Burns Flashcards
Roles of Skin
Regulation of body temperature
- F/E balance
- protect
- sensory
- Vit D
- regenerates itself
Physiology of burns:
1) release of catecholamines
- increases BP/HR
- vasoconstriction
- disrupted BF
Physiology of Burns:
2) increased capillary permeability
- Edema EVERYWHERE (lungs)
- 3rd spacing–> hypovolemia
- fluid shifts
- HR fast but low C.O
what does third spacing and hypovolemia change in electrolytes
Na & K changes
Physiology of burns:
3) decreased perfusion to GI system
- paralytic ileus
- abd distention
- stress ulcer
Physiology of burns:
4) Inflammatory response- destroyed skin
- immunosuppressed
- risk for infection
- lose ability to sweat
Physiology of burns:
5) Increased metabolic demands
- massive catabolism and increase need for calories
- incr. body temp
- incr. O2 demand
Physiology of Burns:
6) RBCs hemolyzing causing hemoconcentration
- high Hct
- high hgb
- incr. blood viscosity
- thick blood= incr. risk DVT, acute kidney injury
What type of diet for burn victims?
High calorie and high PRO diet
SUPERFICIAL (1st deg.) burns
only damages the outermost layer of the skin (epidermis)
- RED, BLISTER, PAINFUL
- heals in a few days
PARTIAL THICKNESS (2nd deg) burns
Destroys epidermis into the dermis
- RED, SWOLLEN, SKINY, EDEMA, BLISTER, VERY PAINFUL
- heals in 2 weeks to 21 days
- d/t hot fluids
FULL THICKNESS (3rd deg) burns
-ALL layers of the skin
-NO PAIN!!
TOUGH, LEATHERY, MANY COLORS, DRY
** CANNOT grow new skin
Treatment for superficial and partial thickness burns
- stop the burning process
- keep moist
- NO ALOVERA with alcohol
- use triple antibiotic cream
- clean 2 x /day with non-adhesive dressing
Treatment for 3rd degree burns
- Surgical excision
- SKIN GRAFT
How long should surgeries be for burn patients
short b/c don’t want to put too much more stress on the patients body
Rule of 9’s
shows extent and % of burns
- add posterior + anterior
- NO 1st degree burns
- must say CHEST & ABDOMEN for full 18%
what day after admission is skin graft done?
day 1 or 2
Complications of skin grafts
1- bleeding
2- donated skin will create a new open wound
3- Grafts are very fragile
What temp should a skin graft room be?
85 F
When to assess if skin graft worked
after first dressing change
-48 hr is first change?
What burns are considered SERIOUS
- face
- eyes
- hands
- feet
- perineum
- CIRCUMFERENTIAL
Why are hand and feet burns serious?
so many joints, can cause contractures
Why is there decr. circulation to 3rd degree burns
d/t swelling and leathery skin
Risk factors for burn complications
- old/young
- CV
- Respiratory/renal dz
- Alcoholism
- malnutrition
What are the two highest complications of burns?
HYPOVOLEMIC SHOCK -most common cause of death
INFECTION
Types of burns:
1) Thermal
most common
- flame
- flash
- scald
- contact with hot objects
Types of burns”
2) Chemical
- acid
- alkalis
- organic compounds
- most common to the hands
Chemical burns
- which substance is most dangerous and why
- how do you treat it
alkali because you don’t feel burning sensation
- RINSE WITH WATER
- NO NEUTRALIZING until cause of burn identified
Chemical burns
-what is there a high risk for
- risk of inhalation injury! check airways for damage or swelling!
Types of burns:
3) Electrical
- there will be an entry and exit wound
- ** check heart
- high voltage can fracture bones
- common in children
Types of Burns:
4) Radiation
uncommon
Burn Care Goals
- prevent infection
- fluid balance
- thermoregulation
- pain control
- skin integrity
- nutrition: start early
- emotional support
Primary Survey
1) AIRWAY
constantly reassess
- give 100 % O2
- Protect airway: INTUBATE
why do you give abdomen and up burn patients 100% O2
to help with carbon monoxide build up
S/S of inhalation injury
- happened in an enclosed space
- fumes
- smoke
- stridor
- hoarse or raspy voice
- carbonaceous sputum
- singed nasal hairs
- swelling : INTUBATE
- MAJOR CAUSE OF MORTALITY
how do you give 100% oxygen
non-rebreathing mask
S/S carbon monoxide poisoning
cherry, red skin
N.V
headache
what type of burns cause ventilation problems
circumferential burns
How to treat circumferential burns
ESCHAROTOMY
what is an Escharotomy
- done at bedside or OR
- made thru elastic eschar
- returns BF to body part
Is escharotomy painful?
No! b/c full thickness wounds cut thru nerves
What meds to give during escharotomy?
BENZOS to help their anxiety
Circulation:
do burns bleed
no
Evaluation of circulation:
5 P’s
BP Pulses Pallor Temp ect
where to insert large bore IVs
NOT under burns
what fluids to use to replace fluids in burns
LACTADE RINGERS
Parkland Formula:
what does it determine?
how much fluid the patient needs
Parkland Formula:
1/2 the first 8 hrs
1/2 over remainder 16 hrs
** time starts at the time of injury
DISABILITY:
how should patient be acting with burns
should be A/O, if not assess for other problems
Disabilty:
-reasons why pt not A/O
- CO poisoning
- Substance abuse
- hypoxia
- pre-exist prob (seizure)
Disability:
-logrolling
to assess for burns on the back
assess for gross deformities d/t burns
EXPOSURE/ENVIRONMENT:
-interventions
e-remove all clothing, jewelry, metal, shoes
- keep warm: cover with blankets
- irrigate with cool water
What do you NEVER use to cool burns
ICE b/c it vasoconstricts
SECONDARY SURVEY
-complete hx and physical
to see if the injury matches the story
Secondary survey:
-EKGs
- assess baseline
- MONITOR when it is an electrical burn
Secondary survey:
-TBSA
calculate to give fluids
-reassess ABGS
Secondary Survey:
-Medications: analgesics and sedatives
IV ONLY! (NO IM OR PO)
- b.c third spacing
- b.c decr. absorption and paralytic ileus
what is the only IM medication you can give to burn pt
TETANUS!
what topical meds are best for burns
Antimicrobials, silver sulfadazine
*caution if sulfa allergy
What do other meds for burns
-stress ulcer and clot prevention meds
What do nurses wear when doing dressing changes
wear all PPE and sterile gloves
Recovery:
-Full thickness wounds
-excision and wound coverage
-skin graft
multiple OR visits
Recovery:
-partial thickness wounds
daily wound care with anti-anxiety meds and pain meds
Rule of thumb for ICU LOS
1% TBSA= 1 day in ICU
Rehab phase
-minimize
- skin and joint contractures
- scarring
- Body image disturbance
- PTSD
autograft
-permanent coverage
sheets or meshed
homograft/allograft
temporary wound coverage
- allows for vascularization
- better control of bacteria
