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NURS 412 Midterm #2 > Burn Management: Acute Phase > Flashcards

Burn Management: Acute Phase Flashcards

1
Q

Acute Phase timeline - when does it begin and when does it end?

A
  • The acute phase begins with the mobilization of extracellular fluid and subsequent diuresis
  • The acute phase is concluded when the burned area is completely covered by skin grafts, or when the wounds are healed
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2
Q

Pathophysiology of the acute phase (5

A
  • Diuresis from fluid mobilization occurs, and the client is less edematous
  • Bowel sounds return
  • Healing begins when WBCs surround the burn wound and phagocytosis occurs
  • Necrotic tissue begins to slough
  • Granulation tissue forms
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3
Q

How do partial and full-thickness burn wounds heal?

A
  • a partial-thickness burn wound heals from the edges
  • full-thickness burns must be covered by skin grafts
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4
Q

What is the biggest risk at this phase?

A

Sepsis - debride early because necrotic tissue is the breeding ground for bacteria

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5
Q

Partial-thickness wounds form:

A

eschar
- once eschar is removed, re-epithelialization begins
- epithelial buds from the dermal bed eventually close in the wound, which heals spontaneously without surgical intervention usually within 10-21 days
- clean wound with sterile water, later with intrasite gel and then silver dressing

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6
Q

Full-thickness wounds require

A

debridement because margins of full-thickness eschar take longer to separate

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7
Q

Acute Phase: Lab Values - Hyponatremia

A

Hyponatremia can develop from excessive GI suction and diarrhea
Water intoxication - dilution hyponatremia. encourage intake of fluids other than water

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8
Q

Acute Phase: Lab Values - Hypernatremia

A

May develop following successful fluid replacement, improper tube feedings, or inappropriate fluid administration

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9
Q

Acute Phase: Lab Values - Hyperkalemia

A

Noted if client has renal failure, adrenocortical insufficiency or massive deep muscle injury
Can cause cardiac dysrhythmias and ventricular failure, muscle weakness, ECG changes

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10
Q

Acute Phase: Lab Values - Hypokalemia

A

Can be caused by lengthy IV therapy without potassium
Vomiting, diarrhea
Prolonged gastrointestinal suction

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11
Q

Complications: Infection

A
  • Localized inflammation, induration, and suppuration
  • Partial-thickness burns can become full-thickness wounds in the presence of infection
  • Wound infection may progress to transient bacteremia
  • Client may develop sepsis - condition becomes critical
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12
Q

Complications: Musculo-skeletal system

A
  • Decreased ROM
  • Contractures (as wound heals)
    Because of pain, client will prefer to assume a flexed position for comfort, encourage the client to stretch and move the burned body parts as much as possible
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13
Q

Complications: Gastrointestinal system

A
  • Paralytic ileus results from sepsis
  • Diarrhea from antibiotics or enteral feedings
  • Constipation - decreased mobility, opioid analgesics
  • Curling’s ulcer - stress ulcer d/t decreased blood flow to GI during emergent phase. give PPI and feed pt as soon as possible.
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14
Q

Complications: Endocrine System

A
  • increased blood glucose production - stress response
  • increased insulin production - not good at reducing blood glucose
  • Hyperglycemia - all patients that come in end up on insulin SS to have glucose managed. hyperglycemia is caused by increased caloric intake necessary to meet metabolic requirements
  • this stress-induced condition is reversed as metabolic demands are met
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15
Q

Predominant therapeutic interventions in the acute phase are: (6)

A
  • wound care
  • excision and grafting
  • pain management
  • physical and occupational therapy
  • nutritional therapy
  • psychosocial care
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16
Q

Wound Care

A
  • Daily observations
  • assessment
  • cleansing
  • debridement
  • dressing reapplication
17
Q

Goals of wound care (2)

A
  1. Prevent infection by cleansing and debriding the area of necrotic tissue that would promote bacterial growth
  2. Promote wound re-epithelialization and/or successful skin grafting
18
Q

Wound Care: Enzymatic debridement

A

Speeds up removal of dead tissue from healthy wound bed
Wounds are cleansed with soap and water or NS to remove the old antimicrobial agent and loose necrotic tissue, scabs or dried blood.
During the debridement phase, the wound is covered with topical antimicrobial.
When partial-thickness burn wounds have been fully debrided a protective coarse or fine-meshed grease-based gauze dressing to protect the re-epithelializing cells as they resurface

19
Q

Wound Care: Appropriate coverage of graft

A

Gauze next to the graft followed by middle and outer dressings
Unmeshed sheet grafts used for facial grafts
- grafts are left open
- complication: Blebs - serosanguineous exudate that prevent graft from attaching.

20
Q

Nursing and Collaborative Management: Excision and grafting

A
  • eschar is removed down to the subcutaneous tissue or fascia
  • graft is placed on clean, viable tissue
  • wound is covered with autograft
  • donor skin is taken within a dermatome
  • choice of dressings varies
  • happens day 1 or 2
21
Q

Excision and grafting: cultured epithelial autographs (CEAs)

A
  • Grown from biopsies obtained from the client’s own skin
  • Used in clients with a large body surface burn area or those with limited skin for harvesting
22
Q

Excision and grafting: Artificial skin

A

Life-threatening full-thickness or deep partial-thickness wounds where conventional autograft is not available or advisable

23
Q

Acute Phase: Pain Management
two kinds of pain and pharmacological management

A
  • Continuous background pain (IV infusion opioid, slow-release opioid, OTC oral analgesics and breakthrough doses
  • anxiolytics which frequently potentiate analgesics are also indicated (lorazepam)
  • Treatment-induced pain - potent short-acting analgesics. premedication with analgesic and anxiolytic via IV or oral.
24
Q

Pain management: Nonpharmacological strategies

A
  • Relaxation strategies
  • Visualization, guided imagery
  • Hypnosis
  • Biofeedback
  • Music therapy
25
Q

Physical and occupational therapy

A
  • good time for exercise is during wound cleaning (skin is softer and dressings removed)
  • imperative to maintain muscle strength and optimal joint function
  • passive and active ROM
  • splints should be custom-fitted
26
Q

Acute Phase: Nutritional Therapy

A
  • Meeting daily caloric requirements is crucial
  • Caloric needs should be calculated by dietician
  • High-protein, high-carbohydrate foods
  • Favourite foods from home
  • Clients should be weighed weekly
    in hypermetabolic and highly catabolic state.

NURS 412 Midterm #2 (18 decks)

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