Burns 4 Flashcards
drug therapy for shock prevention
- different than that for HF pt
- diuretics do NOT increase C.O.
- they decrease circulating volume and C.O by pulling fluid from the circulatory blood volume to enhance diuresis
- **this decreases blood flow to vital organs and increases risk for hypovolemic shock
older burn pts with cardiac diseases may need what
drugs that increase C.O (ie/ dopamine or Intropin) along with fluid therapy
pain management of resuscitation phase
- continually assess the pt pain level, use pain decreasing strategies to prevent complications
- *ensure comfort level of pt
- complementary and integrative therapy measure for pain
what pain management drugs are given
- opiod analgesic (morphine sulfate, hydromorphone (Dilaudid), fentanyl)
- nonopiod analgesic
how do you give opiods in the resuscitation phase
IV route only (prevents delayed absorption)
what are some non drug pain management
- environmental changes: dim lights, comfortable for sleeping
- tactile stimulation: to decrease pain (change position every 2 hrs to reduce pressure spots)
surgical treatment of resuscitation
- surgical procedure for the treatment of inadequate tissue perfusion is escharotomy
- if this is NOT done, can lead to ischemia and necrosis
incision through the eschar relieves pressure causes by constriction force of fluid build up (improves circulation)
escharotomy
what do the nurses need to know to recognize if develops in burn pts
- resp distress changes
- immediately report to burn team of resp therapist
describe the acute phase of burns
- begins 36-48 hrs after injury
- begins when fluid shift resolves and lasts until wound closure is complete
acute phase of burns care is directed at what
*care directed at continual assessment, maintenance of cardio and resp systems and toward GI and nutrition status, burn wound care, pain control and psychosocial
priority nursing intervention of acute phase
-assess cardiovascular and resp systems to maintain these systems and to identify/prevent complications
neuroendocrine changes in acute phase
- increased metabolic demands deplete nutrition stores
* weigh pt daily and compare to preburn wt
a >10% wt loss requires what
eval and modification of calorie intake (indirect calorimetry)
immune changes in acute phase
- *at risk for infection
- burn wound sepsis: serious complication of burn injury
____ is the leading cause of death during the acute phase
infection
-use aseptic technique in caring for wounds and during invasive monitoring to prevenet infection
musculoskeletal changes in acute phase
-mobility problems
assess active and passive ROM for all joints
-leave extremities in neutral position
problems if a burn covers >25% TBSA (acute)
1) wound care management d/t impaired tissue integrity
2) potential for infection d/t decreased immune function and poor nutrition
3) wt loss d/t increased metabolic rate
4) decreased motility d/t open wounds and pain
5) decreased self esteem
wound care management in acute phase
- nonsurgical
- debridement
- hydrotherapy
describe nonsurgical wound care
- remove exudate and necrotic tissue, clean area, stimulate granulation, apply dressings
- *restore tissue integrity
describe debridement wound care
- removal of eschar
- mechanical or enzymatic action
- purpose is to prepare wound for grafting
describe hydrotherapy
application of water for treatment
-debrides and examines wound
describe enzymatic debridement
- can occur by autolysis or artificially by application of exogeneous agents
- total enzyme agents= collagenase (Santyl) used for rapid wound debridement
what is autolysis
disintegration of tissue by pts own cellular enzymes
what are the burn dressings options
standard, biologic, synthetic, artificial skin
describe standard wound dressing
- multiple layers of gauze over topical agents on wound
- gauze- rolelr type gauze bandages-elastic wrap
- *changed every 12-24 hrs (after cleaning area)
describe biologic wound dressing
-used for temporary wound coverage/closure
-skin or membranes form human tissue donors or animals
*adheres or promotes healing
hemografts, heterografts, cultured skin, artificial skin
hemografts
- biologic wound dressing
- aka allografts
- human skin obtained via cadaver and provided through skin bank (high cost)
heterografts
- biologic wound dressing
- aka xenograft
- skin from another species
- pigskin (porcine)
cultured skin
- biologic wound dressing
- growth from small specimen of cells from pts body
artificial skin
- biologic wound dressing
- silastic epidermis
- porous dermis
