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410 Patho Exam 3 > Burns > Flashcards

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

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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

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3
Q

how do you get a thermal burn ?

examples

A

steam
fire/touching
out in the sun
close to a fire

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4
Q

what is our concern for thermal burns ? (2)

A

massive fluid shift

sodium and potassium imbalances

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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

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6
Q

how do we get chemical burns ?

A

acid or alkaline burn
from like gas, fertilizers

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7
Q

what is our concern for chemical burns ? (2)

A

burns from alkaline substance cause severe damage
(protein is dissolved)

( dissolve tissues typically )

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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

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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

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10
Q

how do patients get electrical burns ?

A

lighting strike
electricians touching a wire

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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

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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

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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

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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

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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

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16
Q

how do we get smoke inhalation ?

A

inside the fire or smoke
doesn’t even have to be inside

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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

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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

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19
Q

remember if they are coughing stuff up from smoke inhalation, what does it look like ?

A

black smut

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20
Q

if a patient is just breathing in smoke, what is the patient at risk for ?

A

carbon monoxide poisoning

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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

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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

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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

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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

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25
Q

patients who are at risk of airways burns, tend to be what?

A

intubated because before the swelling gets so bad, intubating will be much harder so we do that

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26
Q

so what are the 4 concerns we have for patients who have smoke inhalation ?

A

CO replaces O2 on hemoglobin

bright red skin

look for evidence of smoke inhalation

may need early intubation

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27
Q

after intubation with burns patients, we have to do what?

A

fluid replacement because of those capillaries are so leaky

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28
Q

as ironic and helpful fluid replacement is for patients, what can happen ?

A

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

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29
Q

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?

A

temperature of burning agent

duration of contact time

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30
Q

what is the most common type of burn ?

A

thermal

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31
Q

why are alkali burns more difficult to manage for chemicals burns instead of acid?

A

because they cause protein hydrolysis and melting

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32
Q

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

A
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33
Q

smoke inhalation injuries are often caused by what two things?

A

breathing noxious chemicals

hot air

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34
Q

smoke inhalation can cause a rapid development of ?

A

airway compromise
pulmonary edema

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35
Q

what are the 3 types of smoke inhalation ?

A

upper airway
lower airway
metabolic asphyxiation

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36
Q

typically when patients go into metabolic asphyxiation, they end up look what skin color ?

A

cherry red skin color

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37
Q

how can we treat metabolic asphyxiation ?

A

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

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38
Q

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

A
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39
Q

assess for upper airway injury
- blisters
- edema
- difficulty swelling
- stridor
- total airway obstruction

A
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40
Q

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

A
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41
Q

assess for lower airway
- facial burns
- hoarseness
- painful swallowing
- carbonaceous sputum
- clothing burns around neck and chest

A
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42
Q

when a patient has an electrical burn, what are some forms of dependency of severity for these patients ?

A

the amount of voltage
tissue resistance
surface area
length of time current flow was sustained
current pathways

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43
Q

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?

A

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

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44
Q

some common sense knowledge
the Current that passes through vital organs proceeds more ?

A

life threatening sequelae

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45
Q

electric sparks may also ignite a patients clothing, causing not only electrial burn but a ?

A

thermal flash injury

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46
Q

severity of injury can be difficult to determine for patients who have electrical burns because most damage occurs where ?

A

below the skin

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47
Q

electrical current cause ______strong enough to ____long bones and vertebrae

A

muscle spams
fracture

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48
Q

to restate, myoglobin from injured muscles and hemoglobin from damaged abcs travel to the kidneys during an electrical burns, causing the potential what ?

A

acute kidney injury

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49
Q

what are some basic classifications of burn injury ?
dont over think it

A

depth of the burn
extend of burn
location of burn
age of patient
pre-burn medical history
circumstances/complicating factors

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50
Q

where do you think on the body is our most concern for having a burn ?

A

face
chest
hands / feet
neck
genital

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51
Q

superficial partial thickness burn is what?
- epidermis

deep partial thickness is what?
- to the dermis

full thickness burn is what?
- down to the bone

A

1st degree
2nd degree
3-4th degree

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52
Q

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 ?

A

cause they completely burned off the nerves, so there is basically nothing there

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53
Q

in a full thickness burns, epidermis and dermis are destroyed, however what is another name for full thickness ?

A

eschar

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54
Q

what is eschar ?

A

leather-y tissue, doesn’t move, no stretching

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55
Q

how does eschar affect the body ? in two ways

A

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

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56
Q

what are two common tools we used to determine the total body surface area ?

A

lund-browder chart
( more accurate )

rules of nines
( initial assessment )

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57
Q

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%?

A

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

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58
Q

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?

A

respiratory obstruction
impaired gas exchange
edema, leathery eschar

self-care difficulty due to limited mobility

high risk for infections

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59
Q

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 ?

A

superficial vascular and nerve supply

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60
Q

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

A
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61
Q

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)

A
  1. scene safety
  2. remove person from source of burn and stop burning process
    ( throw water )
  3. wrap person dry, clean sheet
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62
Q

why do we want to wrap a burn patients in something dry ? (2)

A

prevents wound contamination
provides warmth

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63
Q

while giving a burn patient moist dressing can help reduce the pain and burning feeling, it may cause what?

A

hypothermia

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64
Q

what do we do for chemical burns prehospital phase ? (2)

A

remove chemical particles or powder

flush area with water

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65
Q

what do we do for inhalation burns/injuries? (2)

A

watch for signs for respiratory distress

100% oxygen if CO poisoning is suspected

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66
Q

what are the 3 phases of burn management ?

she wants use to understand the progression, healing, or getting worse

A

emergent (resuscitative)

acute (wound healing)

rehabilitative (restorative)

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67
Q

the emergent phase is up to what?

A

72 hours

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68
Q

what are we mainly focus on in the emergent phase? (3)

A

fluid electrolytes shifts (hypoveolmic shock)
- fluid

gas exchange & edema
( airway is patent )

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69
Q

what are the 3 body systems are at most risk during emery phase ?

A

respiratory
cardiac
Kidney

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70
Q

what are some clinical manifestations of emergent phase ? (6)

A

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 )

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71
Q

has you have hypolvomic shock, what happens ? (3)
blood pressure??
heart rate?
respiratory rate?

A

hypotension
tachycardia
tachypnea

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72
Q

all this fluid leaves during a burn, where do you think red blood cells go ?

risk for

A

they stay in the blood, causing thick blood

risk for clots
( hard to pump )

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73
Q

if you were to do an h&h on these patients, what would it be ?

A

increase
because their blood is so thick, not because of the fluid

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74
Q

once your body detects that you have this damage tissue, what comes in to help ?

A

your white cells
( the inflammation and healing )

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75
Q

fibroblasts and newly formed collagen fibrils begin wound repair within ____hours after injury

A

6-12hours

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76
Q

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

A
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77
Q

impaired circulation to extremities with circumferential burns if left untreated can lead to
tissue ischemia
paresthesia
necrosis

A
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78
Q

what is an eschartomy?

A

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

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79
Q

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 ?

A

iv heparin

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80
Q

remember patients who come in from a burn, their abgs and respiratory distress may be normal however it will change over what?

A

24-48 Hours

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81
Q

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?

A

gag reflex

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82
Q

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?

A

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

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83
Q

if a patient becomes hypoveolmic, blood flow to the kidneys will decrease causing ____?

if this continues AKI will develop

A

renal ischemia

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84
Q

with full-thickness and major electrical burns, releases myoglobin ( muscles cell breakdown ) and hemoglobin (rbc breakdown ) can block ___
causing ?

A

renala tubules

acute kidney injury

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85
Q

so with kidneys, we want to monitor what ?

A

adequacy of
fluid replacement

urinary output
BUN and Creatinine
I&O

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86
Q

how are we going to help a patient with airway management ?
dont over think it

A

high fowlers position
100% oxygen
Deep breathing
suctioning
ABG
early endotracheal intubation

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87
Q

why is suctioning very concerning ?

A

can be irritating
dont always do it

88
Q

how do we handle secretions ?

A

increase iv fluids

89
Q

always remember we need what ???

A

2 large bore ivs

90
Q

what is the formula we need to know about fluid therapy ?

A

parkland formula

91
Q

what is the parkland formula ?

A

4ml of LR(fluid)
multiple by
%TBSA burned
multiple by
KG

4ml * %TBSA burned * KG

92
Q

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%

A
93
Q

monitor urine production is what ?

normal patient .30ml an hour

A

0.5ml/kg/minimum

94
Q

wound care should be delayed until the patient is what?

A

stable

95
Q

we are going to be cleansing
- can be done in the shower and or bed

debridement
- scissors, and cutting skins off

A
96
Q

dressings, how often ?

A

once or twice a day

97
Q

before we do debridement on a patient, we have to make sure what?

A

they are mediated

98
Q

___gloves when ___dressing

___gloves when ____ointment or dressing

A

clean - removing
sterile - applying

99
Q

why do we usually like to keep the face, eye and ears free from pressure ?

A

because not a ton of blood supply and keep them open to prevent scar tissue

100
Q

we always want to use a roll up towel behind a patient neck to prevent what ?

A

contractures

101
Q

GU/GI keep patients perineum what?

A

clean and dry as possible

102
Q

what are some medications we might give patients in the emergent phase of burns ?

A

morphine
dilaudia
halloo
Ativan

103
Q

why do we avoid giving im injections to patients who have burns?

A

pooling in edematous tissues
it will not get absorbed, instead it will just fill up in one section

104
Q

why do we give patients tetanus shots?

A

to prevent further complications

105
Q

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

A
106
Q

once again to review, if the patient is not moving what are they at risk or and what do we give?

A

risk for clots

iv heparin

107
Q

we want to start nutrition how early?

and this will help with what?

A

24 hours

decrease complications
optimize burn wound healing
avoid negative effects with hyper metabolism

108
Q

patients who are in a hypermetablioc state are going to need more what 2 things and why?

A

protein - healing
calories - energy

109
Q

when does acute phase happen ?

A

after 72 hours
were done with fluid resuscitation

110
Q

when does acute phase end ?

A

partial thickness wounds are healed or burns are covered by skin grafts

111
Q

patients who are in the acute phase typically are what ?

dont over think it

A

diuresis ( normal kidney function )

bowel sounds return

healing happens

112
Q

typically a patient heals how ?

if they get infected how ?

A

from the base up and from outside in

their own flora

113
Q

when you got to get a culture, typically from burn patients, if it were to get infected, where would you get it ?

A

edges

114
Q

when do you do skin Grafts for patients ?

A

acute phase

115
Q

acute phase laboratory values sodium

hyponatremia happens how (2)

A

excessive diarrhea, gi suction

water intoxication
- from excess water intake

116
Q

acute phase laboratory values sodium

hypernatremia happens typically right after a patient who has hyponatremia so what might we do ?

A

restrict sodium in iv and oral feedings

117
Q

acute phase laboratory values potassium

how does hyperkalemia happens ?

A

renal failure, massive deep muscle injury

large amounts of potassium are released from damage cells

118
Q

acute phase laboratory values potassium

how does hypokalemia happen ?

A

vomitting, diarrhea
prolonged gi suction
iv therapy without potassium supplementation

119
Q

what are some signs and symptoms of infection that can happen in an acute phase?

A

can’t body temp regulate

increase heart and rr

decrease bp

fever
obtain cultures

decline urine output

120
Q

patients may become delirious, so what do we do as a patient ?

A

orientate them
lights on day
lights off at night

121
Q

again paralytic ileus can happen to these patients, what we going to do for this patients ?

A

treat early feedings
ppi
occult blood

122
Q

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 ?

A

because if its too high, it can cause an infection

increase due to extra calories or stress

treat with insulin

123
Q

note
remember we want pt or OT with musculoskeletal system

A
124
Q

the following flashcards are going to be about the burns part 2 recording, so we may back track on some information

A
125
Q

when does scar tissue start growing after getting burned?

A

6-12 hours

126
Q

what is the biggest concern for cardiac on patients who have burns? (2)

A

dysrhythmias
hypovolemia shock

127
Q

how do we help a patient who may be shivering after a burn ?

A

warming up the iv fluids

128
Q

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 ^

A

compartment syndrome
- tissue ischemia, paraesthesia, necrosis

129
Q

how do we treat compartment syndrome ?

A

escharotmy

130
Q

what is escharotmy ?

A

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
Q

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 ?^

A

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
Q

blood viscosity ___due to fluid loss
blood viscosity is the thickness of the blood

A

increases

133
Q

how do we fix sludging, or that thickness of blood for these patients with increase blood viscosity ?

A

adequate fluid replacement

134
Q

remember a patient can have a respiratory burn without even having a physical or present burn on the skin.

how is this possible?

A

with smoke inhalation or breaking in toxic fumes or breathing in hot air

135
Q

more than likely when a patient has smoke inhalation, they are more than likely going to have what type of airway injury ?

A

lower ( cause their taking deep breaths of fumes into their alveoli )

136
Q

what type of procedure can we do to go check the patient if they have lower airway injuries?

A

fiberoptic bronchoscopy

137
Q

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?

A

gag reflex

138
Q

what confirms the carbon and oxygen in their blood?
dont over think it, its literally in the name

A

carbonxyhemoglobin

139
Q

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

A

breathing
tri-poding
respiratory distress

140
Q

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 ?

A

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
Q

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 ?

A

acute tubular necrosis
because they can’t filter all these waits

142
Q

what is acute tubular necrosis ?

A

decreased blood flow in the tubules of the kidneys causing ischemia and puts your risk at acute kidney injury

143
Q

what are we monitoring in patients with acute kidney injures ?

A

input and output
bun and creatine
urinary output

144
Q

why do we want to intubate patients first before we do any fluid resuscitation ?

A

because of the extreme swelling, it’ll make it harder to insert the tube down the patients throat

145
Q

if you are considered about a patient being exposed to carbon monoxide, what must we give them ?

A

humidified air and 100% oxygen on non-rebreather mask

146
Q

remember we suction as what ?

A

AS NEEDED!!!

147
Q

just like with any major illness, injury or trauma, we must have what ?

A

2 large bore iv lines

148
Q

what is the name of the formula we are going to use for the fluid formula ?

A

parkland (baxter) formula

148
Q

what type of lines goes into large vessels that allows you to give patients larger amounts of fluids ? typically 30% fluid

A

central lines

149
Q

what is the parkland (baxter) formula?

A

4ml (fluid) x % tbsa x kg

150
Q

what is the minimum urine patients who are burned are expected to produce?

what’s normal urine output for normal patients?

A

0.5ml/kg/h

0.30ml/kg/h

151
Q

wound care should be one of the last things we do for a patient why ?

A

patent airway is the main concern

152
Q

what are the two ways of cleaning the wound ?

A

shower ( light friction )
debridement ( cutting the skins - or )

153
Q

how often do we change the dressings?
and where do we do the changes ?

A

once daily - typically in the shower
second in the evening - shower

154
Q

what is the most serious threat to further tissue injury?

A

infection

155
Q

how does infection usually occur ?

A

their own flora - own skin

156
Q

___gloves when ___dressing
____gloves when ____ointment or dressing

A

clean when removing
sterile when applying

157
Q

what are the two methods we can cover and treat burns ?

A

open and closed

158
Q

what is the open method of treating a burn ?

A

burn is covered with topical antimicrobial
no dressing over wound

usually limited to the care of faical burns

159
Q

what is closed method of treating a burn ?

A

sterile gauze dressing are laid over topical antimicrobial

( change every 12 hours to once every 14 days )

160
Q

so to emphasize
open method ?
closed method ?

A

open wound
closed wound with dressing and ointment

161
Q

when a patient has a deep full thickness burn, more than likely they are going to need what?

A

allograft/ homograft skin
( skin grafts 0

cadavers, or synthesis option

162
Q

remember we dont like to treat the face/ears with a closed method, because why ?

A

because there aren’t enough blood supply up to the face so it is just going cause pressure

163
Q

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

A

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
Q

why do we want to keep the ears free of pressure, like not allowing pillows or anything nears the ears, remember open method ?

A

because it will cut circulation off to the ears

165
Q

so if a patient can’t have pillows or anything near their ears cause it will cut circulation off, what should we do ?

A

out a rolled towel to proper their shoulders up and neck up

166
Q

our biggest concern for patients for these neck problems are what?

how do we prevent this ?

A

contractors

elevation, extended

167
Q

hands and feet should always be in what position ?

A

neutral to try to prevent mobility issues
( rice anagram remember )

168
Q

for gu/gi situation, we are worried about what ?

A

infection
- cleaning properly

remember because it will cause infection really bad

169
Q

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 ?

A

put them on a protein pump inhibitor
check for occult blood
early enteral feedings 24-48 hours

170
Q

what are some basic medications we are going to use during the emergent phase ?

A

morphine
hydromorphone (dilaudid)
haloperidol (halldo)
Ativan

171
Q

why do we use iv medications and not oral or im ?

A

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
Q

why do we get a patient a tetanus immunization?
what’s the rule ?

A

10 years you need it
5 years if you have injury

173
Q

why do we not use systemic antibiotics to try to prevent burn infections ?

instead we use topical medications like
- silver sulfadiazine
( antimicrobial )

A

because it increases risk of creating drug resistant flora

increase risk of side effects, things like yeast infections, c-diff, allergic reaction

174
Q

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

A

only if they are diagnosed with sepsis

175
Q

how are we going to prevent dvt or any blood clots ?

A

iv heparin

176
Q

what is our main concern for iv heparin?

A

bleeding

177
Q

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

A

decreases complications and mortality
optimizes burn wound healing
minimizes negative effects of hypermtabolism and catabolism

178
Q

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?

A

24-48hours of admission

179
Q

remember calories is what?
remember protein is what ?

A

energy
healing factors

180
Q

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?

A

cellular death from all that lactic acid and more complications

  • breaking down muscles
181
Q

how much,% is their metabolic needs going to be ?

A

50% more than normal

182
Q

non-intubed patients with <20% tbsa can maintain caloric needs via what?

intoned or >20% tbsa needs what?

A

eating

enteral feeds

183
Q

now onto the acute phase
when does the acute phase start?

A

when were done with fluid resuscitation
healed or skin graft

184
Q

typically when a patient is in the acute phase
what are we going to see?
dont over think it

A

diuresis from fluid mobilization occurs and patient is less edematous

bowel sounds return

healing beings as WBC surrounded burn wound and phagocytosis occurs

185
Q

granulation tissue forms in the acute phase, what is it and what is normal ?

A

brand new tissue, its a healthy red, just a bright pink !

186
Q

full thickness burns will not heal until we remove what and we have to put what as well ?

A

remove eschar

skin grafts

187
Q

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 ?

A

remove it and the body will naturally heal

surgical debridement and then skin graft it because the skin can not replace it

188
Q

acute phase laboratory values
we worry about

how does it happen
hyponatremia ?
hypernatremia ?

A

neuro issues

excessive gi suction, diarrhea
water intoxication

fluid resuscitation
improper tube feedings
restrict sodium in ivs enteral or oral feedings

189
Q

acute phase laboratory values
potassium
what do we worry about ?

how does it happen ?
hyperkalemia ?
hypokalemia ?

A

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
Q

what are some signs and symptoms of infection for patients with burns in the acute phase?

A

hypothermia/hyperthermia
increased heart and respiratory rate
decreased blood pressure
decreased urine output
obtain cultures
lactate level

191
Q

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

A
192
Q

what are we going to see in our neurologic system in patients for acute phase?

A

hallucination
disorientation

193
Q

delirium is often an acute symptom in a neurologic setting, so how do we help prevent this for burn patients ?

A

turn off the lights off at night
turn on lights during the day
decrease level of conscionuess

194
Q

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

A

antibiotics, feedings
opiates, increase fluid and fiber

195
Q

what do we recommend patients to help with musculoskeletal system ?

A

talk to pt and ot
- limit rom

196
Q

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

A
196
Q

patients are going to experience high blood sugar due to ____ & ___so we are going to treat it with ?

A

stress & infection
insulin

197
Q

what is an enzymatic debridement ?
and why do we do it ?

A

a form of removing the skin but it speeds up removal of dead tissue from healthy wound bed

198
Q

when you fully debrided, cover it with what type of gauze?

A

greasy-based gauze
petroleum gauze

199
Q

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 ?

A

fibrin sealant
suture, staples
negative pressure wound therapy

200
Q

what is a complication of grafts?

A

blebs (blisters) because of fluid shifting

201
Q

how do you properly cover a graft, there are 3 steps ?

A

greasy gauze
followed by saline to moistened
dry outer dressing

202
Q

when does grafting need to be done ?
how should it look like healing ?

A

early as possible
normal skin color

203
Q

what are the two kinds of pain patients will have during the acute phase?

A

continuous background pain
treatment pain

204
Q

how do we treat pain for acute phase?

A

opioids, so a slow release
patient controlled analgesia
anxiolytic

205
Q

its very important to use non pain management like what?
dont over think it

A

music therapy
exerice
meditation

206
Q

when is a good time for patients to do physical and occupational therapy ?

A

when changing the dressing

207
Q

what is the diet these patients are going to be on?

A

high protein, high carbohydrates

208
Q

when does the rehabilitation phase begin ?

A

wounds have nearly healed
patient is engaging in some level of self-care

209
Q

when does scaring start for these patients ?

complete healing for scares?

A

4-6 weeks

12 months ( scaring, hyper pigmented and or hypo pigmented )

210
Q

why do we want patients to avoid sunlight ?
and for how long ?

A

3 months
because it will cause more damage and discoloration ( hypersensitive )

211
Q

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

A
212
Q

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

A
213
Q

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.”

A

D. “Increased capillary permeability causes fluid shifts out of blood vessels and results in hypovolemia.”

214
Q

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

A

D. Blood pressure of 86/72 mm Hg

215
Q

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.

A

D. Capillary permeability with fluid shift to the interstitium.

410 Patho Exam 3 (5 decks)

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