Burns Flashcards
1
Q
Burns are caused by:
A
- Dry Heat
- Chemicals
- Ionizing radiation
- Moist Heat
- Electricity
- Hot surfaces
2
Q
Age Related Changes
A
- Thinner skin
- Slower healing time
- Reduced inflammatory and immune responses
- Reduced thoracic and pulmonary compliance
- Pre-existing medical conditions diabetes mellitus, kidney impairment, or pulmonary impairment
3
Q
Prevention Chart 62-1
A
- Minimize sun exposure
- Advise that matches and lighters be kept out of the reach of children.
- Emphasize importance of never leaving children unattended around fire or in bathroom/bathtub.
- Educate about the installation and maintenance of smoke and carbon monoxide detectors on every level of the home and changing batteries annually on birthday.
- Recommend the development and practice of a home exit fire drill with all members of the household.
- Advocate setting the water heater temperature no higher than 48.9°C (120°F).
- Educate about the perils of smoking in bed, smoking while using home oxygen, or falling asleep while smoking.
- Caution against using flammable liquids to start fires and/or throwing flammable liquids onto an already burning fire.
- Warn of the danger of removing the radiator cap from a hot car engine
- Recommend avoidance of overhead electrical wires and underground wires when working outside.
- Advise that hot irons and curling irons be kept out of the reach of children.
- Discourage running electric cords under carpets or rugs.
- Recommend storage of flammable liquids well away from a fire source, such as a pilot light.
- Educate importance of being aware of loose clothing when cooking over a stovetop or flame.
- Recommend having a working fire extinguisher in the home and knowing how to use it.
4
Q
Severity of Burn Injury
A
- Severity determined by multiple factors:
- Age of patient
- Depth of the burn
- How much body surface is involved
- Lung involvement
- Other injuries
- Location of the burn
- Greater than 40% TBSA (total body surface area) burns are at high risk of mortality and morbidity
5
Q
First Degree - Superficial
A
- Least damage; epidermis is only part of skin that is injured
- Caused by
— Prolonged exposure to low-intensity heat (e.g.,
— Short (flash) exposure to high-intensity heat. Redness with mild edema, pain, and increased sensitivity to heat occurs as a result. - Desquamation (peeling of dead skin) occurs 2 to 3 days after burn sunburn)
6
Q
Second Degree - Partial Thickness Table 62-1
A
- Involves epidermis and portion of dermis
- Caused by scalds, flash flame
- Causes pain, hyperesthesia (extreme sensitivity in your sense of touch), sensitive to air currents
- Appears blistered, mottled red base
- Recovery in 2-3 weeks
- Hair follicles remain intact.
7
Q
Third Degree – Full Thickness Burn
A
- Involve total destruction of the epidermis, dermis, sometimes subcutaneous tissue, connective tissue, muscle
- Causes can be flame, hot liquids, electrical currents, chemical contact
- Wound color ranges widely from pale white to red, brown, or charred.
- The burned area lacks sensation because nerve fibers are damaged.
- Appears, pale, white, leathery and dry due to the destruction of microcirculation
- Edema
- Hair follicles and sweat glands are destroyed.
- Severity often deceiving because no pain in the injury area
- Patient may be unconscious or in a coma
- Shock
- Myoglobinuria
- May have Eschar
- May need grafting
- Scarring and loss of contour and function
8
Q
4th Degree - Full Thickness Burn
A
- includes fat, fascia, muscle and or bone
- Caused by prolonged exposure or high voltage electrical injury Extend into deep tissue, muscle, or bone
- Shock
- Myoglobinuria
- Charred appearance
- Amputations likely
9
Q
Classifications of burn depth from Kaplan
A
- Superficial (1st Degree) eg. sunburn
- Superficial partial-Thickness (2nd Degree) eg. Scalds from hot water
- Deep partial-thickness (2nd Degree) eg. Scalds from grease
- Full Thickness (3rd Degree) eg. Extensive contact hot objects
- Deep Thickness (4th Degree) eg. Extensive contact hot objects
— Brunner readings do not get this specific.
10
Q
Body Surface Area
A
- Different methods used to estimate TBSA = Total Body Surface Area affected
- Rule of Nines
- Lund and Browder
- Palmer Method
- Tools used to make decisions on which hospital to treat patient.
- Chart 62-2 gives criteria for referral to Burn Center
11
Q
Rule of Nines
A
As an example, if both legs (18% x 2 = 36%), the groin (1%) and the front chest and abdomen were burned, this would involve 55% of the body.
12
Q
Pathophysiology of Burn Injury
A
- Local and systemic problems which affect F/E, protein losses, sepsis and multiple system changes. (30% or more approx.)
- Anatomic changes – Depending on how deep, skin may not grow back Functional changes – missing protective barrier, F/E balance
— Temperature – skin maintains temperature, Vit D, Phys Identity - Pain – Most are very painful (full thickness burn destroys nerve endings)
- https://www.youtube.com/watch?v=OxPlCkTKhzY
13
Q
Pathophysiology of Burn Injury
A
- Immediately after injury generalized edema
- Hypermetabolism
- Hyperdynamic circulation
- Increased o2 glucose consumption
- Catabolism of muscle and bone
- Immune dysfunction
- Insulin resistance
- Impaired organ perfusion
14
Q
Burn s/s: system
A
- Cardiovascular
— Cardiac depression, edema, hypovolemia - Pulmonary:
— Vasoconstriction, edema - GI:
— Impaired mobility and absorption,vasoconstriction, loss of mucosal barrier function with bacterial translocation, increased pH - Kidney: vaso constriction
- other:
— Altered thermal regulation, immuno-depression, hypermetabolism
15
Q
Cardiovascular Changes
A
- Hypovolemic shock – Common cause of death in early phase in patients with serious injuries
- Volume Fluid Leak in first 24-36 hours peaking at hour 6-8
- Low CO until 18-36 hours post injury or until fluid resuscitation
Nursing Interventions
— Monitor V/S, Cardiac Rhythm especially in cases of electrical burn injuries.
— Edema
— Peripheral pulses
— Fluid Resusitation
16
Q
Fluid and Electrolyte Alterations
A
- Fluid shift: Third spacing or capillary leak syndrome, usually occurs in first 12 hr, can continue 24 to 36 hr
- Profound imbalance of fluid, electrolyte, acid-base; hyperkalemia and hyponatremia levels; hemoconcentration (decrease in plasma volume causing increase in concentration of RBC’s and other constituents)
- Fluid remobilization after 24 hr, diuretic stage begins 48 to 72 hr after injury, hyponatremia and hypokalemia
- Edema can lead a circumferential burn to compartment syndrome.
- Treatment for edema
— Elevation
— Removal of eschar - escharotomy
— Decompression of edema - Fasciotomy
17
Q
Surgical Management of Burns in Resuscitation Phase
A
Escharotomy
Fasciotomy
18
Q
Pulmonary Assessment
A
- Determine if inhalation injury
- Continuous airway assessment is a nursing priority.
- Degree of inhalation depends on source, temp, environment and toxic gas
- Assess for:
— Burns inside mouth
— Singed nasal hairs
— Black particles of carbon
— Edema of nasal septum
— Smoky smell to breath. - Give O2 and Call RRT if: hoarse, brassy cough, drooling, difficulty swallowing, audible breath sounds
21
Q
Immunologic/Thermoregulator/GI
A
- Skin is the largest barrier to infection
- Burn injury produces cytokines that cause WBC destruction
- Loss in ability of body to regulate temperature
- Low Body temps
- Changes in GI function expected
- Decreased blood flow and sympathetic stimulation during early phase cause reduced GI motility, paralytic ileus
- GI bleeding
- Curling’s ulcer (24 hours)
