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NCLEX > Burns > Flashcards

Burns Flashcards

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1
Q 
Rule of Nine's
Head & Neck
Trunk
Arm
Leg
Genitals
A 
Head & Neck - 9%
Trunk - Front: 18%, Back: 18%
Arm - 9% each
Leg - 18% each
Genital - 1%
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2
Q

Parkland Formula

Kind of fluid? When to start it? How much fluid for each 8h?

A

4mL LR x Body weight Kg x TBSA

START FROM INJURY, not when seen
1st 8 hours: ½
2nd 8 hours: 1/4
3rd 8 hours: 1/4

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3
Q

How to determine if fluid volume is adequate

A

Urine Output! NOT daily weight because they are losing this fluid FAST

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4
Q

Temperature of water to use on burn patient

A

Cool water

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5
Q

Medication for burn patients because of their fluid shift?

A

Albumin

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6
Q

Because burn patients are getting fluids fast, what is a good way to determine if we are fluid overloading the patient?

A

CVP - Right atria pressure

We want to prevent R HF

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7
Q

How do we give pain meds to burn patients

A

IV
Not PO because they may not be able to swallow and they work slowly
Not IM because they might not have enough muscle perfusion

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8
Q

Type of immunization if they need protection from Tetanus NOW

A

Immune globulin: Passive immunity

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9
Q

Type of immunization to give to prevent Tetanus

A

Tetanus Toxoid: Active immunity.

This takes 2-4 weeks for the body to make the antibodies

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10
Q

4 things to a assess circulation

A

Pulse
Skin color
Skin temperature
Cap refill

NOT TURGOR

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11
Q

Escharatomy vs Fasciotomy

A

Escharatomy: Cut through eschar to relieve pressure and restore circulation
Fasciotomy: Deeper incision through fascia to restore circulation

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12
Q

Need to assess UO how often in a burn patient

A

qh

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13
Q

Why might not the burn patient have adequate perfusion to the kidneys?

A

Kidneys will retain fluid because of fluid loss, or will not be perfused at all

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14
Q

Why are we worried about red/brown urine?

A

When muscle is damaged, myoglobin is released and needs to be perfused through the kidneys, but if the myoglobin clogs the kidneys, it may lead to Renal failure and we need to call the doctor with this color of urine

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15
Q

Medication to flush out the kidneys

A

Mannitol - don’t refrigerate

Only diuretic to use on burn patient

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16
Q

When should the patient start to diurese?

A

Fluid returns to vascular space in 48 hours if the kidneys are working

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17
Q

Is K high or low? Why?

A

HIGH because K is stored mostly within the cells and injury causes cells to lyse

18
Q

Reasons for Antacid, H2 Antagonists, PPIs to be ordered?

Magnesium carbonate (Mylanta), pantoprozole, or famotidine

A

Prevent Stress ulcer (Curlings ulcer)

19
Q

Why is the burn patient made NPO with NG tube?

When is NG removed?

A

They could develop a paralytic ileus

This is d/t hypovolemia, decreased GI motility (least perfused with trauma), and hyperkalemia (muscle weakness)

NG is removed with return of bowel sounds

20
Q

What key diet components would a burn patient need?

A

Protein and Vitamin C - More calories!! Hyper metabolic state!!

21
Q

How to assess whether GI feedings are moving through the intestines?

A

Residual

If there is a lot of residual, you will want to hold the next feed

22
Q

How to ensure proper nutrition and a positive nitrogen balance in a burn patient?

A

Pre-albumin - lab that changes first

NOT BUN - BUN is a kidney thing, not nutrition indicator
Any who who is starving has a negative balance

23
Q

Preventing contractors in hands and neck

A

Wrap each finger separately and put on a splint

Neck: Head hyperextended without pillows

24
Q

Does eschar need to be removed?

A

YES or else new tissue can’t form and bacteria love to grow in eschar

25
Q

Type of isolation for burn patients

A

Protective isolation

26
Q

How does enzymatic debridement work? Where/when can’t we use it?

A

Sutilains, Collagenase
It eats dead tissue

DO NOT USE on face, over large nerves, if open to a body cavity or if pregnant

27
Q

Hydrotherapy is used to do what? What do these patients need? What is a risk?

A

Debridement
PAIN MEDS
Cross contamination

28
Q

Why do burn patient antibiotics drugs need to be alternated?

A

Bacteria build up resistance or tolerance

29
Q

Why kind of antibiotics are best?

A

Narrow-Spectrum because these will prevent superinfection or 2nd infections

May only use broad spectrum while waiting for wound cultures - must culture before starting

30
Q

Mycin drugs… when do we worry?

A

If BUN or creatine increases
If patient complains of hearing loss

These drugs can lead to ototoxicity and nephrotoxicity

31
Q

How often can harvesting be done to a well nourished site

A

every 12-14 days

32
Q

What to do if skin graft becomes cool/blue?

A

Roll over it with q tips from the center out to remove anything under it (blood, exudate)

33
Q

What happens if graft comes off?

A

Put on sterile saline dressing over the graft, then cover with a dry sterile dressing, then call the physician

34
Q

How long to flush chemical burn

A

15-30 min water

35
Q

First thing to do with an electrical burn? Why?

A

Heart monitor for 24 hours

Hight risk for V FIB

36
Q

Electrical wounds have what?

A

Entrance and Exit

Usually blow out exit

37
Q

what can build up with electrical injuries?

A

Myoglobin and Hgb… Risk of renal damage

38
Q

ED electrical burn… How do we position them?

A

Place on a spine board w/ C Collar… these tend to occur in high places and the force of electricity and cause physical force

39
Q

Are amputations common in electrical burns?

A

Yes because circulation is destroyed

40
Q

What part of the body does electricity destroy?

A

Nerves –> Risk for cataracts, gait problems

NCLEX (23 decks)

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