Burns Flashcards
Exam 4 (Final)
Integumentary System
The skin is composed of how many layers?
Skin composed of two layers
(Technically 3)
Integumentary System
The skin is composed of 2 layers: What are they?
Epidermis
Dermis
Integumentary System
The subcutaneous fat tissue layer is called?
Subcutaneous fat tissue layer (Hypodermis)
Integumentary SystemFunctions include:
Protection from infection
Prevention of loss of body fluids
Thermoregulation
Production of vitamin D
Excretion
Determination of identity
Sensation reception
Burn Injuries:
How many people require medical attention of burns every year? How many require hospitalization?
Approximately 486,000 people require medical attention of burns every year, 40,000 require hospitalization
Burn Injuries:
Patients with burns have what kind of hospitalizations?
Patients with burn injuries have prolonged hospitalizations
Burn Injuries
What role do nurses play? Doing what?
Nurses play an active role in the prevention of burn injuries by education regarding prevention concepts and promoting safety legislation.
Burn Injuries:
What contributes to complexities of care?
Co-morbidities contribute to complexity of care
Burn Injuries:
Who is there a higher occurrence rate in?
Higher occurrence rate among the elderly
Burn Injuries
People who are in heart failure are at risk of what? People who are diabetic are at risk of what?
Person with diabetes wound will heal slower.
People with heart failure are at risk of fluid volume issues.
Classification of Burn Injuries
How can burns be classified?
Causative agent
Depth
Severity
Classification of Burn Injuries
Causative agents include:
Thermal burns
Chemical burns
Electrical burns
Classification of Burn Injuries
Depth include:
Superficial burns
Partial-thickness burns
Full-thickness burns
Classification of Burn Injuries
Superficial burns- are what?
First degree burns
Classification of Burn Injuries
Partial-thickness burns- are what?
Second-degree burns
Classification of Burn Injuries
Full-thickness burns- are what?
Third degree burns
Classification of Burn Injuries
To assess severity of burns, what factors should be considered?
Percentage of body surface area burned
Depth of the burn
Anatomical location of the burn
Person’s age
Person’s medical history
Presence of concomitant injury
Presence of inhalation injury
Classification of Burn Injuries
Superficial (first degree): What is effected?
Epidermis only or small depth of dermis
Classification of Burn Injuries
Superficial (first degree): How long to heal?
Heals in 3 to 5 days without treatment
Classification of Burn Injuries
Superficial (first degree): How does it appear (aka what is hallmark)?
Erythema
Classification of Burn Injuries
Superficial (first degree): What does not occur?
Not calculated for fluid resuscitation
Classification of Burn Injuries
Superficial (first degree): What is an example?
Sun burns, a brief splash of hot water
Burn Classification and Severity (Cont.)
Partial thickness (second degree): What is effected?
Epidermis and most of dermis
Burn Classification and Severity (Cont.)
Superficial partial thickness: What is effected?
Epidermis and limited portion of the dermis
Burn Classification and Severity (Cont.)
Superficial partial thickness: How long does it take to heal?
Heals in 7 to 10 days
Burn Classification and Severity (Cont.)
Deep partial thickness: What is effected?
Epidermis and most of dermis
Burn Classification and Severity (Cont.)
Deep partial thickness: How long to heal?
Heals within 3 to 4 weeks
Burn Classification and Severity (Cont.)
What is the hallmark for second degree burns?
Hallmark for second degree burn is blisters.
Burn Classification and Severity (Cont.)
Full thickness (third degree): How does it appear?
Thick, dry, leathery appearance
Burn Classification and Severity (Cont.)
Full thickness (third degree): What is effected?
Destruction of all layers down to or past fat, fascia, muscle, or bone
Burn Classification and Severity (Cont.)
Full thickness (third degree): How does it feel?
Insensate (no pain)
Burn Classification and Severity (Cont.)
What is a common method of knowing severity of burns?
Rule of Nines
Burn Classification and Severity (Cont.)
A patient has sustained second- and third-degree burns to the entire left arm and both legs anteriorly. Using the rule of nines, what is the percentage of body area with burn injury?
A. 18%
B. 21.5%
C. 24%
D. 27%
D. 27%
Rationale: Each arm is 4.5% for the anterior aspect and 4.5% for the posterior aspect. This patient’s entire arm is involved, thus 9% of body area is calculated. Each leg is 9% for the anterior aspect and 9% for the posterior aspect. The anterior aspects of both legs were involved with this patient, thus 18% of body area is calculated. Total percentage of body areas with burn injury is 27%.
What is the most common cause of death in a patient with burn injury after the first 7 days?
A. Hypovolemia
B. Hypotension
C. Infection
D. Injury inhalation
Infection
What is compromised with severe burn injury?
Immune system
Infection:
How should catheters be handled?
Handle all catheters with clean technique.
Infection:
What should be done to reduce infections?
Handle all catheters with clean technique.
Perform hand hygiene
Infection
Use sterile gloves when dressings are removed and wounds exposed.
Infection:
What should be monitored?
Monitor for signs of septic shock.
Trauma:
Burns wounds can mask what?
Burn wounds may mask some of the classic signs of underlying injuries, such as ecchymosis or swelling.
Trauma:
What should you look for with burns?
Look for concomitant injuries like fractures and head trauma.
Trauma:
What should you ensure with burns?
Ensuring adequate airway, breathing, and circulation
Trauma
How should you treat cervical spine injuries?
Cervical spine injuries should be stabilized and cleared.
Trauma
What should be done if head trauma is suspected?
CT scan if head trauma is suspected
Prehospital Interventions
Remove the patient from thermal source
Cover and prevent hypothermia
Remove jewelry, belts, and clothing that may retain heat
Scalds or asphalt burns: cool with water
Resuscitative Phase—Primary Survey
What is the A of ABCDE?
Airway maintenance with cervical spine protection
Resuscitative Phase—Primary Survey
What is the B of ABCDE?
Breathing and ventilation
Resuscitative Phase—Primary Survey
What is the C of ABCDE?
Circulation with hemorrhage control
Resuscitative Phase—Primary Survey
What is the D of ABCDE?
Disability (assess neurologic deficit)
Resuscitative Phase—Primary Survey
What is the E of ABCDE?
Exposure (completely undress the patient, but maintain temperature)
Secondary Survey:
When is it done?
The secondary survey, which is completed after resuscitative efforts are well established.
Secondary Survey:
What is included?
Detailed history and physical
Complete blood count (CBC)
Comprehensive chemistry panel, including blood urea nitrogen
Creatinine level
Urinalysis
ABG values to include carboxyhemoglobin
EKG
CXR
Secondary Survey:
What is hallmark of this survey?
A complete history and physical examination are the hallmarks of the secondary survey.
Providing Hemodynamic Support
What should be corrected?
Correct fluid, electrolyte, and protein deficits.
Providing Hemodynamic Support
What should be replaced?
Replace continuing losses and maintain fluid balance.
Providing Hemodynamic Support
What should be prevented?
Prevent excessive edema formation.
Providing Hemodynamic Support
What should be maintained urinary output?
Maintain an hourly urinary output of 30 to 50 mL/h (approximately 0.5 mL/kg/h) in adults.
Fluid Resuscitation
ABA recommendations for resuscitation:
2 to 4 mL of LR solution/kg body weight per percentage TBSA burn
(2–4 mL LR × body weight in kg × % TBSA burn)
½ given in the first 8 hours (starting from the time of the burn injury)
¼ given over the next 8 hours
¼ given over the next 8 hours
What is the fluid of choice for fluid resusitation?
Lactated ringers
Circumferential burn to an arm or leg may mimic what?
Circumferential burn to an arm or leg may mimic compartment syndrome.
Circumferential burn to an arm or leg may mimic compartment syndrome.
What should be removed?
Remove rings, watch, and other jewelry.
Circumferential burn to an arm or leg may mimic compartment syndrome.
What should be done to injured extremity?
Elevation and range of motion of the injured extremity
Assess hourly- skin color, sensation, capillary refill, and peripheral pulses
Circumferential burn to an arm or leg may mimic compartment syndrome.
What is done at the bedside? What is used for comfort?
Escharotomy at the bedside
Narcotics and benzodiazepines for comfort
Echarotomy:
What is the most reliable means of assessing arterial blood flow?
Doppler ultrasonography is the most reliable means of assessing arterial blood flow and the need for an escharotomy.
Reparative Phase
Once pt is stabilized, what should be done?
Once stabilized, promote healing and prevent infection.
Reparative Phase
Once pt is stabilized, what should be ensure?
Ensure optimal nutrition.
Reparative Phase
What should be provided?
Providing musculoskeletal support
Reparative Phase
Providing musculoskeletal support: What is done for this?
Physical and occupational therapy begins on day 1.
Reparative Phase
What should be managed?
Managing pain
Reparative Phase
Managing pain: how?
Narcotics intravenously;
absorption of the drug is unpredictable.
Caring for the Wound
includes:
Cleansing
Hydrotherapy
Topical antimicrobial medications
Caring for the Wound
includes: Cleansing- how is it done?
Clean with water and chlorhexidine or normal saline solution and povidone-iodine (Betadine) with each dressing change.
Caring for the Wound
includes: Cleansing- while doing this, what should you observe for signs of?
Observe for signs of infection and rate of healing.
Caring for the Wound
Hydrotherapy:
Hydrotherapy is the preferred approach of most burn centers because the warm, flowing water is beneficial to help loosen exudates, clean and assess the wound, and provide an opportunity for range of motion exercise. Because the procedure is usually painful, patients should receive an analgesic 20 to 30 minutes before beginning and small, frequent doses throughout prn.
Debridement:
What are the types?
Mechanical debridement
Enzymatic debridement
Surgical debridement
Debridement:
Mechanical debridement: What is done? What kind of dressings are used?
Forceps and scissors to gently lift and trim loose necrotic tissue
Wet-to-dry or wet-to-wet dressings
Debridement:
Enzymatic debridement: What is done?
Application of a proteolytic substance to burn wounds to shorten the time of eschar separation
Debridement:
Surgical debridement:
Excised to viable bleeding points while minimizing the loss of viable tissue
Grafts:
What is it?
Autograft of similar color, texture, and thickness from a close location on the body
Grafts:
What are the types?
Sheet graft—
Mesh graft—
Cultured epithelial autografts
Grafts:
Sheet graft:
the harvested skin is applied to the surgically excised area.
Grafts:
Mesh graft:
the harvested skin is slit, and the graft is then placed on the burn site.
Grafts:
What do dressings do in grafts?
Dressings immobilize the grafted area and prevent shearing and dislodging of the graft.
Providing Psychological and Familial Support
Explain what to expect and escort them to the bedside.
Counseling for the patient/family begins on the day of admission.
Weekly family meetings
Establish trust.
Encourage self-care for family and patient.
Work with a psychiatric liaison nurse.
Hallucinations, confusion, and combativeness are common in patients with burn injuries.
Honest and open approach
Rehabilitative Phase- includes?
Physical rehabilitation
High-protein diet
Prevention of scarring and contractures
Psychological rehabilitation
Other Types of Injuries Treated in Burn Centers
Toxic epidermal necrolysis syndrome
Necrotizing fasciitis
Cold injuries
Other Types of Injuries Treated in Burn Centers
Toxic epidermal necrolysis syndrome
TENS is a superficial, exfoliative dermatitis that has been related to multiple sources (adverse reaction to medications, the staphylococcal toxin, or viral infections).
Other Types of Injuries Treated in Burn Centers
Necrotizing fasciitis
Rapid and progressive inflammatory infection of the soft tissue
Other Types of Injuries Treated in Burn Centers
Cold injuries
Localized frostbite or systemic lowering of the body’s core temperature with hypothermia
