Burns

Question 1

basic pathophysiology of burns

Answer 1

thermal damage to the skin causes coagulative necrosis, inflammation, and rapid edema

Question 2

why does edema occur after a burn injury?

Answer 2

increased capillary leakage
vasodilation

Question 3

what factors determine extent of burn injury?

Answer 3

source of burn and temperature
duration of exposure to extreme temperature
skin integrity

Question 4

describe a first degree burn

Answer 4

only effects the epidermis
no edema
possible blistering

Question 5

how is a first degree burn treated?

Answer 5

oral pain medication
cool compresses
should make complete recovery

Question 6

describe a second degree burn

Answer 6

effects epidermis and some of dermis
sensitivity and pain are increased
skin is blistered, mottled, peeling

Question 7

how is a second degree burn treated?

Answer 7

2-3 week recovery
pain control
dead tissue may need to be removed
may require grafting

Question 8

describe a third degree burn

Answer 8

full thickness - epidermis, dermis, maybe subQ tissue
loss of sensation and pain
edema and eschar tissue that sloughs off
waxy skin

Question 9

how is a third degree burn treated?

Answer 9

wound debridement
skin graft
pain control
manage systemic effects in the body

Question 10

describe a fourth degree burn

Answer 10

includes fat, muscle, or bone involvement
usually due to prolonged exposure to temperature source

Question 11

how is a fourth degree burn treated?

Answer 11

almost always requires amputation

Question 12

what stages of burns are likely to cause shock?

Answer 12

third and fourth degree

Question 13

when is a skin graft not beneficial?

Answer 13

fourth degree burns

Question 14

what is the rule of 9s for measuring % burn coverage?

Answer 14

front or back of a leg is 9% body surface
front or back of an arm is 4.5% body surface
front or back of head is 4.5% body surface
front of torso is 18% (belly 9% and chest 9%)
back of torso is 18% (upper back 9% and lower back 9%)
wiener is 1%

Question 15

what is the palmar method for measuring % burn coverage?

Answer 15

patient’s hand equal to 1% body surface area

Question 16

what % surface area of burns is high risk for shock in adults?

Answer 16

> 20% surface area

Question 17

what % surface area of burns is high risk for shock in children?

Answer 17

> 15% surface area

Question 18

how do burns impact the cardiovascular system?

Answer 18

increased capillary permeability causes leaking
decreased intravascular fluid causes decreased CO
decreased CO = decreased tissue perfusion

Question 19

how do burns impact fluid electrolyte balance?

Answer 19

capillary leaking causes third-spacing and peripheral edema

massive destruction of cells releases large amounts of intracellular potassium into circulation, causing hyperkalemia

Question 20

how do burns impact the immune system?

Answer 20

immune response is weakened
damaged epidermal barrier can’t keep pathogens out

Question 21

when are patients at risk of airway complications from burns?

Answer 21

up to 48 hours after event

Question 22

how can burns affect the upper airway?

Answer 22

1. direct thermal injury to face
2. facial and nasal hairs may be singed
3. secondary edema to face and neck may require intubation

Question 23

how can burns affect the lower airway?

Answer 23

smoke inhalation can cause bronchospasm
may have stridor, hoarseness, dyspnea
may need intubation

Question 24

why is carbon monoxide poisoning associated with burn patients?

Answer 24

carbon monoxide is produced when things are burning, burned materials may be inhaled at time of injury

Question 25

assessing for carbon monoxide poisoning

Answer 25

altered mental status, drowsiness, lethargy vomiting headache red flushed skin O2 sat may be normal, need to measure carboxyhemoglobin

Question 26

what is acute respiratory distress syndrome and how is it related to burns injuries

Answer 26

significant hypoxemia because of fluid in the lungs related to burn injuries because it can develop secondary to intubation, which may be required for burn patients

Question 27

emergency burn assessment

Answer 27

assess airway for edema or inhalation airway assess RR and lung sounds assess for bleeding and injury assess level of consciousness are there associated injuries?

Question 28

initial emergency medical treatment of burns

Answer 28

lukewarm water to cool burns, never ice keep patient warm bronchodilators and 100% O2 in NRB if airway compromised

Question 29

when is fluid resuscitation needed?

Answer 29

when >20% body surface area is burned with partial thickness or greater involvement

Question 30

how is fluid resuscitation performed?

Answer 30

large bore IV IV placed in unburned skin fluid should be titrated to maintain desired urinary output foley to measure UOP monitor for fluid volume overload and hypothermia (fluid is cooler than body temp)

Question 31

how is metabolism managed in burn patients?

Answer 31

patients are hypermetabolic use NG feeding and glucose monitoring

Question 32

what types of medications should be used to manage pain?

Answer 32

PCA opioids NSAIDs anxiolytics

Question 33

how should burned skin be cared for?

Answer 33

debridement if necessary dressings should be moist prevent contractures

Question 34

what are contractures?

Answer 34

shortening and hardening of the muscles or ligaments that can cause deformity, can occur after burn injury

Question 35

how does eschar formation impact burn patients?

Answer 35

decreases skin elasticity can prevent chest expansion if located on torso

Question 36

why is an escharotomy performed?

Answer 36

release constriction improve ventilation improve circulation in extremities

Question 37

what is compartment syndrome?

Answer 37

excess third spacing in a localized area that puts pressure on nerves and muscles, and disrupts blood flow to specific area decreased blood flow can cause tissue death

Question 38

why is a fasciotomy performed?

Answer 38

it is used to cut open fascia to relieve pressure on muscles and nerves that occurs with compartment syndrome

Question 39

when are grafts used?

Answer 39

second or third degree burns

Question 40

nursing care of autograft

Answer 40

immobilize and elevate graft site monitor both graft site and donor site for infection always prioritize pain control during wound care keep a close eye out for infection, because burn symptoms can mask sepsis symptoms

Question 41

what is the purpose of a homograft or xenograft?

Answer 41

skin from another human or an animal that is used temporarily to prevent infection

Question 42

nursing care to optimize burn wound recovery

Answer 42

mobilize early - do ROM exercises to prevent contractures compression can reduce swelling and scarring monitor for vascular insufficiency in extremities aggressive pulmonary toileting

Question 43

rehab after burns

Answer 43

psych support for PTSD and body image impact wound healing process can be up to a year reconstructive surgery after wounds have healed pain management can be complex support group