Burns Flashcards
What are the different types of caused of burn injury?
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
Thermal burns
most common type of burn flame scald contact with hot objects Cold Thermal therapy: frostbite
Chemical Burns
Destruction of tissue from necrotizing substances, acids, chemicals
Flush profusely
may need to use saline
Inhalation Burns
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
Electrical Burns
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
How do you classify burn injuries?
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
1st degree superficial partial-thickness burns
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
2nd degree deep partial-thickness burns
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
3rd degree full-thickness burns
reach through the entire dermis and sometimes into subcutaneous fat
the skin cannot heal on its own
leathery, gray, insensitive to pain
4th degree burns
damage not only skin but also muscle and bone
Rule of 9’s
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%
What are some complications of facial, neck or chest burns?
respiratory obstruction
What are some complications of hands, feet, eye burns?
self-care
What are some complications of ears, nose, buttocks, perineum burns?
infection
What are some complications of circumferential burns?
circumferential burns of the extremities can cause circulatory compromise
may also develop compartment syndrome
In the Pre-hospital care phase of burn management how do you care for the patient?
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
In the emergent (resuscitative) phase of burn management how do you care for the patient?
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
What are signs and symptoms of fluid loss in burn patients?
decreased BP
increased heart rate
decreased pulsed
dysrhythmias
What could be causes of fluid loss in burn patient?
hypovolemia -“third spacing” - capillary leak
decreased cardiac output
must treat shock
major shifts of electrolytes
What are the possible cardiac complications in the emergent phase of burn management?
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.
What are the possible respiratory complications in the emergent phase of burn management?
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.
What are the possible urinary complications in the emergent phase of burn management?
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.
What is the Parkland formula for fluid replacement in burn patients
4cc x kg x BSA
administer half of this total over the first 8 hours and the other half over the next 16 hours
What type of fluids do we start with first
crystalloids and then we move to colloids
How do we know if we are giving enough fluid?
urine output should be 1ml/kg/hr
During the emergent phase of burn management what nursing assessments do we perform?
airway management fluid therapy wound care drug therapy nutritional therapy physical/occupational therapy respiratory therapy psychosocial care
During the emergent phase of burn management what interventions do we perform?
intubation IV fluids debridement pain medication, sedation, antibiotics, tetanus, DVT and Ulcer prophylaxis aggressive enteral feedings
What is the acute phase of burn management
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
What are the clinical manifestations during the acute phase of burn management?
edema subsides eschar forms scar tissue lab values hypo/hypernatremia hyper/hypokalemia
What are complications during the acute phase of burn management?
infection (treatment abx) Sepsis (treatment - abx and fluids contractures ( treatment ROM, splinting) Ileus - protonics Curling's ulcer - PPI Hyperglycemia - insulin
What are reasons for infection during the acute phase of burn management?
burn itself- skin is body’s first line of defense
intubation
foley
IV central lines
What is the nursing care and management during the acute phase of burn management?
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
Escharotomy
when they slice someone open to relieve pressure after a burn
What are skin grafts?
surgical procedure
skin or skin substitute is placed over a burn
permanently replace damaged or missing skin
provide a temporary wound covering
What are the different types of skin grafts?
synthetic wound covering - Biobrane autograft allograft xenograft split thickness full thickness CEA - cultured epithelial autograft
How do you care for a patient following a skin graft?
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)
What is the issue with pain for burn patients?
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
what are the nutritional needs for burn patients?
nutritional needs of a patient with large burn area can exceed 5,000 calories/day need protein to promote healing TPN Carbohydrates Fats Proteins
What are issues with the GI/endocrine systems in burn patients?
paralytic ileus
diarrhea/ constipation
curlings ulcer
hyperglycemia
What is the rehabilitation phase in burn management?
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
What are clinical manifestations of the rehabilitation phase of burn management?
Home care management
Prevention of Scarring and contractures
pain/discomfort
psychological problems
How can we meet the emotional needs of a burn patient and their families?
support system
psychiatric crisis
support groups
burn camps
What are discharge needs for burn patients?
wound care splints/jobst ongoing PT/OT Follow-up appointments Emotional support
What are gerontologic considerations of burn patients?
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
