Burns & Oncology Flashcards
Burns ________ capillary permeability and ______ seeps out into the tissue.
increase
plasma
The majority of this occurs in the first 24 hrs and we need to worry about shock.
Burn victimes are in ____. The pulse _____. CO _____. UOP ____.
FVD due to massive fluid shifts bc the capillaries are leaking
pulse increases (compensation for lack of fluid in vascular space)
CO decreases (less volume less pressure)
UOP decreases (kidneys are either trying to hold on to flui or aren’t being perfused)
What all is secreted with burn victims?
Epinephrine and norepinephrine to make you peripherally vasoconstrict to shunt.
ADH and Aldosterone hold on to sodium and water to increase blood volume.
ADH just water.
Aldosterone water and sodium.
Anytime the ______ BP drops below __ the client will not have what?
Anytime the systolic BP drops below 90 the client will not have adequate organ perfusion.
ex. 85/60
Rule of 9’s
Measures % of BSA that is burned.
Head and Neck: 9%
Front of Truck: 18%
Back of Torso: 18%
Arm: 9% each
- Ex. Anterior arm: 4.5%
Leg: 18% each
Genital area: 1%
Partial-thickness burns vs. Full-thickness burns
Partial - first and second degree
Full - third and fourth
Examples of severe burns:
located on face, neck, or chest = interferes with breathing
hands, feet, joints, eyes = interferes with daily life
Risk Factors with Burns:
Heart, lung, kidney disease (less able to compensate or go without perfusion)
Healing issues (pre-existing diabetes or peripheral vascular disease)
Other injuries (falls, smoke inhalation)
Old and very young
A higher mortality is expected in ______ & ______ with burns. Why?
very young and very old
Skin is very thin and they have less subQ fat meaning burns can go deeper.
BSA is a lot less in the very young.
Treatment for Burns:
Stop burning process (blankets, cool water)
——- blankets hold in body heat and keep out germs.
Remove jewelry and non-adherent clothing and cover with dry clean cloth.
Check for inhalation injuries and treat
- —– Carbon Monoxide - oxygen 100%
- —– Hydrogen cyanide - oxygen 100%
- ———– if you suspect inhalation injury = intubate BEFORE swelling occurs
Fluid replacement (LR and albumin)
Medication (albumin, opioids, tetanus toxoid, immune globulin
Infection Control (systemic antibiotics / topical meds)
Wound Care (debridement / grafting
Nutrition (protein and vit. C)
Carbon Monoxide Poisoning
Client will be hypoxic even with O2 sat measuring 100%.
treatment is 100% oxygen
watch for signs of hypoxia, not the O2 sat because it only counts bound hemoglobin, not hemoglobin boung specifically with oxygen.
Hydrogen cyanide
treatment 100% oxygen
antidote at hospital
determine if the burn occurred in an open or closed space
Indicators of inhalation injury:
singed nose or facial hair soot on face coughing up secretions with dark specks dysphagia wheezing blisters found on oral / pharyngeal mucousa hoarseness substernal / intercostal retractions and stridor
** if you see these, intubate in case their airway swells shut
Fluid Replacement with Burns:
Needs at least 2 large bore IV’s.
Crystalloids (LR) and colloids (albumin) are used for fluid replacement
Based on time injury occurred.
- – total amount of fluid needed for first 24, then give half in first 8 hours.
- – (2-4 mL of LR) x (kg) x (TBSA%) = total fluid requirements in first 24 hrs
- 4 mL used for electrical burns to prevent renal damage
How do you tell if fluid replacement in burn victims is adequate?
measure urinary output
min of 0.5 to 1 mL/hg/hr (30-50 mL/hr)
75-100 mL/hr for electrical injuries
Restless burn victim? Think:
pain
hypoxia
inadequate fluid replacement
Albumin
colloid
- administered after first 24 hrs once capillary permeability is normal
- Helps to hold onto fluid in vascular space
- increases vascular volume which increases renal perfusion, BP, and CO
- increases workload of heart bc it’s increasing volume
- WATCH FOR FVE / you’ll know if the CO begins to decrease, you hear crackles or wetness in the lungs
- Measure CVP hourly to ensure you’re not overloading the client!
Why do we give IV pain meds to burn victims?
It’s faster!
IM won’t work if the muscle is damaged or not being perfused.
Immunizations with burns.
Tetanus Toxoid (active immunity) –> takes 2-4 wks to develop immunity
Immune globulin (passive immunity) –> immediate protection
Infection control with burns
Systemic Antibiotic Therapy
Topical Medications
Systemic Antibiotic Therapy with Burns
broad-spectrum avoided (superinfection, secondary infection, sepsis)
- broad-spectrum used until wound cultures return.
- COLLECT CULTURES BEFORE ADMINISTERING ANTIBIOTICS
-mycin durgs –> watch for BUN and creatinine increases (nephrotoxicity)
and for hearing loss (ototoxicity)
Topical Meds and Burns
Why? Reduced blood flow = IV meds may not get to tissues
Silver dressings are antimicrobial.
Left in place for 3-14 days
1) mafenide acetate - acid/base problems likely / stings / reapply if it rubs off
2) silver nitrate - keep wet / electrolyte problems likely
3) antimicrobial ointments - antibacterial coverage / promote moist wound
alternate methods so tolerance isn’t developed
*CHECK FOR SULFATE ALLERGY
How to apply? Thin layer w sterile gloves
Debridement
1 ) enzymatic debridement
- —- sutilains or collagenase eat dead tissue
- ——- don’t use on face (scarring)
- ——- don’t use if pregnant
- ——- don’t use over large nerves
- ——- don’t use if open to body cavity
2 ) hydrotherapy
- —- pain management before this therapy
- —- immersion hydrotherapy (whirlpool) can cause cross-contamination bt injuries
Grafting
Autograft = own
surgeon can re-harvest from same donor site every 12-14 days
blue or cool skin graft = poor circulation
—- may use syringes or pressure to try and work any fluid or air out from under graft to help w adherence
Graft = cover w wet NS gauze
Donor site = dry gauze
