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Patho > Burns part 2 > Flashcards

Burns part 2 Flashcards

1
Q

Management of Airways (EP)

A

-early endotrachial intubation
-escharotomies of chest
-fiberoptic bronchoscopy
-humidified air and 100% O2
-High fowler’s position
-suctioning, chest PT
-bronchodilators

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2
Q

Nursing management of fluid (EP)

A

-2 large-bore IV lines for greater than 15% TBSA

-Central line might be needed for over 20 (book says 30)% TBSA

-Areterial line if frequent ABGs or invasive BP monitoring needed

-Use Parkland (Baxter) formula for fluid replacement (4 mL X weight (kg) X TBSA)

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3
Q

Nursing management of wound care - cleansing/debridement (EP)

A

Cleanse and gently debridement (remove dead tissue)
-can do on shower cart, in shower, or on a bed/stretcher

Surgical debridement
-in OR
-necrotic skin removed
-releasing escharotomies and fasciotomies might happen
(fasciotomies relieve swelling)

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4
Q

Nurse management- wound care: showers and dressings(EP)

A

Once-daily showers
-dressing changes in morning and evening –> antimicrobial dressings can stay for 3-14 days

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5
Q

nurse management: wound infection facts (EP)

A

infection can cause further tissue injury and possible sepsis
-source of infection is patient’s own flora from skin, respiratory, and GI

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6
Q

nurse management: wound care - open method (EP)

A

Burn is covered with topical antimicrobial
-no dressing over wound
-usually limited to care of facial burns

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7
Q

nurse management: wound care - multiple dressing changes/closed method (EP)

how often to change dressings?

A

sterile gauze dressings laid over topical antimicrobial

Dressings changed anywhere bt every 12 hrs to every 14 days

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8
Q

nurse management: wound care - staff percautions around open wounds

A

PPE
-disposable hats
-masks
-gowns
-gloves

use sterile gloves to apply ointment and sterile dressing

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9
Q

nurse management: wound care- grafts (EP)

used for what% TBSA?

A

allograft/homograft skin (for over 50% TBSAs)
-from skin donor cadavers
-used with newer biosynthetic options

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10
Q

nurse management: wound care - face and eyes

A

Face
- cover with ointment and gauze
- don’t wrap –> too much pressure

Eye care for corneal burns
-antibiotic ointment
-artificial tears for moisture and comfort
-periorbital edema might scare patient

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11
Q

nurse management: wound care - ears and hands/arms (EP)

A

Ears
-no pressure!
-no pillows!
-raise head with rolled towel

Hands and arms
-extended and elevated on pillows or foam wedges
-splints can be used on hands and feet
-wraps can reduce edema

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12
Q

nurse management: wound care - perineum (EP)

A

keep clean and dry
assess for indwelling catheter need –> if swollen internally
perineal care
fecal diversion device if loose stool

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13
Q

nurse management: wound care- lab tests and PT (EP)

A

lab tests to monitor fluids and electrolytes
ABGs to assess oxygenation
PT for ROM exercises

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14
Q

Nurse Management: wound care - drug therapy (EP)

A

Analgesics and sedatives
-morphine, Dilaudid, Haldol, Ativan, Midazolam

Tetanus immunization - routine for burns

Antimicrobial agents
-Topical = silver sulfadiazine and mafenide acetate
-systemic are uncommon, but are used if sepsis

VTE prophylaxis
-low weight heparin or low dose unfractioned heparin
-pneumatic compression devices or graduated compression stockings if high bleeding risk

IV pain med for fast action

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15
Q

Nurse management: wound care - nutritional therapy (EP)

A

-only important after fluid replacement happens

early and aggressive nutrition support within hours of injury
-lessens complications/mortality
-optimizes healing
-minimizes effects of hypermetabolism and catabolism

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16
Q

Hypermetabolic state in burn healing
-how to deal with it

A

BMR increases by 50-100%
core temp is raised
catecholamines increase, stimulating catabolism

Early, continuous enteral feeding promotes optimal healing
adequate calories and protein - careful bc of renal isues
supplemental vits and iron

17
Q

Acute phase beginning and end

A

Starts with mobilization of extracellular fluid and subsequent diuresis

Ends when
-partial thickness wounds are healed OR
-full thickness burns are covered with grafts

18
Q

What happens during acute phase?

A

diuresis –> less edematous
Bowel sounds return
-healing starts as WBCs surround burn wound
-necrotic tissue sloughs off
-granulation tissue forms
-partial thickness burns heal from edges and dermal bed
-full thickness burns have eschar removed and skin grafts applied

19
Q

Clinical manifestation (AP)
-what happens with partial and full thickness wounds?

A

partial: eschar is removed and re-epithelialization begins

full: surgical debridement and skin grafting

20
Q

Lab values: sodium (AP)

A

Hyponatremia can happen bc GI suction and diarrhea
-also water intoxication from excess intake –> offer liquids other than water

Hypernatremia could happen after fluid resuscitation
-also improper tube feedings or inappropriate fluid administration –> limit Na

21
Q

Lab values: potassium (AP)

A

Hyperkalemia if
-renal failure
-adrenocortical insufficiency
-massive deep muscle injury
*****K is released from damaged cells

Hypokalemia if
-vomiting, diarrhea
-GI suction –> dead tissue
-IV without K supplement
-lost through wound

22
Q

What can infections do to partial thickness wounds?

A

make them become full thickness wounds!

INFECTION IS MEJOR THING DURING ACUTE PHASE

23
Q

Signs and symptoms of infection from burns (AP)

What kind of bacteria usually cause sepsis?

A

-hypo/hyper thermia
-increased heart- and respiratory rate
-low BP
-low urine output

Usualy G- bacteria –> get cultures and lactate level

24
Q

Complications during acute phase: cardiovascular and pulmonary

A

-same as emergent phase
-new stuff could happen though

25
Q

Complications: Neurologic system (AP)

A

Delerium
-more so at night
-mostly in old ppl
-usually transient
-complications and sequelae can last for years

26
Q

Complicatios: endocrine system (AP)

A

Increased blood glucose levels
-increased mobilization of glycogen stores
-gluconeogenesis

Increased insulin production
-insulin effectiveness decreased due to insulin sensitivity

Hyperglycemia may also be result of high cal intake need –> fucks up wound healing

27
Q

Nurse management: Excision and grafting (AP)

A

Cultured epithelial autographs (CEAs)
-grown from biopsies obtained from the patient’s unburned skin
-used in patients with extensive burns and/or limited skin for harvesting

28
Q

nurse management: nutrition (AP)

A

caloric needs should be calculated by dietitian

high protein and carbs

antioxidant protocol might be good

monitor labs

weekly weigh ins

29
Q

Rehabilitation phase: starts when…

A

wounds have nearly healed

patient is engaging in some level of self care

30
Q

Rehabilitation phase: Pathophysiologic changes

A

Heal either by spontaneous re-epithelialization or by skin grafting

Layers of karatinocytes start rebuilding the tissue structure

Collagen fibers add strength to weakened areas

31
Q

Rehab phase complication: skin and joint contractures

A

most common issues

develops bc shortening of scar tissue in flexor tissues of joint

Proper positioning, splinting, and exercise needed to minimize contractures

32
Q

Why are old people at risk of injury?

A

unsteady gait
limited eyesight
decreased hearing
skin is drier and more wrinkled
thinner dermis –> reduced bloodflow

33
Q

Emotional needs of patient

A

assess circumstances of burn injury

watch for survivor’s guilt, fear of dying, and frustration

new fears may occur in early recovery –> self esteem may be low

sexuality may be a thing

34
Q

how to tend to emotional needs of patient and fam and caregiver?

A

address spiritual and cultural needs

suggest caregiver and patient support groups

35
Q

Potential needs of nursing staff caring for a burn patient

A

might be hard to cope with deformities of burn

ongoing support services or debriefings could be helpful

self care!

Patho (44 decks)

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