Burns Flashcards
Why does plasma seep into tissues with burns?
Increased capillary permeability.
The majority of leaking capillaries with burns occurs when
In the first 24 hrs.
Major nursing diagnosis for 1st 24 hrs with burns
Fluid volume deficit because capillary permeability and leaking fluid.
What happens to HR, CO, Urine output in the 1st 24 hrs after burn
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.
Why is epinephrine secreted with burns initially.
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.
Why are ADH and aldosterone secreted initially with burns?
Aldosterone retains Na and water and ADH retains water so the blood volume goes up.
Treatment for carbon monoxide poisoning and why?
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).
If a patient has burns to neck, chest or face, what might be done prophylactic?
Intubate with ET tube.
Name the rule of 9 percentages
Head is 9, each arm 9, each leg 18, back trunk 18, chest trunk 18, genitals 1.
When does fluid replacement begin for a burn patient?
Based on the time the injury occured
Parkland formula
4mL of LR x percentage % of TBSA burned x KG bodyweight
How to give fluid replacement for a burn patient
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.
How would you determine if a burned client’s fluid volume is adequate?
Normally it is daily weights but with a burn patient, it is urine output.
A client’s respiration are shallow, so what are they retaining? & what acid base balance?
CO2….respiratory acidosis
How does albumin work?
It holds on to fluid in the vascular space.
In a client who is receiving fluids rapidly, what measurement can you take hourly to ensure you are not overloading the client?
CVP because increased volume equals increased CVP.
Difference between Tetanus Toxoid and Immune globin?
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.
What do you check for a circulatory check?
Pulse, temp, cap refill and color
What do you do if the urine is brown or red after a burn?
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.
What drug is given to help flush out the kidneys?
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.
When does the client begin to diurese with a burn client?
After 48 hrs because fluid is going back into the vascular space. So worry about fluid volume excess.
Administering Mannitol
Use an in-line filter, observe solution for clarity before administering, do not fridgerate, assess effectiveness- urine become more clear.
What happens to the potassium level with burn client
goes up. Watch for hyperkalemia. The cells rupture or lyse causing K to come out of the cell.
Where is potassium located?
Inside the cell
What is the most sensitive indicator of overall nutritional status
Prealbumin
What type of isolation will you use with a burn client?
Protective isolation to protect them from what comes from the outside.
What do we worry about when giving -mycin drugs?
Ototoxicity or nephrotoxicity. BUN or creatinine increasing or U/O decreasing or if the client complains of hearing loss. STOP the drug immediately.
What do you do if the skin graft comes off?
Cover it with something moist (sterile dressing) and call doctor. Don’t leave it open or it will dry up.
What is the first thing you do for an electrical injury?
Put them on a continuous heart monitor for 24 hrs. (At risk for v fib).
