Burns Flashcards
1
Q
what are the 5 types of burn injuries?
A
thermal burns
chemical burns
smoke inhalation injury
electrical burns
cold thermal injury
2
Q
what are the 2 biggest concerns we have with burns ?
A
third spacing
- fluid leaking into the institial space
- making you at risk for shock
smoke inhalation
3
Q
how do you get a thermal burn ?
examples
A
steam
fire/touching
out in the sun
close to a fire
4
Q
what is our concern for thermal burns ? (2)
A
massive fluid shift
sodium and potassium imbalances
5
Q
so when a patient has a thermal burn, we understand that our biggest concern is massive fluid shift, however its also sodium and potassium imbalance.
what are we looking for when a patient has sodium imbalance ?
what are we looking for when a patient has potassium imbalance ?
A
sodium - neurological changes
potassium - cardiac changes, like dysrhythmias
6
Q
how do we get chemical burns ?
A
acid or alkaline burn
from like gas, fertilizers
7
Q
what is our concern for chemical burns ? (2)
A
burns from alkaline substance cause severe damage
(protein is dissolved)
( dissolve tissues typically )
8
Q
we like to do what with patients who has a chemical burn ?
A
remove the compound if possible, cut off their clothing
shower the patients off
water to rinse
9
Q
which one if worse for the patient, acid or alkaline for chemical burns ?
A
alkaline because it causes severe damage to the tissue
10
Q
how do patients get electrical burns ?
A
lighting strike
electricians touching a wire
11
Q
what is the issue with electrical burns?
A
we typically can’t see what’s burn, because it goes from the point of contact to where youre grounded.
if youre feet are on the floor, it’ll exit there
sitting on the ground, through your back
lighting strike, it’ll go through your organs
12
Q
when a patient gets an electrical burn, what can happen to our muscles?
A
they tense up so bad that it can result in a patient having a fracture from the muscle spasms
13
Q
since there is a lot of muscle damage when it comes to burns, your cells rupture, so that results in what ?
A
potassium floating around, meaning we are worried about dysrthymias
14
Q
not only we have a lot of potassium floating around, their is myoglobin floating around, which the kidneys aren’t made to filter and control that, causing the patient to have what?
A
acute kidney injury
15
Q
now that we discuss everything for electrical, what are the 4 concerns we are worried for a patient ?
A
hidden injuries
fractures
cardiac dysrhythmias
acute kidney injury
16
Q
how do we get smoke inhalation ?
A
inside the fire or smoke
doesn’t even have to be inside
17
Q
what would you see in a patient who had smoke inhalation ?
A
coughing black/smut
tri-poding
shortness of breath
hoarseness
snig marks around their mouth
18
Q
when a patient has a burn on their chest, face, neck, we are going to be much more worried about what ___ compared to someone who drop something on their foot
A
smoke inhalation
anything close to the airway, its concerning
19
Q
remember if they are coughing stuff up from smoke inhalation, what does it look like ?
A
black smut
20
Q
if a patient is just breathing in smoke, what is the patient at risk for ?
A
carbon monoxide poisoning
21
Q
what is the patho and dangerous behind carbon monoxide posiniong?
A
carbon monoxide is 100% more likely to attach to your hemoglobin rather than oxygen
22
Q
what is the issue behind a patient who has carbon monoxide poisoning ?
A
when you do a pulse ox, the pulse ox can’t tell the difference between oxygen and carbon, so it’ll come out to be normal
23
Q
instead of doing the pulse ox on a patient who has carbon monoxide because they can’t be distinguished, we are instead going to do what?
A
abgs
labs
vital signs
24
Q
another thing that happens if someone is inhaling either smoke or hot air, they are at risk for what?
A
burns of their airway just from breathing hot air !
inflammation and swelling up of their airway from breathing that hot air
25
patients who are at risk of airways burns, tend to be what?
intubated because before the swelling gets so bad, intubating will be much harder so we do that
26
so what are the 4 concerns we have for patients who have smoke inhalation ?
CO replaces O2 on hemoglobin
bright red skin
look for evidence of smoke inhalation
may need early intubation
27
after intubation with burns patients, we have to do what?
fluid replacement because of those capillaries are so leaky
28
as ironic and helpful fluid replacement is for patients, what can happen ?
massive swelling because remember those capillaries are leaky when the burns occurs, but when we come in to help replace that fluid, those capallries are not immediately going to accpet the water, so leakage is still going to be occurring with swelling the body
29
she skips through some slides but im going to talk about them now, however most of it was covered in the past flashcards
severity of a thermal burns depends on what two things?
temperature of burning agent
duration of contact time
30
what is the most common type of burn ?
thermal
31
why are alkali burns more difficult to manage for chemicals burns instead of acid?
because they cause protein hydrolysis and melting
32
notes
dangerous chemicals are in homes, business, and industries
iye and sulfuric acid, common chemicals used to unclog sinks in homes
wet cement, oven cleaners, and have industrial cleaners
organic compounds include phenols and petroleum product
33
smoke inhalation injuries are often caused by what two things?
breathing noxious chemicals
hot air
34
smoke inhalation can cause a rapid development of ?
airway compromise
pulmonary edema
35
what are the 3 types of smoke inhalation ?
upper airway
lower airway
metabolic asphyxiation
36
typically when patients go into metabolic asphyxiation, they end up look what skin color ?
cherry red skin color
37
how can we treat metabolic asphyxiation ?
non-rebreather, with 100% oxygen
they are getting a lot of oxygen, so better chance that oxygen will attach to hemoglobin
hypobarriaric chamber as the end/last result
38
she doesn't want us to really focus on upper and lower airway injury
so for some note
injury to mouth, oropharynx, and or larynx
- thermal burns
- inhalation of hot air, steam or smoke
swelling may be massive and onset rapid
- eschar and edema may compromise breathing
- edema from facial and neck burns can be lethal
- internal pressure from edema may narrow airway
obstruction can occur quickly presenting airway emergency
39
assess for upper airway injury
- blisters
- edema
- difficulty swelling
- stridor
- total airway obstruction
40
lower airway notes
- tissue damage is related to duration of exposure to toxic fumes or smoke
- pulmonary edema may not appear until 12-48 hours after burn
- may manifest as ards
41
assess for lower airway
- facial burns
- hoarseness
- painful swallowing
- carbonaceous sputum
- clothing burns around neck and chest
42
when a patient has an electrical burn, what are some forms of dependency of severity for these patients ?
the amount of voltage
tissue resistance
surface area
length of time current flow was sustained
current pathways
43
something very tragic with patients who have electrical burns is that when they are getting electricuted, they need know they are, however what is the sad part or more so dangerous part?
they need to let go, however the only way they can let go is when they fall
the muscles are so strong and being used during it
44
some common sense knowledge
the Current that passes through vital organs proceeds more ?
life threatening sequelae
45
electric sparks may also ignite a patients clothing, causing not only electrial burn but a ?
thermal flash injury
46
severity of injury can be difficult to determine for patients who have electrical burns because most damage occurs where ?
below the skin
47
electrical current cause ______strong enough to ____long bones and vertebrae
muscle spams
fracture
48
to restate, myoglobin from injured muscles and hemoglobin from damaged abcs travel to the kidneys during an electrical burns, causing the potential what ?
acute kidney injury
49
what are some basic classifications of burn injury ?
dont over think it
depth of the burn
extend of burn
location of burn
age of patient
pre-burn medical history
circumstances/complicating factors
50
where do you think on the body is our most concern for having a burn ?
face
chest
hands / feet
neck
genital
51
superficial partial thickness burn is what?
- epidermis
deep partial thickness is what?
- to the dermis
full thickness burn is what?
- down to the bone
1st degree
2nd degree
3-4th degree
52
something interesting to note, that most of the time patients who have full thickness burns, so that 3-4th degree, dont feel any pain or may even realize about the severity of the pain, why do you think so ?
cause they completely burned off the nerves, so there is basically nothing there
53
in a full thickness burns, epidermis and dermis are destroyed, however what is another name for full thickness ?
eschar
54
what is eschar ?
leather-y tissue, doesn't move, no stretching
55
how does eschar affect the body ? in two ways
if the patient has eschar around the neck, they aren't able to breathe, remember it isn't stretchy enough to expand the airway
or if its on an extremity, circulation is awful, so compartment syndrome is more than likely to occur
56
what are two common tools we used to determine the total body surface area ?
lund-browder chart
( more accurate )
rules of nines
( initial assessment )
57
she is going to test us on the rule of nines
it depends the body in sections, we are going to talk about the percentage
head %?
chest %?
arms %?
legs %?
genital%?
4.5 - total 9
(front and back)
18 - total 36
(front and back)
4.5 - total 9
( for one arm, for both arms, it would be total of 18 )
9 - total 18
( for one leg, total for both legs would be 36 )
1
58
in this flashcard, I want you to tell me what we are mainly concerned about when a patient has a burn somewhere in their body ?
face, neck, chest, torso?
hands, feet, joints, eyes?
ears, nose, buttocks, perineum?
respiratory obstruction
impaired gas exchange
edema, leathery eschar
self-care difficulty due to limited mobility
high risk for infections
59
as mentioned before, when a patient has a circumferential burn on their extremities, circulation problems will occur, which can cause compartment syndrome
not only that, its super hard to treat hands and feet because of what ?
superficial vascular and nerve supply
60
notes
patient risk factors
- preexisting heart, lung or kidney disease contribute to poorer prognosis
- DM and PVD put patient at high risk for delayed healing
- physical weakness make it challenging for patients to recover
( alcohol and malnutrition )
head injuries, or other trauma leads to more difficult time recovering
61
if there comes a time you stumble upon a patient who is burn, what are the steps you are going to do to help ? (3)
1. scene safety
2. remove person from source of burn and stop burning process
( throw water )
3. wrap person dry, clean sheet
62
why do we want to wrap a burn patients in something dry ? (2)
prevents wound contamination
provides warmth
63
while giving a burn patient moist dressing can help reduce the pain and burning feeling, it may cause what?
hypothermia
64
what do we do for chemical burns prehospital phase ? (2)
remove chemical particles or powder
flush area with water
65
what do we do for inhalation burns/injuries? (2)
watch for signs for respiratory distress
100% oxygen if CO poisoning is suspected
66
what are the 3 phases of burn management ?
she wants use to understand the progression, healing, or getting worse
emergent (resuscitative)
acute (wound healing)
rehabilitative (restorative)
67
the emergent phase is up to what?
72 hours
68
what are we mainly focus on in the emergent phase? (3)
fluid electrolytes shifts (hypoveolmic shock)
- fluid
gas exchange & edema
( airway is patent )
69
what are the 3 body systems are at most risk during emery phase ?
respiratory
cardiac
Kidney
70
what are some clinical manifestations of emergent phase ? (6)
shock from hypovolemia
( capillary leakage )
pain
( It hurts )
blisters
(form of healing methods but its painful)
paralytic ileus
( stress ulcers, paralytic ileus, assess occult blood, feed in hours, because protein is important to heal, 24 hours start eating )
shivering
( metabolic increases, calories needs increases)
altered mental status, anxiety
( scared, pain )
71
has you have hypolvomic shock, what happens ? (3)
blood pressure??
heart rate?
respiratory rate?
hypotension
tachycardia
tachypnea
72
all this fluid leaves during a burn, where do you think red blood cells go ?
risk for
they stay in the blood, causing thick blood
risk for clots
( hard to pump )
73
if you were to do an h&h on these patients, what would it be ?
increase
because their blood is so thick, not because of the fluid
74
once your body detects that you have this damage tissue, what comes in to help ?
your white cells
( the inflammation and healing )
75
fibroblasts and newly formed collagen fibrils begin wound repair within ____hours after injury
6-12hours
76
notes
immune system is challenged when burn injury occurs
- skin barrier is destroyed
- bone marrow depression occurs
- circulating levels of immune globulins are decreased
- defects occur in function of WBCs
- patient risk for infection
77
impaired circulation to extremities with circumferential burns if left untreated can lead to
tissue ischemia
paresthesia
necrosis
78
what is an eschartomy?
a procedure to help restore circulation to compromise extremities and expand chest expansion that may contain eschar
by cutting down the eschar to fresh tissue
79
we understand that a patient who has a burn is more than likely not going to be walking around and are at risk for DVT, so they are more than likely going to be on what ?
iv heparin
80
remember patients who come in from a burn, their abgs and respiratory distress may be normal however it will change over what?
24-48 Hours
81
if a patient goes into chest-ray and or bronchoscopy, we are going to numb their throat in hopes to check for any smoke inhalation, blackness in their airway, so once the patient comes out of the procedure, what do we have to wait for to come back?
gag reflex
82
she mentions how we are going to learn acute kidney injury in the next powerpoint, or I guess in the next upcoming deck of flashcards I make however, the main thing she wants us to focus on is that?
acute kidney injury happens from all this myoglobin is floating around and can cause serious issues
so the sooner we recognize something is wrong, the better chances of preventing injury
83
if a patient becomes hypoveolmic, blood flow to the kidneys will decrease causing ____?
if this continues AKI will develop
renal ischemia
84
with full-thickness and major electrical burns, releases myoglobin ( muscles cell breakdown ) and hemoglobin (rbc breakdown ) can block ___
causing ?
renala tubules
acute kidney injury
85
so with kidneys, we want to monitor what ?
adequacy of
fluid replacement
urinary output
BUN and Creatinine
I&O
86
how are we going to help a patient with airway management ?
dont over think it
high fowlers position
100% oxygen
Deep breathing
suctioning
ABG
early endotracheal intubation
87
why is suctioning very concerning ?
can be irritating
dont always do it
88
how do we handle secretions ?
increase iv fluids
89
always remember we need what ???
2 large bore ivs
90
what is the formula we need to know about fluid therapy ?
parkland formula
91
what is the parkland formula ?
4ml of LR(fluid)
multiple by
%TBSA burned
multiple by
KG
4ml * %TBSA burned * KG
92
example of the math problem
200lb male with 25% TBSA burn = 9090ml in the first 24 hours
200 / 2.2 = 90.90
90.90 x 25 = 2,272.5
2,272.5 x 4 = 9,090
she's going to ask us very specific questions about this
first 8 hours you give them 50%
you did the 24 hours number by 2, then you get the number youre suppose to divide 8 with
second 8 hours is 25%
last 8 hours is 25%
93
monitor urine production is what ?
normal patient .30ml an hour
0.5ml/kg/minimum
94
wound care should be delayed until the patient is what?
stable
95
we are going to be cleansing
- can be done in the shower and or bed
debridement
- scissors, and cutting skins off
96
dressings, how often ?
once or twice a day
97
before we do debridement on a patient, we have to make sure what?
they are mediated
98
___gloves when ___dressing
___gloves when ____ointment or dressing
clean - removing
sterile - applying
99
why do we usually like to keep the face, eye and ears free from pressure ?
because not a ton of blood supply and keep them open to prevent scar tissue
100
we always want to use a roll up towel behind a patient neck to prevent what ?
contractures
101
GU/GI keep patients perineum what?
clean and dry as possible
102
what are some medications we might give patients in the emergent phase of burns ?
morphine
dilaudia
halloo
Ativan
103
why do we avoid giving im injections to patients who have burns?
pooling in edematous tissues
it will not get absorbed, instead it will just fill up in one section
104
why do we give patients tetanus shots?
to prevent further complications
105
notes
typically we like to give antimicrobial agents like
- silver sulfadiazine
- mafenide acetate
systemic antibiotics are not usually used because it can increase drug resistant flora of the skin
- only really used for sepsis concern
106
once again to review, if the patient is not moving what are they at risk or and what do we give?
risk for clots
iv heparin
107
we want to start nutrition how early?
and this will help with what?
24 hours
decrease complications
optimize burn wound healing
avoid negative effects with hyper metabolism
108
patients who are in a hypermetablioc state are going to need more what 2 things and why?
protein - healing
calories - energy
109
when does acute phase happen ?
after 72 hours
were done with fluid resuscitation
110
when does acute phase end ?
partial thickness wounds are healed or burns are covered by skin grafts
111
patients who are in the acute phase typically are what ?
dont over think it
diuresis ( normal kidney function )
bowel sounds return
healing happens
112
typically a patient heals how ?
if they get infected how ?
from the base up and from outside in
their own flora
113
when you got to get a culture, typically from burn patients, if it were to get infected, where would you get it ?
edges
114
when do you do skin Grafts for patients ?
acute phase
115
acute phase laboratory values sodium
hyponatremia happens how (2)
excessive diarrhea, gi suction
water intoxication
- from excess water intake
116
acute phase laboratory values sodium
hypernatremia happens typically right after a patient who has hyponatremia so what might we do ?
restrict sodium in iv and oral feedings
117
acute phase laboratory values potassium
how does hyperkalemia happens ?
renal failure, massive deep muscle injury
large amounts of potassium are released from damage cells
118
acute phase laboratory values potassium
how does hypokalemia happen ?
vomitting, diarrhea
prolonged gi suction
iv therapy without potassium supplementation
119
what are some signs and symptoms of infection that can happen in an acute phase?
can't body temp regulate
increase heart and rr
decrease bp
fever
obtain cultures
decline urine output
120
patients may become delirious, so what do we do as a patient ?
orientate them
lights on day
lights off at night
121
again paralytic ileus can happen to these patients, what we going to do for this patients ?
treat early feedings
ppi
occult blood
122
why do we want to watch blood sugar for these patients ?
usually how does the blood sugar increase in these patients and what do we treat it with ?
because if its too high, it can cause an infection
increase due to extra calories or stress
treat with insulin
123
note
remember we want pt or OT with musculoskeletal system
124
the following flashcards are going to be about the burns part 2 recording, so we may back track on some information
125
when does scar tissue start growing after getting burned?
6-12 hours
126
what is the biggest concern for cardiac on patients who have burns? (2)
dysrhythmias
hypovolemia shock
127
how do we help a patient who may be shivering after a burn ?
warming up the iv fluids
128
when a patient has a cardiac issue, typically from a burn patients will get dysrhythmias and hypovolemic shock, this will result in impaired circulation to extremities, typically with circumferential burns.
if these circumferential burns are left untreated, what will happen ?
explain what happens in this syndrome as well ^
compartment syndrome
- tissue ischemia, paraesthesia, necrosis
129
how do we treat compartment syndrome ?
escharotmy
130
what is escharotmy ?
a surgical procedure where a patient eschar is cut down to the healthy tissue inside the body, so it can allow for blood flow
131
once again when we get burned, we are losing a lot of fluid, resulting in edema and swelling around the burn and other parts of the body that are not receiving adequate circulation.
where do you think the blood is going to be when all the fluid leaves the vessels and caps?
risk for ^
how do we prevent it ?^
still there, but now its considered sludgy blood, the blood thickens so much to the point that it puts the patient at risk for developing a blood clot
venous thromboembolism risk
prophylaxis with anticoagulants
132
blood viscosity ___due to fluid loss
blood viscosity is the thickness of the blood
increases
133
how do we fix sludging, or that thickness of blood for these patients with increase blood viscosity ?
adequate fluid replacement
134
remember a patient can have a respiratory burn without even having a physical or present burn on the skin.
how is this possible?
with smoke inhalation or breaking in toxic fumes or breathing in hot air
135
more than likely when a patient has smoke inhalation, they are more than likely going to have what type of airway injury ?
lower ( cause their taking deep breaths of fumes into their alveoli )
136
what type of procedure can we do to go check the patient if they have lower airway injuries?
fiberoptic bronchoscopy
137
remember with any form of bronchoscopy in a patients airway we are going to numb the area in order to do the procedure, however what is important for the Nurse to asses after the procedure?
gag reflex
138
what confirms the carbon and oxygen in their blood?
dont over think it, its literally in the name
carbonxyhemoglobin
139
remember when we are going to be doing fluid resuscitation for these burn patients, they are going to be swelling 10x more now because the body is going to try to get use to it but its going to be very hard and leakage is still going to be occurring. Usually this changes within 24-48 hours on admission and treatment. from normal body swelling to normal fluid swelling.
so while they are swelling what are we going to be checking for ?
dont over think it, think of respiratory
breathing
tri-poding
respiratory distress
140
if a patient already had other cardiopulmonary problems, like heart failure, pulmonary edema, copd, why are they going to have a harder time trying to recover from the burn and fluid resuscitation ?
because of the fact that these patients are already trying to deal with a disease, and now with a burn it makes it harder to handle
141
remember for urinary, we have potassium being dropped out everywhere because from the muscle spams and the burns they just get dumped into your blood stream. Not only the potassium but myoglobin will spill out too, so with everything being spilled out, your kidneys are not use to filtering out, so this puts patients at risk for ?
acute tubular necrosis
because they can't filter all these waits
142
what is acute tubular necrosis ?
decreased blood flow in the tubules of the kidneys causing ischemia and puts your risk at acute kidney injury
143
what are we monitoring in patients with acute kidney injures ?
input and output
bun and creatine
urinary output
144
why do we want to intubate patients first before we do any fluid resuscitation ?
because of the extreme swelling, it'll make it harder to insert the tube down the patients throat
145
if you are considered about a patient being exposed to carbon monoxide, what must we give them ?
humidified air and 100% oxygen on non-rebreather mask
146
remember we suction as what ?
AS NEEDED!!!
147
just like with any major illness, injury or trauma, we must have what ?
2 large bore iv lines
148
what is the name of the formula we are going to use for the fluid formula ?
parkland (baxter) formula
148
what type of lines goes into large vessels that allows you to give patients larger amounts of fluids ? typically 30% fluid
central lines
149
what is the parkland (baxter) formula?
4ml (fluid) x % tbsa x kg
150
what is the minimum urine patients who are burned are expected to produce?
what's normal urine output for normal patients?
0.5ml/kg/h
0.30ml/kg/h
151
wound care should be one of the last things we do for a patient why ?
patent airway is the main concern
152
what are the two ways of cleaning the wound ?
shower ( light friction )
debridement ( cutting the skins - or )
153
how often do we change the dressings?
and where do we do the changes ?
once daily - typically in the shower
second in the evening - shower
154
what is the most serious threat to further tissue injury?
infection
155
how does infection usually occur ?
their own flora - own skin
156
___gloves when ___dressing
____gloves when ____ointment or dressing
clean when removing
sterile when applying
157
what are the two methods we can cover and treat burns ?
open and closed
158
what is the open method of treating a burn ?
burn is covered with topical antimicrobial
no dressing over wound
usually limited to the care of faical burns
159
what is closed method of treating a burn ?
sterile gauze dressing are laid over topical antimicrobial
( change every 12 hours to once every 14 days )
160
so to emphasize
open method ?
closed method ?
open wound
closed wound with dressing and ointment
161
when a patient has a deep full thickness burn, more than likely they are going to need what?
allograft/ homograft skin
( skin grafts 0
cadavers, or synthesis option
162
remember we dont like to treat the face/ears with a closed method, because why ?
because there aren't enough blood supply up to the face so it is just going cause pressure
163
what is the biggest concern we need to tell patients about their eyes when we are trying to treat them with fluid resuscitation ?
like what are we going to do as a nurse as well for the patient
they are going to have a lot of periobital edema and its going to be hard to open their eyes, so we need to warn them about it
comfort and educate
164
why do we want to keep the ears free of pressure, like not allowing pillows or anything nears the ears, remember open method ?
because it will cut circulation off to the ears
165
so if a patient can't have pillows or anything near their ears cause it will cut circulation off, what should we do ?
out a rolled towel to proper their shoulders up and neck up
166
our biggest concern for patients for these neck problems are what?
how do we prevent this ?
contractors
elevation, extended
167
hands and feet should always be in what position ?
neutral to try to prevent mobility issues
( rice anagram remember )
168
for gu/gi situation, we are worried about what ?
infection
- cleaning properly
remember because it will cause infection really bad
169
patients who are not moving and are burned, they are at risk for stress ulcers like any other patients, so what are we going to do to help aid with this ?
put them on a protein pump inhibitor
check for occult blood
early enteral feedings 24-48 hours
170
what are some basic medications we are going to use during the emergent phase ?
morphine
hydromorphone (dilaudid)
haloperidol (halldo)
Ativan
171
why do we use iv medications and not oral or im ?
because iv is immediately received
oral doesn't get observed
im, decreased blood flow, swelling and edema will be even increased, blood will pool there too
172
why do we get a patient a tetanus immunization?
what's the rule ?
10 years you need it
5 years if you have injury
173
why do we not use systemic antibiotics to try to prevent burn infections ?
instead we use topical medications like
- silver sulfadiazine
( antimicrobial )
because it increases risk of creating drug resistant flora
increase risk of side effects, things like yeast infections, c-diff, allergic reaction
174
when is the only time we give systemic antibotics to patients who have burns ?
remember we dont do this because of resistance and risk factors issues
only if they are diagnosed with sepsis
175
how are we going to prevent dvt or any blood clots ?
iv heparin
176
what is our main concern for iv heparin?
bleeding
177
in the first 24 hours for a burn patient, our main concern is fluids, but once those 24 hours past, we need to start on nutrition.
why do we like to start on nutrition ?
dont overthink it
decreases complications and mortality
optimizes burn wound healing
minimizes negative effects of hypermtabolism and catabolism
178
its very likely a patient who has a burn is going to develop hyper metabolism because of the fact that their body needs energy (calories) to move and protein to heal. so within what time frame do we want to start?
24-48hours of admission
179
remember calories is what?
remember protein is what ?
energy
healing factors
180
if patients are in hyper metabolism state, they are going to eventually go into an anaerobic state if we dont fix their needs, how is this bad?
cellular death from all that lactic acid and more complications
- breaking down muscles
181
how much,% is their metabolic needs going to be ?
50% more than normal
182
non-intubed patients with <20% tbsa can maintain caloric needs via what?
intoned or >20% tbsa needs what?
eating
enteral feeds
183
now onto the acute phase
when does the acute phase start?
when were done with fluid resuscitation
healed or skin graft
184
typically when a patient is in the acute phase
what are we going to see?
dont over think it
diuresis from fluid mobilization occurs and patient is less edematous
bowel sounds return
healing beings as WBC surrounded burn wound and phagocytosis occurs
185
granulation tissue forms in the acute phase, what is it and what is normal ?
brand new tissue, its a healthy red, just a bright pink !
186
full thickness burns will not heal until we remove what and we have to put what as well ?
remove eschar
skin grafts
187
so for partial thickness skin will heal but what if it has eschar ?
for full thickness skin will not heal but what do we do now ?
remove it and the body will naturally heal
surgical debridement and then skin graft it because the skin can not replace it
188
acute phase laboratory values
we worry about
how does it happen
hyponatremia ?
hypernatremia ?
neuro issues
excessive gi suction, diarrhea
water intoxication
fluid resuscitation
improper tube feedings
restrict sodium in ivs enteral or oral feedings
189
acute phase laboratory values
potassium
what do we worry about ?
how does it happen ?
hyperkalemia ?
hypokalemia ?
heart changes
renal failure, massive deep muscle injury
large amounts of potassium release
vomiting, diarrhea, prolonged gi suction
iv therapy without potassium
through burn wounds
190
what are some signs and symptoms of infection for patients with burns in the acute phase?
hypothermia/hyperthermia
increased heart and respiratory rate
decreased blood pressure
decreased urine output
obtain cultures
lactate level
191
acute phase complications notes
cardiovascular and respiratory system
if the patient has present illness, we need to make sure its not progressing into something worse
so regular assessment perfusion, respiratory status
192
what are we going to see in our neurologic system in patients for acute phase?
hallucination
disorientation
193
delirium is often an acute symptom in a neurologic setting, so how do we help prevent this for burn patients ?
turn off the lights off at night
turn on lights during the day
decrease level of conscionuess
194
paralytic ileus is something we still have to worry about,
what/why do we do/have for diarrhea
what/why do we do/have for constipation
antibiotics, feedings
opiates, increase fluid and fiber
195
what do we recommend patients to help with musculoskeletal system ?
talk to pt and ot
- limit rom
196
acute phase nursing management (notes)
wound care
- ongoing observation
- assessment
- cleansing
- debridement
- dressing reapplication
excision and grafting
pain management
physical and occupational therapy
nutritional therapy
196
patients are going to experience high blood sugar due to ____ & ___so we are going to treat it with ?
stress & infection
insulin
197
what is an enzymatic debridement ?
and why do we do it ?
a form of removing the skin but it speeds up removal of dead tissue from healthy wound bed
198
when you fully debrided, cover it with what type of gauze?
greasy-based gauze
petroleum gauze
199
eschar we shave it away down to the fascia right above the muscle and usually use skin grafts to help cover it.
how are grafts attached ?
fibrin sealant
suture, staples
negative pressure wound therapy
200
what is a complication of grafts?
blebs (blisters) because of fluid shifting
201
how do you properly cover a graft, there are 3 steps ?
greasy gauze
followed by saline to moistened
dry outer dressing
202
when does grafting need to be done ?
how should it look like healing ?
early as possible
normal skin color
203
what are the two kinds of pain patients will have during the acute phase?
continuous background pain
treatment pain
204
how do we treat pain for acute phase?
opioids, so a slow release
patient controlled analgesia
anxiolytic
205
its very important to use non pain management like what?
dont over think it
music therapy
exerice
meditation
206
when is a good time for patients to do physical and occupational therapy ?
when changing the dressing
207
what is the diet these patients are going to be on?
high protein, high carbohydrates
208
when does the rehabilitation phase begin ?
wounds have nearly healed
patient is engaging in some level of self-care
209
when does scaring start for these patients ?
complete healing for scares?
4-6 weeks
12 months ( scaring, hyper pigmented and or hypo pigmented )
210
why do we want patients to avoid sunlight ?
and for how long ?
3 months
because it will cause more damage and discoloration ( hypersensitive )
211
notes
remember during the rehabilitation phase
the patient needs to be there active during their self-care
reconstructive surgery is often done after a major burn, maybe even a year or longer to wait
212
gerontologic considerations
normal aging process puts the patient at risk for injury because of
- unsteady gait
- limited eye sight
- decreased hearing
- skin drier and more wrinkled
- thinner dermis, reduced blood flow
emotional needs
- burn survivors have guilt, fear of drying and frustrations
- new fears may occur during recovery
- pstd is often that occurs in burn survivors
- self esteem may be adversely affected
- address spiritual and culturel needs
- issue of sexuality must be met with honesty
- caregiver and patient support groups
nursing staff
- difficult to cope with deformities of burn injury
- know your provide care that makes a critical difference
- ongoing support services or debriefings may be helpful
- practice good self-care
213
A patient who is admitted to a burn unit is hypovolemic. A new nurse asks an experienced nurse about the patient’s condition. Which response if made by the experienced nurse is most appropriate?
A. “Blood loss from burned tissue is the most likely cause of hypovolemia.”
B. “Third spacing of fluid into fluid-filled vesicles is usually the cause of hypovolemia.”
C. “The usual cause of hypovolemia is evaporation of fluid from denuded body surfaces.”
D. “Increased capillary permeability causes fluid shifts out of blood vessels and results in hypovolemia.”
D. “Increased capillary permeability causes fluid shifts out of blood vessels and results in hypovolemia.”
214
When monitoring initial fluid replacement for the patient with 40% TBSA deep partial-thickness and full-thickness burns, which finding is of most concern to the nurse?
A. Serum K+ of 4.5 mEq/L
B. Urine output of 35 mL/hr
C. Decreased bowel sounds
D. Blood pressure of 86/72 mm Hg
D. Blood pressure of 86/72 mm Hg
215
During the emergent phase of burn injury, the nurse assesses for the presence of hypovolemia. In burn patients, hypovolemia occurs primarily as a result of
A. Blood loss from injured tissue.
B. Third spacing of fluid into fluid-filled vesicles.
C. Evaporation of fluid from denuded body surfaces.
D. Capillary permeability with fluid shift to the interstitium.
D. Capillary permeability with fluid shift to the interstitium.
