Burns Flashcards
When does a majority of the initial fluid shift out of the vessels occur?
1st 24 hrs
Does the pulse increase or decrease as the fluid leaves the vasculature?
increases (b/c fluid vol deficit)
How long does it take for kidneys to sustain damage from inadequate perfusion?
20 min
Why is epinephrine secreted?
vasoconstriction to shunt blood to vital organs
What 2 hormones will make the make blood volume go up? How do they do it?
ADH –> Retain water only
Aldosterone –> Retain Na and water
Describe the Rule of 9’s (aka Consensus Formula)
Head and neck --> 9% Trunk front --> 18% Trunk back --> 18% Each arm --> 9% Each leg --> 18% Genital --> 1%
Describe the Parkland Formula (formula and admin guide)
(4 ml of LR) x (kg) x (% TBSA burned) = total fluid needed in 1st 24 hrs
Then…
1st 8 hrs = 1/2 of total volume
2nd 8 hrs = 1/4 of total volume
3rd 8 hrs = 1/4 of total volume
If client is restless, what 3 things could this be caused from? Which is the nurses PRIORITY?
Inadequate fluid replacement
Pain
Hypoxia (This is PRIORITY!!!)
What is the best indicator for fluid volume status in burn pts?
UOP
More deaths occur with (upper or lower) body burns?
Upper
If client receiving fluids rapidly, what measurement could be taken hourly to ensure not overloading the client?
CVP (right atrial pressure)
What occurs if heart can’t keep up with the amount of fluid as fluid volume is increased?
Heart is over-stressed, fluid backs up into the lungs
assess for crackles
What are 2 important immunizations for burn pts?
Are they active or passive immunity?
How quickly do they provide protection?
Tetanus toxoid
- Active immunity
- 2-4 wks b/c body must make own antibodies
Immune globulin
- Passive immunity
- Immediate protection b/c getting someone else’s antibodies
4 things to look for with circulatory checks?
1) pulse
2) color
3) temp
4) cap refill
How often check UOP
Hourly
When does the pt begin to diuresis? Why?
What happens to UOP?
48 hrs after burn
Capillaries have healed
UOP increases
What electrolyte imbalance do we watch for in burn pts?
Hyperkalemia
cells lyse and K+ spills into vascular space
Why NPO and NG tube with suction?
Could develop paralytic ileus
What are 3 reasons a burn pt could have a paralytic ileus?
- decreased vascular volume
- decreased GI motility
- hyperkalemia
How many calories should a burn pt consume?
5000 - 6000
What labs are good indicators of nutrition and nitrogen balance?
- Prealbumin (most sensitive current indicator of nutritional status)
- Total protein
- Albumin
Classify burn:
Damage only to epidermis
Superficial thickness
aka First Degree
Classify burn:
Damage to entire epidermis and varying depths of the dermis
Partial-thickness
aka Second Degree
Classify burn:
Damage to entire dermis and sometimes fat
Full-thickness
aka Third Degree
What is the #1 complication with a perineal burn?
infection
What type of isolation is used with the burn pt?
protective
What should we remember when using enzymatic debridement agents to remove necrotic tissue?
Don’t use:
- on face
- if pregnant
- over large nerves
- if area is opened to a body cavity
What to remember with mafenide acetate (Sulfamylon)
Can cause acid/base problems
Stings
If rubs off, apply more
What to remember with silver nitrate
Keep dressings wet
Can cause electrolyte problems
What to remember with povidone-iodine (Betadine)
Stings and stains
May cause allergies and acid/base problems
What should we worry about with aminoglycoside antibiotics (-mycin)? What labs do we watch closely?
Nephro- and ototoxicity
BUN and creatinine to assess kidney function
Where does autograft skin come from?
The pt
How often can new skin be harvested from the same donor site?
Every 12 - 14 days
How long do you flush chemical/electrical burns?
15 - 30 min
What arrythmia is electrical burn pt at risk for?
V-fib
