Burns

Question 0

What are the 2 characteristics of a thermal burn?

Answer 0

1) Caused by flame, flash, scald, or contact with hot objects
2) Most common type of burn

Question 1

What are the 5 times of burns injuries?

Answer 1

1) Thermal burn
2) Chemical burn
3) Smoke inhalation injury
4) Electrical burn
5) Cold thermal injury

Question 2

What are the 3 characteristics of a chemical burn?

Answer 2

1) Results from tissue injury and destruction from acids, alkalis, and organic compounds.
2) Alkali burns are hard to manage because they cause protein hydrolysis and liquification
3) Damage from alkali burns continue after alkali has been neutralized.

Question 3

Chemical burns results in injury to which 4 body structures?

Answer 3

1) Skin
2) Eyes
3) Respiratory system
4) Liver and kidney

Question 4

What are the 3 types smoke inhalation injuries?

Answer 4

1) Carbon monoxide poisoning
2) Inhalation injury above the glottis
3) Inhalation injury below the glottis

Question 5

The severity of electrical burns depends on which 5 factors?

Answer 5

1) Amount of voltage
2) Tissue resistance
3) Current pathways
4) Surface area
5) Duration of the flow

Question 6

What is the probable effect on the human body of the following levels currents (milliamperes)?

1) 1 mA
2) 5 mA
3) 6-16 mA
4) 17-99 mA
5) 100-2000 mA
6) > 2000 mA

Answer 6

1) 1 mA - Perception level and slight tingling
2) 5 mA - Slight shock felt, not painful but disturbing, average individual can let go.
3) 6-16 mA - Painful shock, begin to lose muscular control, commonly referred to as freezing current or “let go” range.
4) 17-99 mA - Extreme pain, respiratory arrest, severe muscular contractions, individual cannot let go.
5) 100-2000 mA - Ventricular fibrillation, muscular contraction and nerve damage begins to occur, death is likely.
6) > 2000 mA - cardiac arrest, internal organ damage, and severe burns, death is probable.

Question 7

Electrical burns put patients at risk for which 3 conditions?

Answer 7

1) Dysrhythmias
2) Metabolic acidosis
3) Myoglobinuria

Question 8

The severity of a burn injury is determined by which 3 factors?

Answer 8

1) Depth of burn
2) Extent of burn
3) Location of burn

Question 9

In the past, burns were classified by degree (i.e., 1st, 2nd and 3rd degree). How does the ABA now advocate categorizing burns?

Answer 9

According to depth of skin destruction:

1) Partial thickness burn
2) Full thickness burn

Question 10

What are the two commonly used guides for determining the total body surface area?

Answer 10

1) Rule of Nines - Considered adequate for initial assessment of adult patients.
2) Lund-Browder Chart - Considered more accurate.

Question 11

How does the “Rule of Nines Chart” break down by body part?

Answer 11

1) Head and Neck - 9%
2) Arms - 9%
3) Ant. Trunk - 18%
4) Post. Trunk - 18%
5) Legs - 18%
6) Perineum - 1%

Question 12

How does the Lund-Browder Chart for classifying burn injuries break down by body part?

Answer 12

1) Head - 7%
2) Neck - 2%
3) Ant. Trunk - 13%
4) Post. Trunk - 13%
5) Butt - 5% (2.5% each)
6) Genitalia - 1%
7) Upper Arms - 8% (4% each)
8) Lower arms - 6% (3% each)
9) Hands - 5% (2.5% each)
10) Thighs - 19% (9.5% each)
11) Legs - 14% (7% each)
12) Feet - 7% (3.5% each)

Question 13

What are the implications of burns on the following body parts:

1) Face, neck or chest
2) Hands, feet, joints or eyes
3) Ears or nose

Answer 13

1) Face, neck or chest - Respiratory obstruction
2) Hands, feet, joints or eyes - Self care problems
3) Ears or nose - Risk for infection

Question 14

What are the 4 phases of burn management?

Answer 14

1) Prehospital care
2) Emergent (resuscitative)
3) Acute (wound healing)
4) Rehabilitative (restorative)

Question 15

What are the 3 characteristics of the Emergent Phase of burn management?

Answer 15

1) Usually lasts 24-48 hours

2) Begins with fluid loss and edema formation and continues until fluid mobilization and diuresis begins

Question 16

explain the pathophysiology of the fluid and electrolyte shift that happens during the Emergent Phase of Burn Management?

Answer 16

1) A massive shift of fluids out of the vessels as a result of ⬆ capillary permeability can lead to Hypovolemic shock.
2) Colloidal osmotic pressure ⬇, resulting in more fluid shift out of the vascular space and into the interstitial space.

Question 17

What are the 2 ways the Emergent Phase of burn management is managed?

Answer 17

1) Airway maintenance via early ET intubation and giving 100% O2.
2) Fluid therapy - Use 1 or 2 large bore IVs and give fluids using the Parland (Baxter) formula.

Question 18

Explain how to calculate the fluid therapy for a 70kg patient using the Parkland (Baxter) formula? Use the following formula:

1) 4mL/Kg/%TBSA = fluid to be given over 24 hours
2) 1/2 is given the 1st 8 hours
3) 1/4 is given each next 8 hours

Answer 18

1) 4mL x 70Kg x 50%TBSA = 14,000 mL of fluid to be given over 24 hours.
2) 1/2 of total in 1st 8 hours = 7,000 mL or 850 mL/Hr
3) 1/4 of total in 2nd 8 hours = 3,500 mL or 436 mL/Hr
4) 1/4 of total in 3rd 8 hours = 3,500 mL or 436 mL/Hr

Question 19

What kind of fluid is used in the fluid therapy of a patient using the Parkland (Baxter) method to manage fluid loss by burn and what is the specific goal of this fluid therapy?

Answer 19

1) Fluid used = Lactated Ringer

2) Goal of fluid therapy = To produce 30-50 mL of urine output per hour

Question 20

What are the 4 things to keep in mind when managing burn wounds?

Answer 20

1) Cleansing can be done in a hydrotherapy tub, cart shower, shower or bed
2) Debridement may be need to be done in the OR (loose necrotic skin is removed)
3) Immersion in a tank should be no longer than 20-30 mins because longer could cause electrolyte loss, chilling and contamination of the wound.
4) Burns should be covered with a topical antibiotic with no dressing over the wound.

Question 21

What 4 pieces of equipment should healthcare staff wear when open burn wounds are exposed?

Answer 21

1) Disposable hats
2) Masks
3) Gowns
4) Gloves

Question 22

What are the 4 characteristics of the Acute Phase of Burn Management?

Answer 22

1) Begins with the mobilization of extra cellular fluid and subsequent diuresis.
2) Concludes when the burned area is completely covered by skin grafts or when the wounds are healed.
3) Diuresis from fluid mobilization occurs, and the patient is no longer grossly edematous.
4) Bowel sounds return

Question 23

What are the 6 characteristics of the Rehabilitation Phase of Nurn Management?

Answer 23

1) Begins when the wound is covered with skin or healed and the patient is able to resume a level of self-care activity.
2) Early psychiatric intervention may be needed
3) Nurse should assess psychoemotional cues
4) Regression is a common emotional response
5) The issue of sexuality must be met with honesty
6) Family and patient support groups may be necessary