Burns Flashcards
basic pathophysiology of burns
thermal damage to the skin causes coagulative necrosis, inflammation, and rapid edema
why does edema occur after a burn injury?
increased capillary leakage
vasodilation
what factors determine extent of burn injury?
source of burn and temperature
duration of exposure to extreme temperature
skin integrity
describe a first degree burn
only effects the epidermis
no edema
possible blistering
how is a first degree burn treated?
oral pain medication
cool compresses
should make complete recovery
describe a second degree burn
effects epidermis and some of dermis
sensitivity and pain are increased
skin is blistered, mottled, peeling
how is a second degree burn treated?
2-3 week recovery
pain control
dead tissue may need to be removed
may require grafting
describe a third degree burn
full thickness - epidermis, dermis, maybe subQ tissue
loss of sensation and pain
edema and eschar tissue that sloughs off
waxy skin
how is a third degree burn treated?
wound debridement
skin graft
pain control
manage systemic effects in the body
describe a fourth degree burn
includes fat, muscle, or bone involvement
usually due to prolonged exposure to temperature source
how is a fourth degree burn treated?
almost always requires amputation
what stages of burns are likely to cause shock?
third and fourth degree
when is a skin graft not beneficial?
fourth degree burns
what is the rule of 9s for measuring % burn coverage?
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%
what is the palmar method for measuring % burn coverage?
patient’s hand equal to 1% body surface area
what % surface area of burns is high risk for shock in adults?
> 20% surface area
what % surface area of burns is high risk for shock in children?
> 15% surface area
how do burns impact the cardiovascular system?
increased capillary permeability causes leaking
decreased intravascular fluid causes decreased CO
decreased CO = decreased tissue perfusion
how do burns impact fluid electrolyte balance?
capillary leaking causes third-spacing and peripheral edema
massive destruction of cells releases large amounts of intracellular potassium into circulation, causing hyperkalemia
how do burns impact the immune system?
immune response is weakened
damaged epidermal barrier can’t keep pathogens out
when are patients at risk of airway complications from burns?
up to 48 hours after event
how can burns affect the upper airway?
- direct thermal injury to face
- facial and nasal hairs may be singed
- secondary edema to face and neck may require intubation
how can burns affect the lower airway?
smoke inhalation can cause bronchospasm
may have stridor, hoarseness, dyspnea
may need intubation
why is carbon monoxide poisoning associated with burn patients?
carbon monoxide is produced when things are burning, burned materials may be inhaled at time of injury
assessing for carbon monoxide poisoning
altered mental status, drowsiness, lethargy
vomiting
headache
red flushed skin
O2 sat may be normal, need to measure carboxyhemoglobin
what is acute respiratory distress syndrome and how is it related to burns injuries
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
emergency burn assessment
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?
initial emergency medical treatment of burns
lukewarm water to cool burns, never ice
keep patient warm
bronchodilators and 100% O2 in NRB if airway compromised
when is fluid resuscitation needed?
when >20% body surface area is burned with partial thickness or greater involvement
how is fluid resuscitation performed?
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)
how is metabolism managed in burn patients?
patients are hypermetabolic
use NG feeding and glucose monitoring
what types of medications should be used to manage pain?
PCA opioids
NSAIDs
anxiolytics
how should burned skin be cared for?
debridement if necessary
dressings should be moist
prevent contractures
what are contractures?
shortening and hardening of the muscles or ligaments that can cause deformity, can occur after burn injury
how does eschar formation impact burn patients?
decreases skin elasticity
can prevent chest expansion if located on torso
why is an escharotomy performed?
release constriction
improve ventilation
improve circulation in extremities
what is compartment syndrome?
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
why is a fasciotomy performed?
it is used to cut open fascia to relieve pressure on muscles and nerves that occurs with compartment syndrome
when are grafts used?
second or third degree burns
nursing care of autograft
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
what is the purpose of a homograft or xenograft?
skin from another human or an animal that is used temporarily to prevent infection
nursing care to optimize burn wound recovery
mobilize early - do ROM exercises to prevent contractures
compression can reduce swelling and scarring
monitor for vascular insufficiency in extremities
aggressive pulmonary toileting
rehab after burns
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
