Burns Flashcards
Why does plasma seep out into the tissue
increased capillary permeability
when does the majority of plasma seep out into tissue
first 24 hours
why does the pulse increase
anytime someone is in a FVD the pulse will increase because the heart works harder
why does the cardiac output decrease
less volume to pump out
why does the urine output decrease
kidneys are either trying to hold on to fluid or they aren’t being professed adequately
how long does it take to hurt kidneys with poor perfusion
20 minutes
why is epinephrine secreted
epinephrine and norepinephrine secretin make you peripherally vasoconstrict, bloodies shunted to the vital organs
why are ADH and aldosterone secreted
retain sodium and water with aldosterone and retain water withADH causing blood volume to go up
does the burning process stop when flames are gone
no
what is the number one cause of death in burns
inhalation injury
what causes inhalation injury
inhaling carbon monoxide or hydrogen cyanide
what does oxygen bind with
hemoglobin
what happens to hemoglobin when carbon monoxide is present
Carbon monoxide attaches to hemoglobin before oxygen can causing hypoxia
why does it matter if a burn occurred inside or outside
if the burn is in a closed space they will inhale more carbon monoxide or hydrogen cyanide so the risk for complications is increased
when you see a Client with neck, face, chest burns what do you focus on
airway
what may be done to prophylactically treat airway
intubate because the airway will swell
indicators of inhalation injury
singed nose hair
singed facial hair
soot on face
coughing up secretions with dark/black specks
difficult swallowing
wheezing
blisters found on the oral/pharngeal mucosa
hoarseness
susternal intercostal retractions and stridor
does more death happen with upper or lower body burns
upper
why do you avoid broad spectrum antibiotics
their usage could lead to super infections and/or sepsis
what is the exception to broad spectrum antibiotic use
use them until wound cultures return
when do you obtain wound cultures
before you start ABX
what should you monitor when giving mycin drugs
increased bun or creatinine or hearing loss
what can mycin drugs cause
ototoxicity and or nephrotoxicity
what do you assume if bun and creatinine increase
they have nephrotoxicity
what happens if they have reduced blood flow to burned area
delivery of ABX is reduced
what do silver impregnated dressings do
provide broad antimicrobial effects to the burn
how long can silver impregnated dressing stay on
3-14 days depending on situation
what can mafenide acetate cause
acid base problems and stings
what can silver nitrate cause
electrolyte problems, keep dressing wet
why should antibiotic drugs be alternated
bacteria will build a tolerance
how do you apply topical agents to a burn
apply a thin layer using sterile gloves
what are enzymatic debridement agents used for
to remove necrotic dead tissue
examples of enzymatic debridement agents
sutilains
collagenase (saintly)
when should you avoid enzymatic debridement agents
dont use on face (scaring)
dont use if pregnant
dont use over large nerves
dont use use if area is opened to a body cavity (internal organ damage)
why is hydrotherapy used for
debridement
what do you need to remember before hydrotherapy
pain management
what could happen to this client if immersion hydrotherapy is used
cross contamination
how often can you reharvest an autograft from the same site
12-14 days if well nourished
what does it mean if the skin graft is blue or cool
poor profusion
what happens if air, blood or exudate is accumulating under the graft
the new graft will not adhere leading to total or partial loss of the graft
why do burn patients need more calories
they are in a hyper metabolic state
what are needed in the diet to promote healing
protein and vitamin c
what labs do you need to ensure proper nutrition and a positive nitrogen balance
pre albumin, nitrogen
what are the circulatory checks
pulse
color
temp
cap refill
what does elevation of the extremity do
may improve circulation by reducing edema
what procedures help relieve pressure
escharotomy
fasciotomy
(relieves pressure and restores circulation
what is the difference between a fasciotomy and escharotomy
the faciotomy cut is deeper into the tissue, it cuts through the fascia of the muscle
how often does urine need to be monitored
every hour
is it possible that no urine will return when you insert the catheter
yes
why would there be no urine in the catheter
the kidneys are trying to retain fluid or they are not being professed adequately
what would cause brown or red urine
RBC and hemoglobin excretion
what drub might be ordered to flush the kidneys
mannitol
if there is no urine output or if it is less than 30ml/hr what do yo worry about
kidney failure
why would a client diurese after 48 hour
fluid returns to vascular space
what do you worry about when pt begins to diurese
FVE
where is most potassium
inside the cell
what happens to cells with a burn
they rupture
what electrolyte embalance does cell lysing cause
hyperkalemia
why are magnesium carbonate, pantoprazole or famotidine prescribed
to prevent stress ulcer (curlings ulcer)
types of antacids
aluminum hydroxide gel (amphojel)
magnesium hydroxide (MOM)
H2 antagonists
famotidine
nizatidine
proton pump inhibitors
pantoprazole, esomeprazole
why would they be NPO and have an NG hooked to suction
They could develop a paralytic ileus
why would they develop a paralytic ileus
decreased vascular volume
decrease GI motility
hyperkalemia
if a client doesn’t have bowel sounds what will happen to the abdominal girth
increase
when is NG tube removed
when bowl sounds return
when you start GI feedings what should you measure to ensure the supplement is moving through GI tract
gastric residual
what should be done to prevent contractures
wrap each finger separately
use splints
hyperextend the neck
what is the number once complication of perineal burn
infection
can new tissue regenerate if old is not removed
no
what likes to grow in eschar
bactera
how many wounds in an electrical burn
2
an entrance and exit
which wound in electrical burn is bigger
exit
what is the first thing you do for an electrical burn
heart monitoring for 24 hours
what arrhythmia is this client at high risk for
V-fib
what can build up in electrical burns
myoglobin and hemoglobin and can cause kidney damage
why does an electrical burn patient need a spine board and c collar
they usually occur in high places, muscle contractions can cause fracture and force can throw victim forcefully
what happens to circulatory system with electrical burns
destroyed
complications of electrical burns
cataracts, gait problems, neurological deficit
