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High Acuity Ex.1 Study Material > Acute Burn Injury > Flashcards

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%
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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
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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
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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. 1/2 of the total fluid given for resuscitation is given in the 1st 8 hours
  2. 1/4 in the 2nd 8 hours
  3. 1/4 in the 3rd 8 hours
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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
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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
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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%
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7
Q

How would you manage patients with tar, asphalt, or melted plastic?

A
  • Cool with water
  • Leave material in place
  • Assure airway
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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
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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
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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
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10
Q

How would you manage flame burns?

A

Smother flames with water or blanket

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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
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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

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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
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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
Q

What are some characteristics of the inflammatory phase of wound healing?

A
  • 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
Q

What are some characteristics of Full-thickness burns (3rd-degree)?

A
  • 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
Q

What is an autograft?

A

Grafy from the patients own thigh, back, or abdomen

28
Q

What are some complications of burn shock?

A
  • 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
Q

What is a heterograph (xenograft)?

A

from a different species—pigskin

30
Q

What is a homograft (allograft)?

A

from live or deceased donor—cadaver skin

31
Q

What are the 6 P’s to assess peripheral circulation?

A

pulselessness, pallor, pain, paresthesia (numbness), paralysis, poikilothermy

32
Q

Describe the Lund & Browder Method for calculating burn injuries

A
  • Most accurate and accepted method for determining the percentage of burn
  • Surface area measurements of body parts are based on patient age
33
Q

What is a contracture?

A

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
Q

What should you assess in a patient with an emergent burn?

A
  • 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

High Acuity Ex.1 Study Material (7 decks)

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