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NUR 230 > Burns > Flashcards

Burns Flashcards

1
Q

what is the epidermis

A

primary barrier
responsible for regeneration

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2
Q

what is the dermis

A

provides mechanical strength

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3
Q

what is the hypodermis

A

subq fat
protects; absorbs shock, thermal insulation,
energy stores

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4
Q

what is the resuscitative phase

A

Injury to onset of diuresis (0-2 days)
* ABC’s
* fluid resuscitation/perfusion

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5
Q

what is acute phase

A

Diuresis to near completion of wound closure (days to months)
* Wound care
* Infection control
* Healing
* Nutritional support

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6
Q

what is the rehab phase

A

Major wound closure to return to optimal level of
adjustment
* psychosocial adjustment
* minimize scarring and contractures
* reenter society

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7
Q

assessment of burn

A

Where occurred- environment
* Age
* Location
* History of the trauma
* Size
* Depth
* Severity
* Source
* Zone of injury

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8
Q

sources of burns

A

Radiation: sun or cancer therapy
* Chemical
* Electrical
* Dry and moist heat (thermal)
* Cold (frostbite)

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9
Q

1st degree burn/superficial thickness

A

above dermis (epidermis)
* Sunburn, flash burn
* Heals w/in a few days
* Dry, red,
* Some swelling
* Painful
* Tingling, itching, peeling

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10
Q

2nd degree burn/partial thickness

A

into dermis
* Scalds, flames, brief hot objects
* Heals 2-3 weeks
* Some scarring and depigmentation possible
* May require grafting
* Pink to red, blisters, weeping, pain, edema

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11
Q

3rd degree/full thickness

A

epidermis, dermis, sometimes
subcutaneous tissue; may involve connective tissue & muscle
* Scalds, flames, prolonged hot objects, tar, grease, chemicals,
electrical current
* Requires grafting
* Dry, pale, white, red, brown, leathery, or
charred
* Edema
* No pain
* Eschar may slough

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11
Q

what need to be intact for skin to regenerate

A

dermis

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12
Q

4th degree burn/deep full thickness

A

down to
muscle/bone
* Prolonged exposure, high-voltage electrical
injury
* Black, dry
* No pain
* Grafting of no benefit
* Amputations likely

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13
Q

how to estimate burn size

A
  • Calculate TBSA burned in
    percentage
  • Methods:
  • Rule of Nines
  • Palmer: size of hand=1% of bsa
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14
Q

severity of burn injury

A

Age
* Depth of burn
* TBSA- injuries that affect > 20% TBSA
considered severe
* Inhalation injury
* Concomitant injuries
* Location- face, perineum, hands, feet,
major joints
* Comorbid conditions

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15
Q

when to suspect an inhalation injury

A

closed space injury
facial injury
singed nasal hair
carbonaceous sputum
wheezing
pharyngeal edema
hoarseness

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16
Q

airway injuries

A

carbon monoxide poisoning
inahaltion injury above the glottis: singed nasal hair, facial burn, carbonaceous sputum
inhalation injury below the glottis

17
Q

resuscitative phase of burn injury at scene

A

At scene:
* Extinguish flames/remove
from source
* Airway maintenance
* Smoke inhalation
* CO poisoning
* High flow O2, intubation
* Cool the burn
* Remove restrictive objects
* Clothing, jewelry
* Cover the burn- infection

18
Q

resuscitative phase at facility

A
  • Airway
  • Assess patency
  • Assess for signs/symptoms
    of inhalation injury/carbon
    monoxide exposure
  • Intubation if necessary
  • Suction- provide pain
    medication
  • Monitor for upper airway
    edema
19
Q

resuscitative pahse at facility circulation

A

Circulation
* Assess vitals, pulses, capillary refill; watch for hypovolemic shock &
compartment syndrome
* Continuous cardiac monitoring
* 2 large-bore IVs, central line
* IV fluid resuscitation
* Foley- monitor urine output (adults: 0.5-1 mL/kg/hr; children <40kg:
1ml/kg/hr)
* Risk for AKI
* Red-colored urine- damage to RBCs and myoglobin
* Monitor I & O hourly

20
Q

resuscitative phase at facility breathing

A
  • Breathing
  • Oxygen (high flow, humidified)
  • Lung sounds
  • Mechanical Ventilation
  • Chest Expansion- escharotomy
    needed?, avoid tight dressings
  • Monitor for pulmonary edema,
    ARDS
21
Q

what is the adult fluid resuscitation formula

A

2mL LR x Kg x % TBSA burned for 24-
hr period
* 1st 8 hrs - 1/2 volume
* next 16 hrs- 1/2 volume

22
Q

how to care for wounds

A
  • Cooling- stop burn process on scene of injury (remove clothing,
    tepid water/saline)
  • Cleaning
  • Covering- dressings, cover patient with dry sheet/blanket, prevent
    hypothermia
  • Comfort- pain control (pharmacologic/nonpharmacologic), warm
    room
  • Prevent infection- protective environment, aseptic technique,
    tetanus, topical antimicrobials
23
Q

initial wound treatment

A
  • Clean with mild soap and water
  • Strip away dead, devitalized tissue
  • Burn wound culture
  • Photographs
  • Escharotomy of circumferential burns
  • Dressing
  • Fasciotomy
  • Tetanus
  • Pain control
24
Q

pain control

A
  • Morphine or fentanyl IV
    PCA
    Nonpharmacologic methods to enhance meds
  • Administer prior to procedures/suctioning
  • Assess for hypoxia
  • Protect from air currents, linens
  • Anxiolytics
25
Q

gi issues

A
  • Abdominal assessment- risk
    for paralytic ileus and
    abdominal compartment
    syndrome
  • NG tube- prevent aspiration,
    decompress stomach
  • Risk for stress ulcers- acid-
    reducing meds
  • Increased nutrition needs
  • May require
    enteral/parenteral nutrition
26
Q

resuscitative phase- labs and diagnostics

A

Chest x-ray
* Glucose: increased
* BUN/Cr: increased
* Hgb/Hct: increased
* Electrolytes
* Sodium: decreased
* Potassium: increased
* Chloride: increased
* ABG: metabolic acidosis
* Urinalysis: osmolality
* Total protein & albumin: decreased

27
Q

acute phase of burn injury

A
  • Prevent Infection, organ system failure,
    metabolic derangement
  • Encourage Healing
  • cleanse/hydrotherapy
  • remove/debride
  • topical preparations
  • protection
  • dressings
  • skin coverings
  • grafting
28
Q

acute phase complications

A
  • Infection- sepsis, ventilator associated pneumonia
  • Heart failure, pulmonary edema
  • Fluid shifts back to intravascular space
  • Blood clots
  • Pressure injuries
  • Respiratory distress, ARDS
  • Delirium
29
Q

preventing infection

A

● Protective environment.
● Restrict plants and flowers, fresh
fruits, vegetables.
● Limit visitors
● Single use equipment
● Monitor for infection
● Administer tetanus toxoid
● Administer antibiotics to treat infection
● Use strict asepsis with wound care

30
Q

gi concerns/nutritional support

A

*Paralytic ileus
*Curling’s ulcer
*Hypermetabolic,
hypercatabolic state
*Increased calorie needs
* Oral route- high-calorie,
high-protein meals/supplements
*Dietary consult

31
Q

what does bronchoscopy do

A

determine extent of burn injury to airway

32
Q

labs for acute phase

A

hbg/hct- decreased
k+- decreased
WBC- increased

33
Q

rehab phase

A

can last years
Minimize contractures and
scarring
* Splinting, positioning, exercise,
ambulation, pressure dressings,
surgery
* Client participation in ADLs and
self-care activities
* Home Health Support
* Psychosocial support and
reintegration
* Follow-up appointments

34
Q

rehab complicatoins

A

Neuropathies and nerve entrapment
* Wound breakdown and/or pressure injury
formation
* Hypertrophic scarring
* Contractures
* Joint instability
* Complex pain

35
Q

electrical burns

A
  • Path of least resistance
  • Low voltage
  • High voltage
  • Entry and exit sites
  • Tetanic contractions
  • Burns
  • Arrhythmias
36
Q

burn care resuscitation

A
  • injury to onset of
    diuresis (0-2 days)
  • ABC’s
  • fluid resuscitation
37
Q

burn care acute

A
  • diuresis to
    permanent wound
    closure (days to
    months)
  • infection control
  • healing
38
Q

burn care rehab

A

Extends for years
after injury
* minimize scarring,
contractures, and
other complications
* reenter society

39
Q
A

NUR 230 (16 decks)

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