BURNS 🔥 Flashcards
In the rule of 9s, what body percentage is each arm?
9%
In the rule of 9’s what body percentage is the whole head AND neck?
9%
In the rule of 9’s the entire trunk of the body is 36%. So what percentage would that make the front (chest + abdomen) and the back?
the front (chest + abdomen) is 18% and your entire back (including butt) is 18%
can be further split into 9%
In the rule of 9’s what body percentage is an entire leg?
18%
Each legs is 18%
**the front of each leg is 9% and the back of each leg is 9%)
if you are outside a medical facility what are the 2 treatment priorities until medical help is had?
cool the burns, warm the person
-cool for at least 20 minutes w/ water
cover with lose clean dressings
What are the 4 DONT’S of treating a burn outside the hospital? (until they can receive medical attention)
-no toothpaste or butter on the burn (will trap heat and keep burning)
-don’t pop or burst blisters
-don’t rip off clothing/ anything stuck to the burn
-don’t apply ice to the burn
In the emergent phase of a burn, what 5 things are we assessing? (if this is outside the hospital?
- ABC’s
-vital signs
-hemodynamic status
-monitor for hypovolemia
-assess extent of burn
What type/ amount of oxygen should a burn patient receive ASAP?
100% humidified oxygen
During the emergent or resuscitative phase of a burn, what are our priorities?
-prevent respiratory distress
-first aid
-prevent shock
-detection + treatment of other injuries
Describe the emergent/ resuscitative phase of a burn.
this is the onset of the injury until fluid resuscitation is complete
Describe the acute/ intermediate phase of a burn?
when diuresis starts to near completion of wound healing
What are the priorities during the acute/ intermediate phase of a burn?
-wound assessment + care
-wound closure
-prevent + treat complications (infection)
-nutritional support
-fluid/ electrolyte imbalance
-GI and renal function
-respiratory/ circulatory function
-pain management
-early positioning + mobility
describe the rehabilitation phase of a burn?
this starts with major wound closure to the return of the patients optimal functioning
What are the priorities during the rehabilitation phase of a burn?
-prevention of scars and contractures
-PT and OT
-cosmetic procedures
-counseling
True or False?
medication, specifically pain meds, can ONLY be given via IV on a burn patient.
true
If a patients burns exceed 20%-25% they should have an __________ placed to suction to avoid aspiration and to help w/ fluid and nutritional needs.
NG tube
During the emergent/ resuscitative phase of a burn, why is a foley catheter placed?
to closely monitor/ COCA urine output
What are the 5 factors used to determine the depth of the burn?
How
Causative agent
Temperature of agent
Duration of contact with agent
Thickness of the burn
An example of a ____ burn is touching a hot object like an iron or stove.
dry
A _______ burn is from hot liquid or steam.
scald
A _____ burn is caused by rough services like carpet or road rash.
friction
A _______ is from radiation like an x-ray or prolonged UV rays.
sunburn
It is important to know and take note of the entry (burn) point and the exit (burn) point with an _______ burn.
electrical
sulfuric battery acid, bleach + ammonia are examples of agents that can cause a _______ burn.
chemical
A thermal burn is from an external heat source, raising the temperature of the skin and tissue, causing cell death and charring. What are the 3 types of burns that fall into this category?
-dry
-scald
-friction
What are 4 essential bits of information that need to be collected about a burn patient to guide their care?
-list of medications
-last tetanus immunization
-current body temperature
-pre burn body weight
The inflammatory response can exacerbate a burn injury because?
-a prolonged inflammatory response can cause prolonged swelling + redness
-a systemic response can affect the entire body
-excessive inflammation can lead to scar tissue and fibrosis, which will restrict movement, possible disfigurement
-chronic inflammation can delay the healing process
According to Prep U, _________ is the analgesic of choice for burn pain.
Morphine Sulfate
Fentanyl is better for procedural pain due to the rapid onset and short duration
why should burn depth be reassessed after 72 hours?
the early burn appearance may change
if a burn patient already has a patent airway, what is the FIRST PRIORITY?
fluid resuscitation
What are the typical fluid and electrolyte shifts that occur in the acute phase of a burn, that as a nurse you need to monitor for?
-hemodilution (decreased hematocrit)
-increased urinary output
-metabolic acidosis
-hyponatremia
-hypokalemia
The nurse provides care for a client with a full-thickness, circumferential burn of the left lower leg. During the nurse’s initial shift assessment, the client is resting and the physical assessment of the left lower extremity is unremarkable. One hour later, the nurse notes the pulses of the left lower leg cannot be obtained by a Doppler ultrasound device, and the capillary refill of the left great toe is greater than 2 seconds. What is the nurse’s best response based on the clinical findings?
contact the provider and prepare for an escharotomy
what kind of precautions and PPE should be used with all burn patients?
universal precautions
-gloves
-gown
-goggles + face shield
(non porous materials)
First degree burn is damage to the __________ layer of the skin, sunburn.
outermost
A second degree burn is the entire epidermis and varies with the dermis. These are very painful with _______.
blisters
Third degree burns are full thickness, destruction to the epidermis, dermis and _________
__________ - with these burns patient have a lack of sensation.
underlying tissue
4th degree burns go all the way down to the deep tissue, muscle or_______. There is deep tissue necrosis.
bone
a TBSA of over 30% could be _____.
fatal
_______ sign is a staph. infection where the superficial layers of the skin rub off with slight pressure, from a burn or an autoimmune disease (pemphigus)
Nikolsky’s
Pemphigus vulgaris is a rare group of autoimmune diseases that causes blisters on the ______ + ________ _________. Affecting the mouth, nose, throat, eyes + genitals.
skin + mucous membranes
A ________ Nikolsky’s sign is when the top layer of skin doesn’t shear off when rubbed.
negative
A _______ Nikolsky’s sign is when the top layer of skin does peel off when rubbed, leaving it pink, moist + tender.
positive
Which treatment of burns involves using jets in water to clean the wounds and burned skin?
hydrotherapy
What does hydrotherapy help to reduce in healing burn wounds?
-redness
-pain
-scarring
-permanent discoloration
how soon after the burn trauma can a patient start hydrotherapy?
-after the initial shock
-after they’re stabilized
What will sodium and potassium levels look like in the acute/ intermediate phase due to fluid re-entering the vascular space with fluid resuscitation?
(potential) hyponatremia and hypokalemia
What is causing metabolic acidosis with a burn injury?
decreased blood flow and oxygen delivery, and fluid and electrolyte loss
How often should a patient’s response to fluid resuscitation therapy be re-evaluated?
-vitals
-urine output
every hour
Background or resting pain, is pain the patient feels at rest, due to the _____/______ ______.
burn/ thermal injury
Procedural pain is intense episodes of pain felt during
1.
2.
3.
4.
PRE-MEDICATE
wound debridement
dressing changes
baths
physical therapy
breakthrough pain is __________, it is felt in between times of medication administration
intermittent
What pain meds are used depending on mild, moderate and severe pain(emergent + acute phases)?
mild - acetaminophen + naproxen
moderate - opioids
severe - fentanyl, lidocaine, ketamine, versed
Benzodiazepines:
valium, Xanax, Ativan, Klonopin
These drugs are used for sedation and hypnosis to help with
1.
2.
3.
anxiety
muscle spasms
reduce seizures
you need sleep to heal
TPN/ PPN support may be needed because these patients will extensive nutritional needs to heal.
high carbohydrates
What puts there body into a hypermetabolic state?
STRESS
they may also need insulin
high cortisol = high BG
Why are J tubes preferred to maintain nutritional status?
they have a lower aspiration risk
TRUE OR FALSE?
fluid resuscitation is only for 3rd and 4th degree burns. (maybe sometimes 2nd degree)
true
