Med-Surg Study Guide
Table of Contents
Burns 2 Hematologic Disorders 63
Cancer 7 Musculoskeletal 65
Cardiac 10 Musculoskeletal System 65
Cardiac Basics 10 Fracture 68
Heart Failure 12 Osteoarthritis 71
Coronary Artery Disease 14 Rheumatoid Arthritis 72
Angina Pectoris 16 Osteoporosis 75
Myocardial Infarction 18 Gout 78
Electrolyte Imbalances 20 Neurology 80
Sodium 20 Brain Anatomy and Physiology 80
Potassium 21 Stroke 82
Calcium 22 Seizure 87
Magnesium 23 Increased Intracranial Pressure 90
Phosphorus 24 Multiple Sclerosis 93
Chloride 25 Parkinson's Disease 95
Relationships 26 Myasthenia Gravis 98
Endocrine 27 Guillain-Barre Syndrome 100
Endocrine System 27 Renal 102
Thyroid Gland and Disorders 29 Kidneys, Nephrons and RAAS 102
Hyper- and Hypoparathyroidism 32 Chronic Kidney Disease 105
Adrenal Glands and Disorders 34 Acute Kidney Injury 107
DI vs SIADH 37 Renal Calculi 109
Diabetes Mellitus 39 Urinary Tract Infections 112
Gastrointestinal 44 Glomerulonephritis 114
The Digestive System 44 Nephrotic Syndrome 115
Gastroesophageal Reflux Disease 46 Dialysis 116
Peptic Ulcer Disease 47 Diuretics 118
Inflammatory Bowel Disease 48 Respiratory Disorders 121
Diverticulosis and -itis 51 Lung Anatomy and Physiology 121
Celiac Disease 52 Pneumonia 122
Hepatitis 53 COPD 123
Cirrhosis 56 Asthma 124
Pancreatitis 58 ARDS 125
Cholecystitis 60 Pleural Effusion 126
Appendicitis 61 Shock 127
, BURNS
Damage to the skin's integrity by some kind of energy source
Types of Burns
Thermal - Most common - caused by flame, flash, scald or contact with hot objects (liquid, steam, fire); e.g.
from cooking, burning leaves, smoking
Chemical - caused by contact with acids, alkali or organic compounds - no heat needed
acids (e.g. hydrochloric, oxalic, hydrofluoric)
alkali (e.g. cement, oven/drain cleaners, heavy industrial cleaners); harder to treat because adheres to
tissue
organic compounds (e.g. phenols and petroleum products)
Electrical - caused by intense heat generated from an electric current that passes through the body and
damages tissue
hard to determine extent of damage because most of damage is below the skin - 'iceberg effect'
Cold - caused by cold exposure to skin; frostbite
Radiation - caused by sun or cancer treatment
Friction - caused by abrasion to skin
road rash (car accident) Superficia Epidermis
rope burn
Sweat
Deep partial gland Dermis
Burn Severity Depends on: thickness Hair
Depth of Burn (2nd degree) Follicle
Extent of Burn
Calculated in % of TBSA Fat
Use Rule of 9s (see next page) Full
thickness
Location of Burn
(3rd & 4th Muscle
Patient risk factors
degree)
If they experienced an inhalation Bone
injury or not
Skin Structure and Degree of Burn
, Extent of Burn
needed
Purpose: 4.5%
4.5%
To calculate the total body surface area burned (TBSA%)
for 2nd, 3rd and 4th degree burns
To determine the amount of fluid therapy needed using the 18%
18%
Parkland Formula 4.5% Front 4.5% 4.5%
Back
To determine if the patient meets criteria for burn unit 4.5%
Add the percent of each body part 1%
burned. 9% 9% 9% 9%
Use for 2nd
This number equals the TBSA%.
degree burns
or greater
Parkland Formula
Purpose: To calculate the total volume of fluids
4 mL X TBSA (%) X Body weight (kg) =
(mL) that a patient needs
total mL of fluid (lactated Ringer's) needed
24 hours after experiencing a burn.
Make sure TBSA is NOT a decimal!
Give first half of Give second half of the
For instance, if a patient has a TBSA% = 45%,
the solution in the solution over the next 16
use 45 in the equation, NOT .45
first 8 hours hours
Patient Risk Factors Inhalation Injury
Preexisting heart, lung, kidney Damage to respiratory system due to
disease (body already taxed) breathing in toxic substances
Diabetes Affects: Upper & lower airways
Peripheral Vascular Disease Signs: Burned in enclosed space
Any chronic disease that causes Burned on face
weakness Spit, mouth, nose have soot
If burn patient also has fractures, Hair singeing (head & nose)
head injuries, other trauma Brignt red skin
Age - children or elderly Hoarse voice
, Depth of Burn
st Degree rd Degree
Superficial p artial thickness Full thickness
Epidermis only All layers are damaged
Least severe Not p ainful due to damage to nerves
Heals in 7 days Skin will NOT heal - needs skin grafting
Erythema Will take months to heal
Blanching on pressure Dry, leathery hard skin (eschar)
Pain/mild swelling May be black, yellow, red, waxy white
Skin pink/red
Warm to touch
Eschar - dead tissue - dangerous if around
No blisters
Usually no scarring torso or extremity; will need to be
removed via escharotomy
th Degree
nd Degree
Deep full thickness
Deep p artial thickness All layers destroyed and In Full Thickness, watch
Epidermis and dermis extends to muscles, bone, for acute tubular necrosis
Very painful ligaments (ATN), due to the release
Blisters NO pain sensation of myoglobin and
Redness that blanches Black, charred with eschar hemoglobin that block
Swelling (mild - moderate) Months to heal kidney tubules.
Shiny red/pink and moist Will need skin grafts
If severe, may need skin grafting
Pre-Hospital and Emergency Care
At scene - Cool large burns no longer than 10 minutes
Remove from source of burn Do not immerse in cool water
Stop the burning process
Do not cover with ice
Small thermal burns (10% or less TBSA)
Do remove as much burned clothing as
Cover with cool, clean, tap water-dampened
possible
towel
Do wrap in sheet/blanket
If >10% TBSA or electrical/inhalation burn and
Chemical burns - remove all chemicals from skin;
patient unresponsive:
remove clothing containing chemical and then
Focus on CAB
flush skin with water
C - Circulation - check for pulse and
Monitor patient with inhalation injury for signs
elevate burned limb(s)
of respiratory distress
A - Airway - check for patency, soot
around nose and on tongue, singed nasal
hair, darkened oral or nasal membranes
B - Breathing - check for ventilation
If patient is responsive, do A B C
Table of Contents
Burns 2 Hematologic Disorders 63
Cancer 7 Musculoskeletal 65
Cardiac 10 Musculoskeletal System 65
Cardiac Basics 10 Fracture 68
Heart Failure 12 Osteoarthritis 71
Coronary Artery Disease 14 Rheumatoid Arthritis 72
Angina Pectoris 16 Osteoporosis 75
Myocardial Infarction 18 Gout 78
Electrolyte Imbalances 20 Neurology 80
Sodium 20 Brain Anatomy and Physiology 80
Potassium 21 Stroke 82
Calcium 22 Seizure 87
Magnesium 23 Increased Intracranial Pressure 90
Phosphorus 24 Multiple Sclerosis 93
Chloride 25 Parkinson's Disease 95
Relationships 26 Myasthenia Gravis 98
Endocrine 27 Guillain-Barre Syndrome 100
Endocrine System 27 Renal 102
Thyroid Gland and Disorders 29 Kidneys, Nephrons and RAAS 102
Hyper- and Hypoparathyroidism 32 Chronic Kidney Disease 105
Adrenal Glands and Disorders 34 Acute Kidney Injury 107
DI vs SIADH 37 Renal Calculi 109
Diabetes Mellitus 39 Urinary Tract Infections 112
Gastrointestinal 44 Glomerulonephritis 114
The Digestive System 44 Nephrotic Syndrome 115
Gastroesophageal Reflux Disease 46 Dialysis 116
Peptic Ulcer Disease 47 Diuretics 118
Inflammatory Bowel Disease 48 Respiratory Disorders 121
Diverticulosis and -itis 51 Lung Anatomy and Physiology 121
Celiac Disease 52 Pneumonia 122
Hepatitis 53 COPD 123
Cirrhosis 56 Asthma 124
Pancreatitis 58 ARDS 125
Cholecystitis 60 Pleural Effusion 126
Appendicitis 61 Shock 127
, BURNS
Damage to the skin's integrity by some kind of energy source
Types of Burns
Thermal - Most common - caused by flame, flash, scald or contact with hot objects (liquid, steam, fire); e.g.
from cooking, burning leaves, smoking
Chemical - caused by contact with acids, alkali or organic compounds - no heat needed
acids (e.g. hydrochloric, oxalic, hydrofluoric)
alkali (e.g. cement, oven/drain cleaners, heavy industrial cleaners); harder to treat because adheres to
tissue
organic compounds (e.g. phenols and petroleum products)
Electrical - caused by intense heat generated from an electric current that passes through the body and
damages tissue
hard to determine extent of damage because most of damage is below the skin - 'iceberg effect'
Cold - caused by cold exposure to skin; frostbite
Radiation - caused by sun or cancer treatment
Friction - caused by abrasion to skin
road rash (car accident) Superficia Epidermis
rope burn
Sweat
Deep partial gland Dermis
Burn Severity Depends on: thickness Hair
Depth of Burn (2nd degree) Follicle
Extent of Burn
Calculated in % of TBSA Fat
Use Rule of 9s (see next page) Full
thickness
Location of Burn
(3rd & 4th Muscle
Patient risk factors
degree)
If they experienced an inhalation Bone
injury or not
Skin Structure and Degree of Burn
, Extent of Burn
needed
Purpose: 4.5%
4.5%
To calculate the total body surface area burned (TBSA%)
for 2nd, 3rd and 4th degree burns
To determine the amount of fluid therapy needed using the 18%
18%
Parkland Formula 4.5% Front 4.5% 4.5%
Back
To determine if the patient meets criteria for burn unit 4.5%
Add the percent of each body part 1%
burned. 9% 9% 9% 9%
Use for 2nd
This number equals the TBSA%.
degree burns
or greater
Parkland Formula
Purpose: To calculate the total volume of fluids
4 mL X TBSA (%) X Body weight (kg) =
(mL) that a patient needs
total mL of fluid (lactated Ringer's) needed
24 hours after experiencing a burn.
Make sure TBSA is NOT a decimal!
Give first half of Give second half of the
For instance, if a patient has a TBSA% = 45%,
the solution in the solution over the next 16
use 45 in the equation, NOT .45
first 8 hours hours
Patient Risk Factors Inhalation Injury
Preexisting heart, lung, kidney Damage to respiratory system due to
disease (body already taxed) breathing in toxic substances
Diabetes Affects: Upper & lower airways
Peripheral Vascular Disease Signs: Burned in enclosed space
Any chronic disease that causes Burned on face
weakness Spit, mouth, nose have soot
If burn patient also has fractures, Hair singeing (head & nose)
head injuries, other trauma Brignt red skin
Age - children or elderly Hoarse voice
, Depth of Burn
st Degree rd Degree
Superficial p artial thickness Full thickness
Epidermis only All layers are damaged
Least severe Not p ainful due to damage to nerves
Heals in 7 days Skin will NOT heal - needs skin grafting
Erythema Will take months to heal
Blanching on pressure Dry, leathery hard skin (eschar)
Pain/mild swelling May be black, yellow, red, waxy white
Skin pink/red
Warm to touch
Eschar - dead tissue - dangerous if around
No blisters
Usually no scarring torso or extremity; will need to be
removed via escharotomy
th Degree
nd Degree
Deep full thickness
Deep p artial thickness All layers destroyed and In Full Thickness, watch
Epidermis and dermis extends to muscles, bone, for acute tubular necrosis
Very painful ligaments (ATN), due to the release
Blisters NO pain sensation of myoglobin and
Redness that blanches Black, charred with eschar hemoglobin that block
Swelling (mild - moderate) Months to heal kidney tubules.
Shiny red/pink and moist Will need skin grafts
If severe, may need skin grafting
Pre-Hospital and Emergency Care
At scene - Cool large burns no longer than 10 minutes
Remove from source of burn Do not immerse in cool water
Stop the burning process
Do not cover with ice
Small thermal burns (10% or less TBSA)
Do remove as much burned clothing as
Cover with cool, clean, tap water-dampened
possible
towel
Do wrap in sheet/blanket
If >10% TBSA or electrical/inhalation burn and
Chemical burns - remove all chemicals from skin;
patient unresponsive:
remove clothing containing chemical and then
Focus on CAB
flush skin with water
C - Circulation - check for pulse and
Monitor patient with inhalation injury for signs
elevate burned limb(s)
of respiratory distress
A - Airway - check for patency, soot
around nose and on tongue, singed nasal
hair, darkened oral or nasal membranes
B - Breathing - check for ventilation
If patient is responsive, do A B C
