Parkland Formula

Assalamualaikum & Hye..

Kali ni Hanna nak sambung sikit tentang burn tu..

Camner Parkland Formula diguna 

And nak kira untuk Fluid Resuscitation.. 

Kita dah tahu camner caranya nak kira percent of burn...

so now kita nak kira berapa jumlah cecair

yang diperlukan untuk gantikan semula cecair badan 

yang hilang akibat burn tu... 

Jom tengok camner nak kira...

Fluid Requirements = TBSA burned(%) x Wt (kg) x 4mL 

Give 1/2 of total requirements in 1st 8 hours, 

then give 2nd half over next 16 hours

*TBSA-total body surface area (percent of burned)

Contoh:

Cecair diperlukan = TBSA (40%) x Brt Bdn (60kg) x 4mL 

Jawapan = 9.6 Liter untuk 24 jam yg pertama..

tapi perlu diberi separuh daripada jumlah tersebut 

untuk 8 jam yg pertama..

maknanya kita kena bagi 4.8 Liter untuk 8 jam pertama..

if kamu rasa kurang faham,

KLIK SINI

(sumber dari google)

Rule of 9's

Assalamualaikum & Hye..

Kali ni Hanna nak cerita pasal camner nak
kira percent of burned pada seseorang patient
yang alami luka terbakar atau kelecuran...

Rule of  9's berfungsi untuk kira berapa
percent atau pun keluasan
luka terbakar / kelecuran pada seseorang pesakit tu...

Klik SINI 

untuk ke website info ni...

Burn

Burn is caused most commanly by fire (dry heat). It also can caused by friction, chemicals, electricity or radiation.

*friction - occurs when skin is scraped off by contact with a surface such as roads, carpets, or other hard
floor surfaces.

*Chemical – Most chemicals that cause burns are either strong acids or bases. Chemical burns can be
deceiving, however. Some agents can cause deep tissue damage not readily apparent when you first look at it.

*Electrical - often cause serious injury inside the body. Look for an entry and exit point as this is often a                     characteristic of this type of injury.

Inhalation burns – there may be burned lips, mouth, and throat.

Depth of burns :-

• Superficial (first degree) - The skin is red, hot and painful but without blisters. Damage is superficial and temporary.
• Partial-thickness (second degree) - The outer layer of skin is damaged. The skin has blisters besides being red, hot and painful.
• Full-thickness (third degree) - All layers of the skin are damaged. The skin may be pale and leathery, or charred. It is relatively painless on the point of the burn because the nerves are damaged. The pain experienced will more then likely result from the surrounding burns which are of lesser degree.

( org yg burn sampai 3rd degree x akan rasa sakit sebab sensori sakit/deria sakit dia dah musnah )

Different Diagnosis : Chest Pain

(sumber dari google)

MI (Myocardial Infarction)

*Onset – Sudden, lasting longer than 30 min.
*Quality – Pressure, dull, achy, tightness
*Location/Radiation – Epigastric or substernal, usually left neck, jaw, arm or back
*Exacerbating Factor – Stress, excertion, or unprovoked

Angina

*Onset – Gradual or sudden, usually brief
*Quality – Pressure, tightness
*Location/Radiation – Chest, usually left neck, jaw and arm
*Exacerbating Factor – Exertion, stress, eating, cold temperature

Pleurisy

*Onset – Rapid
*Quality – Sharp, stabbing
*Location/Radiation – Points tenderness
Exacerbating Factor- Inspiration

Musculoskeletal

*Onset – Variable
*Quality – Sharp, dull, aching
*Location/Radiation – Localized
*Exacerbating Factor – Movement, digital pressure, inspiration

Pericarditis

*Onset – Gradual
*Quality – Sharp, pleuritic
*Location/Radiation – Precardium
*Exacerbating Factor – Supine position

Aortic Dissection

*Onset – Sudden/Severe
*Quality – Tearing
*Location/Radiation – Chest, back
*Exacerbating Factor – Hypertension, smoking

Pulmonary Embolism

*Onset – Sudden*Quality – Sharp-knife like, stabbing, pleuritic
*Location – Chest,back, over lungs area
*Exacerbating Factors – Dislodged thrombi, atrial fibrillation

Esophageal Ruptured

*Onset – Sudden/severe
*Quality – Sharp, burning
*Location/Radiation – Chest, throat, back
*Exacerbating Factors – Swallowing, vomitting

5 Important Steps

Assalamualaikum & Hye..

Kali ni Hanna nak share this important steps..

Tapi usually these steps are use in 

any kind of procedure in nursing..

Before nak start pape procedure pun,

we must look into these 5 steps.

Then diikuti dengan steps of the procedure 

yang kita nak buat tu lah.

Barulah kerja kita berjalan lancar

dan dapat disettlekan dengan jayanya... (:

1. Assessement

-make an assessement before start the procedure.

2. Positioning
-look the possible position for the procedure.

3. Prepare equipment
-we have to prepare an enough equipments for the procedure. what instrument we will use.

4. Procedure
-do the procedure properly step by step

5. Record
-last but not least, record the procedure. when it done, what happen to the pt. or the location of the procedure,  or any important things to write in the record.

IMPORTANT!!
-if the procedure need to maintain an asepsis technic, so we MUST follow it.

(cth: sedia alatan yg cukup)

Mechanical Ventilation

Indication

-Airway obstruction

-Inadequate oxygenation-O2 saturation (<90% on hi-flow oxygen via nonrebreather mask)

-Inadequate ventilation-hypoventilation (high pCO2, pH-acidosis)

-Increased work of breathing, ineffective breathing pattern

-Airway protection

Common Setting

*AC (Assist Control)-Pt. triggers ventilator to deliver a breath. If apnea occurs, a minimum rate & volume will be delivered to the pt.

*CPAP (Continuous Positive Airway Pressure)-Continuous, nonstop positive positive pressure is applied throughout entire respiratory cycle.

*BiPAP (Bilevel Positive Airway Pressure)-Same as CPAP but with 2 preset setting ; one for inspiration & one for expiration

*CMV (Continuous Mandatory Ventilation)-Ventilator delivers a set tidal volume at a set rate regardless of a pt.’s own attemps to breathe. Expect pt. to
require sedation.

*IMV (Intermittent Mandatory Ventilation)-Ventilator delivers a set tidal volume at a set rate, yet also allows the pt. to initiate breaths.

*PSV (Positive Support Ventilation)-For pt. with spontaneous breathing. Ventilator delivers a preset positive pressure for the duration of
inspiration when the pt. initiates a breath.

*SIMV (Syncrhonized Intermittent Mandatory Ventilation)-Ventilator is triggered only by a patient-activated demand valve & therefore, synchronizes with the pt. own
respiratory efforts.

*PEEP (Positive End-Expiratory Pressure)-Maintains a preset positive airway pressure at the end of each expiration. PEEP is used to treat a PaO2 <60 mmHg
on FiO2 >50%

(sumber dari google)

Continuous Bladder Drainage (CBD)

Handling Patient who had CBD

1. Wash hands with soap & water before & after handling bag, catheter or tube.

2. Make sure urine bag are always below the level of patient’s bladder all the time.

3. Check frequently to be sure not to kink or loops in tubing or that patient not lying on tubing.

4. Do not pull on catheter.

5. Wash around catheter entry site with soap & water twice a day or after bowel movement.

6. Do not use powder around catheter entry site.

7. Check around the catheter entry site for sign of irritation, redness, tenderness, swelling or drainage.

8. Offer fluids requently (if not contraindicated to patient’s health status)

9. Empty urine bag each shift; note colour, clarity & odor.

10. Record urine output

11. Notify physician if any following:

- blood, cloudiness, foul odor

- urine output <30mL/hr

- irritation or leaking around catheter entry site.

- fever, abdominal or flank pain

(sumber dari google)