Burns

Question 1

Why does plasma seep into tissues with burns?

Answer 1

Increased capillary permeability.

Question 2

The majority of leaking capillaries with burns occurs when

Answer 2

In the first 24 hrs.

Question 3

Major nursing diagnosis for 1st 24 hrs with burns

Answer 3

Fluid volume deficit because capillary permeability and leaking fluid.

Question 4

What happens to HR, CO, Urine output in the 1st 24 hrs after burn

Answer 4

HR increases to pump more blood to vital organs, CO decreases because there is less volume to pump, Urine output decreases because kidneys are trying to hold on to what little volume they have or because they are impaired.

Question 5

Why is epinephrine secreted with burns initially.

Answer 5

Initially, when someone is burned it causes them to vasodilate which bottoms out BP, so epinephrine causes vasoconstriction which causes BP to go up and shunts blood to vital organs.

Question 6

Why are ADH and aldosterone secreted initially with burns?

Answer 6

Aldosterone retains Na and water and ADH retains water so the blood volume goes up.

Question 7

Treatment for carbon monoxide poisoning and why?

Answer 7

They are hypoxic. 100% oxygen because you want the oxygen to reach the heme molecule before the carbon monoxide reaches it (carbon monoxide is much faster).

Question 8

If a patient has burns to neck, chest or face, what might be done prophylactic?

Answer 8

Intubate with ET tube.

Question 9

Name the rule of 9 percentages

Answer 9

Head is 9, each arm 9, each leg 18, back trunk 18, chest trunk 18, genitals 1.

Question 10

When does fluid replacement begin for a burn patient?

Answer 10

Based on the time the injury occured

Question 11

Parkland formula

Answer 11

4mL of LR x percentage % of TBSA burned x KG bodyweight

Question 12

How to give fluid replacement for a burn patient

Answer 12

Calculate fluid needed for 24 hrs and administer 1/2 of the volume calculated in the first 8 hrs and give the rest over 16 hrs.

Question 13

How would you determine if a burned client’s fluid volume is adequate?

Answer 13

Normally it is daily weights but with a burn patient, it is urine output.

Question 14

A client’s respiration are shallow, so what are they retaining? & what acid base balance?

Answer 14

CO2….respiratory acidosis

Question 15

How does albumin work?

Answer 15

It holds on to fluid in the vascular space.

Question 16

In a client who is receiving fluids rapidly, what measurement can you take hourly to ensure you are not overloading the client?

Answer 16

CVP because increased volume equals increased CVP.

Question 17

Difference between Tetanus Toxoid and Immune globin?

Answer 17

Tetanus toxoid is active immunity in which your body has to produce the antibodies and takes 2-4 weeks to achieve. Immune globin gives immediate protection and is passive immunity in which gives the person antibodies.

Question 18

What do you check for a circulatory check?

Answer 18

Pulse, temp, cap refill and color

Question 19

What do you do if the urine is brown or red after a burn?

Answer 19

It is sometimes normal after a burn but it can clog up the kidney and go into renal failure. (Myoglobin released from muscle breakdown.) So call the physician.

Question 20

What drug is given to help flush out the kidneys?

Answer 20

Mannitol (diuretic), which is not normally given to burn clients but it is an exception to the rule because you are worried about the client going in to renal failure.

Question 21

When does the client begin to diurese with a burn client?

Answer 21

After 48 hrs because fluid is going back into the vascular space. So worry about fluid volume excess.

Question 22

Administering Mannitol

Answer 22

Use an in-line filter, observe solution for clarity before administering, do not fridgerate, assess effectiveness- urine become more clear.

Question 23

What happens to the potassium level with burn client

Answer 23

goes up. Watch for hyperkalemia. The cells rupture or lyse causing K to come out of the cell.

Question 24

Where is potassium located?

Answer 24

Inside the cell

Question 25

What is the most sensitive indicator of overall nutritional status

Answer 25

Prealbumin

Question 26

What type of isolation will you use with a burn client?

Answer 26

Protective isolation to protect them from what comes from the outside.

Question 27

What do we worry about when giving -mycin drugs?

Answer 27

Ototoxicity or nephrotoxicity. BUN or creatinine increasing or U/O decreasing or if the client complains of hearing loss. STOP the drug immediately.

Question 28

What do you do if the skin graft comes off?

Answer 28

Cover it with something moist (sterile dressing) and call doctor. Don’t leave it open or it will dry up.

Question 29

What is the first thing you do for an electrical injury?

Answer 29

Put them on a continuous heart monitor for 24 hrs. (At risk for v fib).