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Critical Care Nursing > Burns > Flashcards

Burns Flashcards

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1
Q

GI Complications of Burns

A

Paralytic Ileus
Constipation
Diarrhea
Curling Ulcer

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2
Q

Endocrine Complications of Burns

A

increased insulin production
insulin insensitivity
hyperglycemia

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3
Q

Musculoskeletal Complications of Burns

A

Contractures

decreased ROM

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4
Q

Collaborative Management for Burns

A 
Pain Management
Wound Care
Excision and Grafting
Fluids
Nutrition
Physical Therapy
Occupational Therapy
Psychosocial
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5
Q

Nursing Diagnosis for Burns

A 
Acute Pain
Fluid and Electrolyte imbalance
Nutrition less than Body requirements
Immobility rt contractures
Risk for Skin Breakdown
Risk for infection
Disturbed Body image
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6
Q

Three phases and times of Burn management

A

Emergent/resuscitative (72 hours)
Acute/healing
Rehab/ restorative

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7
Q

Emergent phase for burn interventions 1st 72 hours

A

Airway

Fluids

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8
Q

main concerns during the emergent phase for burns (2)

A

hypovolemic shock

edema

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9
Q

emergent phase of burns (increased or decreased)

  • vascular volume
  • hct
  • serum k
  • serum na
  • serum protein
A 
vascular volume-decreased
hct-increased
serum protein -decreased
serum K- increased
serum na- decreased
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10
Q

expected findings in the emergent phase (6)

A 
shock
painful/painless
blisters
paralytic ileus
shivering
ALOC
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11
Q

complication in the emergent phase
Cardiovascular (5)
Respiratory (4)
Renal (2)

A

cardiovascular-

  • decreased peripheral circulation
  • paresthesias
  • dysrhythmias
  • hypovolemic shock
  • tissue ischemia and necrosis

respiratory-

  • upper airway burns leading airway obstruction dt edema
  • lower airway
  • pneumonia
  • pulmonary edema

renal-

  • decreased perfusion leading to renal ischemia
  • ATN rt myoglobinuria 2ndry to hgb destruction
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12
Q

Emergent phase in burn injuries

  • airway management (6)
  • fluids (2 types)
  • iv lines (3)
  • wound care (3)
  • facial care method of wound care
  • eye care (3)
  • ear care (2)
  • hand/arms (3)
  • pericare
  • lab tests
  • meds (5)
  • nutrition (1)
A

airway management

  • immediate intubation if face and neck injuries and resp distress
  • 02,
  • humidified air if no intubation,
  • escharotomies
  • fiberoptic bronchoscopy (if smoke inhahation)
  • bronchodilators for brochospasm

Fluids
-types- lactated ringers, albumin

IV Lines (3)

  • 2 large bore if 15% TBSA
  • Picc line if 30% of TBSA
  • Arterial line for frequent ABGs and BP

wound care - daily shower, morning and evening dressing change

facial care- open method

eye care- frightening pt cannot open eyes dt edema, artificial tears, antbx ointment

ear care- no pillows, pressure free

hand/arms positioning- 1. overextension and 2. elevation preferred, 3 early rom

perineal care

routine lab tests- CBC,

meds- analgesics, tetanus, antibx, systemic meds if invasive wound sepsis, VTE prophylaxis

-nutrition (high carbohydrate, high protein)

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13
Q

emergent phase fluid resuscitation (2)

- name of fluid replacement formula

A
  • 2 large bore ivs if 15% of TBSA burn

- Parkland fluid replacement formula

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14
Q

Parkland fluid replacement calculations for emergent phase fluid resuscitation

A

50% of (4ml x TBSA x wt (kg))
ex: 4ml x 5 x 50=1000/2= 500ml for 1st 8 hours
Another 50% (500ml) given over 16 hours

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15
Q

restorative phase interventions 6-12 months (8) which includes meds (3)

A

-PT
-OT
-Pain
-wound care
-nutritionn
-reconstructive surgery
-Psychosocial/psychiatric support
-meds
antihistamine for itching
antidepressants if needed
water based creams

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16
Q

dressing change methods in emergent phase

  • open include
  • close include
A

open-topical antibiotic, no dressing

close- topical antibiotics, sterile dressing changed every 12-24 hours

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17
Q

Interventions in Emergent phase in burn injuries (10)

A
  • airway management (6)
  • fluids (2 types)
  • iv lines (3)
  • wound care (3)
  • facial care method of wound care
  • eye care (3)
  • ear care (2)
  • hand/arms (3)
  • pericare
  • lab tests
  • meds (5)
  • nutrition (1)
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18
Q

Acute phase starts and ends with (2) then 9 interventions in between

A

begin with diuresis and ends with evidence of wound healing

  1. fluids
  2. wound care
  3. excision and grafting
  4. pain/anxiety
  5. PT/OT
  6. nutrition
  7. RT
  8. psychosocial
  9. meds
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19
Q

time of administration and rationale for colloids in burn pts

A

after the 12-24 hours postburn when capillary permeability returns to near normal and plasma can remain in vascular space and expand the circulating volume

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20
Q

assessment of adequate fluid resuscitation in burns

A

urine output of 75-100 ml/hr in electrical burns
MAP >65 and SBP >90 and HR less than 120 measured by arterial line for accuracy dt inaccurate manual BP rt vasoconstriction and edema

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21
Q

sources of wound infection (3)

A

Pt’s own flora, respiratory tract, GI and skin

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22
Q

protective equip when changing open wounds (4)

A

hats, masks, gown, glove

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23
Q

meds for burns

  • analgesics (7)
  • tetanus
  • bronchodilators
  • sedatives/hypnotics
  • antidepressants
  • anticoagulants
  • nutritional supplements
  • gi support
A
  • analgesics- morphine, dilaudid, hydromorphone, fentanyl, oxycodone and acetaminophen (percocet), nsaids ketoralac, adjuvants gabapentin
  • tetanus-
  • bronchodilators
  • sedatives/hypnotics- lorazepam for anxiety, midazolam for sedation, zolpidem for sleep
  • antidepressants- sertaline( prozac), citalopram( celexa)
  • anticoagulants -enoxaparin( lovenox), heparin for DVT prophylaxis
  • nutritional supplements- vit A, C, E, multi for healing; zinc iron for red cellformation and cell integrity, oxandrolone for weight gain and lean muscle mass
  • gi support- ppi and h2 blocker for stomach acid and prevent curling’s ulcer; nystatin for candida overgrowth
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24
Q

causes of hyponatremia in burns

A
  • gi suctioning
  • diarrhea
  • vomiting
  • third spacing
  • fluids/ water intake
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25
Q

annother name for dilutional hyponatremia and intervention

A

water intoxication- drink juice instead of water

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26
Q

when do you see hypernatremia in burns? causes of hypernatremia

A

after successful fluid resuscitation. causes are too much salt intake like in hypertonic fluids, dietary sodium, bicarbonate intake, too little water intake as in NPO, meds and conditions that cause salt retention such as glucocorticoids, cushings, kidney failure, aldosteronism failure to produce

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27
Q

this type of crystalloid can cause hypernatremia

A

hypertonic solution

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28
Q

these disease or conditions can cause hypernatremia

A

cushings- excess corticosteroids causes sodium to be retained
kidney failure- causes decrease excretion of sodium
aldosteronism causes sodium and water retention

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29
Q

types of burns (5)

A 
thermal
electric
cold thermal
smoke inhalation
chemical
30
Q

these (2) affect treatment plan

A

type of burn and severity of burn

31
Q

thermal burns examples(3)

A

steam, hot liquids, flames

32
Q

electrical burns can cause these system problems (5)

A

respiratory, cardiac, skeletal(amputation, loss of organ function, tissue destruction

33
Q

chemical burns when in contact with three main compounds

A

acid
alkali
organic

34
Q

thermal burns can be caused by (4)

A

flame
flash
scald
contact

35
Q

severity of thermal burns depend on (2)

A

temperature and duration of contact

36
Q

interventions for chemical burns

A

1 remove chemical from skin

37
Q

continued tissue destruction xhours after removal of chemical

A

72 hours

38
Q

causes of inhalation injuries (2)

A

inhalation of hot air

inhalation of noxious chemicals

39
Q

this is a major predictor of mortality in burn victim

A

smoke inhalation injury

40
Q

3 types of smoke inhalation injuries

A

metabolic asphyxiation
upper airway injury
lower airway injury

41
Q

metabolic axphyxiating is due to what and treatment

A

Carbon monoxide poisoning, 100% humidified o2

42
Q

manifestations of metabolic asphyxiation (3)

A

1 hypoxia 2. carboxyhemoglobinemia

43
Q

upper airway injury manifestations (8)

A 
blisters
 edema
hoarseness
difficulty swallowing
stridor
copious secretions
retractions
total airway obstruction
44
Q

lower airway injuries manifestations (9)

A 
facial burns
singed facial hair
singed nasal hairs
dyspnea
wheezing
carbonaceous sputum
hoarseness
ARDS
ALOC
45
Q

damage (2) dt electrical burns can lead to (2)?

A

nerves and vessels lead to tissue anoxia and death

46
Q

severity of electrical burn depend on (5)

A 
voltage
tissue resistance
current pathways
surface area
duration of exposure
47
Q

burning inside the skin without evidence of burn on the skin surface

A

iceberg effect

48
Q

effecct of electrical burn on bones

A

fractures

49
Q

risks for (4) in electrical burns

A

dysrhythmias
myoglobinuria
metabolic acidosis
cardiac arrest

50
Q

thermal flash injury can be this type of burn

A

electrical

51
Q

severity of injury depends on (4)

A

depth 1st thru 4th degrees (superficial, superficial partial thickness, deep partial thickness, full thickness)
extent %TBSA
location face, neck,chest
pt risk factors

52
Q

burns to the face, neck and chest lead to complications in

A

respiratory obstruction

53
Q

burns to the hands, feet, joints and eys will lead to complicatios in

A

self care

54
Q

burns to ears, nose, buttocks, perineum may lead to

A

infection

55
Q

circumferential burn leads to (1) due to (1)

A

distal circulation problems dt compartment syndrome

56
Q

concurrent conditions that make for poor prognosis and recovery time

A

cardiac, respiratory, renal, debilited,

Conditions: DM, PVD, head trauma, factures, head injuries

57
Q

interventions for small thermal burns and large thermal burns

A

cover with cool damp towel for small burns

large burns- ABC, remove clothing,wrap in clean dry sheet or blanket do not immerse in cool water or icepace

58
Q

inhalation injuries

A

treat quckly with 100% humidified 02if CO poisoning

59
Q

chemical injuries (2)

A

1 brush solid particles off

2use water lavage

60
Q 
manifestations in the initial burn
vascular volume
serum na
serum k
serum protein
A

vascular volume decreased
serum na decreased
serum k increased
serum protein decreased

61
Q

redness, blanch on pressure, no blisters, mild pain

A

superficial or 1st degree

62
Q

ex of superficial or 1st deg burn (2)

A

sunburn, heat flash

63
Q

2 major classifications of burns

A

partial thickness and full thickness

64
Q

2 types of partial thickness burns

A

superficial, deep

65
Q

vesicles, red, shiny, wet, severe pain, mild to moderate edema

A

deep partial thickness

66
Q

ex of deep partial thickness burns (7)

A 
flame
flash
scald
contact burns
chemical
tar
 eletric current
67
Q

deep partial thickness burn or this degree burn

A

2nd

68
Q

dry, waxy white, leathery, hard; no pain, involves muscles, bone, tendons

A

full thickness 3 and 4th degree burns

69
Q

when does the emergent phase end

A

with fluid remobiliz`ation and diuresis

70
Q

avoid grapefruit juice when taking these meds (17)

9 categories and 17 drugs

A

Statins (cholesterol-lowering drugs): lovastatin (Mevacor), atorvastatin (Lipitor), simvastatin (Zocor, Vytorin)
Antihistamines: ebastine
Calcium channel blockers (blood pressure drugs): nitrendipine, felodipine (Plendil), nifedipine (Adalat, Procardia)
Psychiatric drugs: buspirone (BuSpar), triazolam (Halcion), carbamazepine (Tegretol), diazepam (Valium), midazolam (Versed), sertraline (Zoloft)
Immunosuppressants: cyclosporine (Neoral), tacrolimus (Prograf)
Pain medications: methadone
Impotence drug (erectile dysfunction): sildenafil (Viagra)
HIV medication: saquinavir (Invirase)
Antiarrhythmics: amiodarone (Cordarone)

71
Q

problem and pt teaching re cyclosporine (4)

A

nephrotoxic- mon bun and creatinine
avoid grapefruit juice- can decrease levels of cyclosporine
htn- monitor bp
infection- avoid crowds

72
Q

interventions for smoke inhalation (7)

A 
humidified 02
high fowlers
cough and deep breath every hour
reposition q1-2 hr
suction and physiotherapy
ventilator/intubation for severe resp distress (sob and horseness)
bronchodilators

Critical Care Nursing (5 decks)

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