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Med Surg 1 > Burns > Flashcards

Burns Flashcards

1
Q

What are the three types of burn?

A
  1. Superficial Partial thickness
  2. Deep Partial thickness
  3. Full thickness
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2
Q

Describe Superficial Partial thickness burn in the follow:

  • Appearance
  • Color
  • Pain
  • Depth
A
  • Skin intact; dry
  • Red
  • Pain present
  • Epidermis layer
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3
Q

Describe Deep Partial thickness burn in the follow:

  • Appearance
  • Color
  • Pain
  • Depth
A
  • Skin not intact; blistering, moist
  • Red and Pink
  • very painful
  • Dermis layer
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4
Q

Describe Full thickness burn in the follow:

  • Appearance
  • Color
  • Pain
  • Depth
A
  • Skin not intact; shiny, waxy, leathery
  • Red, Pink, yellow, white, black
  • No pain
  • Subcutaneous layer
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5
Q

What four things to keep in mind for burn care?

A
  1. Avoid running as it can fan flames
  2. Avoid the use of ice/cold water (causes vasoconstriction, cool water for few mins is okay)
  3. Remove restrictive items (clothing, jewelry)*
  4. Leave skin open or cover w/ non-adhesive cloth to prevent infx and pain.

*unless items are burned onto the skin already

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6
Q

Which type of burn is the Rule of Nines used for?

A

2nd degree (Deep Parital) and 3rd degree (Full)

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7
Q
  • What is the purpose of Rule of Nines?
A
  • Estimate the % of TBSA of burns.

Total Body Surface Area (TBSA)

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8
Q

When is it considered a local vs systemic burn response?

A

Local < 20% > Systemic

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9
Q

What are the three phases of Burn Care?

Include approximate days

A
  1. Emergent (Day 1 to 2)
  2. Acute (2 days to 2 months)
  3. Rehabilitation (3 months to 1 year)
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10
Q

What are the five priorties in order during the emergent phase of burn care?

A
  1. Impaired gas exchange or ineffective airway clearance
  2. Risk for Fluid and electrolytes Imbalance
  3. Compartment syndrome
  4. Hypothermia
  5. Acute pain

prioritized specfically in order

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11
Q

What three factors may impair gas exchange or airway clearance during the emergent phase of burns?

A
  1. Location of eschar
  2. Location of burn and smoke inhalation
  3. Carbon monoxide (CO) poisoning
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12
Q

why would eschar cause impaired gas exchange?

A

As eschar loses moisture it begins to tighten; if located on chest it can prevent the expansion of the lungs.

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13
Q

What are four possible objective measures of smoke inhalation?

A
  1. Soot in sputum
  2. Singed nose hairs
  3. Blisters on lips
  4. Hoarse voice
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14
Q

What two possibilities can smoke inhalation lead to?

A
  1. Immediate risk of airway closing
  2. Delayed effect of ARDS

Acute Respiratory Distress Syndrome

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15
Q

What are two effective ways to check for CO poisoning?

What is an ineffective way to check?

A
  1. Carboxyhemoglobin levels
  2. ABGs
  3. CO-Pulse oximetry

Pulse ox will not detect CO2 poisening; must use pulse CO oximeter

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16
Q

Cherry red skin color can be indicative of what?

A

CO poisening

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17
Q

What is a treatment indicated for CO poisoning?

A

Hi-flow oxygen

nonrebreathing face mask

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18
Q

Why is CO poisening a possibility w/ burns?

A

CO binds to hemoglobin with much greater affinity than oxygen, forming carboxyhemoglobin (COHb)

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19
Q

When is fluid loss the greatest during a burn?

A

Greatest fluid loss in first 12 hrs

20
Q
  1. Which electrolytes are monitored for burn victims?
  2. What are the risks?

Which is the main electrolyte?

A
  1. Potassium (risk for hyperkalemia)
  2. Sodium (risk for hyponatremia)

Hyperkalemia R/T cell destruction releasing K+ in blood stream

21
Q

What are the possible fluid imbalances of burn patients during the emergent phase?

A

Edema and hypovolemic shock

22
Q

What are the interventions for fluid & electrolyte imbalance for burn victims?

A
  1. Consider albumin*
  2. Isotonic IV (LR, NS)
  3. Monitor UO (foley cath)

*pulls fluid out of third spacing

23
Q

What is compartment syndrome?

A

Condition caused by too much pressure in the muscles can cause compression of blood vessels

24
Q

What are two symptoms of compartment syndrome?

A
  1. Severe pain
  2. Lack of pulse

Neurovascular checks

25
What treatment may be required for compartment syndrome?
Fasciotomy | Incision to allow muscles to swell out instead of compressing vessels
26
What are three interventions for hypothermia?
1. Warmer room 2. Warm IV fluid 3. Bair hugger
27
What 3 events are monitored in the "intermediate/acute phase of burn care"?
1. Monitor signs for fluid overload (*pulmonary edema, JVD*) 2. Septic shock R/T infection 3. Delayed ARDS | Acute Respiratory Syndrome
28
What are the main 5 concerns of "**rehabilitation phase** of burn care"?
1. Risk of infection 2. Imbalanced nutrition 3. Acute pain 4. Impaired physical mobility 5. Ineffective psychosocial coping
29
What are the three different skin grafts for burn care? Where are they taken from?
1. Autograft (self) 2. Allograft (cadaver) 3. Xenograft (animal)
30
What are the nutrition requirements for burn care?
Increased caloric and protein intake
31
Impaired physical mobility during rehabilitative care of burn patients increases risk of what?
Risk of contractures
32
What difference in location may electrical burns be compared to thermal?
Internal organ damage may not be seen, electricity causes a burn where it exits the body, commonly on the feet, which are the “ground.”
33
What are two concerns for patient with electrical burns?
1. Cardiac monitored for dysrhythmias 2. Rhabdomyolysis (damage to heart and **kidneys**)
34
Rule of Nines: Full Head | Front and Back
Total 9%
35
Rule of Nines: Anterior Torso
Total 18% | Thoracic and abdomen region
36
Rule of Nines: Posterior Torso
Total 18% | Includes buttocks
37
Rule of Nines: one Leg
Total 18% | two parts each 9% (anterior/posterior)
38
Rule of Nines: one arm
Total 9% | Four parts each 4.5% (anterior/posterior)
39
Rule of Nines: perineal
Total 1%
40
What would the nurse anticipate before debridement?
Give prophylaxis pain medication 30 mins before | Debridement is very painful
41
What are two signs of rhabdomyolysis?
1. Dark colored urine 2. massively elevated serum creatine (CK) levels* | R/T muscle tissue breakdown
42
When can ARDS occurs?
Between 6 to 72 hours and even as late a week.
43
What are the five S/Sx of ARDS
1. White patching on CXR 2. Decreased lung compliance 3. Refractory hypoxemia 4. Alveolar hemorrhage 5. Atelectasis
44
Which skin grafting has the greatest risk for rejection and infection
Xenograft
45
What are **direct** causes of ARDS?
Any direct injury on pulmonary (*COVID*) Septic shock

Med Surg 1 (7 decks)

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