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NU 374 > Burns > Flashcards

Burns Flashcards

1
Q

__ hampers the ability to shiver

A

small muscle

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2
Q

infants < 6 months old rely on ___ temperature controls

A

metabolic temp controls

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3
Q

temperature regulation for burns

A
  • monitor core temperature
  • external protection ie blankets, warm room
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4
Q

first degree burn

A
  • Involves the epidermal layer only
  • Self-replacing 3-6 days after skin sloughs off
  • Skin intact; No blisters; erythema; blanches; Desquamation within 1 week of injury
    mild pain for several days
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5
Q

second degree burn (partial thickness)

A
  • Extends into dermal layer
    Self-healing with scarring in approx. 14-21 days
  • Wet appearance; shiny skin, weepy; intact and partially open blisters; wound blanches; sensitive to temperature, air, and touch
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6
Q

deep 2nd (almost full thickness)

A
  • Deep 2nd burns resemble full-thickness but structures such as sweat glands and hair follicles are intact
    Self-healing with significant scarring in > 21 days
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7
Q

third degree (full-thickness)

A
  • Extends to the subcutaneous layer destroying nerve endings, sweat glands, and hair follicles
  • Periphery of wound has 1st or 2nd degree characteristics
    Color varies (velvet red, white, black, brown)
    Thrombosed vessels can be seen
    Dry leathery appearance
    Degree of pain is dependent on depth (appears with healing)
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8
Q

fourth degree (deep full-thickness)

A
  • Injures underlying structures including muscle, fascia, and bone with exposure of ligaments, tendons, and bone
  • Color varies with charring in deepest areas
    Impaired ROM
    Dull dry appearance
    Insensitive to pain
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9
Q

minor burn

A

Partial thickness <10%
Full thickness <2%

treat outpatient prn

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10
Q

moderate burn

A

Partial thickness 10-20%
Full thickness 3-10%
Hot liquids

treat in hospital with burn center expertise

Topical treatments
Autografting may be required

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11
Q

major burn

A

Partial thickness >20%
Full thickness >10%
Burns involving face, eyes, ears, hands, feet, and perineum
Electrical burns, flame burns, inhalation injuries, pre-existing conditions

treat in specialized burn center
- Surgical excision and grafting
Amputation if no circulation to area

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12
Q

key points of moderate and major burns

A
  • Most dramatic fluid shift in first 8-12 hrs.
  • Fluid replacement is calculated from burn injury time not ER arrival
  • Hypotonic IVF=high risk of hyponatremia, cerebral edema and seizures
  • Increases in cyanosis, deep tissue pain, cap refill and decreased pulses with a circumferential burn=immediate MD call
  • Elevate burned extremities
  • Frequent monitoring and linen changes
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13
Q

nursing assessment: history

A

brief: inhalation injury
detailed: if non-life threatening

A thorough health history is important. It can help determine the seriousness of the injury. Depending on the severity of the burns, it may not be possible to get all of the data at once.

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14
Q

nursing assessment: detailed history

A

Description of incident (Date, time, cause)
r/o smoke inhalation or associated fall
Document treatment received thus far
Child’s recent health status
allergies
Current meds
Recent or chronic illness
Immunization history (esp. most recent tetanus)
Evaluate for abuse vs. accidental injury

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15
Q

physical assessment: primary survey

A
  • Airway- is it patent? Maintainable?
  • inhalation injury suspicion
  • Skin color
  • Respiratory-effort? Symmetry? Breath sounds?
  • Cardiovascular- pulse strength? Perfusion? Heart rate? Edema? (grade)
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16
Q

physical assessment: secondary survey

A

Determine burn depth

Estimate TBSA (rapid estimation with chart or child’s hand)

Any other traumatic injuries? (cervical, internal)
- Perform head to toe exam to rule out associated injuries
- Knowing the mechanism of injury helps predict the type of associated trauma
- Do not be overwhelmed by the appearance of the burn

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17
Q

Suspect inhalation injury if:

A
  • Burns around mouth, nose, or eyes
  • Black colored sputum
  • Hoarseness or stridor
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18
Q

pediatric airway anatomy

A

Relatively small airway

Less edema is needed to develop obstruction
- Larynx more anterior than in adult
- Glottis more angulated and more anterior
- Narrowest point is cricoid, not glottis
- Insert NGT for decompression which will help to eliminate swallowed air

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19
Q

breathing assessment

A

Normal use of abdominal muscles when breathing
Ensure bilateral breath sounds
Obtain CXR for tube placement
Secure tubes

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20
Q

care of burn patient: introduction

A
  • ABC’s first
  • Proper wound management critical in all phases of care
  • Survival and functional outcome both depend on successful burn wound healing
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21
Q

care of burn patient: circulation

A

Initiate fluid resuscitation immediately
Establish early IV access:
- Percutaneous Cutdown
Femoral IO

prehospital/during primary triage at hospital:
- 5 years old and younger: use LR @ 125ml/hr.
- 6 – 14 years old: use LR @ 250ml/hr.
- Fluid for child <10kg: use D5LR

22
Q

care of burn patient: disability

A

Assess level of consciousness
Hypoglycemia
Hypoxia

23
Q

care of burn patient: expose, examine and environmental control

A

Remove all clothing including diaper
Assess for associated or pre-existing injuries
Cover with clean, dry linens
Conserve body heat

24
Q

secondary survey: history

A

Events leading to injury
Past medical history
Immunization history
Allergies
Consider potential for abuse

25
Q

secondary survey: calculate TBSA burn

A

Bigger head Front and Back totals
Smaller legs
Palmer method
(Infant hand – 1%)

26
Q

secondary survey: fluid resuscitation

A

½ of total in the 1st 8 hours post injury

The other 1/2 over the next 16 hours

27
Q

fluid resuscitation formular

A

children > 14 yr or > 40kg:
2mL/kg x patients weight in kg x TBSA, divide by 2 (run based on burn time)

children < 14 yr or < 40kg:
3mL/kg x patients weight in kg x TBSA, divide by 2 (run based on burn time)

electrical burns:
4mL/kg x patients weight in kg x TBSA, divide by 2 (run based on burn time)

28
Q

fluid resuscitation formulas are ____. the nurse should ___ to maintain ____.

A

Fluid resuscitation formulas are ESTIMATES only!!
- Titrate IVF ↑ or ↓ by 1/3 to maintain U/O of 1ml/kg/hr.

29
Q

escharotomy

A

Circumferential extremity or torso burns
Rarely done prior to transfer
Consult with the burn center

30
Q

pain management of burns can reduce:

A

Sleep deprivation
Anxiety
tantrums
Pruritus
Post-traumatic stress
Regression
Contractures (from scars and disuse)
Graft loss (movement)

31
Q

pain management of burns

A

Narcotics-morphine (IV or PO)
Anesthetics-propofol or ketamine
Antihistamines-diphenhydramine
Relaxation
Distraction
Medical play
Guided imagery
Family participation

32
Q

child abuse

A

Pattern not compatible with history given
Story changes
Younger sibling is blamed for injury
Caregiver absent at time of injury
Delay in seeking treatment
Child appears passive
Other injuries

33
Q

transfer criteria

A

Partial and Full-thickness burns to:
- face
- hands
- feet
- genitalia
- perineum

Inhalation injury
Chemical injury
Electrical injury

34
Q

average hot water heater setting

A

140°

35
Q

boiling water temperature

A

212°

36
Q

temperature of cooking oil when frying

A

350-450°

37
Q

flash point of cooking oils temperature

A

500-700°

38
Q

temperature for burn injury in 10 sec

A

130°

39
Q

burn injury in 5 seconds

A

140°

40
Q

temperature for instantaneous full thickness burn

A

160°

41
Q

prevention of burns

A

Stop drop and roll

Plug outlets

Water heater temperature

Back burner cooking

Cabinet locks

No smoking

How not to start a fire…..

42
Q

fire escape plan

A
  • working smoke detectors
  • two ways out
  • practice at least 1x/month
  • have a meeting place
  • count heads
43
Q

broselow tape is used if

A

use if age or weight is unknown to detect TBSA

44
Q

rule of nines

A

Rule of nines in 2nd and 3rd degree burns
Calculate percent of each area burned and not the entire area

Note: If one surface of an upper extremity is burned = 4 ½ percent TBSA rather than 9% as indicated on the lower extremities.

45
Q

rule of nines: infant

A
46
Q

patients palmar surface (hand and fingers) TBSA %

A

1% TBSA

47
Q

oliguria

A
  • Usually due to inadequate resuscitation
  • Associated with elevation of SVR and reduction of cardiac output
  • Diuretics are contraindicated
  • Requires increased hourly fluid administration
48
Q

hourly urine output

A
  • large sized pre-teens and adolescents: 0.5mL/kg/hr (30-50mL/hr)
  • infants and children: 1mL/kg/hr

If expected UOP increased/decreased for 2 consecutive hours:
- Decrease / increase fluid infusion by 1/3

49
Q

monitoring resuscitation

A

Assess mental status frequently

Anxiety and restlessness may reflect hypoxia

Urinary output most reliable guide
- Indwelling bladder catheter
- Dependent upon normal renal function

50
Q

limited glycogen stores when under age __

A

1 year old
- monitor blood glucose

51
Q

pediatric patients are more susceptible to (fluid ___)

A

fluid overload

52
Q

resuscitation and LR

A
  • Mimics intravascular fluid
  • Treats hypovolemia
  • Replaces intracellular sodium deficits
  • For moderate and severe burns
  • Infuse via large bore IV, Central line, or IO route

NU 374 (18 decks)

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