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Critical Care Final > Burns > Flashcards

Burns Flashcards

1
Q

Roles of Skin

A

Regulation of body temperature

  • F/E balance
  • protect
  • sensory
  • Vit D
  • regenerates itself
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2
Q

Physiology of burns:

1) release of catecholamines

A
  • increases BP/HR
  • vasoconstriction
  • disrupted BF
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3
Q

Physiology of Burns:

2) increased capillary permeability

A
  • Edema EVERYWHERE (lungs)
  • 3rd spacing–> hypovolemia
  • fluid shifts
  • HR fast but low C.O
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4
Q

what does third spacing and hypovolemia change in electrolytes

A

Na & K changes

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5
Q

Physiology of burns:

3) decreased perfusion to GI system

A
  • paralytic ileus
  • abd distention
  • stress ulcer
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6
Q

Physiology of burns:

4) Inflammatory response- destroyed skin

A
  • immunosuppressed
  • risk for infection
  • lose ability to sweat
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7
Q

Physiology of burns:

5) Increased metabolic demands

A
  • massive catabolism and increase need for calories
  • incr. body temp
  • incr. O2 demand
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8
Q

Physiology of Burns:

6) RBCs hemolyzing causing hemoconcentration

A
  • high Hct
  • high hgb
  • incr. blood viscosity
    • thick blood= incr. risk DVT, acute kidney injury
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9
Q

What type of diet for burn victims?

A

High calorie and high PRO diet

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10
Q

SUPERFICIAL (1st deg.) burns

A

only damages the outermost layer of the skin (epidermis)

  • RED, BLISTER, PAINFUL
  • heals in a few days
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11
Q

PARTIAL THICKNESS (2nd deg) burns

A

Destroys epidermis into the dermis

  • RED, SWOLLEN, SKINY, EDEMA, BLISTER, VERY PAINFUL
  • heals in 2 weeks to 21 days
  • d/t hot fluids
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12
Q

FULL THICKNESS (3rd deg) burns

A

-ALL layers of the skin
-NO PAIN!!
TOUGH, LEATHERY, MANY COLORS, DRY
** CANNOT grow new skin

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13
Q

Treatment for superficial and partial thickness burns

A
  • stop the burning process
  • keep moist
  • NO ALOVERA with alcohol
  • use triple antibiotic cream
  • clean 2 x /day with non-adhesive dressing
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14
Q

Treatment for 3rd degree burns

A
  • Surgical excision

- SKIN GRAFT

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15
Q

How long should surgeries be for burn patients

A

short b/c don’t want to put too much more stress on the patients body

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16
Q

Rule of 9’s

A

shows extent and % of burns

  • add posterior + anterior
  • NO 1st degree burns
  • must say CHEST & ABDOMEN for full 18%
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17
Q

what day after admission is skin graft done?

A

day 1 or 2

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18
Q

Complications of skin grafts

A

1- bleeding
2- donated skin will create a new open wound
3- Grafts are very fragile

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19
Q

What temp should a skin graft room be?

A

85 F

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20
Q

When to assess if skin graft worked

A

after first dressing change

-48 hr is first change?

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21
Q

What burns are considered SERIOUS

A
  • face
  • eyes
  • hands
  • feet
  • perineum
  • CIRCUMFERENTIAL
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22
Q

Why are hand and feet burns serious?

A

so many joints, can cause contractures

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23
Q

Why is there decr. circulation to 3rd degree burns

A

d/t swelling and leathery skin

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24
Q

Risk factors for burn complications

A
  • old/young
  • CV
  • Respiratory/renal dz
  • Alcoholism
  • malnutrition
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25
Q

What are the two highest complications of burns?

A

HYPOVOLEMIC SHOCK -most common cause of death

INFECTION

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26
Q

Types of burns:

1) Thermal

A

most common

  • flame
  • flash
  • scald
  • contact with hot objects
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27
Q

Types of burns”

2) Chemical

A
  • acid
  • alkalis
  • organic compounds
    • most common to the hands
28
Q

Chemical burns

  • which substance is most dangerous and why
  • how do you treat it
A

alkali because you don’t feel burning sensation

  • RINSE WITH WATER
  • NO NEUTRALIZING until cause of burn identified
29
Q

Chemical burns

-what is there a high risk for

A
  • risk of inhalation injury! check airways for damage or swelling!
30
Q

Types of burns:

3) Electrical

A
  • there will be an entry and exit wound
  • ** check heart
  • high voltage can fracture bones
  • common in children
31
Q

Types of Burns:

4) Radiation

A

uncommon

32
Q

Burn Care Goals

A
  • prevent infection
  • fluid balance
  • thermoregulation
  • pain control
  • skin integrity
  • nutrition: start early
  • emotional support
33
Q

Primary Survey

1) AIRWAY

A

constantly reassess

  • give 100 % O2
  • Protect airway: INTUBATE
34
Q

why do you give abdomen and up burn patients 100% O2

A

to help with carbon monoxide build up

35
Q

S/S of inhalation injury

A
  • happened in an enclosed space
  • fumes
  • smoke
  • stridor
  • hoarse or raspy voice
  • carbonaceous sputum
  • singed nasal hairs
  • swelling : INTUBATE
  • MAJOR CAUSE OF MORTALITY
36
Q

how do you give 100% oxygen

A

non-rebreathing mask

37
Q

S/S carbon monoxide poisoning

A

cherry, red skin
N.V
headache

38
Q

what type of burns cause ventilation problems

A

circumferential burns

39
Q

How to treat circumferential burns

A

ESCHAROTOMY

40
Q

what is an Escharotomy

A
  • done at bedside or OR
  • made thru elastic eschar
  • returns BF to body part
41
Q

Is escharotomy painful?

A

No! b/c full thickness wounds cut thru nerves

42
Q

What meds to give during escharotomy?

A

BENZOS to help their anxiety

43
Q

Circulation:

do burns bleed

A

no

44
Q

Evaluation of circulation:

5 P’s

A 
BP
Pulses
Pallor
Temp
ect
45
Q

where to insert large bore IVs

A

NOT under burns

46
Q

what fluids to use to replace fluids in burns

A

LACTADE RINGERS

47
Q

Parkland Formula:

what does it determine?

A

how much fluid the patient needs

48
Q

Parkland Formula:

A

1/2 the first 8 hrs
1/2 over remainder 16 hrs
** time starts at the time of injury

49
Q

DISABILITY:

how should patient be acting with burns

A

should be A/O, if not assess for other problems

50
Q

Disabilty:

-reasons why pt not A/O

A
  • CO poisoning
  • Substance abuse
  • hypoxia
  • pre-exist prob (seizure)
51
Q

Disability:

-logrolling

A

to assess for burns on the back

assess for gross deformities d/t burns

52
Q

EXPOSURE/ENVIRONMENT:

-interventions

A

e-remove all clothing, jewelry, metal, shoes

  • keep warm: cover with blankets
  • irrigate with cool water
53
Q

What do you NEVER use to cool burns

A

ICE b/c it vasoconstricts

54
Q

SECONDARY SURVEY

-complete hx and physical

A

to see if the injury matches the story

55
Q

Secondary survey:

-EKGs

A
  • assess baseline

- MONITOR when it is an electrical burn

56
Q

Secondary survey:

-TBSA

A

calculate to give fluids

-reassess ABGS

57
Q

Secondary Survey:

-Medications: analgesics and sedatives

A

IV ONLY! (NO IM OR PO)

  • b.c third spacing
  • b.c decr. absorption and paralytic ileus
58
Q

what is the only IM medication you can give to burn pt

A

TETANUS!

59
Q

what topical meds are best for burns

A

Antimicrobials, silver sulfadazine

*caution if sulfa allergy

60
Q

What do other meds for burns

A

-stress ulcer and clot prevention meds

61
Q

What do nurses wear when doing dressing changes

A

wear all PPE and sterile gloves

62
Q

Recovery:

-Full thickness wounds

A

-excision and wound coverage
-skin graft
multiple OR visits

63
Q

Recovery:

-partial thickness wounds

A

daily wound care with anti-anxiety meds and pain meds

64
Q

Rule of thumb for ICU LOS

A

1% TBSA= 1 day in ICU

65
Q

Rehab phase

-minimize

A
  • skin and joint contractures
  • scarring
  • Body image disturbance
  • PTSD
66
Q

autograft

A

-permanent coverage

sheets or meshed

67
Q

homograft/allograft

A

temporary wound coverage

  • allows for vascularization
  • better control of bacteria

Critical Care Final (5 decks)

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