Burns 2 Flashcards
main two vascular changes that occur with burns
1) fluid shift/3rd spacing
2) fluid remobilization
describe the fluid shift that occurs
occurs after initial vasoconstriction
then blood vessels dilate near the burn and dilate and leak into interstial space
describe the 3rd spacing
- 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
what does the electrolyte imbalance in the fluid shift cause
- hypovlemic, metabolic acidosis, hyperkalemia, hyponatremia
- hemoconcentration: increased hematocrit, hemoglobin, and blood osmolarity (d/t vascular dehydration)
describe fluid remobilization
- 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
what are GI changes with burns
- 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
what is curling’s ulcer
- acute gatroduodenol ulcer that occurs with stress of severe injury
- may develop 24 hrs after severe burn injury
____ is a stressor that disrupts homeostasis
injury
what are the two compensatory responses of burns (adaptive)
inflammatory and sympathetic
describe the inflammatory response
- triggers healing in injured tissue
- causes the fluid shift and resuscitation phase
describe the sympathetic response
-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
what is the general (for all burns) emergency management
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
what are the goals of initial burn emergency management
open airway
ensure adequate breathing and circulation
limit extent of injury
maintain function of vital organs
why is the etiology of the burn important
cause of injury affects prognosis and treatment
describe dry heat burns
open flame in explosions or house fires (also cause flash burns)
describe moist heat burns
(scald)
contact with hot liquid or steam
describe contact burns
hot metal, tar, grease contacts skin (full thickness injury)
describe chemical burns
d/t home or industrial or assault
describe electrical burns
- electrical current enters body
- grand masquerader**
- can be thermal, flash or true electrical
describe grand masquerader
electrical burns
appear small on surface but big internal injury
generate heat and damage tissue
what is one of the first things done upon entry to hosptial
pt is weighed (dry weight)
wt before edema forms
describe the resuscitation phase
first phase
occurs from onset to 24-48 hrs
priorities for management for resuscitation phase
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
what should you ask the pt about the burn injury
circumstance
time, place, source, cause of injury
helps with management of pt
assessment in resuscitation
- use systemic approach to ensure no problem is missed
- assessment of *respiratory system is the most critical to prevent life threatening complication
who is at the greatest risk for respiratory problems
pt with burn injury and inhalation injury
what is a nursing priority with burns
*continuous airway assessment
what is one of the first parts of the resp assessment
determine if direct airway injury
burns on face may indicate this
(esp burns inside the mouth)
what are s/s of pulmonary injury
- hoarse
- brassy
- difficulty swallowing
- produce exhalation (wheezes, stridor)
if the s/s of pulmonary injury are present…
give oxygen and call rapid response team
*may indicate that the pt is about to lose airway
if wheezing sound disappears what does this indicate
impending airway obstruction and needs immediate intubation
describe pulmonary overload r/t burns
- circulatory overload from fluid resuscitation may cause CHF
- this causes high pressure and pushes fluid into lung tissue
what is one of the main problems with pulmonary overload and what are the S/S
**excess fluid makes gas exchange difficult
SOB, dyspnea in supine, crackles
treatment of pulmonary overload
elevate HOB to 45 degrees, apply O2, call RRT
this is the leading cause of death from fire
carbon monoxide poisoning
describe carbon monoxide poisoning
- colorless, odorless, tasteless gas
- vasodilation causes “cherry red” skin
severe and fatal carbon dioxide level
severe: 41-60%
fatal: 61-80%
what can heat damage of the pharynx cause
produces edema and upper airway obstruction (NEED to be intubated before obstruction occurs)
