BURNS Flashcards
Where do most burns occur?
Home - Think safety water temp 120F or 48.9C
After a burn many physiological changes occur. Why does plasma seep out into the tissue?
Increased capillary permeability. Occurs in the first 24hrs.
Vassels leaking b/c damaged from heat, so vascular vol. decreases can go into shock FVD.
Why does the pulse increase?
Because any time you have a FVD the pulse will increases, heart rate increases to pump fluid to organs.
Why does the cardiac output decrease?
Less volume to pump out.
Why does the urine output decrease?
B/C kidneys are either trying to hold on to fluid of they are not being perfused adequately. Dangerous b/c it only takes 20 min b/f kidney damage can occur.
Why is epinephrine secreted?
B/C makes you vasoconstrict and shunts blood to vital organs. With a “normal” BP of 120/80, anytime the systolic BP drops below 90, the Pt. will not have adequate organ perfusion. This can be very dangerous.
Why are ADH and Aldosterone secreted?
To Retain sodium & Water with aldosterone and Retain water with ADH. Therefore, the blood volume will go up!
What is the most common airway injury with a burn injury?
Carbon minoxide poisoning.
Normally, O2 binds with_____?.
Carbon monoxide travels much faster than O2. Therefore, it gets to the hemoglobin first and binds. can O2 bind now?
Hemoglobin
NO - now the Pt. is Hypoxic!
What treatment is given for airway injury with a burn ?
100% O2-to make sure more O2 is in the race! For this reason it is important to determine if the burn occured in an open or closed space b/c if Pt. inhaled more Carbon minoxide increases the risk of airway injury.
When you see a Pt. with burns to the neck/face/chest you had better think what?
Airway -monitor breathing problems.
HCP may choose to intubate prophylactically b/c if they wait to long swelling can get worse and wont go down.
If a Pt. is burned over 40% of their of their body. How do you think this is determined?
The common formula is the “Rule of Nines”
What is the “Rule of Nines”
It is an estimated of total body surface area affected.
- Neck & Head = 9%
- Trunk - Front 18% Back 18%
- Arm 9% (each)
- Leg 18% (each)
- Genital Area 1%
Treatment: For Pt. with burns > 20-25% TBSA includes:
Fluid Replacement
Emergency Management
Medication Management
Treatment: Fluid replacement includes?
-Most important aspect of burn management is fluid
replacement.
-It is important to know what time the burn occured b/c
fluid therapy for the first 24 hrs is based on the time the
injury occurred, not when the tx was implemented.
What is the common rule known as the Parkland Rule for calculating fluid replacement for burns?
Calculate what is needed for the first 24hrs and give half the volume calculated during the first 8 hrs.
Consensus Formula
(4mL of LR) X (body weight in kg) X (%0f TBSA burned) + total fluid requirement for the first 24 hrs after burn.
1st 8 hours = 1/2 of total volume
2nd 8 hours = 1/4 of total volume
3rd 8 hours = 1/4 of total volume
To calculate fluid replacement properly, you also need to know the Pt. weight in kilograms and TBSA affected.
* 1kg = 2.2pds
If the burn Pt. is restless it could suggest 3 problems:
- Inadequate fluid replacement
- Pain
- Hypoxia - nursing priority b/c it kills
Which of the following would you choose to decide if a Pts fluid volume is adequate?
Their weight or their urine output?
Urine Output:
Adult: min 0.5mL/kg/hr output
Child: min 1mL/kg/hr output
Note: in burns its urine output, in other cases its weights
A Pt. weighing 235 lbs has a 30% total body surface area burn. The HCP order is: Titrate IV fluids to maintain urinary output at 0.5 ml/kg/hr. What is the desired output?
Record answer as a whole number ______mls/hr
235lbs / 2.2= 107kg
0.5 X 106.8 X 1 = 53.4
= 53 mls/hr
Treatment 2. Emergency Management
A pt. was wrapped in a blanket to stop the burning process. Since the flames are gone, does that mean the burning process has stopped?
NO!
What else could have been done to stop the burning process?
Cool water - No ice or Ice water causes vasoconstriction
How else does the blanket help the burned pt.?
By holding in body heat and keeping out germs
Why would you remove jewelry/clothing from a burned Pt.?
B/C swelling with occur and metal gets hot. Also remove clothing remove non-adherent clothing and cover with a clean dry cloth.
What are 5 signs of an airway injury?
- Singed nose hair
- Singed facial hair
- Soot
- Coughing up stuff with dark specks or blk secretions
- Blister on the oral/pharyngeal mucosa
Is there more deaths with upper or lower body burns?
Upper
If a Pt. respirations are shallow. You know they are retaining what? Therefore which acid base imbalance will they have?
CO2
Respiratory Acidosis
Medication management for Burns:
How does Albumin help a pt. who is burned?
Albumin hold fluid in the vascular space. Therefore INCREASES vascular volume, cardiac output, blood pressure and kidney perfusion, which all helps to improve FVD b/c we are putting more fluid in the vascular space.
* more vol = more pressure
NOTE: When albumin in administered everything increases so must monitor for FVE! As the VV increases, the wrk load of the heart increases b/c more vol. to pump. If you STRESS the heart too much pt. could be thrown into FVE. Therefore cardiac output decreases b/c heart is failing. Wet lung sounds are heard b/c if heart isn’t pumping blood forward it is going back into the lungs.
If a pt. is receiving fluids rapidly, was is a measurement you could take hourly? to ensure that you are not over loading the pt.
CVP-looks at Rt. atrial pressure. If numbers increase to quickly the Rt. atrium is failing quickly.
Pain Management:
Why are I.V. pain meds preferred over
I.M. meds with burns?
I.V. meds act quickly; they act fast!
Pain Management:
In order for an I.V. med to work, you must have adequate _______? to the muscle
Perfusion
If the Pt. is badly burned you dint have adequate perfusion.
Immunization:
Tetanus Toxoid - is what kind of immunity?
Active or Passive?
Active immunity
it takes 2-4 weeks to develop their own immunity.
Immunization:
Immune globulin think ______ protection. What kind of immunity is it?
Tetanus protection
Passive Immunity - b/c Immune globulin is immediate protection which gives the pt. antibodies. The body does not have to work for the antibodies. Administered by injection.
Circulatory System:
- What does it mean when a pt. has a circumferential burn on their arm?
- What should you be checking?
- It means the arm is burnt all the way around.
2. Check for circulation
If the Pt. vascular check in their arm is bad, what are the names of the procedures to relieve the pressure?
- Escharotomy - relieves the pressure and restores the circulation, cuts through the escar.
- 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.
Renal System:
An indwelling catheter is inserted to measure urine output.
- How often will this need to be monitored?
- Is it possible that when you insert the catheter that no urine will return?
- Why is it possible to have no return?
- Hourly
- Yes!
- Kidneys are attempting to hold the fluid or they are not being perfused adequately?
What would you do if the urine was brown or red?
Call HCP
What drug might be ordered to flush out the kidneys?
Manitol
* do not refrigerate
If there is no urine output or if its less than 30mL/hour, you would start worrying about?
Kidney failure
After 48hrs the Pt. will start to diurese. Why?
B/C fluid is going back into the vascular space. which puts pt. at risk for FVE. Resulting in increase urine output.
Electrolyte Imbalance:
The pt. serum potassium level is 5.8. Where do we find most of our potassium?
Inside the Cell
With a burn what happens to the cells?
Rupture (Lice).
What happens to the number of potassium ions in the serum ( vascular space)?
Increase
What electrolyte imbalance will occur? Hyperkalemia or Hypokalemia.
Hyperkalemia
GI System:
Why do you think magnesium carbonate ( Gaviscon), pantoprazole (Protonix), or famotidine (pepcide) are ordered?
To prevent stress ulcer AKA: Curlings
List 2 antacids that are used with G.I. upset?
Antacids:
- Aluminum hydroxide gel (Amphojel)
- Magnesium hydroxide ( milk of mg)
List 3 H2 Antagonists?
- Ranitidine (Zantac)
- Famotidine (Pepcid)
- Nizatidine ( Axid)
Why would a HCP want the pt. NPO and have a NG tube hooked to suction?
Because they could develop pariyatic illius and NG would prevent aspiration.
why would the pt. develop pariyatic illius?
- decreased vascular volume
- decreased G.I. motility
- Hyperkalemia - sign muscle weakness
- If a pt. does not have bowel sounds what will happen to the abdominal girth?
- Will the pt need more or less calories?
- increase
2. more- b/c in hyper metabolic state therefore require protein and Vit.C to maximize nutrition.
The NG tube is removed when you hear what?
Bowel Sounds
When you start GI feedings, what should you measure to ensure that the supplement is moving through the G. I. tract?
Gastric Residuals - hold feeding if gastric residual increases by 50 ml. If you withdrawl fluid return it!
