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Med-Surg > burns > Flashcards

burns Flashcards

1
Q

3 layers of the skin

A

epidermis, dermis, hypodermis/subcutaneous

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2
Q

any wound alters and disrupts ______ and ______ of the skin but is dependent on the individual wound

A

anatomic and physiologic function

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3
Q

wounds heal by ______ or ________ formation depending on extent of tissue involvement

A

regeneration or scar formation

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4
Q

wounds can be ________, ________ ________, or _______ _________

A

superficial, partial thickness, or full thickness

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5
Q

phases of wound healing

A
  • inflammatory phase
  • proliferation phase
  • remodeling/maturation
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6
Q

the inflammatory phase is also the

A

lag or exudative phase

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7
Q

duration of the inflammatory phase

A

1-4 days

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8
Q

what happens during the inflammatory process

A

blood clot forms; wound becomes edematous; debris of damaged tissue and blood clot are phagocytosed

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9
Q

proliferation phase is also known as the

A

fibrolastic or connective tissue phase

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10
Q

duration of proliferative phase

A

5 - 20 days

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11
Q

what happens during the proliferation phase

A

collagen produced; granulation tissue forms; wound tensile strength increases

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12
Q

remodeling phase is also known as the

A

maturation phase

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13
Q

duration of remodeling phase

A

21 days to months or even years

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14
Q

what happens during the remodeling phase

A

fibroblasts leave wound; tensile strength increases; collagen fibres reorganize and tighten to reduce scar size

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15
Q

burn injuries usually result from

A

energy transfer from a heat source to the body in which the agent exceeds the threshold for resistance

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16
Q

most burn injuries occur in

A

the home

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17
Q

2 most common burn etiologies are

A

flame and cold

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18
Q

gerontologic considerations

A
  • impaired senses and reaction times
  • tend to incorrectly assess risk
  • thinner skin, with decreased microcirculation and increased susceptibility to infection
  • morbidity and mortality rates associated with burns are greater than in the older adult
  • chronic illness decreases the older adult’s ability to withstand the multisystem stresses resulting from a major burn
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19
Q

3 types of energy that cause burn injuries

A
  • thermal
  • chemical
  • electrical
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20
Q

thermal injuries

A
  • the most common type of burn injury
  • varies according to severity
  • better prognosis
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21
Q

most common type of burn injuries

A
  • flame source
  • scald burns from steam
  • contact with a hot object
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22
Q

3 distinct zones that appear in a bull’s eye pattern

A
  • zone of coagulation
  • zone of stasis
  • zone of hyperemia
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23
Q

zone of coagulation

A

tissue is completely destroyed -> cellular death

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24
Q

zone of stasis

A
  • surrounds non-viable tissue
  • compromised blood supply, inflammation and tissue injury -> potentially viable
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25
Q

zone o f hyperemia

A
  • blood flow secondary to the natural inflammatory response
  • sustains least amount of damage
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26
Q

electrical injuries

A

electricity travels the path of least resistance; therefore tissue, nerves, and muscle are easily damaged, bone is not

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27
Q

effects of electricity on the body

A
  • type of current (alternating or direct)
  • pathway of the current
  • duration of contact
  • resistance of the body tissue
  • amount of voltage
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28
Q

chemical injuries

A

result from contact, ingestion, inhalation or injection of acids, alkalis or vesicants - blistering agents

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29
Q

alkaline substances

A
  • not neutralized by tissue fluids as readily as acids
  • adhere to tissue causing protein; hydrolysis and liquefaction
  • damage occurs rapidly and continues until the pH returns to a normal physiologic level
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30
Q

_______ ________ is a critical element in determining the severity of the injury

A

contact time

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31
Q

pathophysiology of burns

A
  • cell damage
  • increase vascular permeability
  • fluids, electrolytes, proteins move from the intravascular to interstitial space
  • decrease tissue perfusion
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32
Q

decrease tissue perfusion in burns can lead to

A
  • edema formation
  • hypovolemic shock - BURN SHOCK
33
Q

burn shock (hypovolemic) from burns can cause

A

vasoconstriction

34
Q

Phases of burn management

A
  • emergent / resuscitative
  • acute / intermediate
35
Q

emergent / resuscitative management phase

A
  • from onset of injury to completion of fluid resuscitation
  • first aid, prevention of shock, prevention of respiratory distress, detection and treatment of concomitant injuries, wound assessment and initial care
36
Q

acute / intermediate management phase

A
  • from beginning of diuresis to near completion of wound closure
  • wound care and closure, prevention and treatment of complications including infection, nutritional support
37
Q

what do you assess in immediate care

A

A- support the airway and protect the cervical spine
B- assesses and promotes breathing
C - apical pulse and BP
neurological status - indications of cerebral hypoxia

38
Q

signs of cerebral hypoxia

A
  • restlessness
  • confusion
  • difficulty responding to questions
  • decrease LOC
39
Q

when does the acute/intermediate phase of burn management occur

A

begins 48-72 hrs post burn injury

40
Q

what are focused assessments in the acute / intermediate phase

A
  • maintenance of respiratory and circulatory status
  • fluid and electrolyte balance
  • GI function
41
Q

priorities of care in acute/intermediate phase

A
  • infection prevention
  • burn wound care
  • pain management
  • nutritional support
42
Q

other important assessments for burn pts

A
  • determine the depth of burn damage
  • ABG - hypoxemia, metabolic acidosis
  • carboxyhemoglobin level
  • CBC, creatinine and myoglobin levels
  • electrolytes
43
Q

what is the carboxyhemoglobin level

A

extent of smoke inhalation

44
Q

what would you expect the creatinine and myoglobin levels to be in a burn pt and why

A

increased due to muscle damage

45
Q

what can you expect electrolytes to look like in a burn pt

A
  • hyponatremia - massive fluid shifts
  • hyperkalemia - fluid shifts and cell lysis
  • BUN - fluid loss or increase protein breakdown
46
Q

classification of burn injuries

A
  • depth
  • considerations in determining depth
  • superficial burns
  • superficial partial thickness
  • deep partial thickness burns
  • full thickness burn
47
Q

depth of burn injuries

A
  • depth of tissue destruction
  • depth depends on how much the skins dermis is affected
  • burn depth determines whether spontaneous healing will occur and helps determine the plan of care
48
Q

considerations in determining depth

A
  • how the injury occurred
  • causative agent
  • temperature of the burning agent
  • duration of contact with the burning agent
  • thickness of the skin in area burned
49
Q

superficial burns

A
  • damages only the dermis
  • pink or red
  • dry
  • slight swelling; no blister formation
50
Q

superficial partial thickness

A

epidermis is destroyed and a small portion of the underlying dermis is injured
- painful, pink and moist
- hair follicles intact; often presents as blisters
- heals in 5 to 10 days without scarring

51
Q

deep partial thickness burns

A
  • extends into the reticular layers of the dermis
  • difficult to distinguish from a full-thickness burn
  • red or white
  • mottled
  • moist or fairly dry
  • severe pain
  • takes up to 14 days to heal with variable amounts of scarring
52
Q

full thickness burn

A
  • involves the total destruction of the dermis and extends into the subcutaneous fat; can also involve muscle and bone
  • heals by contraction or epithelial migration; requires skin grafting
  • wound color ranges widely from mottled white to red, brown, or black
  • wound appears leathery
  • hair follicles and sweat glands are destroyed
53
Q

what is TBSA

A

estimated % of total body surface area
- rule of nines

54
Q

what is rule of nines

A

anatomic body parts are counted as multiples of 9%

55
Q

deep partial thickness burns TBSA

A

<15% TBSA in adults or <10% in children

56
Q

full thickness burns TBSA

A

<2% TBSA not involving special care areas

57
Q

moderate, uncomplicated burn injury

A
  • deep partial thickness burns of 15-25% TBSA in adults or 10-20% in children
58
Q

major burn injury

A
  • deep partial thickness burns >25% TBSA in adults or >20% in children
  • all full thickness burns >/= 10% TBSA
  • all burns involving special care (eyes, ears, face, hands, feet, perineum, joints)
  • all pts with inhalation injury, electrical injury, or concurrent trauma
59
Q

parkland baxter formula for fluid restriction

A
  • first 24 hrs crystalloids
  • 24 hrs colloids
60
Q

parkland baxter formula for fluid restriction first 24 hr crystalloids

A

lactated ringers solution: 4ml/kg per percentage of TBSA burned; 50% given during first in 8 hrs; 25% given during the following 8hrs

61
Q

parkland baxter formula for fluid restriction 24 hrs colloids

A
  • 0.3-0.5 ml/kg per percentage of TBSA burned
  • capillary membrane has returned to normal/near normal and plasma remains in the vascular space and expands the circulating volume
  • glucose in water; amount to replace estimated evaporative losses
62
Q

hemodynamic instability

A

fluid lost from the vascular, interstitial, and cellular compartments
- hypovolemic shock - BURN shock

63
Q

hemodynamic instability begins

A

almost immediately with injury to capillaries in the burned area and surrounding tissue

64
Q

what to expect in hemodynamic instability

A

decrease CO
increase PVR
decrease perfusion of vital organs

65
Q

respiratory system dysfunction

A

smoke inhalation and post burn lung injury

66
Q

smoke inhalation and post burn lung injury is injury caused by . . .

A
  • injury caused by toxic gas exposure
  • injury above the level of the vocal cords d/t direct heat or chemicals
  • injury below the level of the vocal cords causing pulmonary edema, pneumonia and later signs of inflammation
67
Q

manifestations of inhalation injury

A
  • hoarseness, hacking cough, soot in mouth or nose, singed nose hairs
  • drooling; inability to handle secretions), darkened sputum, mucosal burns
  • laboured and shallow breathing
68
Q

carbon monoxide

A

colorless, odorless, tasteless, nonirritating gas produced from incomplete combustion of carbon-containing materials

69
Q

carbon monoxide poisoning

A

affinity of hemoglobin for CO is 200x greater than for oxygen

70
Q

hypermetabolic response

A

stress of burn injury increased metabolic and nutritional requirements

71
Q

what is increased during hypermetabolic response

A

catecholamines and cortisol increased in an attempt to maintain homeostasis; heat production increase to balance heat losses

72
Q

hyper metabolism and stress peaks includes

A

glycolysis, proteolysis, lypolysis

73
Q

hypermetabolism and stress peaks at

A

7-17 days post burn

74
Q

when pt experiences hypermetabolism + stress what to expect

A
  • tissue breakdown decrease as the wounds heal
  • increase O2 consumption
  • increase glucose use
  • protein and fat wasting
75
Q

why can renal insufficiency occur in burn pts

A

d/t hypovolemic state, damage to the kidneys at the time of the burn, or administered drugs

76
Q

how can the GI tract be affected in burn pts

A
  • gastric dilation and decreased peristalsis
  • acute ulceration of the stomach and duodenum
77
Q

neurological changes that can occur in burn pts

A
  • neurological damage; head injuries, carbon monoxide poisoning, fluid volume deficit, hypovolemia
  • d/t periods of hypoxia
78
Q

how can the musculoskeletal system be affected in burn pts

A
  • fractures that occur at the time of the accident
  • deep burns extending to the muscles and bones
  • hypertrophic scarring and contractures
  • increases tissue catabolism = severe protein and fat wasting
79
Q

_______ is a significant complication of the acute phase of burn injury

A

sepsis

Med-Surg (15 decks)

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