Burns Flashcards
Where do most burns occur?
home
Why does plasma seep out into the tissue?
increased capillary permeability
When does majority of the plasma seep out into the tissue?
first 24 hours
What do you worry about with plasma seeping into the tissues?
shock
Why does the pulse increase with burns?
Burns can cause FVD, which causes the pulse to increase
Why does the cardiac output decrease with burns?
There is less volume to pump out
Why does the urine output decrease with burns?
kidneys are trying to hold on to the fluid that is left or the kidneys are not being perfused well
Why is epinephrine secreted with burns?
This causes vasoconstriction and shunts blood to the vital organs.
anytime the systolic BP drops below what number means the organs are not being adequately perfused?
90
Why are ADH and aldosterone secreted with burns?
ADH retains water and aldosterone retains sodium and water. This is to try and increase the blood volume.
What percentage is the head and neck in the rule of 9’s?
9%
what percentage is the trunk in the rule of 9’s?
Front: 18%
Back: 18%
What percentage is the genital area in the rule of 9’s?
1%
What percentage are the arms in the rule of 9’s?
9% each
What percentage are the legs in the rule of 9’s?
18% each
What is another name for partial thickness burns?
first and second degree burns
What is another name for full thickness burns?
third and fourth degree burns
What are ways to stop the burning process?
wrap the client in a blanket cool water (no longer than 10 minutes)
Why should you remove a clients jewelry?
swelling will occur
metal gets hot
what is the number one cause of death with burns?
inhalation injury
What are burn injuries caused by?
inhaling carbon monoxide or hydrogen cyanide
What is treatment for carbon monoxide poisoning and hydrogen cyanide?
100% oxygen
Why is it important to determine if the burn occurred in an open or closed space?
a closed space could lead to more carbon monoxide and/or hydrogen cyanide being inhaled and could cause more complications
What should you focus on when a client has burns to the neck/face/chest?
airway
What might a primary care provider do prophylactically for a client with facial area burns?
endotracheal tube
indications of inhalation injury
singed nose hair/facial hair soot on face coughing up secretions with dark specks difficult swallowing wheezing blisters on the oral/pharyngeal mucosa hoarseness substernal/intercostal retractions stridor
what is one of the most important aspects of burn management?
fluid replacement
how many large bore IV’s will the client need for fluid replacement?
2
What will be used for fluid replacement?
crystalloids (LR) and colloids (albumin)
Why is it important to know what time the burn occured?
fluid replacement therapy is based on the time that the injury occurred.
how much of the total fluid needed for the first 24 hours do you give within the first 8 hours?
1/2 of total volume
what do you need to know to properly calculate fluid replacement?
clients weight in kilograms
What is the formula for fluid replacement for the first 24 hours?
(2-4 mL of LR) X (body weight in kg) X (% of total body surface area burned)
what is the goal urinary output for an electrical burn client?
75-100 mL/ hr
what is the required urinary output for a child?
1 mL/kg/hr
why is albumin a medication for burns?
Holds fluid in the vascular space
Why is albumin administered after the first 24 hours?
capillary permeability is normal again
What is a potential complication of albumin?
FVE
what could be measured hourly to monitor for FVE with albumin?
CVP
what is the drug of choice for pain management with burns?
opioids
what are common topical drugs used with burns?
mafenide acetate (Sulfamylon) silver nitrate antimicrobial ointments
why should antibiotic drugs be alternated?
bacteria will build resistance or tolerance
why are broad spectrum antibiotics avoided with burns?
could lead to super infections or secondary infections or even sepsis
what should be collected before antibiotics are started?
cultures
how do you apply topical agents to a burn?
apply a thin layer with sterile gloves
What are two types of debridement?
enzyme debridement
hydrotherapy
What is important to remember before sending a client to hydrotherapy?
pain management
what is an autograft?
using the client own skin for a skin graft
after how long can a surgeon re-harvest from the same donor site if the client is well nourished?
12-14 days
what would it mean if the graft becomes blue or cool?
poor circulation
will the client need more or less calories?
more
what two things are needed in the diet to promote healing?
protein
vitamin C
what lab work checks to ensure proper nutrition and positive nitrogen balance?
Pre-albumin
what are complications of burns?
circulation renal failure electrolyte imbalance stress ulcers paralytic ileus contractures infections
how many wounds are there with electrical burns?
2 (entrance and exit)
what is the first thing you do for an electrical injury?
heart monitoring for 24 hours
what kind of arrhythmia is an electrical burn client at risk for?
v fib
why are amputations common with electrical burn clients?
circulatory system is destroyed
