Burns 4

Question 1

drug therapy for shock prevention

Answer 1

• 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

Question 2

older burn pts with cardiac diseases may need what

Answer 2

drugs that increase C.O (ie/ dopamine or Intropin) along with fluid therapy

Question 3

pain management of resuscitation phase

Answer 3

• 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

Question 4

what pain management drugs are given

Answer 4

• opiod analgesic (morphine sulfate, hydromorphone (Dilaudid), fentanyl)
• nonopiod analgesic

Question 5

how do you give opiods in the resuscitation phase

Answer 5

IV route only (prevents delayed absorption)

Question 6

what are some non drug pain management

Answer 6

• environmental changes: dim lights, comfortable for sleeping
• tactile stimulation: to decrease pain (change position every 2 hrs to reduce pressure spots)

Question 7

surgical treatment of resuscitation

Answer 7

• surgical procedure for the treatment of inadequate tissue perfusion is escharotomy
• if this is NOT done, can lead to ischemia and necrosis

Question 8

incision through the eschar relieves pressure causes by constriction force of fluid build up (improves circulation)

Answer 8

escharotomy

Question 9

what do the nurses need to know to recognize if develops in burn pts

Answer 9

• resp distress changes

- immediately report to burn team of resp therapist

Question 10

describe the acute phase of burns

Answer 10

• begins 36-48 hrs after injury

- begins when fluid shift resolves and lasts until wound closure is complete

Question 11

acute phase of burns care is directed at what

Answer 11

*care directed at continual assessment, maintenance of cardio and resp systems and toward GI and nutrition status, burn wound care, pain control and psychosocial

Question 12

priority nursing intervention of acute phase

Answer 12

-assess cardiovascular and resp systems to maintain these systems and to identify/prevent complications

Question 13

neuroendocrine changes in acute phase

Answer 13

• increased metabolic demands deplete nutrition stores

* weigh pt daily and compare to preburn wt

Question 14

a >10% wt loss requires what

Answer 14

eval and modification of calorie intake (indirect calorimetry)

Question 15

immune changes in acute phase

Answer 15

• *at risk for infection

- burn wound sepsis: serious complication of burn injury

Question 16

____ is the leading cause of death during the acute phase

Answer 16

infection

-use aseptic technique in caring for wounds and during invasive monitoring to prevenet infection

Question 17

musculoskeletal changes in acute phase

Answer 17

-mobility problems
assess active and passive ROM for all joints
-leave extremities in neutral position

Question 18

problems if a burn covers >25% TBSA (acute)

Answer 18

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

Question 19

wound care management in acute phase

Answer 19

• nonsurgical
• debridement
• hydrotherapy

Question 20

describe nonsurgical wound care

Answer 20

• remove exudate and necrotic tissue, clean area, stimulate granulation, apply dressings
• *restore tissue integrity

Question 21

describe debridement wound care

Answer 21

• removal of eschar
• mechanical or enzymatic action
• purpose is to prepare wound for grafting

Question 22

describe hydrotherapy

Answer 22

application of water for treatment

-debrides and examines wound

Question 23

describe enzymatic debridement

Answer 23

• can occur by autolysis or artificially by application of exogeneous agents
• total enzyme agents= collagenase (Santyl) used for rapid wound debridement

Question 24

what is autolysis

Answer 24

disintegration of tissue by pts own cellular enzymes

Question 25

what are the burn dressings options

Answer 25

standard, biologic, synthetic, artificial skin

Question 26

describe standard wound dressing

Answer 26

• multiple layers of gauze over topical agents on wound
• gauze- rolelr type gauze bandages-elastic wrap
• *changed every 12-24 hrs (after cleaning area)

Question 27

describe biologic wound dressing

Answer 27

-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

Question 28

hemografts

Answer 28

• biologic wound dressing
• aka allografts
• human skin obtained via cadaver and provided through skin bank (high cost)

Question 29

heterografts

Answer 29

• biologic wound dressing
• aka xenograft
• skin from another species
• pigskin (porcine)

Question 30

cultured skin

Answer 30

• biologic wound dressing

- growth from small specimen of cells from pts body

Question 31

artificial skin

Answer 31

• biologic wound dressing
• silastic epidermis
• porous dermis