Burns 2

Question 1

main two vascular changes that occur with burns

Answer 1

1) fluid shift/3rd spacing

2) fluid remobilization

Question 2

describe the fluid shift that occurs

Answer 2

occurs after initial vasoconstriction

then blood vessels dilate near the burn and dilate and leak into interstial space

Question 3

describe the 3rd spacing

Answer 3

• aka capillary leak syndrome
• causes excessive wt gain
• continues leak of plasma from vascular into interstial
• causes impaired fluid and electrolyte balance which leads to decreased blood volume and blood pressure

Question 4

what does the electrolyte imbalance in the fluid shift cause

Answer 4

• hypovlemic, metabolic acidosis, hyperkalemia, hyponatremia
• hemoconcentration: increased hematocrit, hemoglobin, and blood osmolarity (d/t vascular dehydration)

Question 5

describe fluid remobilization

Answer 5

• 24 hrs after burn occurs
• capillary leak stops
• fluid shifts from interstitial to intravascular
• blood volume increases, diuresis, body wt returns to normal
• hyponatremia, hypokalemia

Question 6

what are GI changes with burns

Answer 6

• decreased C.O and fluid shift causes decreased blood flow to GI
• GI mucosal tissue integrity and motility are impairs
• sympathetic increase in epi which inhibits motility and GI blood flow
• peristalsis decreases, paralytic ileus, abdominal distention

Question 7

what is curling’s ulcer

Answer 7

• acute gatroduodenol ulcer that occurs with stress of severe injury
• may develop 24 hrs after severe burn injury

Question 8

____ is a stressor that disrupts homeostasis

Answer 8

injury

Question 9

what are the two compensatory responses of burns (adaptive)

Answer 9

inflammatory and sympathetic

Question 10

describe the inflammatory response

Answer 10

• triggers healing in injured tissue

- causes the fluid shift and resuscitation phase

Question 11

describe the sympathetic response

Answer 11

-occurs with any physical stressor
-cardio, resp, GI
ex/ thirst, increased RR and HR, decreased GI, increased catecholamines, decreased urine output, vasoconstricted skin, increased blood sugar, wt gain and fluid retention

Question 12

what is the general (for all burns) emergency management

Answer 12

1) assess patent airway
2) administer O2
3) cover pt with blanket
4) keep pt NPO
5) elevate extremities if NO fractures
6) initiate IV line, fluid replacement
7) administer tetanus toxoid (prophylatic)
8) perform head to toe assessment

Question 13

what are the goals of initial burn emergency management

Answer 13

open airway
ensure adequate breathing and circulation
limit extent of injury
maintain function of vital organs

Question 14

why is the etiology of the burn important

Answer 14

cause of injury affects prognosis and treatment

Question 15

describe dry heat burns

Answer 15

open flame in explosions or house fires (also cause flash burns)

Question 16

describe moist heat burns

Answer 16

(scald)

contact with hot liquid or steam

Question 17

describe contact burns

Answer 17

hot metal, tar, grease contacts skin (full thickness injury)

Question 18

describe chemical burns

Answer 18

d/t home or industrial or assault

Question 19

describe electrical burns

Answer 19

• electrical current enters body
• grand masquerader**
• can be thermal, flash or true electrical

Question 20

describe grand masquerader

Answer 20

electrical burns
appear small on surface but big internal injury
generate heat and damage tissue

Question 21

what is one of the first things done upon entry to hosptial

Answer 21

pt is weighed (dry weight)

wt before edema forms

Question 22

describe the resuscitation phase

Answer 22

first phase

occurs from onset to 24-48 hrs

Question 23

priorities for management for resuscitation phase

Answer 23

1) secure airway
2) support circulation and organ perfusion by fluid replacement
3) keep comfortable with analgesic
4) prevent infection, wound care
5) maintain body temp
6) provide emotional support

Question 24

what should you ask the pt about the burn injury

Answer 24

circumstance
time, place, source, cause of injury
helps with management of pt

Question 25

assessment in resuscitation

Answer 25

• use systemic approach to ensure no problem is missed

- assessment of *respiratory system is the most critical to prevent life threatening complication

Question 26

who is at the greatest risk for respiratory problems

Answer 26

pt with burn injury and inhalation injury

Question 27

what is a nursing priority with burns

Answer 27

*continuous airway assessment

Question 28

what is one of the first parts of the resp assessment

Answer 28

determine if direct airway injury
burns on face may indicate this
(esp burns inside the mouth)

Question 29

what are s/s of pulmonary injury

Answer 29

• hoarse
• brassy
• difficulty swallowing
• produce exhalation (wheezes, stridor)

Question 30

if the s/s of pulmonary injury are present…

Answer 30

give oxygen and call rapid response team

*may indicate that the pt is about to lose airway

Question 31

if wheezing sound disappears what does this indicate

Answer 31

impending airway obstruction and needs immediate intubation

Question 32

describe pulmonary overload r/t burns

Answer 32

• circulatory overload from fluid resuscitation may cause CHF
• this causes high pressure and pushes fluid into lung tissue

Question 33

what is one of the main problems with pulmonary overload and what are the S/S

Answer 33

**excess fluid makes gas exchange difficult

SOB, dyspnea in supine, crackles

Question 34

treatment of pulmonary overload

Answer 34

elevate HOB to 45 degrees, apply O2, call RRT

Question 35

this is the leading cause of death from fire

Answer 35

carbon monoxide poisoning

Question 36

describe carbon monoxide poisoning

Answer 36

• colorless, odorless, tasteless gas

- vasodilation causes “cherry red” skin

Question 37

severe and fatal carbon dioxide level

Answer 37

severe: 41-60%
fatal: 61-80%

Question 38

what can heat damage of the pharynx cause

Answer 38

produces edema and upper airway obstruction (NEED to be intubated before obstruction occurs)