Burns Flashcards
List four different types of burns.
Thermal
Electrical
Chemical
Radiation
Type of burn associated with steam, scald, contact with heat, fire
thermal burn
Type of burn associated with lightning, electricity (high or low voltage)
electrical burn
Type of burn associated with acids and alkalines, tar, or asphalt
chemical burns
Type of burn associated with exposure to industrial equipment
radiation burn
What depth of injury if a sunburn, minor steam burn?
Superficial (epidermal burn)
What are the various depths of a partial thickness burn?
Superficial: sunburn, minor steam burn
Moderate: wet and weepy, very painful
Deep: no blisters, minimal fluid leakage
What are the characteristics of a full thickness burn?
Destruction of all layers of skin down to and including subcutaneous tissue
Pale white or charred in color and leathery
Painless and insensitive to palpation
What is the zone of coagulation?
- the site of greatest heat transfer
- irreversible skin death occurs
What is the zone of stasis?
- characterized by pronounced inflammatory reaction
- potentially salvageable area but it can be converted by infectionor inadequate resuscitation to full-thickness injury
What is the zone of hyperemia?
- outermost area; minimal cell involvement
- where early spontaneous recovery occurs
What percentage of burn produces a primarily local response?
Burns that do not exceed 20% TBSA produce a primarily local response
What percentage of burns results in both local and systemic responses and is considered a major burn?
Those that exceed 20%
What is involved in a systemic response to burns?
- Systemic responses include release of cytokines and other mediators into the systemic circulation
- Fluid shifts and shock result in tissue hypoperfusion and organ hypofunction
What are some of the effects of major burns?
- Fluid and electrolyte shifts
- Cardiovascular effects
- Pulmonary injury
- Upper airway
- Renal and GI alterations
- Immunologic alterations
- Effect on thermoregulation
What effects can major burns have on the respiratory system?
- Upper airway
- Inhalation below the glottis
- Carbon monoxide poisoning
- Restrictive defects
What are the phases of burn management?
Emergent or Immediate Resuscitative
* From onset of injury to completion of fluid resuscitation
Acute
* From beginning of diuresis to near completion of wound closure
Rehabilitation
* From major wound closure to return to individual’s optimal level of physical and psychosocial adjustment
When does the emergent or immediate resuscitative occur?
From onset of injury to completion of fluid resuscitation
When does the acute phase of burn management occur?
From beginning of diuresis to near completion of wound closure
When does the rehabilitation phase of burn management occur?
From major wound closure to return to individual’s optimal level of physical and psychosocial adjustment
What is involved with airway management in burn management?
Intubation for inhalation injuries
What is the Parkland formula for circulatory management?
4 mL RL X kg X BSA burn = 24hrfluidresuscitation
half is given in first 8hrs
half is given in last 16hrs(all within 24hrs)
What is the objective for renal management in burn management?
keep u/o > 0.5 mL/kg/hr
What is important to watch for in GI management during burn management?
- paralytic ileus (common)
- Curling’s ulcer (acute gastric erosion resulting as a complication from severe burns when reduced plasma volume leads to ischemia and cell necrosis of the gastric mucosa)
What is involved in wound care for burns?
Washing of wounds
Debridement- natural, mechanical, chemical, surgical
Blister management- leave intact unless impairing ROM
Dressings: Silver-Flamazine,Acticoat,AquacelAG
Skin grafting – see options in Table 59-7
What is involved in pain management during burn management?
Burn pain is thought to have both nociceptive and neuropathic pain
for** partial thickness** burns
morphine orfentanylinfusion with boluses for dressing changes
Consider anxiety and sleep deprivation roles on pain
Consider nonpharmacologic measures
What are signs of compartment syndrome?
- Circumferential burns
- Tight compartment
- Pain with passive ROM
- Paralysis
- Decreased sensation (vibration)
- Paresthesia
- Decreased pulses
What is the treatment for compartment syndrome?
escharotomies
What are short-term complications of burns?
- Shock- hypovolemic, neurogenic
- Renal failure(acute tubular necrosis and AKI)
- Respiratory distress, failure
- Hypothermia
- Pneumonia
- Inflammation - SIRS
- Infection - sepsis
- Tissue damage
- Multiple organ failure
What are long-term complications of burns?
- Scarring
- Contractures
- Weakness
- Thermoregulation
- Itching
- Pain
- Body image disturbances
- Psychological concerns
What are some tools to estimate the extent of body surface area injured?
- Rule of Nines
- Lund and Browder Method
- Palmer Method
What is the Rule of Nines?
A system that assigns percentages in mutliples of nine to major body surfaces to estimate the total body surface area injured by burn
What is the Lund and Browder model?
A more precise method of estimating the extent of a burn; it recognizes that the percentage of TBSA of various anatomic parts, especially the head and legs, changes with growth. Accounts for changes that occur with age as well.
What is the Palmer method?
A method of estimating the extent of burns for scattered burns. The size of a patient’s palm is about 1% of TBSA.
What immunologic changes occur with burns?
**Diminished resistance to infection due to alterations in the immune cells; sepsis continues to be the leading case of morbidity and mortality in patients with thermal injuries
What are priorities during the emergent or immediate resuscitative phase of burn care?
- Primary survey: A, B, C, D, E
- Prevention of shock
- Prevention of respiratory distress
- Detection and treatment of concomitant injuries
- Wound assessment and inital care
What are priorities during the acute phase of burn care?
- Wound care and closure
- Prevention or treatment of complications, including infection
- Nutritional support
What are priorities during the rehabilitation phase of burn care?
- Prevention of scars and contractures
- Physical, occupational, and vocational rehabilitation
- Functional and cosmetic reconstruction
- Psychosocial counselling
What are key nursing diagnoses associated with nursing burn care?
- Impaired gas exchange
- Impaired skin integrity
- Interrupted family processes
- Ineffective airway clearance
- Fluid volume deficit
- Hypothermia
- Pain
- Anxiety
- Collaborative problems: acute respiratory failure, distributive shock, acute renal failure, compartment syndrome, paralytic ileus, Curling’s ulcer
- Risk for infection
- Impaired mobility
- Disturbed body image
- Imbalanced nutrition
- Impaired coping
- Decreased perfusion
What are some disorders of wound healing?
- Scars
- Keloids
- Failure to heal
- Contractures
In the rule of nine, what percentage is the anterior and posterior head?
9% (4.5% each)
In the rule of nine, what percentage is the anterior trunk?
18%
In the rule of nine, what percentage is the posterior trunk?
18%
In the rule of nine, what percentage is the genital area?
1%
In the rule of nine, what percentage is the anterior and posterior arm?
9% (4.5% each side) for each arm
In the rule of nine, what percentage is the anterior and posterior legs?
18% (9% each side) per leg
What is the shortest of the three phases in burn management?
emergent or immediate resuscitative phase
What is involved in nutritional support for burn patients?
- Adequate protein intake to promote wound healing
- Base targets on pre-burn status
Which groups are at greatest risk for burn injuries?
A. Middle Adults
B. Older Adults
C. Children
D. Teenagers
E. Young Adults
B. Older Adults
C. Children
Severe electrical contact injuries are often caused by low-voltage lines in which form?
A. Alternating current
B. Direct current
C. Current source
D. Reflex arc
A. Alternating current
Description of superficial burns
- Involves epidermis only
- May be caused by the sun or brief exposure to hot liquids
- Erythema, pain, minimal edema
- No blisters, dry skin
- Heals in 3 to 7 days via sloughing of the epidermal layer, no scarring
Description of superficial, partial-thickness burn
- Involves the epidermis and th epapillary layer of the dermis (superficial layer)
- May be caused by hot liquids, brief contact with hot objects, or flash flame
- Erythema, brisk cap refill, blisters, moistness
- Moderate edema, very painful
- Heals in 10-14 days via re-epithelialization
- No scarring; potential for hypo-or hyperpigmentation
Description of deep, partial-thickness burn
- Involves the epidermis and the reticular layer of the dermis (deep layer)
- May be caused by flame, hot liquids, radiation, tar, or other hot objects and materials
- Erythematous or pale, sluggish or absent cap refill
- Moist or dry, no blisters
- Significant edema and altered sensation
- Heals in 21 days or longer
- Potential for scarring and hypo- or hyperpigmentation
- May require skin grafting for optimal function or appearance
Description of full-thickness burn
- Involves the epidermis, dermis, and subcutaneous layer
- May be caused by flame, electricity, or chemicals
- Dry, leathery, white
- Absent capillary refill
- Generally requires skin grafting
- Heals via contraction and granulation tissue formation
- Autografting is required for healing
- Scarring and hypo or hyperpigmentation
Description of subdermal burn
- Involves the epidermis, dermis, subcutaneous layer, and muscle, tendon, or bone
- May be caused by electricity, prolonged contact with flame, or a hot object or material
- Charred, dry appearance
- Requires skin grafting, flap, or amputation
What is burn shock?
Combination of distributive and hypovolemic shock; can rapidly lead to cardiovascular collapse
