Burns Flashcards
GI Complications of Burns
Paralytic Ileus
Constipation
Diarrhea
Curling Ulcer
Endocrine Complications of Burns
increased insulin production
insulin insensitivity
hyperglycemia
Musculoskeletal Complications of Burns
Contractures
decreased ROM
Collaborative Management for Burns
Pain Management Wound Care Excision and Grafting Fluids Nutrition Physical Therapy Occupational Therapy Psychosocial
Nursing Diagnosis for Burns
Acute Pain Fluid and Electrolyte imbalance Nutrition less than Body requirements Immobility rt contractures Risk for Skin Breakdown Risk for infection Disturbed Body image
Three phases and times of Burn management
Emergent/resuscitative (72 hours)
Acute/healing
Rehab/ restorative
Emergent phase for burn interventions 1st 72 hours
Airway
Fluids
main concerns during the emergent phase for burns (2)
hypovolemic shock
edema
emergent phase of burns (increased or decreased)
- vascular volume
- hct
- serum k
- serum na
- serum protein
vascular volume-decreased hct-increased serum protein -decreased serum K- increased serum na- decreased
expected findings in the emergent phase (6)
shock painful/painless blisters paralytic ileus shivering ALOC
complication in the emergent phase
Cardiovascular (5)
Respiratory (4)
Renal (2)
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
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)
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)
emergent phase fluid resuscitation (2)
- name of fluid replacement formula
- 2 large bore ivs if 15% of TBSA burn
- Parkland fluid replacement formula
Parkland fluid replacement calculations for emergent phase fluid resuscitation
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
restorative phase interventions 6-12 months (8) which includes meds (3)
-PT
-OT
-Pain
-wound care
-nutritionn
-reconstructive surgery
-Psychosocial/psychiatric support
-meds
antihistamine for itching
antidepressants if needed
water based creams
dressing change methods in emergent phase
- open include
- close include
open-topical antibiotic, no dressing
close- topical antibiotics, sterile dressing changed every 12-24 hours
Interventions in Emergent phase in burn injuries (10)
- 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)
Acute phase starts and ends with (2) then 9 interventions in between
begin with diuresis and ends with evidence of wound healing
- fluids
- wound care
- excision and grafting
- pain/anxiety
- PT/OT
- nutrition
- RT
- psychosocial
- meds
time of administration and rationale for colloids in burn pts
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
assessment of adequate fluid resuscitation in burns
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
sources of wound infection (3)
Pt’s own flora, respiratory tract, GI and skin
protective equip when changing open wounds (4)
hats, masks, gown, glove
meds for burns
- analgesics (7)
- tetanus
- bronchodilators
- sedatives/hypnotics
- antidepressants
- anticoagulants
- nutritional supplements
- gi support
- 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
causes of hyponatremia in burns
- gi suctioning
- diarrhea
- vomiting
- third spacing
- fluids/ water intake
annother name for dilutional hyponatremia and intervention
water intoxication- drink juice instead of water
when do you see hypernatremia in burns? causes of hypernatremia
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
this type of crystalloid can cause hypernatremia
hypertonic solution
these disease or conditions can cause hypernatremia
cushings- excess corticosteroids causes sodium to be retained
kidney failure- causes decrease excretion of sodium
aldosteronism causes sodium and water retention
types of burns (5)
thermal electric cold thermal smoke inhalation chemical
these (2) affect treatment plan
type of burn and severity of burn
thermal burns examples(3)
steam, hot liquids, flames
electrical burns can cause these system problems (5)
respiratory, cardiac, skeletal(amputation, loss of organ function, tissue destruction
chemical burns when in contact with three main compounds
acid
alkali
organic
thermal burns can be caused by (4)
flame
flash
scald
contact
severity of thermal burns depend on (2)
temperature and duration of contact
interventions for chemical burns
1 remove chemical from skin
continued tissue destruction xhours after removal of chemical
72 hours
causes of inhalation injuries (2)
inhalation of hot air
inhalation of noxious chemicals
this is a major predictor of mortality in burn victim
smoke inhalation injury
3 types of smoke inhalation injuries
metabolic asphyxiation
upper airway injury
lower airway injury
metabolic axphyxiating is due to what and treatment
Carbon monoxide poisoning, 100% humidified o2
manifestations of metabolic asphyxiation (3)
1 hypoxia 2. carboxyhemoglobinemia
upper airway injury manifestations (8)
blisters edema hoarseness difficulty swallowing stridor copious secretions retractions total airway obstruction
lower airway injuries manifestations (9)
facial burns singed facial hair singed nasal hairs dyspnea wheezing carbonaceous sputum hoarseness ARDS ALOC
damage (2) dt electrical burns can lead to (2)?
nerves and vessels lead to tissue anoxia and death
severity of electrical burn depend on (5)
voltage tissue resistance current pathways surface area duration of exposure
burning inside the skin without evidence of burn on the skin surface
iceberg effect
effecct of electrical burn on bones
fractures
risks for (4) in electrical burns
dysrhythmias
myoglobinuria
metabolic acidosis
cardiac arrest
thermal flash injury can be this type of burn
electrical
severity of injury depends on (4)
depth 1st thru 4th degrees (superficial, superficial partial thickness, deep partial thickness, full thickness)
extent %TBSA
location face, neck,chest
pt risk factors
burns to the face, neck and chest lead to complications in
respiratory obstruction
burns to the hands, feet, joints and eys will lead to complicatios in
self care
burns to ears, nose, buttocks, perineum may lead to
infection
circumferential burn leads to (1) due to (1)
distal circulation problems dt compartment syndrome
concurrent conditions that make for poor prognosis and recovery time
cardiac, respiratory, renal, debilited,
Conditions: DM, PVD, head trauma, factures, head injuries
interventions for small thermal burns and large thermal burns
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
inhalation injuries
treat quckly with 100% humidified 02if CO poisoning
chemical injuries (2)
1 brush solid particles off
2use water lavage
manifestations in the initial burn vascular volume serum na serum k serum protein
vascular volume decreased
serum na decreased
serum k increased
serum protein decreased
redness, blanch on pressure, no blisters, mild pain
superficial or 1st degree
ex of superficial or 1st deg burn (2)
sunburn, heat flash
2 major classifications of burns
partial thickness and full thickness
2 types of partial thickness burns
superficial, deep
vesicles, red, shiny, wet, severe pain, mild to moderate edema
deep partial thickness
ex of deep partial thickness burns (7)
flame flash scald contact burns chemical tar eletric current
deep partial thickness burn or this degree burn
2nd
dry, waxy white, leathery, hard; no pain, involves muscles, bone, tendons
full thickness 3 and 4th degree burns
when does the emergent phase end
with fluid remobiliz`ation and diuresis
avoid grapefruit juice when taking these meds (17)
9 categories and 17 drugs
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)
problem and pt teaching re cyclosporine (4)
nephrotoxic- mon bun and creatinine
avoid grapefruit juice- can decrease levels of cyclosporine
htn- monitor bp
infection- avoid crowds
interventions for smoke inhalation (7)
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
