NCLEX Review: Integumentary Module
Welcome to the Integumentary NCLEX Review from BrainyNurses.com!
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This week, we will be covering the Integumentary NCLEX Review Module from our Online NCLEX Review. The topics covered in this review are Management of Animal Bites, Wounds, Burns, and a sample NCLEX Question on Homografts.
Integumentary NCLEX Review Preview Video
Straight from the FULL online course!
Management of Animal Bites
Bites such as dog, cat, rodent, human, insect/bee, spider, tick and snake. May or may not have a break in skin integrity. Pain and tenderness present with all fresh bites.
Local reactions with many
- Local inflammation
Systemic reactions with spider and snake
- Nausea and vomiting
- Respiratory difficulty
- Determine type of injury to direct treatment
- Thoroughly clean and irrigate. Sterile dressing if applicable but may leave the wound open
- Topical antibiotic ointment and monitor for signs of infection and healing
- IV antibiotics with human bites, and severe, high-risk animal bites
- Tetanus prophylaxis
- Rabies prophylaxis if bite from bats, raccoons and most wild animals. In some cases, animal control will be involved. They will
- impound the animal to evaluate for 10 days for rabies.
- Snake and spider bites, such as the black widow, may require symptomatic care.
- Ice to the site to decrease absorption
- Anti venom therapy which may need to be obtained from the health department
- Observe for signs of neurotoxicity and administer muscle relaxants as prescribed
Draining wounds may need a drainage system such as a wound VAC.
- Factors affecting wound healing
- Renal insufficiency or failure
- Presence of infection
- Stress which alters the immune response
- Medications such as such as anti-inflammatory drugs, cancer-fighting agents and anticoagulants can alter the normal healing process
- Inadequate nutrition
- Vascular insufficiency
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Care of Burns
Determining surface area
- Rule of Nines
- Lund Browder in children. More accurate but more complex.
- Rule of hands
IV fluids are calculated with the Parkland (Baxter) formula
One half of the total amount of fluid should be administered in the first 8 hours. Calculate from the time of the burn.
Weight x 4 mL/kg x % of burned area. Include calculation of burn percentage when caring for burn patients.
Not uncommon to give over 500-1000 ml per hour during various phases of burn care.
Central line is recommended in larger burns for volume resuscitation, pain control and nutrition with TPN if needed.
Fluid and electrolyte balance a major concern with burns and any thermal injury. Intake and output, daily weights, and IV fluid replacement. Goal is 1 mL/kg/hr. Monitor for fluid overload in the acute or intermediate phase. Avoid “free water” as a fluid replacement. Need electrolytes and protein in drinks.
Skin grafts are sometimes needed for burn victims, especially for larger burns.
For more information and management of burns, you need to get our full textbook. It is provided with our online review or available on Amazon and iTunes.
Sample NCLEX Question
As we talked about during the previous section, skin grafts are sometimes needed for burn patients.
- Temporary grafts
- May be pig skin or from another species
- Used to relieve pain and promote rapid epithelialization
- Skin graft from a skin bank (homo sapien)
- Skin (automatically) from the patient
- Donor site and grafted site
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