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Nursing and Complex Care > Burns > Flashcards

Burns Flashcards

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1
Q

What is the definition of a BURN

A

Burns are caused by a transference of energy from a heat source to the body.

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2
Q

What are the aims of treatment?

A
  1. Prevention
  2. Best Practise Care
  3. Prevention of disability
  4. Rehabilitation
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3
Q

What is the functioning role of the Skin?

A
  1. Regulation of body temperature
  2. Excretion of bodily fluids
  3. Sensory perception
  4. Protect the inner organs
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4
Q

Causes of Burns?

A
  1. Thermal- Flames, Flashes, Contact with hot objects & Cigarette burns
  2. Chemical- Acids, Alkali, Cresols & Pesticides
  3. Electrical- Coagulation necrosis of the tissue due to heat generated by the current. Severity is determined by:
    a) Voltage
    b) Duration
    c) Tissue Resistance
    d) Surface area affected
    e) Current Pathway
  4. Smoke inhalation- Major determinant of mortality in fire victims.
  5. Radiation- UV rays, Sun beds, Exposure to radioactive materials, radiotherapy (x-rays)
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5
Q

Burn assessments are determined by what?

A
  1. Burn assessments are determined by the tissue involved and the % TBSA
  2. Determined by the layer of skin that is injured.
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6
Q

What are the affected layers?

A
  1. Epidermal
  2. Superficial dermal
  3. Mid dermal
  4. Deep dermal
  5. Full thickness burns
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7
Q

Superficial Burns

A
  1. Involves only the epidermis
  2. Red & painful
  3. Caused by sun burn or minor flashes
  4. Small blisters may develop/ Skin peels within delayed days
  5. Heals within 7 days
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8
Q

What are the treatment for Superficial Burns?

A
  1. First aid
  2. Regular application of Hydrogel
  3. Moisturisers to soothe
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9
Q

Superficial Dermal Partial Thickness Burns

A
  1. Involves the epidermis and the superficial dermis
  2. Painful (Nerves are exposed)
  3. Blisters are a trademark
  4. Capillaries are brisk
  5. Heals within 14days by epithelialisation.
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10
Q

Mid Dermal Partial Thickness Burn

A
  1. Dermal is damaged- Preservation is vital
  2. Pain present but less severe
  3. Capillary return is present but delayed
  4. Need to wait 2-3days to determine progression and healing
  5. Heals within 14-21days: requires silver dressing
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11
Q

Deep Dermal Partial Thickness Burns

A
  1. Exposed deep dermal damage.
  2. Pale due to damage to blood vessels
  3. Diminished capillary refill
  4. Loss of sensation (mild)
  5. Recovery >21days
  6. Treatment: First aid, silver/anti- biotic dressing & surgical interventions
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12
Q

Full thickness burns

A
  1. Epidermis and dermal is destroyed
  2. Penetration to the muscles and tendons
  3. Sensation is lost
  4. White/waxy in appearance
  5. Leathery (eschar)
  6. Management: Silver/anti-biotic dressings, & skin grafting
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13
Q

Total Body Surface Area

A
  1. Associates with the area that is injured
  2. Determines facility and degree of the treatment
  3. Includes 3 methods:
    a) Lund Browders Chart
    b) Rule of Nine
    c) Palmers Method
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14
Q

Lund Browders Method

A
  1. Determines the % TBSA affected by splitting the body into smaller areas.
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15
Q

Rule of Nine

A
  1. Assigns percentages in multiple of 9s to major body parts
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16
Q

Palmers Method

A
  1. Taking the patients hand to estimate the % of burns, palm equates to 1%
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17
Q

Burn Zones

A

Includes:

  1. Zone coagulation
  2. Zone Ischaemia
  3. Zone hyperaemia
18
Q

What is the Zone Coagulation?

A
  1. Irreversible Necrosis
  2. Nearest heat source is primary injury
  3. Extent determined by tempt. and duration
19
Q

What is the Zone of Ischaemia?

A
  1. Reduced dermal circulation
  2. Potentially viable tissue
  3. Can progress to necrosis
20
Q

What is the Zone of Hyperaemia?

A
  1. Reversible

2. Increased blood flow and inflammation

21
Q

Simple Burn Pathology

A
  1. Burn
  2. Increased vascular permeability
  3. Decreased intracellular volume/Oedema
  4. Increased hemocrit/ Decreased blood volume
  5. Increased viscosity
  6. Increased peripheral resistance
  7. Leads to burn shock
22
Q

Simple Burn Pathology (continued)

A
  1. Increased heart rate to try to compensate
  2. Continued fluid loss; Fluid starts to shift outside the vascular compartment (Oedema; Pulmonary Odema)
  3. Decreased organ perfusion; Leads to organ damage
  4. Increased viscosity (increased clotting)
23
Q

Burn Pathology of the Heart

A
  1. Decreased volume triggers the SNS to release catecholamine = Increases HR; Vasoconstriction
  2. Myocardial contractility is suppressed by inflammatory cytokine necrosis factor.
  3. Most fluid is lost 24-36hrs post burn. Peaking 6-8hrs
  4. Capillary regains their integrity and fluid shifts back into the vascular space. Resolves the burn shock.
  5. Diruesis begins for days to 2 weeks post.
24
Q

Burn Pathology of the LUNGS

A
  1. Inhalation injury is the leading cause of death.
  2. Bronchoconstiction results from the release of histamine, serotonin and thromboxane.
  3. High Risk of Oedema
  4. These patients will ultimately have 100% SpO2 however are hypoxic; supplemental O2 may be needed.
  5. Risk of Respiratory Failure or altered Respiratory distress syndrome.
25
Q

Burn Pathology of the KIDNEYS

A
  1. Dysfunction of the kidneys due to poor perfusion
  2. Haeglobinuria: Blood in the urine (burgundy color)
  3. Muscle damage: Excretion of Myoglobin
  4. Insufficient blood flow to the kidneys results in Hb and myoglobin to obstruct the renal tubules. Resulting in acute tubular necrosis or ARF.
26
Q

Burn Pathology of the SKIN

A
  1. Skin regulates temperature

2. Ultimately these pts will have low temperatures but then become hyperthermic.

27
Q

Burn Pathology of the GIT

A
  1. Risk of Curlings ulcers and paralytic ileus (intestinal blockage w/o the physical obstruction)
  2. Signaled my occult blood in stool/ bloody vomitus or ground coffee material
  3. GIT distention: increased GIT permeability
28
Q

Burn Pathology of F&E:

A
  1. Oedema:
    a) tends to resolve within 10 days
    b) dependant on depth of injury
    c) Can cause compartment syndrome: increased pressure within a confined body space
  2. Hypernatremia
  3. Hyperkalaemia/Hypokalaemia
  4. Anaemia: RBC destruction
  5. Evaporative fluid loss of 3-5L’s in 1st/24hrs
29
Q

How should First Aid be given?

A
  1. Cooling with running water:
    a) 20mins
    b) if >10% TBSA injured then reconsider time
  2. Do not use ICE
  3. Immerse in water or wet towels if running water is not available
  4. Cover with cling wrap (do not wrap)
  5. Keep the patient warm
30
Q

How should minor burns be managed?

A
  1. History taking: Identification, Cause, Mechanism, Co-morbidities.
  2. Wound assessment:
    a) Determine the depth and degree of the burn
    b) Wound is dressed tailored to the burn
  3. Tetanus (important) bacteria grows on the burn
  4. Oedema Management
  5. Minimise Infection
  6. Follow up.
31
Q

Pain Management of Burns (often severe burns)

A

Pain 1-3: Paracetamol & NSAIDs
Pain 4-7: Paracetamol, NSAIDs, Tramadol & (-/+) Endone
Pain 8-10: Paracetamol, NSAIDs, Tramdol, Oxycontin SR & Endone for break through. (Consider admission)

32
Q

Management of Severe Burns

A
  1. Cooling is important
  2. Chemical burns:
    a) dilute with irrigation
    b) Litmus paper to test removal
  3. Primary & Secondary survey
  4. Airway: Clear, Patent, Voice
  5. Breathing:
    a) Humidified O2 mask
    b) Monitor chest movements
  6. Circulation: HR, BP, Capillary refill & 2 large bore IVC
  7. Fluid resusciation: Parklands formula
  8. Pain management: 2-5 Morphine repeat every 5 mins
  9. Wound assessment: Extent of burns
  10. Circumferential burns: Elevate limbs, Neuro obs, consider eschartomy (debridement of necrosed tissue)

Other:

  1. Keep the patient warmed
  2. Tetanus Immunglobin
  3. FBE
  4. NGT for burns >20%
33
Q

What are your Airway management considerations?

A 
Risk of obstruction due to swelling secondary to burn injury. Highest risk of:
1. Soot in the mouth
2. Carboneous Sputum 
3. Facial Burns
4. Singed nasal/facial hair.
5. Stidor and hoard voice
Patients may require intubation
34
Q

Fluid Resuscitation Considerations:

A
  1. Giving patient Parklands Formula
  2. Equation: (3-4mls x %TBSA x Kg/24hrs)
  3. 1/2 fluid is administered in first 8hrs post injury
  4. 1/2 fluid given over next 16 hrs post injury
  5. Time is counted from time of injury and not time of admission
  6. Crystalloid: Hartmans/NS (careful of hyperkalaemia)
35
Q

Management of Circumferential Full Thickness Burns

A
  1. Require vigilance monitoring
  2. Eschar (underlying necrosed tissue) acts as tourniquet
  3. Limbs -> Hinders circulation
  4. Chest -> Hinders chest movements
  5. Abdomen -> Hinders chest movements
  6. Eschartomy -> Full thickness incision of burn down to the subcutaneous tissue
36
Q

What are the Burn Management stages?

A
  1. Emergent/Resuscitative Phase
  2. Acute Phase
  3. Rehabilitation Phase
37
Q

What is the Management of emergent/resuscitative phase?

A
  1. First Aid
  2. ABC
  3. Remove all or any jewelry
  4. Cover the patient & ensure they are warm
  5. Ensure all cooling has occured
  6. IV access
  7. Determine the depth/degree of burns
  8. Appropriate fluid replacement
  9. Strict monitoring:
    a) Hourly vital signs
    b) Neuro obs
    c) Neurological assessments
    d) Urine Output
  10. Social care
38
Q

What is the Management of acute phase?

A
  1. Continuous Assessments
  2. Maintain respiratory status:
    (x-rays, ABGs, chest physio, humidified O2)
  3. Maintain circulatory status:
    (diuresis begins: 48hr marks- fluid moves back into the intracellular space).
  4. Monitor F&E: Impact of fluid shifts/ need for blood replacment?
  5. Maintain GIT function: Commencing early feeding, identifying source of infection.
  6. Minimise infection: Anti-pyretics & room tempt. 37-38c
  7. Wound management
  8. Pain manangement
  9. Nutritional support
  10. Mobility:
    a) Careful positioning
    b) Mobilise as soon as possible
    c) Aim to prevent contractions/scarring
    d) Prophylactic DVT prevention.
  11. Social care
39
Q

What are your wound care managements?

A
  1. Hydrotherapy:
    a) Physiotherapy time
    b) Allows assessments of the wound
    c) Natural debridement/ cleaning of the wound
  2. Tropical anti-biotic therapy: acticoat, aquacel silver, silvazine
  3. Dressings:
    Mod-High: alginate/hydrocellular foam
    Mod-low: Hydrocolloids/ hydrocellular foam
    Dry/dehydrated: Hydrogel.
  4. Facial burns are left open
  5. Debridement: Natural, mechanical, chemical, surgical
40
Q

Why would patients require skin grafting?

A
  1. Used for Full thickness burns
  2. Minimises infections
  3. Reduces protein, fluid and electrolyte loss
  4. Decrease heat loss

Nursing and Complex Care (8 decks)

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