Burns

Question 1

Safety considerations for preventing burns

Answer 1

1. keep electrical sockets covered, keep matches and lighters out of reach
2. Smoke detector in house, change batteries every 6-12 months
3. Keep anything flammable at least 3 feet from heat sources
4. clean lint tray in dryer after each use
5. have and practice escape plan
6. do not let pot handles stick out when cooking
7. if toddlers are in the home, tablecloths should not be used
8. set the water heater no higher than 120 degrees F

Question 2

Pathophysiological changes after a burn

Answer 2

-increased capillary permeability (cause plasma to seep out into the tissue)
-majority occurs in the first 24 hours, worry about shock!
-pulse increases (due to FVD)
-decreased cardiac output because decreased volume to pump out
-decreased urine output
-epinephrine and norepinephrine secreted so blood is shunted to the vital organs
-secretion of ADH and aldosterone (to retain sodium and water–> increase in blood volume)

Question 3

rule of nines

Answer 3

head and neck: 9%
trunk- front 18%, back 18%
arm- 9% each
leg- 18% each
genital area-1%

Question 4

treatment for burns

Answer 4

-emergency management
-fluid replacement
-medication management
-infection control
-wound care
-nutrition

Question 5

stop the burning process

Answer 5

-wrap the client in a blanket to stop the burning
-cool water to stop burning- no more than 10 minutes
-remove jewelry
-remove non-adherent clothing and cover the burns with a clean, dry cloth

Question 6

inhalation injury

Answer 6

caused by carbon monoxide or hydrogen cyanide

Question 7

carbon monoxide poisoning

Answer 7

-client will be hypoxic
-give 100% oxygen

Question 8

hydrogen cyanide poisoning

Answer 8

treat with 100% oxygen

Question 9

indicators of inhalation injury

Answer 9

-singed nose hair
-singed facial hair
-soot of face
-coughing up secretions with dark specks
-difficult swallowing
-wheezing
-blisters found on the oral/pharyngeal mucosa
-hoarseness
-substernal/intercostal retractions and stridor (bad signs)

Question 10

fluid replacement

Answer 10

-two large bore IVs
-give crystalloids and colloids (albumin)
-fluid replacement based on the time the injury occurred, not when the treatment started

Question 11

fluid replacement

Answer 11

(2-4mL of LR) x (body weight in kg) x (%TBSA burned)= total fluid requirements for the first 24 hours

1st 8 hours= 1/2 of total volume
2nd 8 hours = 1/4 of total volume
3rd 8 hours = 1/4 of total volume

Question 12

adequate urinary output

Answer 12

0.5-1mL/kg/hr (30-50 mL/hr) in adults
75-100 mL/hr for electrical injuries
1mL/kg/hr for children

Question 13

albumin actions

Answer 13

-holds on to fluids in the vascular space
-increase in vascular volume
-increase in kidney perfusion
-increase in blood pressure
-increase in cardiac output
-increase in the workload of the heart

**if you stress the heart too much the patient may go into fluid overload
monitor CVP hourly*

Question 14

Pain management burns

Answer 14

-Opioids are drug of choice
-give IV not IM

Question 15

immunizations for burns

Answer 15

tetanus & hepatitis

Question 16

infection control

Answer 16

-give abx
-broad spectrum until culture is back
-with -mycins monitor for ototoxicity & nephrotoxicity

Question 17

topical medications
-mafenide acetate
-silver nitrate
-antimicrobial ointments

Answer 17

-silver impregnated dressings deliver a uniform amount of silver to the wound
-dressings can be left in place for 3-14 days

*check for sulfate allergies

Question 18

applying topical agent to burn

Answer 18

-think layer using sterile gloves!!

Question 19

wound care: debridement

Answer 19

-enzymatic debridement agents remove necrotic tissue
-sutilains, collagenase
-do not use on face, do not use if pregnant, do not use over large nerves, do not use if area is open to body cavity

hydrotherapy
-pain management

Question 20

wound care: grafting

Answer 20

-autograft: use client’s own skin
-apply dressing until bleeding stops then leave open to air
-if client is well nourished, same donor site can be used every 12-14 days

Question 21

nutrition for burns

Answer 21

-eat more calories
-vitamin C & protein
-check pre-albumin level

Question 22

complications of burns

Answer 22

-circulation
elevation to decrease edema
if vascular check is decreased may need an escharotomy or fasciotomy

-renal system
monitor urine output with catheter every hour
may not urinate, kidneys are trying to hold on to the fluid that remains
urine may be red or brown
after 48 hours, client may diurese because fluid is going back into the vascular space
Mannitol to flush out kidneys

-electrolyte imbalance
cells rupture with a burn so K+ will be released into the vascular space and may cause hyperK+

-GI system
give magnesium carbonate, pantoprazole or famotidine to prevent stress ulcer (Curling’s)

-integumentary
contractures
wrap fingers separately, use splints
hyperextend the neck, no pillows

Question 23

chemical burn

Answer 23

remove client from chemical
flush with water for 15-30 minutes (cool water or sterile saline
brush powder chemicals off first, then flush

Question 24

electrical burns

Answer 24

2 wounds (entrance & exit)
continuous heart monitoring for 24 hours-monitor for V fib
myoglobin and hemoglobin may build up and cause kidney damage
amputations are common because circulatory system is destroyed