, sitting.
• relieving factors: elevation, lying, walking.
• associated symptoms: edema, varicosities, weeping ulcers at ankles.

• Resuscitative phase: Life threatening, airway or breathing problems, cardiopulmonary instability, hypovolemia, hypothermia-shock phase. Every organ is involved in this response with a TBSA burn of 20% or greater.
• Acute Care phase: wound healing, wound closure prevention of infection.
• Rehabilitation phase: support for adequate wound healing, prevention of scarring, contractures, and psychological support

• Oxygen alterations: assess airway, breathing, administer O2. 
• monitor HBCO levels-carbon monoxide
• elevate HOB and implement HAP percautions
• assist with pulmonary secretion suctioning
• Observer for signs of airway obstructions
• Intubation?
• Maintain accurate documentation
• Impaired gas exchange: High Flow Oxygen
• Ineffective airway clearance: laryngeal swelling can occur at anytime during first 24 hours and up to 72 hours increased risk of edema. monitor for intubation
• Fluid resuscitation: Parkland Burn Formula-(4ml X TBSA (%) X Weight (KG)) give 50% in first 8 hours. LR is the standard for the first 24-36 hours. Capillary Leak seals after 24 hours approx. which allows albumin to be given without leakage into the interstitium. 
• Electrolytes: Potassium increased risk for hyper or hypo-due to cellular damage, kidney damage, metabolic acidosis. increased risk for hyponatremia as well
• Ineffective kidney tissue perfusion: myoglobinuria(proteins)-port wine color in urine-leading to damage to glomerular apparatus-tubules. Fluids, forced diuresis with mannitol, osmotic diuretics-hourly urine output that is double recommended. UO every hour for first 48-72 hours.
• Ineffective peripheral tissue perfusion: 6 P's (Pulselessness, pallor, pain, paraesthesia, paralysis, poikilothermia) 
• Inflammatory phase: 3-5 days after injury.
• Proliferative phase: 4-20 days after injury.-epithelization-cells begin to cover the wound and bring collagen to heal.
• Maturation phase: 20-over a year-scar tissue begins to form.
• Imbalanced nutrition: metabolism increases 40-100% depending on TBSA burned.
• Topical antibiotic therapy is needed for burn injury. Silver sulfadiazine, mafenide acetate cream, bacitracin, pure silver.
• Wound closure: Autografts, allografts (homografts), xenografts, synthetic skins

• Type 1-absolute or relative insulin production:stress response, infection or missed insulin injection are some main causes of DKA in children or adolescence. 
• S/S: BG elevated, ph low,urine ketonse, kussmaul respirations, WBC may be elevated.
• Focused assessment: respiratory status, LOC, hydration status, electrolyte acid balance.
• Treatment: hydration, insulin drip as ordered, continuous cardiac monitoring, monitor Potassium level, urine output >30ml/hr, neurological check every 1-2 hours-assess for signs of ICP due to increased risk of cerebral edema with re-hydration.

• +1: barely perceptible pit
• +2: deeper pit-rebounds in a few seconds
• +3: deep pit rebounds in 10-20 sec
• +4: deep pit rebounds in >30 sec

• cimentidine (Tagamat)
• ranitidine (Zantac)
• famotidine (pepcid)
• Pantoprazole

IV site to bag

Most commonly ordered insulin that are mixed: NPH (intermediate-acting) and Regular  insulin (short-acting

• Never mix Insulin Glargine “Lantus” with any other type of insulin.
• Administer the dose within 5 to 15 minutes after drawing up because the regular insulin binds to the NPH and this decreases its action.
• insert air into both vials than draw from CLEAR TO CLOUDY