burns Flashcards
increased risk of death in which age groups?
really old, really young
most common airway injury (burn)
carbon monoxide poisoning
rule of nines (adult)
- head/neck
- arms
- trunk (back and front)
- genitals
- legs
9% - head/neck 9% - arms 18% - trunk (back and front) 1% - genitals 18% - legs
if burn client is restless, consider which 3 problems?
- inadequate fluid replacement
- pain
- hypoxia
examine what to determine if fluid volume is adequate?
urine output
why is there more death with upper body burns?
airway injury
burn client with shallow respirations - retaining what and experiencing what imbalance?
CO2, acid
respiratory acidosis
measure this hourly to ensure not overloading burn client with fluid
CVP - want to see slow rise of BP
why give albumin to burn patient?
draws volume into the vessels
increases: vascular volume, BP, CO, workload of heart
why are IV meds preferred to IM meds in burn clients?
decreased perfusion to absorb IM
acts quicker
tetanus toxoid: type of immunity and length of time to develop
active, 2-4 weeks
immune globulin: type of immunity and length of time to develop
passive, immediate
escharotomy
cut through eschar to relieve pressure and restore circulation
fasciotomy
cut deep into tissue - through eschar and fascia - relives pressure and restores circulation
burn client circulatory check (x4)
pulse
color (skin)
temp (skin)
cap refill
burn client with brown or red urine: action and what it means
call provider
muscle damage –> myoglobin –> could gunk up glomerulus –> kidney damage
drug used to flush out kidneys in burn patient
mannitol - osmotic diuretic
uop less than 30mL/hour in burn client, worry?
kidney failure
48 hours post burn concern?
client will begin to diurese (if kidneys not damaged) because fluid is going back into vascular space; worry about fluid volume excess
electrolyte imbalance frequently seen in burn patients
hyperkalemia because cells have lysed and expelled contents into serum
prevent stress ulcer/Kerling’s ulcer in burn patients
carbonate/magnesium carbonate (Mylanta)
pantoprazole (Protonix)
famotidine (Pepcid)
paralytic ileus in burn patients: why and treatment
decreased vascular volume and gi motility; hyperkalemia
treat with: NPO and NG tube hooked to suction
labs to ensure proper nutrition and positive nitrogen balance in burn patients? x3
albumin (status weeks ago)
prealbumin (status today)
total protein
superficial thickness burn
aka 1st degree
damage to epidermis only
partial thickness burn
aka 2nd degree
damage to entire epidermis and varying depth of dermis
full-thickness burn
aka 3rd degree
damage to entire dermis and sometimes fat
1 complication with perineal burn
infection
eschar
dead tissue, needs to be removed for tissue to regenerate
bacteria love it!
enzymatic drugs to treat eschar in burn patients
sutilanis (Travase)
collagenase (Santyl)
silver sulfadiazine
“eats” dead tissue
hydrotherapy
aka whirlpool therapy
eschar debridement
- give pain meds first
- worry about cross contamination
considerations for broad spectrum abx in burn patients?
avoid to prevent secondary infection, superinfection
ok to use until wound cultures return
two ae of -mycins
nephrotoxicity (will see increase in BUN, creat)
ototoxicity
how often can you reharvest from a graft donor site (given patient is well nourished?)
every 12 - 14 days
how long do you flush a chemical burn?
15 to 20 minutes
priority for new electrical burn patient?
heart monitor for 24 hours
what arrhythmia is electrical burn patient at risk for?
v fib
what causes renal damage in electrical burn patient?
myoglobin, hemoglobin build up
