burns

Question 1

6 types of burns

Answer 1

1. thermal
2. chemical
3. inhalation
4. electrical
5. radiation
6. extreme temperature burns

Question 2

thermal burns

Answer 2

caused by flame, flash, scald or contact with hot objects

Question 3

chemical burns

Answer 3

exposure to acid, alkaline, or chemicals

Question 4

inhalation burns

Answer 4

causes oral/nasal, esophageal & direct parenchymal lung injury
(alveoli = functional part of lung)

Question 5

electrical burns

Answer 5

results from conversion of electrical energy into heat

Question 6

radiation burns

Answer 6

transfer of radiant energy to the body

ex: radiation therapy for cancer

Question 7

extreme temperature burns and who is at risk?

Answer 7

frostbite
children & older adults increased risk d/t reduced ability to generate heat

Question 8

what is the most common type of burn

Answer 8

thermal burn

Question 9

severity of a burn is determined by…

Answer 9

1. depth
2. extent of burn calculated in % of total body surface area (TBSA)
3. location
4. age of pt, pre-burn medical hx & circumstances or complicating factors

Question 10

1st degree burn

Answer 10

superficial partial thickness
*epidermis

Question 11

2nd degree burn

Answer 11

deep partial thickness
*dermis

Question 12

3rd & 4th degree burn

Answer 12

full thickness
*fat, muscle and bone

Question 13

rule of nines

Answer 13

used for initial assessment to measure the extent of burns

Question 14

primary goal in emergency

Answer 14

-stop the burning by removing the source
-ABC’s
-assess burns
-transfer to burn center, as needed
-stabilization

Question 15

3 phases of burn management

Answer 15

1. emergent (resuscitative) phase
2. acute phase
3. rehabilitation phase

Question 16

emergent (resuscitative) phase

Answer 16

*time needed to resolve the immediate, life-threatening problems from burn injury
*massive F&E shifts r/t massive increase in capillary permeability

~ lasts up to 72 hours from time burn occurred
~ ends when fluid mobilization and diuresis begins

Question 17

main concerns of emergent phase

Answer 17

hypovolemic shock PRIMARY CONCERN
edema formation

Question 18

clinical manifestations of emergent phase

Answer 18

hypovolemic shock (decrease BP)
blisters

if partial/full thickness –> nerve endings are damaged, so painless at first, then very painful

Question 19

how is the CV system susceptible to complications in the emergent phase?

Answer 19

shock, increased blood viscosity, VTE
circumferential burns & edema impairs circulation more

*escharotomy: treatment where scalpel opens and allows perfusion to area swelling - slice top of skin to allow for decreased circulation

Question 20

how is the respiratory system susceptible to complications in the emergent phase?

Answer 20

concern for injury of the upper and lower airway

Question 21

how is the urinary system susceptible to complications in the emergent phase?

Answer 21

acute renal failure d/t decreased blood flow to kidneys (w/ shock) and excessive myoglobin and hemoglobin released can block renal tubules (pt will experience renal shutdown)

Question 22

nursing management in the emergent phase

Answer 22

airway management
fluid therapy
-aggressive resuscitation with 2 large bore IV’s or CVAD and fluid resuscitation
-crystalloids (LR), colloids (albumin) or combo of the 2
-amt/formula determined by location + extent of burn

Question 23

wound care during emergent phase

Answer 23

-debridement: necrotic tissue is removed
-escharotomies & fasciotomies
-physically and mentally demanding for patient (excruciating pain)
-permanent skin coverage is primary goal

Question 24

when wounds are exposed…

Answer 24

PPE (hats, masks, gloves, gowns)
sterile gloves to apply ointments/dressings
keep room warm - >85 (bc pt have no skin barrier)

Question 25

drug therapy during the emergent phase

Answer 25

opioid analgesics & sedatives - ATC & IV route
tetanus immunization (if not had in the last 10 years)
VTE prophylaxis
topical antimicrobial agents
-silver sulfadiazine
-systemic only if concerns regarding sepsis (Abx)

Question 26

nutritional therapy during emergent phase

Answer 26

enteral feedings to treat extreme hyper metabolic state

Question 27

acute phase

Answer 27

~ begins with mobilization of ECF and subsequent diuresis
~ ends when partial-thickness wounds are healed and full-thickness burns are covered by skin grafts

takes weeks to months
watch labs closely –> F&E influx
physical therapy and occupational therapy

Question 28

partial thickness vs full thickness wound in acute phase

Answer 28

partial: eschar formation = removed & re-epithelialization occurs

full: eschar takes longer to separate; surgical debridement & skin grafting is common