Burns Flashcards
What is a burn
- Injury to the skin or other organic tissue primarily caused by
- Heat
- Radiation
- Radioactivity
- Electricity
- Friction
- Or contrast with chemicals
Length of stay for burn patients
0.5-1 day for % of burn for total body surface area
1.A person with 80% TBSA burn will stay in the ICU for 40-80 days and will be discharged when hemodynamically stable
Number one cause of death from burns
Residential fire
Risk factors for mortality of burns
- Age
- Sex
- Religion
- Type of burn
- Percent of burn
- Cause of burn
- Time to cooling and resuscitation
- Regional factors
- Socioeconomic
- Other risk factors
Burn prevention
- HIgh income vs low income
- Smoke detectors
- Hot water heater temps (Set them lower)
- Housing codes
- Cooking
- Open fires
- Kerosene
- Loose clothing
- Electrical cords (Burn your face)
- Hot irons/curling irons
- Flammable liquids
Tar Burn
- Contact burn (Hand touching tar)
- Tar cools on contact
- Removal of tar is NOT an emergency (don’t remove right away)
- Please pass the mayo (Apparently mayo breaks down tar)
Causes of chemical burns
- Strong acids
- Drain cleaners
- Paint thinner
- Gasoline
- Concrete
- Lawn chemicals
- Hair products
Thermal burns
- Most common type of burn
- Children are at highest risk
- Can come from any heat source
- Damage ranges from superficial to all layers of the skin
- Deepest going to the muscle tendons, ligaments and bone
Pathophysiology burn cycle
- Heat causes coagulation necrosis of the skin and sub Q
- Release of vasoactive peptides
- Altered capillary permeability
- Loss of fluid causing severe hypovolemia
- Decreased CO and myocardial function causing altered pulmonary resistance and pulmonary edema
- Decreased UOP
- Infection
- SIRS
- MODS
Burns affect on: Renal
- Decreased Urine osmotic pressure (UOP) and GFR
- Toxins released from burn cause acute tubular necrosis
- Myoglobinuria
- Needs early resuscitation
Burns affect on: Lungs
- P/F ratio (would be decreased)
- Pulmonary edema
- ARDS
- Aspiration
- Septicemia
Burns affect on: GI
- Muscular atrophy causes decreased absorption and increased intestinal permeability advancing to increased bacterial translocation… essentially sepsis
- Acute gastric dilation first 2-4 days
- Paralytic ileus
- Curling ulcer
- Acute cholecystitis or pancreatitis
- Abdominal compartment syndrome
Burns affect on: Immune
- Decreased Function of our T and B lymphocytes and macrophages causing increased infection rate and sepsis
- Common infections
- Step
- Pseudo
- Staph
- Candida albicans
- Other gram negative organisms
Burns affect on: Metabolism
- Hyper metabolic rate: elevated glucose, free fatty acids and amino acids
- Negative nitrogen balance
- Electrolyte imbalance
- Deficiencies in vitamins and essential elements
- Metabolic acidosis due to hypoxia and lactic acidosis (Plus the whole kidneys)
Burn shock
- Not simple shock, combo of Hypovolemic and distributive and accompanied by cardiogenic shock
Burn shock patho
- Not a simple shock
- Caused by massive tissue destruction; activation of the inflammatory response system
- Burn shock is an ischemia and reperfusion injury
- Massive burn: you can have myocardial depression factor occur, causing Decreased CO and decreased SVR this combo will decrease tissue perfusion
- Microcirculation of blood
First stage of burn shock
- Hypodynamic
- Hypovolemic with rapid fluid loss from the intravascular space within the first 24-48 hours
Goal of burn shock
- Maintain organ function by resuscitation and if successful the pattern of shock can be reversed
Burn: priority nursing assessment
- ABC
- Assess the severity of the burn
- Type
- Depth
- Location
- Extent
- Assess response to treatment
- Temp
- Vitals
Burn assessment
- Depth
- Size
- Cause
- Time
- Site affected
- Smoke inhalation
- Other
- Time of cooling
- Any treatment
- Questionable cause of fire (Arson?)
First degree burn
- Superficial thickness
- Only in the epidermis
- Painful
- Does not blister
- Does not scar
Superficial partial thickness burn
- Also called a second degree burn
- May not require surgery but may scar and be more painful
- Blisters and weeps
- Increasing depth, increased risk of infection/scarring
- Involves the epidermis only
Can be like.a sun burn
Deep partial thickness burn
- Also called second degree
- Require surgery and form more scars and are less painful
- Red color, and eschar present
- Blisters and weeps
- Increasing depth, increased risk of infection/scarring
- Involves the epidermis and some portion of the dermis
Hallmark sign is capillary return: if sluggish blanching its a deep dermal burn
Full thickness burn
- Also called third degree
- Dry
- Insensate to light touch and pin prick (not painful)
- Can be black in color
- Small areas will heal with substantial scar or contracture
- Large areas require skin grafting
- High risk of infection
- Involves the entirety of the dermis
Fourth degree burn
- Goes to muscle/bone
- Leads to loss of the burned part
- Can be appearing yellow with severe edema
Rule of 9’s: How much is an arm worth
4.5% anterior, 4.5% Posterior
9% total per arm
Rule of 9’s
- Way to quickly assess BSA
- Essentially breaks every segment of the body to a set amount
Rule of 9’s: How much is a leg worth
9% anterior 9% posterior
18% total per leg
Rule of 9’s: How much is the torso worth
9% anterior 9% posterior for the upper torso
9% anterior, 9% posterior for the lower torso
36% total
Her diagram differed a little from others
Rule of 9’s: How much is the head worth
4.5% anterior, 4.5% posterior
9% total
Rule of 9’sL How does Peds differ from adults
- Peds: their head is worth more (9% anterior, 9% posterior)
- Legs are worth less, at 7% anterior 7 posterior
Burn and fluid resuscitation: requirements
- Burns greater than 20% BSA
- Burns greater than 10% total BSA with inhalation
Parkland formula for burns
4ml * Body weight (kg) TBSA (%) = Total fluid volume in 24 hours
Multiply the BSA as a whole number not as a decimal (35 not .35)
Fluid res: how much fluid is given in the first 8 hours
1/2 the volume
Fluid res: how much fluid is given in the next 16 hours
1/2 the volume
Burn: Nursing mgmt
- Stop the burning process
- Airway mgmt
- Hemodynamics
- Fluid replacement
- Pain mgmt
- Infection
- Hypothermia
- GI system
- Urinary support
- Nutritional support
- Mobility
- Psych support to patient and fam
Med mgmt of burns: Silver nitrate
- Reduces fluid evaporation
- Bacteriostatic
- Does Not penetrate eschar
- Depletes sodium and potassium
Med mgmt of burns: Silver sulfadiazine
- Bacteriostatic
- Does Not penetrate eschar
- Effective against gram =/- and yeast
- Stains everything
Med mgmt of burns: Mafenide acetate
- Topical, bacteriostatic
- Effective against gram +/-
- Penetrates eschar
- painful to remove
- can cause metabolic acidosis
Med mgmt of burns: Polymyxin B bacitracin:
- Effective with gram negative only
- easy to use
- Can cause sensitivity to meds
Med mgmt of burns: Gentamicin topical
- Bactericidal aminoglycoside
- Ototoxic
- Nephrotoxic
Surgical mgmt of burns
- Escharotomy
- Fasciotomy
- Wound care (Mechanical, hydrotherapy, enzymatic)
- Biologic skin covering (Allograft, xenograft, aminon, cultured, artificial, synthetic)
- Perm skin covering (Autograft, artificial, cultured epithelium)
Nursing actions:post skin graft
- Maintain the immobilization of the skin graft (can take days)
- Elevate extremities
- Wound care: aseptic technique
- Monitor for infection
- Pain mgmt: Premedication
- Patient education
Complications of burns
- Acute airway block with head/neck burns
- Hemodynamic instability
- Shock: Hypovolemic and others
- Refractory hypothermia
- Renal failure
- Pulmonary edema/ards
- Septicemia
- MOD
- Muscle and joint mobility: Contractures
A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse’s priority when assessing the severity of the client’s burns?
1. Age of the patient
2. Associated medical history
3. Location of the burn
4. Cause of the burn
- Location of the burn
A nurse is assessing a client who is brought to the emergency room with burn injuries. Which of the following findings should the nurse identify as a deep partial-thickness burn?
- The burn area is black in color and pain is absent.
- The burned area is pink in color with blisters present.
- The burn area is red in color with eschar present.
- The burn area is yellow in color with severe edema.
- The burn area is red in color with eschar present.
1.) Indicates full thickness burn
2.) Superficial partial thickness burn
3.) Correct deep partial thickness burn and finding may include moderate edema and reports of pain.
4.) At this stage eschar that is present is soft and dry.
Indicated full thickness
A nursing in the ED is caring for a patient that has just been admitted with a 30% burn injury to her lower extremities. What intervention should the nurse perform first.
- Clean and dress the wound
- Administer pain medication
- Administer a tetanus booster
- Administer IV fluids
- Administer IV fluids, thinking ABC its the circulation
After completing the rule of nines, you determine that the patient that weighs 169 lbs. has a 26% TBSA burn. Using the Parkland Formula and determine how much fluid the patient needs to receive over the first 8 hours of burn resuscitation.
1. 30, 030 ml IV Fluid
2. 60,060 ml IV Fluid
3. 1,877 ml IV Fluid
4. 3,753.75 ml IV Fluid
I got a different answer than what is listed so tbd
