Burns Flashcards
Where do most burns occur?
At home
Why does plasma seep out into the tissue and when does the majority of this occur?
Increased capillary permeability; first 24 hours
What is the major concern with burn patients?
Hypovolemic shock - fluid status
Why does the cardiac output decrease in burn patients?
Less volume to pump out
Why does the urine output decrease in burn patients?
Kidneys are either trying to hold onto fluid or they aren’t being perfused
Why is epinephrine secreted?
Causes vasoconstriction, shunts blood back to vital organs; want to give the patient their pressure back
Why are ADH and aldosterone secreted?
Retain sodium and water with aldosterone
Retain water with ADH
–> Blood volume will go up
What is the most common airway injury?
Carbon monoxide poisoning; client is hypoxic
Treat with 100% oxygen
Is it important to know if the burn occurred in an open or closed space?
Yes - more carbon monoxide in closed space
What might a physician prophylactically do for a patient with burns to the neck, face, or chest?
Intubate
Explain the rule of nines.
Head and neck: 9% Trunk: front 18%; back 18% Genital area: 1% Leg: 18% each Arm: 9% each
Why is it important to know what time the burn occurred?
Fluid replacement for the first 24 hours is based on the time the injury occurred, not when treatment is started
Explain the parkland formula for fluid replacement.
(4ml of LR) X (weight in kg) X (%of TBSA burned) = total fluid replacement for first 24 hours
1st 8 hours = 1/2 total volume
2nd 8 hours = 1/4 total volume
3rd 8 hours = 1/4 total volume
What is used to determine if a client’s fluid volume is adequate?
Urine output
What 2 things can be done to stop the burning process?
- Blanket
2. Cool water
Should jewelry be removed from a burn patient?
Yes - swelling occurs, metal gets hot
Should clothing be removed from a burn patient?
Non-adherent clothing and cover with clean dry cloth
What are 4 signs of airway injury/burn?
- Singed hair or eyebrows
- Soot present around mouth and nose
- Blistering
- Coughing up mucous with black specks
A client’s respirations are shallow. They are retaining _____ and therefore they are in respiratory acidosis.
CO2
Why is albumin given to the burn patient?
Holds onto fluid in the vascular space (can’t give for first 24 hours)
Increases vascular volume, kidney perform, BP, cardiac output).
In a client who is receiving fluids rapidly, which is a measurement you could take hourly to ensure you’re not overloading the client?
CVP
What are the 2 immunizations given to burn patients?
- Tetanus toxoid
2. Immune globulin
Relieves the pressure and restores the circulation, cuts through the eschar.
Escharotomy
Relieves the pressure and restores circulation but the cut is much deeper into the tissue, the cut goes through the eschar and the fascia.
Fasciotomy
Does a burn patient have a foley?
Yes - check output hourly
What would you do if the urine was brown or red?
Call doctor
What drug might be ordered to flush out the kidneys?
Mannitol
never put in fridge, inspect in light for crystals
What electrolyte imbalance is a burn patient at risk for?
Hyperkalemia (cells split up and releases potassium)
Why would a physician want a burn patient to be NPO and have an NG tube hooked to suction?
Patient could develop a paralytic ileus due to decreased vascular volume and hyperkalemia. NG tube removed when BS X 4 quads
Classification of burns:
Damage only to epidermis
Superficial thickness
Classification of burns:
Damage to entire epidermis and varying depths of the dermis
Partial thickness
Classification of burns:
Damage to entire dermis and sometimes fat
Full thickness
What are 2 specific measures for a patient who has burns on their hands?
- Wrap each finger separate
2. Use splints to prevent contractures
Should a client with burns on their head or neck use a pillow?
No - promotes chin to chest
What 2 things like to grow in eschar?
Bacteria and fungus
Necrotic tissue must be removed
What type of isolation is used with burn patients?
Reverse isolation
What are the 2 enzymatic drugs used to eat dead tissue?
- Sutilanis (Traverse)
2. Collagenase (Santyl)
Can be used to debride. Give pain medication to patients at least 30 minutes prior. Worry about cross contamination.
Hydrotherapy
What are the 4 common drugs used with burns?
- Silver sulfadizine (silveadene)
- Mafedine acetate
- Silver nitrate
- Povidone-iodine (betadine)
What 3 things must be monitored when giving -mycin drugs?
- BUN
- Creatinine
- Hearing loss
(ototoxicity and nephrotoxicity - assume they are toxic if BUN and Cr are increasing)
Removes the dead burned tissue and takes good skin from a healthy donor site (usually the buttock or thigh).
Grafting
What should be done first when someone has suffered a chemical burn?
Remove patient from chemical
Remove contacts
Flush for 15-20 minutes for body; 30 minutes for eyes
How many wounds occur from an electrical burn?
2 - enter and exit
What is the first thing you do for an electrical injury?
Turn off electricity for 24 hours
What arrhythmia is an electrical burn patient at risk for?
V. Fib
