Terms for NRS 440 final exam

1. Thermal burns
– Thermal burns are caused by flame, flash, scald or contact with hot objects.
– What is the most common type of thermal burn?
They include, Flame, Scald (from steam, hot or molten liquid), Contact (from a hot object, such as a hot cooking pan) Electrical burns, Radiation burns (sunburn, medical radiation treatment for cancers, welding exposures) and Chemical burns.
– What determines the severity of injury?
Severity of burns depends on the temperature of burning agent and duration of contact time
2. Smoke inhalation burns
– Smoke inhalation burns are from inhalation of hot air or noxious chemicals
– Smoke inhalation burns cause damage to respiratory tract
– Major predictor of mortality in burn victims
– Smoke inhalation burns need to be treated quickly
– Smoke inhalation burns is more prone to ARDS and pneumonia


3. What are types of inhalation injuries:
a) Metabolic asphyxiation.
– This occurs when there is excess of carbon monoxide (CO) and therefore inadequate amounts of oxygen are supplied to the tissues and organs to maintain normal metabolic processes
– Carbon monoxide is produced by incomplete combustion of burning materials and when inhaled it displaces oxygen, this low level of oxygen is also known as hypoxia and when CO levels are 20% or greater it can cause death.
– It’s treated with 100% humidified oxygen, carbon monoxide poisoning may occur in the absence of burn injury to the skin and hence one can look fine on outside, but dying on inside.. Terms for NRS 440 final exam.
b) Upper airway injury
– Upper airway injury is injury to mouth, oropharynx and/or larynx caused by inhalation of hot air, steam or smoke
– Swelling may be massive and rapid onset
i. Eschar and edema may compromise breathing
ii. Swelling from scald burns can be lethal
– Damage to mucus membranes; may need immediate intubation
– Upper airway injury signs include:
• Presence of facial burns
• Hoarseness, painful swallowing (new)
• Singed nasal hair
• Carbonaceous sputum (blackish)
• Darkened oral and nasal membranes
• Clothing burns around chest and neck
• History of being burned in enclosed space
c) Lower airway injury
– Lower airway injury is injury to trachea, bronchioles, and alveoli
– Lower airway injury results from exposure to smoke or toxic fumes
– Pulmonary edema may not appear immediately after the burn but until 12-24hrs.

4. Severity of injury is determined by: –
a) Depth of burn
b) Extent of burn in percentage of TBSA
c) Location of burn
d) Patient risk factors. Terms for NRS 440 final exam.

5. What are the common problems relating to the critically ill patient?
a) Anxiety
b) Emergency situation (codes, ICU psychosis)
c) Nutritional alterations
d) Environmental stressors (sensory overload/deprivation)
e) Sleep deprivation
f) Pain
g) Physiological instability
h) Delirium
i) End of life issues (death is higher in the ICU pt population)

6. What interventions can be used in the critical care setting to decrease negative pt outcomes
a) Avoiding restraints
b) Keeping the noise down
c) Medication management: optimize pt’s orientation/awareness

7. What are some of the changes in health care delivery that we must consider as high acuity nurses?
Higher acuities, advancing technologies
a) Older population: complex health problems/ multiple co-morbidities
b) Increase in nosocomial infections
c) Limited reimbursements
d) Advent of RRT
e) Nurses requiring advanced certifications. Terms for NRS 440 final exam.

8. How can aging changes make caring for pts more challenging?
a) Older adults don’t always present with typical symptoms: a geriatric pt with an infection may be brought in d/t confusion/delirium. Treating the problem (pain/infection) may clear the mental status changes
b) Older adults have fewer protective SQ layers, making their skin considerably more fragile than younger pts; monitoring skin integrity is key
c) Older adults are less able to metabolize meds, so it’s important to monitor carefully for s/s of drug toxicity


9. What makes cardiac cells unique?
The muscle cells of the heart are unique and responsible for the electrical stimulation that leads to proper mechanical fxn; SA node conducts on its own w/o any nearby cells helping.

10. When would you want to monitor someone's telemetry?
- See changes in heart rhythm, electrolyte imbalances, known cardiac events, syncopal episodes, overdoses (known/unknown)

11. Steps to reading an EKG?
a) Determine HR: look at r-to-r interval to determine regularity
b) Identify the presence of p waves: recognizable?
c) Measure the PR interval: # of small boxes between p and r
d) Identify and measure the QRS complex: small boxes between beginning of Q and end of S
e) Identify and measure the QT interval: # of small squares between beginning of Q and end of T waves. Terms for NRS 440 final exam.

12. Afib is associated with?
– Advanced age, valvular heart disease, CAD, hypertensive heart disease, pulmonary disease, chronic lung disease, and surgery (especially open-heart surgery)

13. Significance of atrial arrhythmias?
- Reduces CO by eliminating atrial kick (reduces ventricular filling volume and CO by 25% -> fatigue and malaise)
- Can decrease BP, may lead to CHF or MI
- Coagulation risks with lack of turbulent flow of blood in atria -> can lead to a stroke.
- Causes (supraventricular rhythms) 
- Age, enlarged heart, cardiac injury
- The shorter time in diastole reduces the time available for coronary artery perfusion - increases risk for myocardial ischemia (deficiency of blood supply to heart muscles. Terms for NRS 440 final exam.

14. Implantable cardioverter defibrillator (ICD)
– Detects and terminates life-threatening episodes to tachycardia or fibrillation’
– Internal defibrillator that can detect when it needs to shock the pt out of a fatal arrhythmia
– People who survive a first episode of a life-threatening VT are at high risk of further episode

15. Pacemakers
– Used to pace the heart when the normal conduction pathway is damaged or diseased
– Pacing circuit consists of a power source, one or more conduction (pacing) leads, and myocardium
– Electrical signal (stimulus) travels from the pacemaker, through the leads, to the wall of the myocardium
– Myocardium is captured and stimulated to contract
– Sensitivity control regulates the ability of the pacemaker to detect the heart’s intrinsic electrical activity
– Initially indicated for symptomatic Brady dysrhythmias and anti-tachycardia and overdrive pacing

16. Anti-tachycardia pacing
– Delivery of a stimulus to the ventricle to terminate tachydysrhythmias. Terms for NRS 440 final exam.

17. Overdrive pacing
– Pacing the atrium at rates of 200-500 impulses per min to terminate atrial tachycardias

18. Temporary pacemakers
– Power source outside the body; a stopgap measure used during procedures either as backup or for situations where you want the heart beating so fast it’s basically standing still; usually IJ or femoral vein placement
– Transcutaneous (external): pacing via defibrillator pads; done in unstable pts as a bridge to an actual pacemakers; apply pads if pt seems unstable (never hurts to have them ready)
– Transvenous: pacing electrode threaded through a vein into the right atrium, right ventricle, or both
– Epicardial: placed in surgery, electrodes inserted through epicardium of the RV and possible the RA (wire must be puled b4 DC)
– Permanent: require gen change (battery replacement) q 5-10yr; output procedure


19. Permanent pacemakers
– power source inside the body

20. Pacemaker malfunction
– Failure to sense: failure to recognize spontaneous atrial or ventricular activity, and pacemaker fires inappropriately
– Failure to capture: depolarization does not occur after a pacer-generated impulse
– Lead damage, battery failure, dislodgment of the electrode

21.Pacemaker complications. Terms for NRS 440 final exam.
– Local infection
– Bleeding and hematoma
– Hemothorax
– Ventricular ectopy and tachycardia
– Movement or displacement of the electrode
– Phrenic nerve stimulation (hiccoughing)
– Rarely cardiac tamponade