Burns Flashcards
1
Q
The risk of death is increased in very ___ pts and very ___ pts
A
old, young
2
Q
Why are elderly people at greater risk when burned
A
less body fat
3
Q
Why are children at greater risk when burned
A
less TBSA; burn more
4
Q
5 types of burns
A
- thermal
- chemical
- smoke/inhalation
- electrical
- cold thermal injury
5
Q
electrical burn pts are at an increased risk for
A
AKI; assess bun, creat, I&O
6
Q
where do most burns occur?
A
@ home
7
Q
Burn patho
A
- pt burned
- increased vascular/capillary permeability
- increased edema/3rd spacing
- decreased blood volume (fluid rushing into vascular spaces)
- increased blood viscosity
- increased peripheral resistance
- burn shock
8
Q
Why does blood get more viscous following a burn injury
A
decrease in circulating Na+, Cl+, H2O in blood
9
Q
why do burn patients present dehydrated but have high H/H
A
the loss of blood volume causes the H/H to appear more concentrated; will drop soon
10
Q
burn severity is determined by (4)
A
- depth of burn
- extent in regards to TBSA
- location
- pt rx factors
11
Q
rule of nines percentages; anterior and posterior Head and neck \_\_\_ Each arm \_\_\_ Each leg \_\_\_\_ Trunk \_\_\_\_ Perineum \_\_\_
A
Head and neck: 9% Each arm: 9% Each leg: 18% Trunk: 36% Perineum: 1%
12
Q
patients with burns on the face, neck, and chest are at increased risk for
A
respiratory obstruction
13
Q
patients with burns on the hands, feet, joints, and eyes are at increased risk for
A
self care defecit
14
Q
patients with burns on the ears, nose, butt, and perineum are at increased risk for
A
infection
15
Q
circumferential burns can cause
A
circulation problems; think compartment syndrome
16
Q
circumferential burn assessment (2)
A
- assess circulation
- neurovascular assess
- pulse
- color
- capillary refill
17
Q
Emergent phase goals
A
stabilize! preserve vital organ function; avoid MODS
18
Q
Acute phase goals
A
normalize; promote wound healing
19
Q
Rehabilitative phase goals
A
restore; PT and OT
20
Q
How long should large thermal injuries be cooled for?
A
no longer than 10 min
21
Q
What is the most common airway injury?
A
Carbon monoxide poisoning
22
Q
Carbon monoxide poisoning patho
A
inhaled CO2 replaces and displaces O2
23
Q
Why can a pulse ox be insufficient in diagnosing carbon monoxide?
A
it only measures what binds to hemoglobin- O2 or not.
24
Q
What is carboxyhemoglobinemia
A
increased CO2 in blood; causes pt to be hypoxic and increase cardiac output
25
How is carbon monoxide poisoning Dx
carboxy Hgb test
26
How is carbon monoxide poisoning Tx
100% O2
27
How many types of carbon monoxide poisoning are there?
1. Mild
2. Medium
3. Extreme
28
Mild carbon monoxide poisoning s/s (4)
1. slight headache
2. Nausea
3. Vomiting
4. Fatigue
29
Medium carbon monoxide poisoning s/s (4)
1. Severe headache
2. Confusion
3. Drowsiness
4. Tachycardia
30
Extreme carbon monoxide poisoning s/s (4)
1. Unconsciousness
2. Convulsions
3. Cardio-resp. failure
4. Death
31
The emergent burn phase lasts from
the time of burn to the first 72 hrs
32
When does the emergent burn phase end?
when fluid mobilization and diuresis begins
33
Emergent phase interventions
1. FLUIDS FLUIDS FLUIDS
2. Airway management
3. fasciotomy/escharotomy
4. wound management
34
how many IVs will burn pts receive
2 large bore IVs if TBSA >15%
35
Always remember fluid administration is based upon the time of ____ not time Tx begins.
time of injury
36
What type of fluids should emergent burn patients get?
LR, albumin when stable
37
What type of fluid is contraindicated for emergent burn pts?
NS, Cl+ can increase risk of met. acidosis
38
What is the parkland formula?
4mL x TBSA burned x pt weight in Kg
39
What color urine is normal for pts in the emergent phase?
brown/red- due to the release of Hgb in blood
40
how many mL/hr of urine should be a pts output?
30mL/hr
41
decreased capillary permeability should increase ____, increase ____, and decrease ____.
increase urine output
increase BP
decrease pulse
42
What is an escharotomy?
cuts through the eschar; skin
43
What is a fasciotomy?
cuts through the muscle; fascia
44
Dressing changes are done ___ and ___ and are ____!
done in the am and pm
| STERILE
45
What is the biggest threat to pts in the emergent burn phase?
INFECTION; usually from pts normal flora
46
Burn pt ear care
No pillows/pressure; neck roll- hyperextension to decrease rx of contractures
47
how are burn patients extremities positioned?
extended and elevated on pillows or foam wedges; to decrease pressure
48
if a patient has perineal burns what should the nurse do?
insert a foley
49
Burn patients are at risk for ____ acidosis
Metabolic acidosis assess ABGS, BUN, Creat, I&O
50
Burn pts will be splinted to
prevent contractures
51
Emergent phase drug therapy (6)
1. fluids LR/albumin
2. analgesics IV
3. sedatives IV
4. Tetanus shot
5. IV immunoglobulins
6. topical antimicrobial agents
52
What type of immunity is the tetanus shot?
active; the body has to actively create antibodies
53
What type of immunity is IV immunoglobulins?
passive; the antibodies are already present
54
What are the topical antimicrobial agents that can be applied to the skin?
1. silver sulfadiazine
| 2. mafenide acetate
55
Why are burn patients not put on BS antibiotics?
increases their risk of MRSA and have poor circulation; pts are not administered until sepsis occurs
56
what is the number 1 leading cause of death in pts following stabilization of burns
sepsis
57
Burn patients are in what kind of metabolic state?
hypermetabolic
58
when should enteral nutrition be initiated
as soon as possible
59
severe burn patients cannot meet their basic ____ needs and are at risk for _____
basic metabolic needs; paralytic ileus
60
how many calories a day should burn patients receive?
5000 cal/day
61
when should PN be administered?
only if GI tract is not working
62
When does the acute phase begin?
72 hours after injury; when fluids mobilize and diuresis occurs
63
When does the acute phase end?
When superficial wound heal or full thickness burns are covered by grafts
64
Acute phase is essentially the restorative phase as these things occur
1. fluid mobilizes
2. capillary perm. decreases
3. bowel sounds return
4. wound healing begins
65
Hypo or hyper natremia can occur in which phase
acute
66
s/s of hyponatremia (5)
1. dizzy
2. weak
3. muscle cramps
4. headache
5. confusion
67
Hyponatremia tx
increase po fluids
68
s/s hypernatremia
1. thirsty
2. tired
3. confused
4. seizures
5. edema
6. bounding pulses
69
Hypernatremia tx
fluid restrictions
70
hyperkalemia in the acute phase is due to (3)
1. decreased cap. perm.
2. renal failure
3. adrenocortical insufficiency
71
Hypo/hypernatremian and hyperkalemia in the acute phase can cause _____.
infection
72
acute phase cardiovasc. complications (2)
1. vfib
| 2. hyperkalemia
73
acute phase respiratory complication
compromised airway
74
acute phase neurological complication
hypoxia
75
acute phase musculoskeletal complication
contractures
76
acute phase GI complications (4)
1. paralytic ileus
2. stress ulcers
3. diarrhea
4. constipation
77
acute phase endocrine complication
hyperglycemia due to stress
78
Acute phase interventions
1. wound care
2. excision/grafting
3. pain mngmt
4. PT/OT
5. Nut. therapy
79
what is eschar?
dead tissue that needs to be removed to avoid infection
80
what is enzymatic debridement?
topical creams; removes dead tissue
81
Proper graft coverings
1. petroleum gauze
2. wet dressing
3. dry dressing
82
when should iv pain meds be administered?
before wound care
83
graft site care (6)
1. elevate/immobilize
2. avoid pressure
3. avoid weight
4. mo. for infection
5. lubricate
6. splint
84
it is important to ___ antibiotics when cleaning wounds
alternate; avoid super infection
85
what type of dressing is important for graft pts
pressure dressing; stops bleeding
86
Hydrotherapy in the acute phase cannot be done if the pt is not _____ stable
hemodynamically
87
acute burn pt nutrition (4)
- high protein
- high carb
- low Na+
- low K+
88
what labs are monitored for nutrition status?
- albumin
- total protein
- pre albumin
89
The rehabilitation phase begins when
- wounds have healed
| - pt can engage in some self care
90
Rehab. phase #1 complication
contractures
91
what are the two priorities in the rehab phase
1. prevent contractures
| 2. pain management
92
1st degree burns are
sunburns or minor heat or friction burns
93
2nd degree burns are
more severe; normal skin barriers are compromised; blisters
94
3rd degree burs are
full thickness and can penetrate dermis, muscle, and bone
95
How do electrical burns put pts at increased rx of AKI
injured muscle releases myoglobin, clogging kidneys and causing metabolic acidosis
96
upper airway burn manifestations (5)
1. blisters
2. edema
3. difficulty swallowing
4. stridor
5. airway obstruction
97
Lower airway burn manifestations (5)
1. Altered mental status
2. Carbonaceous sputum/soot
3. Dyspnea
4. Singed hair
5. Wheezing
98
Unresponsive burn pt. priorities
CAB
99
Responsive burn pt priorities
ABC
100
chemical burns can be irrigated from
2 to 24 hrs
101
increased blood viscosity causes an increase in sludging which puts the pt at risk for
VTE
102
VTE risk factors (5)
1. elderly
2. obese
3. extensive or low extremity burns
4. low extremity trauma
5. immobilization
103
s/s of hypoxia
increased agitation, anxiety, restlessness, chng in breathing
104
biggest urinary burn complication
acute tubular necrosis
