Burns Flashcards
What are the 2 most common burns?
Flame and scald
How are burns classified?
By the depth of the injury and the extent of the TBSA that is burned
What factors are considered when determining the depth of a burn?
- how injury occurred
- causative agent
- temperature of burning agent
- duration of contact
- thickness of skin in burned area
How are burns described?
- superficial
- superficial-partial thickness
- deep-partial thickness
- full thickness
Superficial burns only damage what?
the epidermis
Superficial Burns
- red and dry
- slight swelling
- NO blister
- painful like sunburn
- no scarring
How long does it typically take superficial burns to heal?
7 days with usually no scarring
Superficial Partial-Thickness burns affect how much of the skin?
the epidermis is destroyed and small portion of underlying dermis
Superficial Partial-Thickness burns
- blistered
- exposed dermis is red and moist
- hair follicles are intact
- no scarring
How long does it take Superficial Partial-Thickness burns to heal?
14-21 days
Deep Partial-Thickness burn affects how much?
Extends into the reticular layer of the dermis and is hard to distinguish from full-thickness
Deep Partial-Thickness Burn
- red or white
- mottled
- moist or fairly dry
- severe pain
- permanent scarring
How long does it take Deep Partial-Thickness burns to heal?
3-8 weeks
How much will a Full-Thickness burn affect?
involves total destruction of dermis and continues into the subcutaneous fat
Can also involve muscle and bone
How do Full-Thickness burns heal?
By contraction or epithelial migration
Will require surgery
Full-Thickness Burns
- charred/leathery skin
- hair follicles/sweat glands are destroyed
- no longer experiences pain
- significant scarring
A deep partial-thickness burn can convert to a full-thickness burn in how long?
24 hours
How can the nurse prevent a deep-partial thickness burn from converting to full-thickness burn?
Immediate assessment and management
-application of cool tap water for a minimum of 5 minutes
Why should the use of ice water be avoided for large burn injuries?
It can result in hypothermia and increased mortality
Why is tap water good for burn injuries?
- reduction of pain
- reduction of tissue necrosis and need for skin grafting
What are the 3 distinct zones seen as a Bulls Eye pattern in burns?
- zone of coagulation (center)
- zone of stasis
- zone of hyperemia
When is fluid volume loss at its greatest?
first 6-8 hours
When does capillary integrity return towards normal?
36-48 hours after the burn
What are the special care areas that are automatically considered major burns?
eyes, ears, face, hands, feet, perineum, joints
Burns of 60% TBSA can cause what?
- depressed myocardial contractility
- hemoconcentration
- massive edema formation
- hypovolemic shock
What is the onset of Burn Shock?
Fluid loss continues and vascular volume decreases, the CO and BP drop
Burn Shock is characterized by what?
- capillary leak
- third spacing
- severe hypovolemia
- decreased CO
What is the preferred IV fluid for burn resuscitation?
Lactated Ringer’s b/c sodium and potassium concentration are similar to normal intravascular levels
Lactate Ringers solution can also be converted to Bicarbonate by the liver to correct what seen w/ Burn Shock?
Metabolic ACIDOSIS
If Fluid Resuscitation is delayed, large burn wound victims are at risk for what?
Abdominal Compartment Syndrome
Abdominal Compartment Syndrome
fluid shifts into the abdominal cavity causing increased abdominal distention that interferes w/ pulmonary ventilation
The volume loss into the peritoneal space w/ Abdominal Compartment Syndrome results in what?
- decreasing CO
- hypotension
- decreasing urine output
Escharotomy
surgical incision into the eschar to relieve the constricting effect of the burned tissue
Severe lactic acidosis is associated w/ what?
high early mortality
Consequences of inhalation injury
- upper airway edema
- bronchospasm
- small airway occlusion
- increased dead space
- tracheobronchitis
- pneumonia
What are the 2 categories of pulmonary injuries?
upper airway injury
inhalation injury below glottis
Upper airway injury result from what?
direct heat and edema
S/S of Upper Airway injury
- mechanical obstruction
- bronchospasms
- edema
Treatment for Upper Airway injury
Short course of endotracheal intubation
Inhalation injury below the glottis results from what?
inhaling noxious gases or steam
S/S of Inhalation Injury
- hypersecretion
- severe mucosal edema
- possible bronchospasm
- atelectasis
- expectoration of carbon particles
What is the most common cause of inhalation injury?
Carbon Monoxide
What is Standard care for Carbon Monoxide poisoning?
100% oxygen for 6 hours until HbCO level is below 10% and patient is asymptomatic
Any patient w/ possible inhalation injury must be observed for how long?
24 hours
S/S of Possible Pulmonary Damage
- burns of face/neck
- singed nasal hair
- hoarseness, voice change, dry cough, stridor
- sooty or bloody sputum
- labored breathing or tachypnea
- erythema and blistering of oral/pharyngeal mucosa
What are the 2 potential GI complications that may occur w/ burns?
paralytic ileus and curling ulcer
What are the 3 phases of burn care?
- emergent/resuscitative
- acute intermediate
- rehabilitation
What steps are important to remember?
CABD circulation airway breathing disability
Nursing Management for Circulation
- monitor Apical pulse/BP frequently
- tachycardia/slight hypotension are expected
- urinary catheter is placed
- strict I/O’s
- daily weights
- large bore IV
- maybe endotracheal intubation
Immediate interventions for establishing airway are?
100% humidified oxygen
What can occur because of high-voltage electrical injuries?
- spinal cord injury
- cardiac arrhythmias
How long should a person have cardiac monitoring after an electrical injury?
24 hours after cessation of arrhythmia
What may indicate cerebral hypoxia?
- restlessness
- confusion
- difficulty answering questions
- decreasing LOC
If the burn exceeds 20% TBSA what type of tube should be inserted?
NG tube to low suction to decompress abdomen and prevent vomiting
Why must a BP cuff be removed between readings?
It may act as a tourniquet as the extremity swells
What color urine indicated muscle damage?
burgundy colored/pigmented
When does the Acute/Intermediate phase of burn care begin?
48-72 hours after burn injury
What is the most frequent clinically related complication that occurs in patients w/ fire/flame injuries?
Pneumonia
What are the 2 goals of Debridement?
- to remove tissue contaminated by bacteria and foreign bodies
- to remove devitalized tissue or burn eschar in prep for grafting/healing
Why are autografts the ideal covering for burn wounds?
They are the patient’s own skin and will not be rejected
Purposes of wound covering are?
- decrease risk of infection
- prevent further loss of protein, fluid, and electrolytes
- minimize heat loss
Homograft
donor skin from a cadaver
What are commonly used after grafting to immobilize the graft?
Occlusive dressing
What type of dressing may be used to protect grafts?
Synthetic dressing
Hyperalgesia
enhanced intensity of pain
4 Types of Pain w/ Burn patients
- rest pain/constant background/dull pain
- breakthrough pain/intermittent;short duration;rapid onset
- procedural
- psychogenic pain;anticipatory pain
Rest pain is best handled by what type of medication?
Regularly scheduled long-acting opioids
Procedural pain requires what?
premedication w/ analgesic meds before painful procedures
What is the analgesic of choice for Burn Pain?
Morphine sulfate
Other Medications for Burns
- ketamine
- fentanyl
- PCA pump
- oxycodone
What type of diet will burn patients be on?
High protein and calorie rich diet
Promoting Mobility in burn patients
- deep breathing
- turning
- proper positioning
- low air loss/rotation beds
- elastic pressure bandages for lower extremities
