Burns Flashcards
What are the four types of burns
Thermal Burns
Flash, flame, contact, scalding burns
Can include radiation buns
Chemical Burns
Acids, alkalis, organic compounds
Electrical Burns
Intense heat generated by electrical current
Inhalation Injury
Chemicals, hot air, or other substances can damage the airway
What is the difference between partial and full thickness burns?
Partial thickness (anything above subcutaneous tissue)
1st degree involves epidermis
2nd degree involves epidermis and dermis
Full thickness (subcutaneous tissue down to bone)
3rd degree involves epidermis and dermis down to subcutaneous fat, muscle and possibly bone
Using the rule of nines, what parts of the body are considered 4.5%
front/back of head
front/back of entire arms
Using the rule of nines, what parts of the body are considered 9%
front/back of chest (upper back)
front/back of abdomen (lower back)
front/back of legs
Using the rule of nines, what part of the body is considered 1%
genitals
What is the Emergent phase:
first 72 hours after the burn has occurred
What is the Acute phase:
Starts after 72 hours and ends when partial-thickness wounds are healed or full thickness are grafted-lasts weeks to months
What is the Rehabilitation phase:
wounds have nearly healed and they are able to participate in self-care
What are the two major parts of injury in the emergent phase of a burn
Burn injury causes damage to tissue, then inflammatory response (increased capillary permeability) causes more issues such as:
fluid out of the intravascular space and into the interstitial spaces (third spacing)
Shift of electrolytes and possible necrosis of tissue
The immune system is also compromised because the skin is removed and the inflammatory process reduces the availability of the innate and specific immune systems
At risk of hypovolemic shock
Expected labs for burn victims
Hypoalbuminemia
Hyponatremic
Hyperkalemic
Increased BUN, creatinine
Low GFR
ABGs (effects of respiratory injury)
Manifestations of the emergent phase of a burn
altered mental status possible
high level of pain for superficial burns no pain for deep burns
tachycardia, hypotension, dysrhythmias
hoarseness, difficulty swallowing, hypoactive/absent bowel sounds
oliguria
Manifestations of a First degree Thermal Burn
-blanching with pressure, tenderness, pain, redness
Manifestations of a Second degree Thermal Burn
-blanching with pressure, pain, blisters, change in skin color
Manifestations of a Third degree Thermal Burn
-absence of pain, eschar, impaired sensation, no blanching
Manifestations of a First degree Electrical Burn
Cardiovascular disruptions-dysrhythmias, cardiac arrest
Manifestations of a Second degree Electrical Burn
May look superficial, but will have internal injuries that are more severe
Manifestations of a Third degree Electrical Burn
Possible fractures or dislocations from muscle contraction
What is the first intervention for a chemical burn
remove the source of the the chemical burn
What are the secondary effects of major burns you should monitor for?
acute kidney injury
What is a TBSA calculation
Total Body Surface Area (Rule of Nines)
What are some medications you treat for the secondary effects of major burns
Analgesics
Sedatives
VTE prophylaxis
Tetanus immunization
Antibiotics/antimicrobials
Fluid therapy (use Parkland Formula)
Isotonic fluids-most commonly LR
Possible albumin administration
What is the Parkland Formula
Determine fluid resuscitation for burn victims over the first 24 hours by:
multiplying 4ml times the percentage of body surface area times the patient’s weight in kg
multiply by .5 and give first half the first 8 hours and the second half the next 16 hours
If pt produces less than 30ml of urine/hr with current level of fluid therapy, tell doc. SHOULD have large diuresis as fluid shifts back into interstitial space
Circumferential burns (compartment syndrome) often require what intervention?
Escharotomy or fasciotomy (allows swelling to occur without compromising circulation)
What are the two types of wound care?
Open method: creams and salves with no dressing (around face and head)
Closed method: Burns have dressings
T/F: You should always use sterile technique and provide pain medication when performing wound care on burn victims
True.
What are the nursing priorities in order when a burn victim is in the emergent phase?
Monitor and manage airway
Provide oxygen support as needed
Establish IV access
Replace fluid therapy and monitor for effectiveness/over replacement
Strict I&O monitoring
Monitor for infection
Perform wound care
Monitor and prevent pressure injuries
Monitor and report abnormal lab values
Coordinate with PT/OT
Describe the nutritional needs of a burn victim
hypermetabolic state, high calories diet
Describe the sx of the acute phase of burn victim
Hyperglycemia r/t increased stress hormones can impede healing process
Increased urine output
increased pain level
What are some lab manifestations of the acute phase of burn victims
Monitor for hemodilution
May change from hyponatremic to hypernatremia and hyperkalemic to hypokalemic. Must monitor chem panel
Elevated WBC and ESR/CRP
Hyperglycemia
ABGs
Describe the changes in pharmacology for the acute phase of a burn
Starting to wean off of narcotics (pain meds) and sedation if possible
Try switching to PO fluid/electrolyte replacement
VTE prophylaxis
Antibiotics/antimicrobials
Continue monitoring glucose, may use insulin to control
What type of wound care would a nurse perform during the acute phase
Manual debridement or with enzymes
Excision (escharectomy) (prep for graft)
Skin Grafting
How do you prep a burn patient for OT/PT
Remove dressings to increase possible ROM
Will possibly have splints etc. to prevent contractures
What is a Allograft
Try Cadaveric skin to see if pt will accept transplant at all
TEST TO DO AUTOGRAFT, NOT PERMANENET
What is a Autograft
Skin taken from patient if there is enough
Skin grafts are typically meshed which allows the graft to cover a larger area
What do you do if there is not enough skin available to make a graft
Possible cultured epithelial autograft (CEA).
Dermal Substitute
Different types that may be permanent or used as a bridge for a severely burned patient waiting on CEA
T/F: The burn site is often more painful than the donor site
False: Donor site if often more painful than burn site
What are the common complications found in burn patients?
Paralytic ileus
Contractures
Constipation
Curling’s ulcer (Burns cause a reduction in plasma volume, which can lead to ischemia and cell death in the stomach lining)
Hyperglycemia
Itching, pain, skin flaking are manifestations of what phase of burn healing
Rehabilitation Phase
