Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Module 2 > Burns > Flashcards

Burns Flashcards

1
Q

Management of Patients with Burn Injuries

Most burns occur in _____

A

the home.
Prevention is key!

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Functions of the skin

A

Protection from infection and injury
Prevents loss of body fluids
Regulates body temp
Provides tactile sense

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

The strongest predictors for mortality

A

Increased % TBSA
Presence of inhalation injury
Increased age

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of burns

A

Thermal
Chemical
Electrical
Radiation
Inhalation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Thermal burns:

A

: exposure to heat- flame, flash, scald, or contact with hot objects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Chemical burns

A

acids, alkaline agents, or organic compounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Electrical burns:

A

severity based on voltage and length of exposure. Risk for potential cervical spine injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Radiation exposure:

A

thermal effect; damage to the cellular DNA

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Inhalation injuries:

A

inhalation of thermal and/or chemical irritants (upper vs lower airway injury)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

_____ is the most common type of burn.

Especially:

A

Thermal
85% of all burns are thermal.

scalding in children (very curious) and elderly.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Chemical – tissue continues to burn until:

-\_\_\_\_\_\_ must begin immediately \_\_\_\_\_\_\_ ***outcome improved for victim
A

chemical is completely removed. Dust off dry chemical. Remove clothing articles touching the skin.

Continuous irrigation
at the scene

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Electrical- make sure:

Severity difficult to assess, may have:

A

scene is safe and victim no longer in contact with source.

exit and entrance wound, organ damage.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Zones of burn injury

At the center is the zone of ______, zone of most damage, tissue is ______

Zone of _____, injured cells, potentially salvageable, but with ______, necrosis can occur

Zone of _____: minimal injury, full recovery

A

Zone of coagulation
not viable

Zone of stasis
persistent ischemia

Zone of hyperemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

burn can evolve and worsen over time

A
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

At the center is the zone of coagulation, zone of most damage, tissue is _____

A

not viable

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Zone of stasis, injured cells, potentially salvageable, but with persistent ________________

A

ischemia, necrosis can occur

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Severity of Burn Injury

A

Depth of burn
Extent of burn
Location of burn
Age
Risk factors

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Burn Depth Classifications

A

Superficial thickness (1st degree)

Partial thickness (2nd degree)

Full thickness (3rd & 4th degree)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Layers of skin affected :

1st- 4th

A

1st- epidermis

2nd- dermis

3rd- subcutaneous

4th- muscle

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

First Degree - Superficial

Involves only _____

Causes:

S&S:

Treatment:

A

epidermis.

Causes: radiation burn or brief exposure to heat source.

S&S: Redness, pain, moderate to severe tenderness; minimal edema, peeling, itching

Treatment: Mild analgesics, cool compresses, skin lubricants; heals within a few days

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Second Degree - Partial Thickness

Involves:

Causes:

S&S:

Treatment:

A

epidermis & dermis; may extend into hair follicles.

scalds, flash flame, contact

Moist blebs, blisters, edema, mottled white, pink to cherry-red, moderate to severe pain

Usually heal 2-3 weeks, depending on depth and area; may require grafting

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Third Degree -

Includes:

Causes:

S&S:

Treatment:

A

Full Thickness

epidermis, dermis, and sometimes subcutaneous tissue; may involve connective tissue and muscle

Causes: flame, prolonged exposure, electrical, chemical, contact

S&S: Dry, leathery, eschar, waxy white, dark brown, or charred appearance, strong burn odor
No pain at burn sites due to loss of nerve endings; severe pain in surrounding areas.

Surgical intervention required.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Fourth Degree –

Includes:

______ appearance

Causes:

Treatment:

A

Full Thickness

deep tissue, muscle, and bone

Charred

Causes: prolonged exposure or high voltage, electrical injury

Amputations likely; grafting of no benefit

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
24
Q

Inhalation injury

Caused by inhalation of _____ and/or _____ irritants

Upper vs lower airway injury:

History of injury important
Hx of injury: suspect inhalation with _________ and burns of ____, ____, and ____

Burns of the face, mouth, anterior neck

Clinical signs:

_______ for definitive diagnosis

A

thermal and/or chemical

Upper vs lower airway injury: Upper airway above the glottis, lower airway below the glottis

enclosed spaces

face, mouth, anterior neck

singed facial hair, carbonaceous sputum, hoarse voice, stridor

Bronchoscopy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
25
Q

Extent of Burn – Rule of Nines

Expressed as a percent of total body surface area (TBSA). Divide body surfaces into multiples of nine.

A

Head- 9%
Left arm- 9%
Right arm- 9%
Anterior chest 18%
Posterior chest 18%
Left leg- 18%
Right leg- 18%
Genital region- 1%

Note:
anterior and posterior of head 9%.
Anterior chest 9 + abd 9 =18%
If approximately half of arm were burned, the TBSA burned = 4.5%;
anterior thigh + anterior lower leg = 4.5 % (total 9%)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
26
Q

_______ is another method and is more accurate for children

With all methods, estimate at initial evaluation and again _________

A

Lund-Browder chart

72 hours later.

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
27
Q

Children and burns

Prevention!

Splash and spill burns from hot food off stove is common

Hallmark signs of child abuse:

A

Definite line of demarcation
Frequent or repetitive hospital visits
Symmetrical burn wounds
Cigarette burns

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
28
Q

Other vulnerable populations

A

The elderly patient
Clients with reduced mental capacity
People with reduced mobility and/or sensory impairments

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
29
Q

Electrical- make sure scene is safe and victim no longer in contact with source.

Severity difficult to assess, may have exit and entrance wound, organ damage.

Monitor:

A

ECG- arrhythmias possible

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
30
Q

_____ of burn determines treatment- surgical grafting?

A

Depth

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
31
Q

Do not put anything on a burn!!!!!

Any burn that is circumferential- all around the arm- worried about:

A

compartment syndrome- check pulses, cap. Refill.

32
Q

Burn Centers

Most minor burn injuries can be managed in community hospitals
Statewide:
Jaycee Burn Center - Chapel Hill, NC
Wake Forest Baptist Medical Center Burn Center - Winston Salem, NC

Burn Center Referral Criteria -

A

Partial thickness burns greater than 10% total body surface area (TBSA).

33
Q

On the Scene Care

A

Prevent injury to rescuer
Stop injury: extinguish flames or remove from the source
Cool the burn
Remove restrictive objects
Cover the wound
Irrigate chemical burns
Primary survey: ABCDE

34
Q

On the Scene Care

Treat patient with falls and electrical injuries as for potential ______ injury.

Don’t touch person if still in contact with the _______

Do:

A

cervical spine

electrical current

assessment surveying all body systems and obtain a history of the incident and pertinent patient history

35
Q

Airway management

Administer _______ if carbon monoxide poisoning suspected

Consider_____ & ______ (esp. burns to the face & neck)

Place in ______ position (unless spinal cord injury)

_______ if needed to relieve resp. distress

Turn, cough, deep, breath

Provide suctioning & chest physiotherapy

Bronchoscopy

_______ to treat severe bronchospasm

A

100% humidified O2

early intubation and ventilator support

high Fowlers

Escharotomy

Bronchodilators

36
Q

Why consider early intubation and ventilator support for burns to face and neck? Edema?

What is escharotomy? – Dead tissue- cutting in to dead tissue to allow for expansion

Signs and symptoms of carbon monoxide poisoning?

A

Dull headache
Weakness
Dizziness
Nausea or vomiting
Shortness of breath
Confusion
Blurred vision
Loss of consciousness

37
Q

carbon monoxide

Odorless, tasteless, colorless, gas, binds to O2 molecule..?

A
38
Q

Phases of Burn Injury

A

I. Emergent: onset of injury to completion of fluid resuscitation

II. Acute: from beginning of diuresis to near completion of wound closure

III. Rehabilitative: from wound closure to return to optimal physical and psychosocial adjustment

39
Q

Emergent Phase:

(____ days)

Onset of ______ and _____

A

0-3 days

Onset of hypovolemic shock and edema

40
Q

Emergent Phase
Fluid & Electrolyte Shifts

Increased ____________
loss of intravascular proteins & fluids into the _______
_____ and _____

Increased insensible water loss by ______

Hemolysis of RBCs (elevated Hct from ______)

Major electrolyte shifts:

A

CAPILLARY PERMEABILITY

interstitial compartment

edema and decreased blood volume

evaporation

HEMOCONCENTRATION

HYPERkalemia, HYPOnatremia

41
Q

What does Increased capillary permeability mean?

Fluid loss from burn skin 5-10 times greater from undamaged skin

Peak fluid leak at ___, but continues up to ___

A

Water, electrolytes, proteins leak out of vasculature=EDEMA

6-8 hr
36 hr

42
Q

Massive fluid shift

***Electrolyte shift– sodium and potassium switch leading to hyperkalemia and hyponatremia

Low sodium- <135
Hyperkalemia- >5

A
43
Q

Burn Shock

Fluid shifts + fluid losses =

What do you think vital signs will look like in burn shock?

A

Intravascular volume depletion

Low bp, high hr

44
Q

Emergent Phase Pathophysiology continued

Inflammation & healing
______ occurs-repair begins within ______

Immunologic changes
____ immune response

Burns < ___ TBSA produce primarily a local response; burns > ___ = local and systemic response (includes release of cytokines and other mediators)

Burns cause the proteins inside the cells to denature and coagulate, resulting in a form of cell death known as ________

A

Coagulation necrosis - 6-12 hrs after injury

Reduced

25%

coagulative necrosis.

45
Q

CV:
Pulmonary:
Kidney:
Thermoregulatory:
GI:

A

CV: decreased cardiac output, decreased BP, increased HR, edema

Pulmonary: inhalation injury, upper and lower airway injury

Kidney: function may be affected with hypovolemia

Thermoregulatory: inability to regulate body temp (low at first, then elevated)

GI: organ ischemia and dysfunction

46
Q

Management of Emergent Phase

A

Fluid resuscitation (next slide)
Pain management
Foley catheter
NPO or NGT to low intermittent suction
Continuously monitored
ECG with electrical burns
Emotional support

NGT with burns > 25% TBSA

47
Q

Therapeutic Management:Fluid resuscitation

___ of injury

_____ or ____ preferred for major burns

___ during first 24 hours

Fluid calculation based on BSA ex. ABA

Indicator of adequate fluid resuscitation:

Baseline ____

A

Time

Large bore IV or central line

LR

urine output: 0.5-1 mL/kg/hr*
*more for electrical burns
Rely on urine output instead of BP (bc BP is not an accurate estimate)
Want at least 30 ml/hr

weight

48
Q

Fluid resuscitation formula

Don’t have to memorize. Just know a massive amount of fluids are given

~1400 ml in 24 hrs

A
49
Q

Acute phase
(_______)

Begins with:

Concludes when:

A

Acute phase- 48-72 hrs to weeks to months

Begins with mobilization of extracellular fluid and diuresis

Concludes when partial thickness wounds are healed, or full thickness burns are covered by skin grafts

lymphatics reabsorb fluid=diuresis

50
Q

Acute Phase
Fluid and Electrolyte Shifts

Fluid reenters the vascular space from the interstitial space (______)

Increased _____

Sodium is lost with diuresis and due to dilution as fluid enter vascular space: hyponatremia, varies

Potassium shifts from extracellular fluid into cells: potential _____

Metabolic ____

A

HEMODILUTION

urinary output

HYPOkalemia

acidosis

50
Q

Acute Phase
Fluid and Electrolyte Shifts

Fluid reenters the vascular space from the interstitial space (______)

Increased _____

Sodium is lost with diuresis and due to dilution as fluid enter vascular space: hyponatremia, varies

Potassium shifts from extracellular fluid into cells: potential _____

Metabolic ____

A

HEMODILUTION

urinary output

HYPOkalemia

acidosis

51
Q

What happens if you were overaggressive with fluid resuscitation during emergent phase?

A

SOB, crackles, …listen to lungs

52
Q

Acute Phase Healing

Partial thickness wounds: healing begins, after:

Full thickness wounds: require _______________ to heal

Early excision (surgical removal) reduces effects of _______

A

eschar is removed, re-epithelization begins, heals within 10-21 days

surgical debridement and skin grafting

inflammatory mediators

53
Q

Rehabilitation Phase

Begins once:

May happen within 2 weeks or even months later.

Depends on ____ of burns

Rehab goals:

Common Complications:

A

the client’s wounds have healed and client is prepared to engage in self care

extent

Resume functional role in society
Rehabilitate from reconstructive surgery (cosmetic or functional)

contractures and scarring

54
Q

Therapeutic Management:Pain management:

Poor _______, IV in small repeated doses

May give _____ prior to dressing changes

A

Opioids
NSAIDs
Anxiolytics
Sedatives
Anesthetic agents
Antidepressants

tissue perfusion
PO meds

55
Q

What’s the difference between background pain, procedural pain, and breakthrough pain?

A
56
Q

Therapeutic Management:Wound care

A

Wound cleaning
Topical antibacterial therapy
Wound dressing
Wound debridement (4 types)

56
Q

Therapeutic Management:Wound care

A

Wound cleaning
Topical antibacterial therapy
Wound dressing
Wound debridement (4 types)

57
Q

Wound debridement (4 types)

A

Natural- from dressing removal
Mechanical- done in bath (keep room warm)
Chemical- topical
Surgical- go to OR

58
Q

Therapeutic Management:Wound grafting

Types (autograft, homograft, xenograft)
Care of donor site
Care of graft site

A
59
Q

Therapeutic Management:Prevention of infection

____ is the #1 issue.

A

Infection controlled environment

Monitor temperature (hyperthermia common after BI)

Tetanus vaccination

Antibiotic or antifungal per wound culture results

Controlling hypergylcemia. A lot of patients will develop insulin resistance

Sepsis

60
Q

Therapeutic Management:Restoration of function

A

Proper positioning
Specialty beds
Passive and active ROM
Splints of functional devices
Compression garments
OT and PT
Functional and cosmetic reconstruction

61
Q

Compression garments: wear __________, to minimize __________

A

most of the day, up to a year

contractures and scarring

62
Q

Complications

Resp.:

Cardio:

GI:

Kidney :

A

Sepsis

Respiratory: acute resp failure, ARDS

Cardiovascular: heart failure, pulmonary edema

GI: paralytic ileus, Curling’s ulcer, translocation of bacteria, abdominal compartment syndrome

Kidney: myoglobinuria-> ATN (ATN- acute tubular necrosis
)

63
Q

Nutrition

________ state – feed as soon as able to eat

When oral route used:

Intubated patients –

Three-fold increase in basal metabolic rate

A

Hypermetabolic

high-protein, high calorie meals and supplements

enteral feedings

64
Q

Emotional/psychological needs

Remember, a burn injury can be a crisis for a family.

Elicit patient wishes as early as possible.

A
65
Q

Start enteral nutrition therapy early:

A

blunts the metabolic response, maintain gut viability, decrease bacterial translocation

66
Q

Burn patients with >20% TBSA injury suffer long and severe response to injury:

A

hyperdynamic and hypermetabolic response (catabolic state, muscle wasting)

67
Q

Inflammatory response can remain elevated for ____ after injury

A

months

68
Q

Electrical injuries require:

A

baseline ECG and heart monitoring,

larger fluid volume resuscitation (4ml/kg/TBSA) and want greater urine output,

potential for cervical spine injury

69
Q

Skin reproducing cells are located along shafts of hair follicles and sweat glands. Burn depth determines if spontaneous re-epithelization will occur

A
70
Q

Smoke inhalation is major predictor of mortality: inhalation injury disrupts the supply of oxygen to the body by immense swelling of the upper respiratory tract, chemical irritation of the lower respiratory tract, and injuries resulting from noxious gases, such as carbon monoxide and cyanide

A
71
Q

_________ is best indicator of adequate fluid resuscitation

A

Urine output

72
Q

Early _____ reduces effects of inflammatory mediators

A

excision

73
Q

Need ________ pain assessment and management

A

around the clock

74
Q

Goal of ______ with insulin resistance

A

normoglycemic

Module 2 (6 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions