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Adult Health 2 Test 4 > Burns > Flashcards

Burns Flashcards

1
Q

What are the different types of caused of burn injury?

A

Thermal - fire, too hot of water
Chemical - acid, some type of chemical, can effect lungs
Inhalation - smoke fire
Electrical - entrance and exit, heart, lungs and stomach can be damaged

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2
Q

Thermal burns

A 
most common type of burn
flame
scald
contact with hot objects 
 Cold Thermal therapy: frostbite
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3
Q

Chemical Burns

A

Destruction of tissue from necrotizing substances, acids, chemicals
Flush profusely
may need to use saline

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4
Q

Inhalation Burns

A

Inhalation of hot air, chemicals into respiratory tract
Three types of smoke inhalation injuries
Carbon monoxide poisoning
Inhalation injury above the glottis
Inhalation injury below the glottis
Treat - put them on a face mask of 10L O2
If glottis is swollen then intubate to protect the airway
Cherry red is a sign of carbon monoxide poisoning

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5
Q

Electrical Burns

A

Intense heat generated from an electrical current
resulting from coagulation necrosis
may result from direct damage to nerves and vessels causing tissue anoxia and death
The severity of the electrical injury depends on the amount of voltage

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6
Q

How do you classify burn injuries?

A

Severity determined by:
Depth of burn: how many layers
Extent of burn: total body surface area
Location of burn: some areas more susceptible to problems than others
Other patient risk factors: age, other medical problems
Burn degrees: first, second, third, and fourth

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7
Q

1st degree superficial partial-thickness burns

A

those in which the epidermis is the only layer of skin destroyed
uncomplicated healing occurs in 3 to 5 days
blanches with pressure, top layer of the dermis

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8
Q

2nd degree deep partial-thickness burns

A

extend into the upper layers of the dermis or even into its deeper layers.
healing occurs in 2 to 3 weeks
blisters, does not blanch

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9
Q

3rd degree full-thickness burns

A

reach through the entire dermis and sometimes into subcutaneous fat
the skin cannot heal on its own
leathery, gray, insensitive to pain

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10
Q

4th degree burns

A

damage not only skin but also muscle and bone

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11
Q

Rule of 9’s

A 
one sided - double for both sides 
head - 4.5% 
upper chest - 9%
abdomen - 9% 
each arm - 4.5% 
each leg - 9%
genital area - 1%
palms - 1%
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12
Q

What are some complications of facial, neck or chest burns?

A

respiratory obstruction

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13
Q

What are some complications of hands, feet, eye burns?

A

self-care

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14
Q

What are some complications of ears, nose, buttocks, perineum burns?

A

infection

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15
Q

What are some complications of circumferential burns?

A

circumferential burns of the extremities can cause circulatory compromise
may also develop compartment syndrome

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16
Q

In the Pre-hospital care phase of burn management how do you care for the patient?

A 
remove from source 
rescuers protect themselves 
stop burning-remove clothes-if airway/breathing impaired-deal with this first
Initiate treatment
  ABC's
  Cool area - watch for hypothermia
  Remove clothing 
  Transfer to burn center
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17
Q

In the emergent (resuscitative) phase of burn management how do you care for the patient?

A

may last from onset to 5 or more days (usually up to 72 hours)
Resolve immediate problems - hypovolemic shock and edema formation
Do a CBC and BMP
If H&H is elevated - start or increase fluid
If H&H is decreased - stop fluids

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18
Q

What are signs and symptoms of fluid loss in burn patients?

A

decreased BP
increased heart rate
decreased pulsed
dysrhythmias

19
Q

What could be causes of fluid loss in burn patient?

A

hypovolemia -“third spacing” - capillary leak
decreased cardiac output
must treat shock
major shifts of electrolytes

20
Q

What are the possible cardiac complications in the emergent phase of burn management?

A

dysrhythmias and hypovolemic shock. Impaired circulation in the extremities. If untreated ischemia, paresthesia, necrosis, and gangrene can occur. Escharotomy (a scalpel or electrocautery incision through the full-thickness eschar) is frequently performed. Initially, there is an increase in blood viscosity with burn injury because of the fluid loss that occurs in the emergent phase. Microcirculation is impaired because of the damage to skin structures that contain small capillary systems. These two events result in a phenomenon termed sludging. Sludging can be corrected by adequate fluid replacement.

21
Q

What are the possible respiratory complications in the emergent phase of burn management?

A

The respiratory system is especially vulnerable to two types of injury. First, upper airway burns that cause edema formation and obstruction of the airway. Second is the lower airway injury. Upper airway distress may occur with or without smoke inhalation, and airway in that either level may occur in the absence of burn injury to the skin. Chest x-ray may initially appear normal on admission, with changes noted over the next 24 to 48 hours. ABG may also appear normal on admission, but change during hospitalization.

22
Q

What are the possible urinary complications in the emergent phase of burn management?

A

ATN, hypovolemic. With full-thickness and electrical burns, myoglobin (from muscle breakdown) and hemoglobin are released into the bloodstream and occlude the renal tubules. Give fluids.

23
Q

What is the Parkland formula for fluid replacement in burn patients

A

4cc x kg x BSA

administer half of this total over the first 8 hours and the other half over the next 16 hours

24
Q

What type of fluids do we start with first

A

crystalloids and then we move to colloids

25
Q

How do we know if we are giving enough fluid?

A

urine output should be 1ml/kg/hr

26
Q

During the emergent phase of burn management what nursing assessments do we perform?

A 
airway management
fluid therapy 
wound care 
drug therapy 
nutritional therapy 
physical/occupational therapy 
respiratory therapy 
psychosocial care
27
Q

During the emergent phase of burn management what interventions do we perform?

A 
intubation 
IV fluids 
debridement 
pain medication, sedation, antibiotics, tetanus, DVT and Ulcer prophylaxis 
aggressive enteral feedings
28
Q

What is the acute phase of burn management

A 
begins about 72 hours after injury and lasts until wound closure is complete 
mobilization of extracellular fluid 
burn area covered with skin grafts 
wounds are healed 
may take weeks or months
29
Q

What are the clinical manifestations during the acute phase of burn management?

A 
edema subsides 
eschar forms 
scar tissue 
lab values 
  hypo/hypernatremia 
  hyper/hypokalemia
30
Q

What are complications during the acute phase of burn management?

A 
infection (treatment abx)
Sepsis (treatment - abx and fluids 
contractures ( treatment ROM, splinting)
Ileus - protonics 
Curling's ulcer - PPI
Hyperglycemia - insulin
31
Q

What are reasons for infection during the acute phase of burn management?

A

burn itself- skin is body’s first line of defense
intubation
foley
IV central lines

32
Q

What is the nursing care and management during the acute phase of burn management?

A

wound care
infection big problem (gram +) MRSA, Acinetobacter, Pseudomonas, Klebsiella
Daily observation, assessments, cleaning, debridement and dressing changes
Antimicrobial creams - silver sulfasiazine (Silveadene)
Mafenide acetate (Sulfamylon)
Topical antibiotics
Polysporin - face
hydrotherapy
debridement
multiple dressing
pressure garment therapy

33
Q

Escharotomy

A

when they slice someone open to relieve pressure after a burn

34
Q

What are skin grafts?

A

surgical procedure
skin or skin substitute is placed over a burn
permanently replace damaged or missing skin
provide a temporary wound covering

35
Q

What are the different types of skin grafts?

A 
synthetic wound covering - Biobrane 
autograft 
allograft 
xenograft 
split thickness 
full thickness
CEA - cultured epithelial autograft
36
Q

How do you care for a patient following a skin graft?

A 
care of donor site
care of graft site 
elevation/proper positioning 
infection control 
donor site ( know your physicians and units policies regarding care of the donor and graft sites)
37
Q

What is the issue with pain for burn patients?

A

big issue-on going assessment
initially IV meds need to be given
ongoing pain vs. treatment induced pain
break through pain
pain tolerance/medication tolerance
addiction - don’t worry about it at this point

38
Q

what are the nutritional needs for burn patients?

A 
nutritional needs of a patient with large burn area can exceed 5,000 calories/day
need protein to promote healing 
TPN
Carbohydrates
Fats 
Proteins
39
Q

What are issues with the GI/endocrine systems in burn patients?

A

paralytic ileus
diarrhea/ constipation
curlings ulcer
hyperglycemia

40
Q

What is the rehabilitation phase in burn management?

A

Begins when wound closure is complete and ends when the patient returns to the highest possible level of functioning
Patient is able to resume level of self care activity
Goal:assist patient in resuming functional role in society

41
Q

What are clinical manifestations of the rehabilitation phase of burn management?

A

Home care management
Prevention of Scarring and contractures
pain/discomfort
psychological problems

42
Q

How can we meet the emotional needs of a burn patient and their families?

A

support system
psychiatric crisis
support groups
burn camps

43
Q

What are discharge needs for burn patients?

A 
wound care 
splints/jobst
ongoing PT/OT
Follow-up appointments 
Emotional support
44
Q

What are gerontologic considerations of burn patients?

A

normal aging puts the patient at risk for injury because of:
unsteady gait
failing eyesight
diminished hearing
the fact that wounds take longer to heal

Adult Health 2 Test 4 (5 decks)

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