BURNS: Brunner's Ch 62: Managements of Patients with Burn Injury Flashcards
A patient is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the skin appears charred. Based on these assessment findings, what is the depth of the burn on the patients arm? A) Superficial partial-thickness B) Deep partial-thickness C) Full partial-thickness D) Full-thickness
D) Full-thickness
A full-thickness burn involves total destruction of the epidermis and dermis and, in some cases, underlying tissue as well. Wound color ranges widely from white to red, brown, or black. The burned area is painless because the nerve fibers are destroyed. The wound can appear leathery; hair follicles and sweat glands are destroyed. Edema may also be present. Superficial partial-thickness burns involve the epidermis and possibly a portion of the dermis; the patient will experience pain that is soothed by cooling. Deep partial-thickness burns involve the epidermis, upper dermis, and portion of the deeper dermis; the patient will complain of pain and sensitivity to cold air. Full partial thickness is not a depth of burn.
The current phase of a patients treatment for a burn injury prioritizes wound care, nutritional support, and prevention of complications such as infection. Based on these care priorities, the patient is in what phase of burn care? A) Emergent B) Immediate resuscitative C) Acute D) Rehabilitation
C) Acute
The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. During this phase, attention is directed toward continued assessment and maintenance of respiratory and circulatory status, fluid and electrolyte balance, and gastrointestinal function. Infection prevention, burn wound care (i.e., wound cleaning, topical antibacterial therapy, wound dressing, dressing changes, wound dbridement, and wound grafting), pain management, and nutritional support are priorities at this stage. Priorities during the emergent or immediate resuscitative phase include first aid, prevention of shock and respiratory distress, detection and treatment of concomitant injuries, and initial wound assessment and care. The priorities during the rehabilitation phase include prevention of scars and contractures, rehabilitation, functional and cosmetic reconstruction, and psychosocial counseling.
A patient in the emergent/resuscitative phase of a burn injury has had blood work and arterial blood gases drawn. Upon analysis of the patients laboratory studies, the nurse will expect the results to indicate what?
A) Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
B) Hypokalemia, hypernatremia, decreased hematocrit, and metabolic acidosis
C) Hyperkalemia, hypernatremia, decreased hematocrit, and metabolic alkalosis
D) Hypokalemia, hyponatremia, elevated hematocrit, and metabolic alkalosis
A) Hyperkalemia, hyponatremia, elevated hematocrit, and metabolic acidosis
Fluid and electrolyte changes in the emergent/resuscitative phase of a burn injury include hyperkalemia related to the release of potassium into the extracellular fluid, hyponatremia from large amounts of sodium lost in trapped edema fluid, hemoconcentration that leads to an increased hematocrit, and loss of bicarbonate ions that results in metabolic acidosis.
A patient has experienced an electrical burn and has developed thick eschar over the burn site. Which of the following topical antibacterial agents will the nurse expect the physician to order for the wound?
A) Silver sulfadiazine 1% (Silvadene) water-soluble cream
B) Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream
C) Silver nitrate 0.5% aqueous solution
D) Acticoat
B) Mafenide acetate 10% (Sulfamylon) hydrophilic-based cream
Mafenide acetate 10% hydrophilic-based cream is the agent of choice when there is a need to penetrate thick eschar. Silver products do not penetrate eschar; Acticoat is a type of silver dressing.
An occupational health nurse is called to the floor of a factory where a worker has sustained a flash burn to the right arm. The nurse arrives and the flames have been extinguished. The next step is to cool the burn. How should the nurse cool the burn?
A) Apply ice to the site of the burn for 5 to 10 minutes.
B) Wrap the patients affected extremity in ice until help arrives.
C) Apply an oil-based substance or butter to the burned area until help arrives.
D) Wrap cool towels around the affected extremity intermittently.
D) Wrap cool towels around the affected extremity intermittently.
Once the burn has been sustained, the application of cool water is the best first-aid measure. Soaking the burn area intermittently in cool water or applying cool towels gives immediate and striking relief from pain, and limits local tissue edema and damage. However, never apply ice directly to the burn, never wrap the person in ice, and never use cold soaks or dressings for longer than several minutes; such procedures may worsen the tissue damage and lead to hypothermia in people with large burns. Butter is contraindicated.
An emergency department nurse has just admitted a patient with a burn. What characteristic of the burn will primarily determine whether the patient experiences a systemic response to this injury?
A) The length of time since the burn
B) The location of burned skin surfaces
C) The source of the burn
D) The total body surface area (TBSA) affected by the burn
D) The total body surface area (TBSA) affected by the burn
Systemic effects are a result of several variables. However, TBSA and wound severity are considered the major factors that affect the presence or absence of systemic effects.
A nurse on a burn unit is caring for a patient in the acute phase of burn care. While performing an assessment during this phase of burn care, the nurse recognizes that airway obstruction related to upper airway edema may occur up to how long after the burn injury? A) 2 days B) 3 days C) 5 days D) 1 week
A) 2 days
Airway obstruction caused by upper airway edema can take as long as 48 hours to develop. Changes detected by x-ray and arterial blood gases may occur as the effects of resuscitative fluid and the chemical reaction of smoke ingredients with lung tissues become apparent.
A patient has sustained a severe burn injury and is thought to have an impaired intestinal mucosal barrier. Since this patient is considered at an increased risk for infection, what intervention will best assist in avoiding increased intestinal permeability and prevent early endotoxin translocation?
A) Early enteral feeding
B) Administration of prophylactic antibiotics
C) Bowel cleansing procedures
D) Administration of stool softeners
A) Early enteral feeding
If the intestinal mucosa receives some type of protection against permeability change, infection could be avoided. Early enteral feeding is one step to help avoid this increased intestinal permeability and prevent early endotoxin translocation. Antibiotics are seldom prescribed prophylactically because of the risk of promoting resistant strains of bacteria. A bowel cleansing procedure would not be ordered for this patient. The administration of stool softeners would not assist in avoiding increased intestinal permeability and prevent early endotoxin translocation.
A patient has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. After ensuring cardiopulmonary stability, what would be the nurses immediate, priority concern when planning this patients care? A) Fluid status B) Risk of infection C) Nutritional status D) Psychosocial coping
A) Fluid status
During the early phase of burn care, the nurse is most concerned with fluid resuscitation, to correct large-volume fluid loss through the damaged skin. Infection control and early nutritional support are important, but fluid resuscitation is an immediate priority. Coping is a higher priority later in the recovery period.
The nurse is preparing the patient for mechanical debridement and informs the patient that this will involve which of the following procedures?
A) A spontaneous separation of dead tissue from the viable tissue
B) Removal of eschar until the point of pain and bleeding occurs
C) Shaving of burned skin layers until bleeding, viable tissue is revealed
D) Early closure of the wound
B) Removal of eschar until the point of pain and bleeding occurs
Mechanical dbridementcan be achieved through the use of surgical scissors, scalpels, or forceps to remove the eschar until the point of pain and bleeding occurs. Mechanical dbridement can also be accomplished through the use of topical enzymatic dbridement agents. The spontaneous separation of dead tissue from the viable tissue is an example of natural dbridement. Shaving the burned skin layers and early wound closure are examples of surgical dbridement.
A patient with a partial-thickness burn injury had Biobrane applied 2 weeks ago. The nurse notices that the Biobrane is separating from the burn wound. What is the nurses most appropriate intervention?
a. Reinforce the Biobrane dressing with another piece of Biobrane.
b. Remove the Biobrane dressing and apply a new dressing.
c. Trim away the separated Biobrane.
d. Notify the physician for further emergency-related orders.
c. Trim away the separated Biobrane.
As the Biobrane gradually separates, it is trimmed, leaving a healed wound. When the Biobrane dressing adheres to the wound, the wound remains stable and the Biobrane can remain in place for 3 to 4 weeks. There is no need to reinforce the Biobrane nor to remove it and apply a new dressing. There is not likely any need to notify the physician for further orders.
An emergency department nurse learns from the paramedics that they are transporting a patient who has suffered injury from a scald from a hot kettle. What variables will the nurse consider when determining the depth of burn? A) The causative agent B) The patients preinjury health status C) The patients prognosis for recovery D) The circumstances of the accident
A) The causative agent
The following factors are considered in determining the depth of a burn: how the injury occurred, causative agent (such as flame or scalding liquid), temperature of the burning agent, duration of contact with the agent, and thickness of the skin. The patients preinjury status, circumstances of the accident, and prognosis for recovery are important, but are not considered when determining the depth of the burn.
A nurse is caring for a patient who has sustained a deep partial-thickness burn injury. In prioritizing the nursing diagnoses for the plan of care, the nurse will give the highest priority to what nursing diagnosis?
a. Activity Intolerance
b. Anxiety
c. Ineffective Coping
d. Acute Pain
d. Acute Pain
Pain is inevitable during recovery from any burn injury. Pain in the burn patient has been described as one of the most severe causes of acute pain. Management of the often-severe pain is one of the most difficult challenges facing the burn team. While the other nursing diagnoses listed are valid, the presence of pain may contribute to these diagnoses. Management of the patients pain is the priority, as it may have a direct correlation to the other listed nursing diagnoses.
A triage nurse in the emergency department (ED) receives a phone call from a frantic father who saw his 4-year-old child tip a pot of boiling water onto her chest. The father has called an ambulance. What would the nurse in the ED receiving the call instruct the father to do?
A) Cover the burn with ice and secure with a towel.
B) Apply butter to the area that is burned.
C) Immerse the child in a cool bath.
D) Avoid touching the burned area under any circumstances.
C) Immerse the child in a cool bath.
After the flames or heat source have been removed or extinguished, the burned area and adherent clothing are soaked with cool water briefly to cool the wound and halt the burning process. Cool water is the best first-aid measure. Ice and butter are contraindicated. Appropriate first aid necessitates touching the burn.
A nurse is teaching a patient with a partial-thickness wound how to wear his elastic pressure garment.
How would the nurse instruct the patient to wear this garment?
a. 4 to 6 hours a day for 6 months
b. During waking hours for 2 to 3 months after the injury
c. Continuously
d. At night while sleeping for a year after the injury
c. Continuously
Elastic pressure garments are worn continuously (i.e., 23 hours a day).
A patient is brought to the ED by paramedics, who report that the patient has partial-thickness burns on the chest and legs. The patient has also suffered smoke inhalation. What is the priority in the care of a patient who has been burned and suffered smoke inhalation? A) Pain B) Fluid balance C) Anxiety and fear D) Airway management
D) Airway management
Systemic threats from a burn are the greatest threat to life. The ABCs of all trauma care apply during the early postburn period. While all options should be addressed, pain, fluid balance, and anxiety and fear do not take precedence over airway management.
