Acute Burn Injury Flashcards
1
Q
How is the rule of nines calculated?
A
- head = 9%
- anterior trunk, posterior trunk = each 18%
- arms = 18% (each arm 9%)
- legs = 36% (each leg 18%)
- perineum = 1%
2
Q
Describe some characteristics of Superficial partial-thickness burns (2nd-degree)?
A
- Involves epidermis + upper 3rd of the dermis
- Characterized by light to bright red skin or mottling; may appear wet and weeping w/ bullae (blisters)
- PAINFUL
- Heals in 10-14 days
- Ex: brief contact w/ flames, hot liquid, exposure to dilute chemicals
2
Q
What is burn shock?
A
- It is a complication caused by the loss of fluid from the vascular compartment into the area of injury, resulting in hypovolemia
- Greater than 40% of their body is burned, fluid shifts from intravascular to interstitial
3
Q
What is the parkland formula for fluid resuscitation?
A
4ml of LR per TBSA burned X kg of body weight = total fluid given for resucitation
- 1/2 of the total fluid given for resuscitation is given in the 1st 8 hours
- 1/4 in the 2nd 8 hours
- 1/4 in the 3rd 8 hours
3
Q
What are some signs and symptoms of carbon monoxide poisoning?
A
- CO blocks O2 binding sites on hemoglobin molecule
- S/S: headache, dizziness, ↑HR, ↑RR, N/V dyspnea, confusion
- Administer 100% O2
- We need to get a serum carboxyhemoblogin level,
- If level is 20% = patient will complain of headache, if beween 60%-80% = seizures, coma, death
4
Q
What are some characteristics of the Maturation phase (REMODELING) of wound healing?
A
- scar now thin & white instead of red & raised w/ granulation tissue
- Iccurs for 1 year or more after the wound is closed
- scar tissue is never as strong as normal tissue and varies in visibility
5
Q
When will you begin fluid resuscitation in a patient?
A
- Greater than 20% burn will begin fluid recitation for adults
- For children greater than 10%
7
Q
How would you manage patients with tar, asphalt, or melted plastic?
A
- Cool with water
- Leave material in place
- Assure airway
7
Q
What are some nursing interventions to prevent contractures?
A
- position affected body parts in antideformity positions; change position frequently
- Apply splints
- encourage AROM 24-48 hours after injury
- assist w/ PROM
8
Q
What are some interventions for patients who have emergent burns?
A
- remove jewelry
- administer supplemental O2 (100 %); prepare for intubation
- turn/cough/deep breathe/suction!!!
- insert indwelling urinary catheter
-
administer fluids (LR)—Parkland Formula
- USE CRYSTALLOID FLUIDS FOR IMMEDIATE BURNS
- monitor HR, BP, LOC, peripheral pulses
- meticulously monitor I & O (goal: UO > 0.5 ml/kg/hr )
- monitor pulmonary artery catheter readings
- You want Mean arterial BP >70, you want to check urine output, check HR
- place NG tube
- administer IV pain medications (morphine, fentanyl)
- obtain blood specimens for lab tests, X-rays, ECG
- cover wounds w/ saline dressings
- keep patient warm
9
Q
What are the clinical manifestations of lower airway injuries and what would you do with this patient?
A
- S/S: none or s/s of upper airway injury, ↑pH, ↓pCO2, ↑RR (respiratory alkalosis)
- Prep for intubation! Turn patient often and assist w/ coughing and deep breathing
10
Q
How would you manage flame burns?
A
Smother flames with water or blanket
12
Q
What would you assess in a patient who has had an inhalation injury?
A
- Singed facial hair, burns to nose/mouth
- Altered LOC
- Carbonaceous sputum
- Signs of airway obstruction: resp rate and HR, use of accessory muscles, stridor, wheezing, hoarseness, crackles
- Upper airway edema peaks at 24-48 hours after injury
- ET tube stays in patient for max of 7 days, then they will get a trach
12
Q
What are some important vitamins and minerals needed for wound healing?
A
Key vitamins and minerals for wound healing: iron, zinc, calcium, phosphate, potassium, vitamin C
13
Q
What are some characteristics of Deep partial-thickness burns (2nd-degree)?
A
- Involves entire epidermis + deep layer of the dermis
- Characterized by redness w/ patchy white areas that blanch w/ pressure; edema; no blisters
- Healing can take up to 6 weeks
- Ex: contact w/ hot liquids or solids or intense radiant energy
15
Q
What are some methods to ensure proper infection control in burn patients?
A
- change gloves often, wash hands!!!
- watch for signs of infection (pain, swelling, redness, pus)
- clean wound (1-2X/d) w/ sterile NS, Hibiclens
- apply topical antimicrobial therapy
- Silver sulfadiazine (Silvadene)
- Bacitracin ointment
- Topical antimicrobials are best because sometimes it can’t reach the wound because of damage
- Debride wound
16
Q
How would you manage scald burns?
A
Cool area with water
17
Q
What is healing by secondry intention?
A
- wound is left open to heal; edges cannot be approximated (like pressure ulcers, abrasions)
- healing occurs inside out—healing is primarily by contraction and generation of scar tissue
18
Q
What are some characteristics of the proliferative phase of wound healing?
A
- IT IS THE REGENERATION PHASE
- Begins on day 3 and lasts about 2-3 wks; complete healing continues for 1-2 yrs
- Collagen deposition – fibroblasts synthesize & secrete collagen, elastin, & proteoglycans which reconstruct connective tissue
- Angiogenesis—formation of new blood vessels w/in hours of injury
- Granulation tissue development—scar formation
- Wound contraction—edges of wound are drawn together
19
Q
What is the major goal of wound care?
A
wound closure
20
Q
What are some characteristics of Superficial Burns (1st-degree)?
A
- Involves only the epidermis
- Characterized by erythema (heat and redness) and pain, no blisters
- Ex: sunburn, minor steam burns
21
Q
How is pain managed in burn patients?
A
- pain is individualized and subjective
- give medication around-the-clock
- to minimize procedural pain, give IV morphine or fentanyl 30 minutes before wound debridement or dressing changes
- psychological contributors to pain experience: feeling of LOSS (control, appearance, love, function, job), anxiety
- nonpharmacologic techniques: imagery, distraction, massage
22
Q
What is a fasiotomy?
A
It is a cut in the skin to allow for expansion
23
Q
What are some characteristics of an Upper Airway Injury?
A
- Obstruction at the pharynx/larynx
-
S/S: facial burns, ↑RR, hoarseness, stridor (crowing sound on inspiration), carbonaceous sputum
- RR = 20+, carbonaceous sputum = grey, black sputum, they are on 100% O2 10L/min, nonrebreather mask
- Prep for intubation! Raise HOB 30o, turn patient often and assist w/ coughing and deep breathing
24
What are some characteristics of the inflammatory phase of wound healing?
* begins w/in minutes of injury & last ~ 3 days; longer w/ infection or necrosis
* clotting process begins (hemostasis)
* blood vessels constrict & platelets aggregate to form a clot
* fibrous meshwork begins to form
* 10-30 minutes after injury, mast cells cause capillaries to dilate, hence see classic signs of inflammation: warmth, redness, edema, pain
* WBCs soon become active to clean up the wound & start further healing
* ingestion of injurious agents by phagocytes (neutrophils and monocytes)
* fibroblasts (cells that make collagen) begin to form
* epithelialization (growth of skin) begins
* inflammation occurs after every injury & is vital for tissue repair and restoration
26
What are some characteristics of Full-thickness burns (3rd-degree)?
* Involves destruction of all layers of the skin (including subcutaneous tissue)
* **Appears pale white or charred, red or brown, and _leathery_**
* **Usually painless** and insensitive to palpation; _susceptible to infections_
* If
26
What is an autograft?
Grafy from the patients own thigh, back, or abdomen
28
What are some complications of burn shock?
* **hyperkalemia (from the released of damaged cells) -** release of K+; metabolic acidosis; myoglobinuria
* **hypokalemia (losing potassium through the wounds) -** loss of K+; hemodilution
* **hyponatremia (loss of sodium) -**; vomiting/diarrhea; NG drainage
* **infection -** wounds, catheter, IVs, etc.
* **hypothermia -** loss through open wounds
* **Renal -** happens esp. in electrical burns; treat myoglobinuria with fluids and diuresis
* Myoglobinuria (a lot of muscle pigment is released into the blood), this in turn can clog the renal tubules and other vessels in the body. It also damages the tubules. **Want urine output to be 1.2ml/kg/hr**
* **Neruo -** possible head injury, **hypovolemia**, **inadequate ventilation,** electrolyte imbalances; assess neuro status
* **Hypovolemia -** Occurs from 3rd spacing, fluid moves in between the cells and the lymph system doesn’t remove the extra fluid, vasoconstriction;
* Want cap refill
* **assess peripheral circulation using 6 Ps:** pulselessness, pallor, pain, paresthesia (numbness), paralysis, poikilothermy
* **Gastrointestinal -**
* Paralytic ileus r/t ↓K+ or hypovolemia; assess Bowl Sounds; NGT to low suction-prevents abd distention, emesis, aspiration
* Curling’s ulcer r/t ↓tissue perfusion or ↑gastric acid; give antacids/H2 blockers
29
What is a heterograph (xenograft)?
from a different species—pigskin
30
What is a homograft (allograft)?
from live or deceased donor—cadaver skin
31
What are the 6 P's to assess peripheral circulation?
pulselessness, pallor, pain, paresthesia (numbness), paralysis, poikilothermy
32
Describe the Lund & Browder Method for calculating burn injuries
* Most accurate and accepted method for determining the percentage of burn
* Surface area measurements of body parts are based on patient age
33
What is a contracture?
abnormal flexion and fixation of a joint caused by loss of the normal elasticity of the skin (i.e., formation of scar tissue over a joint)
34
What should you assess in a patient with an emergent burn?
* mechanism of injury
* location and size of burn
* hx: cardiac, pulmonary, renal, DM
* patient age, allergies, last tetanus (Tdap) immunization **(Tdap will be given if the patient doesn’t know when their last one was)**
* Type and amount of fluid administered
