Burns

Question 1

First Degree Burns

Answer 1

Superficial injuries that involve outermost layer of skin (sunburn)

Question 2

Second Degree Burns

Answer 2

Involve entire epidermis and varying portions of dermis, painful with blisters

Question 3

Third Degree Burns

Answer 3

Total destruction of the epidermis, dermis and underlying tissue, lack of sensation

Question 4

Fourth Degree Burns

Answer 4

Deep burn necrosis, extends into deep tissue, muscle or bone

Question 5

Factors in Determining Burn Depth

Answer 5

how the injury occured, causative agent, temperature of agent, duration of contact with agent, thickness of the skin at the injury

Question 6

Rule of nines

Answer 6

most common method for TBSA estimation, based on anatomic regions

Question 7

Lund and browder

Answer 7

recognizes % of TBSA of various anatomic parts

Question 8

Palmer

Answer 8

used to estimate extent of scattered burns, size of patient’s hand, including fingers is 1% TBSA

Question 9

Patho of Burns

Answer 9

chemical injury, heat transfer from one site to another, thermal, electrical (skin and upper airway mucosa are most common), radiation

Question 10

Major Burn Injury

Answer 10

Burns more than 30% may produce a local and
systemic response and are considered major burns
Systemic response includes release of cytokines and other mediators into systemic circulation
Fluid shifts and shock result in tissue hypoperfusion and organ hypofunction

Question 11

Effects of MBI

Answer 11

Fluid and electrolyte shifts
 Cardiovascular effects
 Pulmonary injury
o Upper airway
o Lower airway
o Carbon monoxide poisoning
o Restrictive defects
 Renal and GI alterations
 Immunologic alterations
 Effect on thermoregulation

Question 12

Phases of burn injury

Answer 12

Emergent/ rescusitative, acute/ intermediate, rehab

Question 13

Emergent

Answer 13

Onset of injury to completion of fluid
resuscitation

Question 14

Acute/intermediate

Answer 14

From beginning of diuresis to wound closure

Question 15

Rehab

Answer 15

From wound closure to return to optimal physical and psychosocial adjustment

Question 16

On the scene care

Answer 16

Prevent injury to rescuer
Stop injury: extinguish flames, cool the burn,
irrigate chemical burns
ABCs: establish airway, breathing, and circulation
Start oxygen and large-bore IVs
Remove restrictive objects and cover the wound
Do assessment surveying all body systems and obtain a history of the incident and pertinent patient history
Note: Treat patient with falls and electrical injuries as for potential cervical spine injury

Question 17

Emergent Care in the hospital

Answer 17

Patient is transported to emergency department
 Fluid resuscitation is begun
 Foley catheter is inserted
 Patient with burns exceeding 20% to 25% should have an NG
tube inserted and placed to suction
 Patient is stabilized and condition is continually monitored
 Patients with electrical burns should have ECG
 Address pain; only IV medication should be administered
 Psychosocial consideration and emotional support should be given to patient and family

Question 18

Nursing management of emergent phase

Answer 18

ABC
Vital signs and hemodynamic status
Monitor for fluid volume deficit
Assess extent of the burn

Question 19

Emergent potential complications

Answer 19

Acute respiratory failure
Distributive shock
Acute kidney injury
Compartment syndrome
Paralytic ileus
Curling’s ulcer

Question 20

Acute/intermediate

Answer 20

48 to 72 hours after injury
Continue assessment and maintain respiratory and circulatory support, fluid and electrolyte balance, GI and renal function
Prevention of infection, burn wound care, pain
management, modulation of the hypermetabolic response, and early positioning/mobility

Question 21

Nursing Management during Acute/intermediate

Answer 21

Restoring fluid balance
Preventing infection
Modulating hypermetabolism
Promoting skin integrity
Relieving pain and discomfort
Promoting mobility
Strengthening coping strategies
Supporting patient and family processes
Monitoring and managing complications

Question 22

Complications during Acute/ Intermediate

Answer 22

ARDs/ARF, HF, pulmonary edema, sepsis, delirium, visceral damage with electrical burns

Question 23

Rehab

Answer 23

Rehabilitation is begun as early as possible in the emergent phase and extends for a long period after the injury
Focus is on wound healing, psychosocial support, self-image, lifestyle, and restoring maximal functional abilities so that the patient can have the best quality life, both personally and socially
The patient may need reconstructive surgery to improve function and appearance
Vocational counseling and support groups may assist the patient

Question 24

Fluid resuscitation for burns

Answer 24

manages shock, Maintain blood pressure of greater than 100 mm Hg
systolic and urine output of 30 to 50 mL/hr;
maintain serum sodium at near normal levels

Question 25

Consensus Formula

Answer 25

2-4ml/kg

Question 26

Evans formula

Answer 26

1ml/kg/% BSA of crystalloids + 1ml/kg/% BSA colloids + 2000 ml glucose in water

Question 27

Brooke Army formula

Answer 27

2mls x TBSA X weight, half the amount given in 1st 8 hrs

Question 28

Parkland Baxter formula

Answer 28

4 mls X TBSA X weight, half the amount given in 1st 8 hrs

Question 29

Hypertonic saline formula

Answer 29

0.5 mmol sodium per kg of body weight per TBSA

Question 30

F&E Shifts- emergent

Answer 30

Generalized dehydration
Reduced blood volume and hemoconcentration
Decreased urine output
Trauma causes release of potassium into
extracellular fluid: hyperkalemia
Sodium traps in edema fluid and shifts into cells as
potassium is released: hyponatremia
Metabolic acidosis

Question 31

Acute F&E shift

Answer 31

Fluid reenters the vascular space from the interstitial
space
Hemodilution
Increased urinary output
Sodium is lost with diuresis and due to dilution as
fluid enters vascular space: hyponatremia
Potassium shifts from extracellular fluid into cells:
potential hypokalemia
Metabolic acidosis

Question 32

Burn Wound Care

Answer 32

Wound cleaning
o Hydrotherapy
Use of topical agents
Wound debridement
o Natural debridement
o Mechanical debridement
o Surgical debridement
Wound dressing, dressing changes, and skin grafting

Question 33

Burn Psychosocial support

Answer 33

Patient’s outlook, motivation, and support system are important to overall well-being and ability to progress
Psychological support of patient and family
Early consultation with mental health professionals
Discharge planning for reintegration
Support groups
Organizations

Question 34

Burn Pain

Answer 34

Burn pain has been described as one of the most severe forms of acute pain
Pain accompanies care and treatments such as wound cleaning and dressing changes
Types of burn pain
o Background or resting
o Procedural
o Breakthrough

Question 35

Burn Pain Management

Answer 35

Analgesics
o IV use during emergent and acute phases
o Morphine
o Fentanyl
o Other
Role of anxiety in pain
Effect of sleep derivation on pain
Nonpharmacologic measures

Question 36

Nutritional Support for Burns

Answer 36

Burn injuries produce profound metabolic
abnormalities, and patient with burns have great nutritional needs related to stress response, hypermetabolism, and requirement for wound healing
Goal of nutritional support is to promote a state of nitrogen balance and match nutrient utilization
Nutritional support is based on patient preburn status and % of TBSA burned
Enteral route is preferred. Jejunal feedings are
frequently used to maintain nutritional status with a lower risk of aspiration in a patient with poor appetite, weakness, or other problems

Question 37

Home Care instruction for Burns

Answer 37

Mental health, Skin and wound care, Exercise and activity, Nutrition, Pain management, Thermoregulation and clothing, Sexual issues