Burns Flashcards
Why does plasma seep out into the tissues after a burn?
Increase capillary permeability
When does the majority of 3rd spacing occur?
1st 24 hours
Why might a burn pt go into shock?
Fluid volume deficit from 3rd spacing
What happens to the HR during fluid volume deficit?
Increases to shunt blood to vital organs
Why is epinephrine secreted?
Vasoconstricts and shunts blood to vital organs
What is the most common airway injury with burns?
Carbon monoxide poisoning
Why might a sat probe read 100% and red in color with carbon monoxide poisoning?
Carbon monoxide is bound to the hgb
How to treat hypoxia
100% O2
What do you do prophylactically when someone is burned to the neck/face/chest?
Intubate due to risk of airway injury
Rule of Nines
Head: 9% Chest: 18% Back: 18% Each arm: 9% Each leg: 18% Genitals: 1%
How to calculate fluid replacement
From the time of the burn, calculate the total amount needed for the first 24 hours. Give half of the total volume during the first 8 hours. 2nd 8 hours: 1/4. 3rd 8 hours: 1/4.
Parkland Formula
(4mL of LR) * (weight in kg) * (%TBSA) = Fluid volume for 1st 24 hours
Nurse’s priority in burn pt
Hypoxia, not pain
How do you determine if the pt’s fluid volume is adequate?
UOP 0.4mL/kg/hr (30-50mL/hr)
Why not use ice for burns?
Vasoconstriction inhibits blood flow to extremities, use cool water
How does a blanket help with burns
Holds in body heat and keeps out germs
How to treat burns after stopping burning process
Remove jewelry and non-adherent clothing, cover wound with a clean dry cloth
A client’s respirations are shallow. What are they retaining?
CO2 (resp acid)
Albumin
Holds onto fluid in the vascular space. Increases volume, BP, kidney perfusion, CO
What happens to CO during fluid volume excess?
Decreases, workload on heart is too much and it’s too stressed
In a client who is receiving fluids rapidly, what should you measure hourly to make sure they’re not overloaded?
CVP, not UOP
Why not use IM pain meds in burn pts
You must have adequate perfusion to the muscle
Tetanus toxoid booster
Active immunity (takes 2-4 weeks to develop immunity)
Immune globulin
Immediate protection, passive immunity
What shot will burn pts get if they haven’t had a recent tetanus shot?
Immune globulin
Eschar
Dry, dark scab falling away of dead skin
What is included in a circulatory check?
Pulse, color, temp of skin, capillary refill
Escharotomy
Relieves the pressure and restores the circulation, cuts through eschar
Fasciotomy
Relieves the pressure and restores the circulation, but the cut is much deeper into the tissue. It cuts through the fascia of the muscle
Skin turgor
Checks hydration, NOT circulation
Sensation
Neurovascular check, NOT circulation
Why might urine not return when inserting a catheter?
Kidneys are retaining the fluid or aren’t being perfused adequately
What would you do if the urine was brown or red?
Call doc. It’s normal, but the doc will want to flush out kidneys
What drug is ordered to flush out the kidneys?
Mannitol
Mannitol is what type of fluid?
Hypertonic diuretic
How to care for mannitol
Inline filter, observe for crystals, do not refridgerate
Diuretics are not usually given to burn pts except mannitol, why?
We don’t want to decrease CO, the goal with mannitol is to save the kidneys
If there is no urine output, what do you worry about?
Kidney failure
Why should the pt begin to diaries after 48 hrs?
Fluid is going back into the vascular space. Now worry about fluid volume excess
Where do you find K
Inside the cell
Why is serum K increased in burn pts?
Cells burst and release the K into the cell
Why is mag carbonate, pantoprazole, or famotidine ordered?
To prevent a curling’s stress ulcer
Why does the doc want the burn pt to be NPO and have an NG tube hooked to suction?
They could develop a paralytic ileus (nothings moving in the intestines, it builds up and they could aspirate)
Why could they develop a paralytic ileus?
Decreased vascular volume, GI motility, hyperkalemia
If a client doesn’t have bowel sounds, what happens to abdominal girth?
Increases
When will the NG tube be removed?
When bowel sounds return
What maximizes nutrition in the pt?
Protein and vitamin C
When you start GI feeds, what is measured to ensure it’s moving through the intestines?
Gastric residuals
What lab work do you check to ensure proper nutrition and a positive nitrogen balance?
Prealbumin, total protein, or albumin
What might the pt with partial and full thickness burns develop?
Contractures
First degree burn, damage only to epidermis
Superficial thickness
Second degree burn, damage to entire epidermis and varying depths of dermis
Partial thickness
Third degree burn, damage to entire dermis and sometimes fat
Full thickness
How to care for burns on hands
Wrap fingers individually, use splints to prevent contractures
How to care for neck
Hyperextend neck, no pillows, could cause chin to chest contracture
1 complication of perineal burn
Infection
Do you remove eschar?
Yes, new tissue can’t generate if you don’t. Also, bacteria grows in it
What isolation with burn pts
Protective/reverse
What enzymatic debridement agents can be used to remove necrotic, dead tissue?
Sutilains, collagenase. Enzymatic drugs eat dead tissue.
-Don’t use on face, if pregnant, over large nerves, open body vacity
Hydrotherapy
Used to debride, give pain meds prior
Major complication of hydrotherapy
Cross contamination
Why are antibiotics alternated
So bacteria won’t build resistance or tolerance
Why are broad spectrum antibiotics used
To prevent super infections or secondary infections, or until cultures come back
What do you worry about with mycin drugs?
If the pts BUN or creatinine increases or if the pt complains of hearing loss. These drugs can lead to ototoxicity and/or nephrotoxicity
Purpose of grafts
Removes burned dead tissue until healthy tissue is seen
Autograft
Uses pts own skin. The donor site is an open wound, a dressing is applied until bleeding stops, then it can be left open to air
When can the surgeon reharvest from the same donor site?
If the client is well nourished, every 12-14 days
If the graft becomes blue or cool what does this mean?
Poor circulation
Why are sterile q-tips ordered to roll with gentle pressure from the center of the graft out to the edges?
To attach it to where it needs to be
What do you do if the graft comes loose?
Cover with sterile dressing
How to handle a chemical burn?
FIRST remove the client from the chemical and begin flushing, don’t wait for order
2 wounds of electrical burns
Entrance and exit, entrance is usually smaller. When it finds an exit, it usually blows out that area. Deal with the injuries you see, but don’t forget about the damage you can’t see (heart)
What is the first thing you do for an electrical injury?
Continuous heart monitor for first 24 hours
What arrhythmia is the client with an electrical burn at risk for?
V fib for first 24 hours
Why might kidney damage occur with electrical burns?
Myoglobin is released with muscle injury, and hemoglobin can build up causing kidney damage
Why might the electrical burn pt be placed on a spine board with a c-collar?
Electrical injuries occur in high places. Muscle contractions can cause fractures, and the force of the electricity can actually throw the victim forcefully
Why are amputation common with electrical burns?
Circulatory system is destroyed, extremities aren’t perfused
Complications of electrical wounds
Cataracts, gait problems, any type of neuro deficit. Anywhere there’s a vessel, there’s a nerve too, so they get damaged too.
Silver sulfadiazine
Soothing. Apply directly, if it rubs off, apply more. Can lowers WBC and cause a rash.
Mafenide acetate
Can cause acid base problems and stings. Apply more if rubbed off
Silver nitrate
Keep dressings wet, can cause electrolyte problems
Povidone-iodine
Stings and stains. May cause allergies and acid-base problems.
