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Medsurg exam 3 > Burns > Flashcards

Burns Flashcards

1
Q

The risk of death is increased in very ___ pts and very ___ pts

A

old, young

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2
Q

Why are elderly people at greater risk when burned

A

less body fat

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3
Q

Why are children at greater risk when burned

A

less TBSA; burn more

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4
Q

5 types of burns

A
  1. thermal
  2. chemical
  3. smoke/inhalation
  4. electrical
  5. cold thermal injury
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5
Q

electrical burn pts are at an increased risk for

A

AKI; assess bun, creat, I&O

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6
Q

where do most burns occur?

A

@ home

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7
Q

Burn patho

A
  1. pt burned
  2. increased vascular/capillary permeability
  3. increased edema/3rd spacing
  4. decreased blood volume (fluid rushing into vascular spaces)
  5. increased blood viscosity
  6. increased peripheral resistance
  7. burn shock
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8
Q

Why does blood get more viscous following a burn injury

A

decrease in circulating Na+, Cl+, H2O in blood

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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

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10
Q

burn severity is determined by (4)

A
  • depth of burn
  • extent in regards to TBSA
  • location
  • pt rx factors
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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%
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12
Q

patients with burns on the face, neck, and chest are at increased risk for

A

respiratory obstruction

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13
Q

patients with burns on the hands, feet, joints, and eyes are at increased risk for

A

self care defecit

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14
Q

patients with burns on the ears, nose, butt, and perineum are at increased risk for

A

infection

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15
Q

circumferential burns can cause

A

circulation problems; think compartment syndrome

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16
Q

circumferential burn assessment (2)

A
  1. assess circulation
  2. neurovascular assess
    - pulse
    - color
    - capillary refill
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17
Q

Emergent phase goals

A

stabilize! preserve vital organ function; avoid MODS

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18
Q

Acute phase goals

A

normalize; promote wound healing

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19
Q

Rehabilitative phase goals

A

restore; PT and OT

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20
Q

How long should large thermal injuries be cooled for?

A

no longer than 10 min

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21
Q

What is the most common airway injury?

A

Carbon monoxide poisoning

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22
Q

Carbon monoxide poisoning patho

A

inhaled CO2 replaces and displaces O2

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23
Q

Why can a pulse ox be insufficient in diagnosing carbon monoxide?

A

it only measures what binds to hemoglobin- O2 or not.

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24
Q

What is carboxyhemoglobinemia

A

increased CO2 in blood; causes pt to be hypoxic and increase cardiac output

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25
Q

How is carbon monoxide poisoning Dx

A

carboxy Hgb test

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26
Q

How is carbon monoxide poisoning Tx

A

100% O2

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27
Q

How many types of carbon monoxide poisoning are there?

A
  1. Mild
  2. Medium
  3. Extreme
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28
Q

Mild carbon monoxide poisoning s/s (4)

A
  1. slight headache
  2. Nausea
  3. Vomiting
  4. Fatigue
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29
Q

Medium carbon monoxide poisoning s/s (4)

A
  1. Severe headache
  2. Confusion
  3. Drowsiness
  4. Tachycardia
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30
Q

Extreme carbon monoxide poisoning s/s (4)

A
  1. Unconsciousness
  2. Convulsions
  3. Cardio-resp. failure
  4. Death
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31
Q

The emergent burn phase lasts from

A

the time of burn to the first 72 hrs

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32
Q

When does the emergent burn phase end?

A

when fluid mobilization and diuresis begins

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33
Q

Emergent phase interventions

A
  1. FLUIDS FLUIDS FLUIDS
  2. Airway management
  3. fasciotomy/escharotomy
  4. wound management
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34
Q

how many IVs will burn pts receive

A

2 large bore IVs if TBSA >15%

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35
Q

Always remember fluid administration is based upon the time of ____ not time Tx begins.

A

time of injury

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36
Q

What type of fluids should emergent burn patients get?

A

LR, albumin when stable

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37
Q

What type of fluid is contraindicated for emergent burn pts?

A

NS, Cl+ can increase risk of met. acidosis

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38
Q

What is the parkland formula?

A

4mL x TBSA burned x pt weight in Kg

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39
Q

What color urine is normal for pts in the emergent phase?

A

brown/red- due to the release of Hgb in blood

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40
Q

how many mL/hr of urine should be a pts output?

A

30mL/hr

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41
Q

decreased capillary permeability should increase ____, increase ____, and decrease ____.

A

increase urine output
increase BP
decrease pulse

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42
Q

What is an escharotomy?

A

cuts through the eschar; skin

43
Q

What is a fasciotomy?

A

cuts through the muscle; fascia

44
Q

Dressing changes are done ___ and ___ and are ____!

A

done in the am and pm

STERILE

45
Q

What is the biggest threat to pts in the emergent burn phase?

A

INFECTION; usually from pts normal flora

46
Q

Burn pt ear care

A

No pillows/pressure; neck roll- hyperextension to decrease rx of contractures

47
Q

how are burn patients extremities positioned?

A

extended and elevated on pillows or foam wedges; to decrease pressure

48
Q

if a patient has perineal burns what should the nurse do?

A

insert a foley

49
Q

Burn patients are at risk for ____ acidosis

A

Metabolic acidosis assess ABGS, BUN, Creat, I&O

50
Q

Burn pts will be splinted to

A

prevent contractures

51
Q

Emergent phase drug therapy (6)

A
  1. fluids LR/albumin
  2. analgesics IV
  3. sedatives IV
  4. Tetanus shot
  5. IV immunoglobulins
  6. topical antimicrobial agents
52
Q

What type of immunity is the tetanus shot?

A

active; the body has to actively create antibodies

53
Q

What type of immunity is IV immunoglobulins?

A

passive; the antibodies are already present

54
Q

What are the topical antimicrobial agents that can be applied to the skin?

A
  1. silver sulfadiazine

2. mafenide acetate

55
Q

Why are burn patients not put on BS antibiotics?

A

increases their risk of MRSA and have poor circulation; pts are not administered until sepsis occurs

56
Q

what is the number 1 leading cause of death in pts following stabilization of burns

A

sepsis

57
Q

Burn patients are in what kind of metabolic state?

A

hypermetabolic

58
Q

when should enteral nutrition be initiated

A

as soon as possible

59
Q

severe burn patients cannot meet their basic ____ needs and are at risk for _____

A

basic metabolic needs; paralytic ileus

60
Q

how many calories a day should burn patients receive?

A

5000 cal/day

61
Q

when should PN be administered?

A

only if GI tract is not working

62
Q

When does the acute phase begin?

A

72 hours after injury; when fluids mobilize and diuresis occurs

63
Q

When does the acute phase end?

A

When superficial wound heal or full thickness burns are covered by grafts

64
Q

Acute phase is essentially the restorative phase as these things occur

A
  1. fluid mobilizes
  2. capillary perm. decreases
  3. bowel sounds return
  4. wound healing begins
65
Q

Hypo or hyper natremia can occur in which phase

A

acute

66
Q

s/s of hyponatremia (5)

A
  1. dizzy
  2. weak
  3. muscle cramps
  4. headache
  5. confusion
67
Q

Hyponatremia tx

A

increase po fluids

68
Q

s/s hypernatremia

A
  1. thirsty
  2. tired
  3. confused
  4. seizures
  5. edema
  6. bounding pulses
69
Q

Hypernatremia tx

A

fluid restrictions

70
Q

hyperkalemia in the acute phase is due to (3)

A
  1. decreased cap. perm.
  2. renal failure
  3. adrenocortical insufficiency
71
Q

Hypo/hypernatremian and hyperkalemia in the acute phase can cause _____.

A

infection

72
Q

acute phase cardiovasc. complications (2)

A
  1. vfib

2. hyperkalemia

73
Q

acute phase respiratory complication

A

compromised airway

74
Q

acute phase neurological complication

A

hypoxia

75
Q

acute phase musculoskeletal complication

A

contractures

76
Q

acute phase GI complications (4)

A
  1. paralytic ileus
  2. stress ulcers
  3. diarrhea
  4. constipation
77
Q

acute phase endocrine complication

A

hyperglycemia due to stress

78
Q

Acute phase interventions

A
  1. wound care
  2. excision/grafting
  3. pain mngmt
  4. PT/OT
  5. Nut. therapy
79
Q

what is eschar?

A

dead tissue that needs to be removed to avoid infection

80
Q

what is enzymatic debridement?

A

topical creams; removes dead tissue

81
Q

Proper graft coverings

A
  1. petroleum gauze
  2. wet dressing
  3. dry dressing
82
Q

when should iv pain meds be administered?

A

before wound care

83
Q

graft site care (6)

A
  1. elevate/immobilize
  2. avoid pressure
  3. avoid weight
  4. mo. for infection
  5. lubricate
  6. splint
84
Q

it is important to ___ antibiotics when cleaning wounds

A

alternate; avoid super infection

85
Q

what type of dressing is important for graft pts

A

pressure dressing; stops bleeding

86
Q

Hydrotherapy in the acute phase cannot be done if the pt is not _____ stable

A

hemodynamically

87
Q

acute burn pt nutrition (4)

A
  • high protein
  • high carb
  • low Na+
  • low K+
88
Q

what labs are monitored for nutrition status?

A
  • albumin
  • total protein
  • pre albumin
89
Q

The rehabilitation phase begins when

A
  • wounds have healed

- pt can engage in some self care

90
Q

Rehab. phase #1 complication

A

contractures

91
Q

what are the two priorities in the rehab phase

A
  1. prevent contractures

2. pain management

92
Q

1st degree burns are

A

sunburns or minor heat or friction burns

93
Q

2nd degree burns are

A

more severe; normal skin barriers are compromised; blisters

94
Q

3rd degree burs are

A

full thickness and can penetrate dermis, muscle, and bone

95
Q

How do electrical burns put pts at increased rx of AKI

A

injured muscle releases myoglobin, clogging kidneys and causing metabolic acidosis

96
Q

upper airway burn manifestations (5)

A
  1. blisters
  2. edema
  3. difficulty swallowing
  4. stridor
  5. airway obstruction
97
Q

Lower airway burn manifestations (5)

A
  1. Altered mental status
  2. Carbonaceous sputum/soot
  3. Dyspnea
  4. Singed hair
  5. Wheezing
98
Q

Unresponsive burn pt. priorities

A

CAB

99
Q

Responsive burn pt priorities

A

ABC

100
Q

chemical burns can be irrigated from

A

2 to 24 hrs

101
Q

increased blood viscosity causes an increase in sludging which puts the pt at risk for

A

VTE

102
Q

VTE risk factors (5)

A
  1. elderly
  2. obese
  3. extensive or low extremity burns
  4. low extremity trauma
  5. immobilization
103
Q

s/s of hypoxia

A

increased agitation, anxiety, restlessness, chng in breathing

104
Q

biggest urinary burn complication

A

acute tubular necrosis

Medsurg exam 3 (3 decks)

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