Burns Flashcards
where do most burns occur
at home
why does plasma seep out into the tissues following a burn
increased capillary permeability
when does most plasma seep out into the tissue following a burn
first 24 hours
does your pulse increase or decrease following a burn, why?
increase - fluid volume deficit
what happens to CO following a burn
decrases - less volume
what happens to urine output following a burn? why?
decrease - kidneys trying to retain fluid or aren’t being perfused adequately
what catecholamine is ecreted following a burn and why?
epi - causes vasoconstriction - shunts blood to vital organs
what else is secreted during a burn to improve fluid levels
aldosterone and ADH - increase blood volume
what is the most common airway injury in a burn patient
CO poisoning - CO binds stronger causes hypoxia
what is the treatment for airway injury in burn patients
give 100% O2 to knock CO out
why is it important to know if the burn occured in a closed space or not
more smoke inhalation
what do you immediately think of if you see a patient with burn injuries to head or neck
airway!
what is a prophylactic measure the HCP may do for a burn victim
intubation - incase airway closes
what is the common formula to approximate burn area
9% everwhere
18% front of torso and back
1% groin
what is one of the most important burn managmenet interventions
fluid replacement
why is it important to know what time the burn occured
fluid therapy is calculated for the first 24 hours folowing the time of injury
what is the formula called to calculate fluid replacement in burn victims
parkland formula
what is the parkland formula
(4mL) x (body weight in Kg) x (% of TBSA burned) = total fluid requirement
how is the first 24 hours of fluid replacement divided up (1st, 2nd and 3rd 8 hour periods)
1st 8 hours = 1/2 of total volume
2nd 8 hours = 1/4 of total volume
3rd 8 hours = 1/4 of total volume
a restless burn client suggests what 3 problems
hypoxia ** priority
pain
inadequate fluid replacement
what should be done to stop the burning process
soak area with cool water
why do you remove jewlery on a burn victim
because swelling will occur
what should be done with clothing on a burn victim
removed and replaced with clean dry cloth
what medication is given for burn victims
albumin
why is albumin given to burn victims
holds fluid in vascular space
increases CO, BP, organ persion
what are you worried about with giving albumin
fluid overload
what should you look at to ensure you are not overloading a patient when rapidly infusiong fluids
CVP - need central line to measure
why are IV pain meds preferred over IM with burns
act quickly ad Im requires adequate perfusion which is not necessarily the case
whats the differene in immunity between giving tetnus toxoid and immune globulin
tentus toxoid - active immunity takes time to make own antibodies
IG - passive; but immunity immediately
what are the 4 components of circulatory check
pulse
skin color
tem of skin
cap refill
what are the names of procedures to relive pressure
escharotomy - cut through eschar
fasciotomy - cut is much deeper cutrs through the fascia of the muscle
how often does urine output need to be monitored in a burn victim
hourly
what does it mean if the urine is brown or red in a burn victim
muscle and tissue damage - can clog kidneys
what drug may be ordered to flush the kidneys
mannitol
what happens to serum potassium following a burn and why?
potassium usually in a cell - when a cell is damaged potassium leaks out and increases serum level
are you worried about hyper or hypokalemia in a burn victim
hyper
what can happen to the GI system in a burn patient? what medication is given?
can get a stress ulcer (hurlings ulcer)
given antacids, H2 Antagonists or PPI
ex. magenesium carbonate or pantaprazole
what interventions might a primary health care provider order for a burn patient that are non pharmacological
NPO and NG tube - prevent paralytic ileus
what does suction and an NG tube prevent in a burn patient? why?
paralytic ileus - decraesed vascular volume
decreased GI motility, hyperkalemia
if a client doesn’t have bowel sounds what will happen to abdominal girth
increase
do burn patients need more or less calories
more; they are in a hypermetabolic state
when should an NG tube be removed
when you hear bowel sounds
when you start GI feedings, wht should you measure to ensure that the supplement ismoving throuhg he GI tract?
gastric residuals >50
what is some lab work you could check to ensure proper nutrtion and a postive nitrogen balance?
pre albumin
total protein
or albumin
clients with partial or full thickness burns may experience what?
contractures
what are the 3 classifations of burns
superfical, partial and full thickness
what is a superfical thickness burn classifed as
first degree burn - damage to only epidermis
what is a partial thickness burn classifed as
second degree burn - damage to entire epidermis and varying deptshof the dermis
what is a full thickness burn classifed as
damage to entire dermis and sometiems fat
if a patient has burns to their hands what are some spefici measures that should be taken
wrap each finger separately and use splints to prevent contractures
what should be done to prevent chin-to-chest contracture
hyper extend the neck
what is the number 1 complication with a perineal burn
infection
what is eschar? what needs to be done with it?
dead tissue - needs to be removed
what happens if eschar is not removed
new tissue cannot regenerate and bacteria can grow (infection)
what type of isolation will you use with the burn client? why?
protective; severly immunocompromised
what might be used to help remove necrotic dead tissue
enzymatic debridement agents
whe should enzymatic drugs not be used on a burn patient to remove necrotic tissueq
- not on face
- not if pregnant
- not over large nerves
- dont use if are is opened to body cavity
what is another method other than enzymatic drugs to debride that requires pain medication priro
hydrotherapy
what is our main concern with hydrotherapy
cross contamination
what are common drugs used with burns
mafenide acetate - can cause acid base problems and stings
silver nitrate - keeps these dressings wet, can cause electrolyte problems
provideone - iodine - stings and stains
why are broad spectrum antibitocs avoided
super infections or secondary infections
what do we worry about when giving antibitoics with the suffix mycin
clients BUN or creatinine - if increasing assume nephrotoxicitiy
drugs can lead to ototoxicity or nephrotoxicity
what should you first do in a chemical burn
remove client from chemical and begin flushing for 15-30mins with water
how many wounds are expected with an electrical burn
2 - entrance (smaller) and exit (bigger)
what is the first thing you do with an electrical burn
heart monitor for 24 hours
what arrhythmia is an electrical burn patient at high risk for
Vfib
what can build up in electrical burns and cause what
myoglobin and hemoglobin can build up and cause renal damage
