Burns

Question 1

Types of Burns

Answer 1

Thermal Burns
Chemical Burns
Electrical Burns-40-1000 volts, entry and exit site
Radiation: least common
Inhalation: smoke causes chemical damage to the lungs, decreased surfactant, local inflammation=ARDS

Question 2

Degree of Injury

Answer 2

Partial or full-thickness
First-degree: partial thickness, superficial, red
Second-degree: partial-thickness, blisters, heals 3-7 days, sunburn
Third-degree: Full-thickness, damage throughout the dermis, dry, black, brown or charred appearance, needs surgical debridement and a skin-graft
Fourth-degree: skin, fat, muscle and bone, extensive debridements, grafting and amputation

Question 3

Pathophysiology: Key Points

Answer 3

With greater than 25% surface area damage, expect systemic effects
Direct skin injury
Fluid shifts: hypovolemic shock
Pulmonary system: affected by shock state worsened if inhalation injury
Myocardial: HR increases BP decreases and CO falls
Immunosuppression-decreased lymphocyte activity
Psychological Response
F/E Imbalances: hypo, hypernatremia, hyperkalemia

Question 4

Pain Response

Answer 4

Background pain: constant pain felt at rest of “non-procedure activities”
Procedural pain: felt during dressing changes or wound debridement: high intensity

Question 5

Assessing Extent of Burns: Rule of NInes

Answer 5

Head 9%
Anterior thorax 18%
Posterior thorax 18%
Each arm 9% 
Each leg 18%
Pubic area (1%)

Question 6

Fluid Resuscitation

Answer 6

Required for injuries affecting more than 15% of surface area
Large bore IVs, central lines, cut-downs
Typically Lactated Ringers in the first 24 hours based on weight
Colloids are added during the second 24 hours along with dextrose
Many formulas used, not tested on this information
LR: 2-4 ml X kg wt x % burn

Question 7

Wound Care

Answer 7

Stop the burning by cooling, wet down, remove smoldering clothing, irrigate chemical burns
Cover with clean towels until client transferred to a Burn Center
Any third degree burn, small or large should go to a Burn Center
Cleanse, debride, topical agents, dressings, eschar removal daily, hydrotherapy all done daily

Question 8

Nursing Diagnosis

Answer 8

Impaired Gas exchange/Ineffective Airway Clearance
Hypothermia: loss of skin defenses
Risk for Infection
Risk for Stress Ulcers-histamine blockers (pepcid)
Imbalanced Nutrition: need protein
Alteration in comfort: acute pain
Impaired physical mobility: Turn, circle-electric bed
Disturbed Body Image: lots of encouragement
Ineffective Coping: keep family/friends involved