Test 2

Oxygenation and Skin

70 questions
2 dosage calc

Hand washing
Assess before Address

ABC – Oxygen first

Wound healing
First intention – edges brought together with skin lined up in approximated
position
Second intention – Granulation and contraction; deeper tissue injury or
wound
Third intention – delayed closure; high risk for infection with resulting scar
Pressure ulcers
Who is more likely to get a pressure ulcer? Bed/chair bound patients,
incontinent, inadequate nutrition/hydration, AMS, PVD
What time of assessment? BRADEN SCALE
Bony prominences – elbows, sacrum, heels
Elevate with pillows, turn q2
Ways to prevent skin breakdown? Turn q2, elevate with pillows, clean and dry
What type of diet should they have? High protein, High calorie
Standard precautions
Color, drainage and amount, eschar, odor

Wound assessment – Location, size, color, extent of tissue involvement, cell types
wound base and margins, exudate, condition of surrounding tissue, presence of
foreign bodies
Partial thickness – damage to epidermis, upper layers of dermis, SUPERFICIAL
MINIMAL LOSS OF TISSUE INTEGRITY
Full thickness – damage extends into lower layers of dermis LOSS OF TISSUE
INTERITY
Type of care for open wound – dressings, physical, drug, and nutrition therapies,
electrical stimulation, wound VAC, Hyperbaric oxygen therapy, skin substitutes,
debridement, skin grafting
Burns – type of fluids (LR first, usually within the first hour)
Rule of Nines
Head 9% - 4.5 front, 4.5 back
Right arm 9% - 4.5 front, 4.5 back
Left arm 9% - 4.5 front, 4.5 back
Truck 36% – 18 front, 18 back
Right leg – 18% - 9 front, 9 back
Left leg 18% - 9 front, 9 back
Groin 1%
What to assess? Depth of burn injury – size and depth of injury
severity determined by how much body surface is involved, differences in
skin thickness in various parts of the body
smoke inhalation: cough and hoarseness, chest pain, coughing up blood,
trouble breathing (SOB, noisy breathing) headache, nausea, abd pain,
eye irritation, vision problems, fainting, soot in nostrils and throat
dark nostrils
Treatment: hyperbaric treatment
Superficial thickness – epidermis only (Peeling of dead skin 2-3 days after
Injury
Partial thickness – involves entire epidermis and dermis (varying depths)
Full thickness – destruction of entire dermis and epidermis, skin does not
regrow
Burns from waist up first assessment is ALWAYS THE AIRWAY
What do they sound like? Hoarseness, cough
What type of care – START WITH HAND WASHING AND GLOVES then assess
before address
Lab results in recently burned pt
Hgb – elevated as a result of fluid volume loss
Hct – elevated as a result of fluid volume loss
Urea nitrogen – elevated as a result of fluid volume loss
Glucose – elevated as a result of the stress response and altered uptake
across injured tissues
Sodium – decreased, trapped in edema fluid and lost through plasma leakage
Potassium – elevated as a result of disruption of the sodium-potassium
pump, tissue destruction, and red blood cell hemolysis
Chloride – elevated as a result of fluid volume loss and reabsorption of
chloride in urine
PaO2 – slightly decreased
PaCO2 – slightly increased from respiratory injury
pH – low as a result of metabolic acidosis
Carboxyhemoglobin – elevated as a result of inhalation of smoke and CO2

Shingles – deep pain and itching, followed by vesicles with red base arise along the
nerve line * Treated with antiviral medications
Scabies – intense itching, curved or linear ridges in the skin, visible horizontal white
skin ridges are formed by burrowing of the mite into the outer skin layers

Psoriasis – over production of keratin, autoimmune

Treated with topical corticosteroids, topical tar and anthralin preparations,
and UV light – not curable

Chronic Bronchitis – caused by chronic exposure to irritants, especially cigarette

smoke
Excessive mucus, productive cough, airflow obstruction

COPD – dusky to cyanotic color, recurrent cough and increased sputum production,
edema, increased respiratory rate, exertional dyspnea, digital clubbing
be careful with oxygen being too high
Sit up and lean forward to assist with breathing
Nasal cannula
Keep 02 sats between 92-94%

Emphysema – LOSS OF LUNG ELASTICITY AND HYPERINFLATION OF LUNG

alveolar wall destruction, enlarged air spaces, decreased alveolar-capillary diffusing
area (no cyanosis, dyspnea, ineffective cough, orthopenic, exertional dyspnea)
Breathing techniques – pursed lip breathing
How does the chest look? Barrel chest, rest of the body is think
Advanced emphysema has what breath sounds
Position to help with breathing – sitting up and leaning forward
Leads to right sided heart failure

Bronchoscopy – a procedure done to look at the degree of damage to the airways

through a small scope and to allow suctioning of secretions and debris

Total Laryngectomy
Removal of the larynx, stoma in the neck to breathe
Priorities are airway maintenance and ventilation, hemorrhage
Wound, flap reconstructive tissue care
Pain management
Nutrition
Speech and language rehabilitation
The upper airway is separated from the throat and esophagus and a permanent
Laryngectomy stoma in the neck is created

Tracheostomy – when do you suction the catheter? COMING OUT

Acute asthma – medications

Based on step category for severity and treatment – Preventative or Rescue
Bronchodilators – short and long-acting beta2 agonists, Cholinergic
antagonists, Methylxanthines
 Anti-inflammatory agents –corticosteroids, NSAIDs, Leukotriene antagonists,
Immunomodilators

How to teach diaphragmatic breathing

Abdominal breathing!!
Lie on back with knees bent, place hands on abdomen to create resistance.
Breathe in, if hands move you are doing it correctly.

Pursed lip breathing – Emphysema

Close your mouth and breathe in through nose. Purse lips, like whistling, and
breathe out slowly. Don’t puff out cheeks. Spend at least twice as much time
breathing out as in.
Why do you do it? Helpful in managing dyspneic episodes