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Complex care final > Burns part one > Flashcards

Burns part one Flashcards

1
Q

signs of inflammation

A

-pain, heat, swelling, loss of function

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2
Q

patho of a burn injury

A

-burn&raquo_space; pain&raquo_space; inflammatory process&raquo_space; fluid shifts&raquo_space; edema&raquo_space; tissue and organ damage&raquo_space; fluid mobilization diuresis&raquo_space; healing rehab&raquo_space; or shock&raquo_space; tissue organ damage continues

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3
Q

inflammatory process

A
  • PAIN
  • Increased blood flow
  • Release of Vasoactive substances
  • Increased capillary permeability
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4
Q

complications of fluid loss in burns

A
  • Edema
  • Hypovolemia
  • Shock!
  • Pain continues!
  • Tissue and Organ Damage
  • decreased fluid in blood = decreased BP and CO (perfusion)
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5
Q

how to classify burns

A
  1. etiology
  2. Depth of tissue damage
  3. total body surface area (TBSA) involved and severity
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6
Q

burn etiology

A
  • most common: fire/flame and scald
  • african amercian children
  • elderly
  • thermal
  • chemical
  • electrical
  • radiation
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7
Q

thermal burns

A
  • exposure to heat generating sources
  • flame, steam, scald, hot objects/surfaces
  • inhalation: heated gases
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8
Q

chemical burns

A

-alkaline, acidic agents and organic compounds

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9
Q

electrical burns

A

-injury related to voltage

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10
Q

radiation burns

A

-usually from radiation therapy or exposure to industrial exposure (nuclear plants)

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11
Q

role of the skin

A
  • protective barrier
  • sensation
  • water balance
  • temperature regulation
  • vitamin production
  • cosmetic
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12
Q

degree of the burn

A
  1. superficial partial thickness (1st): epidermis
  2. deep partial thickness (2nd): dermis
  3. full thickness (3rd and 4th): fat, muscle, bone
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13
Q

how long after the burn can you tell how much damage

A

24 hours

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14
Q

how to know the depth of a burn

A
  • if you tug on a hair and it comes out then the burn is as deep as the hair follicle (deep partial thickness)
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15
Q

deep partial thickness injuries loose the ability to…

A

-thermoregulate

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16
Q

classification according to burn depth

A
  • epidermis: superficial
  • minimally into the dermis: superficial partial thickness
  • dermis: deep partial thickness
  • SQ: full thickness
  • muscle: full thickness
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17
Q

superficial burn common cause

A
  • sunburn

- minor scalds

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18
Q

superficial burn signs

A
  • mild erythema, hypersensitivity, blanches, pain

- causes pain and discomfort but no real medical intervention needed

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19
Q

superficial burn will heal within

A

a few days (3-5)

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20
Q

management of superficial burn

A
  • no admit to burn unit or real medical intervention
  • heals without scarring
  • OTC- relief gel or cream
  • Hydration: PO
  • NSAIDS
  • Acetaminophen/Ibuprofen
  • Diphenhydramine (Benadryl)
  • Moisturize: No alcohol or perfumes
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21
Q

superficial burn injury level

A
  • epidermal layer (outermost layer)
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22
Q

superficial-partial thickness burn level

A
  • epidermis & minimal layers of Dermis
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23
Q

superficial-partial thickness burn appearance

A
  • Blisters, erythema, shiny, wet , inflamed
  • Pain: hypersensitivity r/t nerve injury and nerve exposure
  • mild to moderate edema
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24
Q

superficial-partial thickness burn healing time

A

1-3 weeks with minimal to zero scar tissue

-(7-21 days)

25
Q

fluids and superficial-partial thickness burn

A
  • without adequate perfusion burn damage Can extend further into the dermis and convert to a deep partial thickness burn
    • this would be secondary injury
  • give fluids: small area have them drink, large area (>70%)= IV
26
Q

would you pop or deroof a blister

A
  • leave alone if they are calling

- in our care: deroof

27
Q

management of partial thickness

A
  • promote self healing
  • may need graft
  • blisters: deroof > 2cm
  • Antimicrobial topical with non adherent dressings = daily wound care with thorough cleansing
  • hydration
  • abx if infection present
28
Q

deep partial thickness characteristics

A
  • Less moist, Decreased sensation & pain

- Light pink to cherry red

29
Q

deep partial thickness injury level

A
  • epidermis and bottom layers of dermal tissue
30
Q

deep partial thickness risks

A
  • conversion to full thickness
31
Q

deep partial thickness management

A
  • Systemic fluid support
    minimize conversion to deeper tissue injury*
  • Pain management : varying levels
  • increase Nutritional needs
  • May require excision and skin grafting
  • Assess and RX for maximum Function
  • PT and OT right away (esp. when on joints)
32
Q

full thickness burn injury level

A
  • all layers including portions of subcutaneous tissue
33
Q

full thickness burn signs

A
  • Non blanching
  • Non tender
  • Dry, white, brown, black, tough & leathery, red , waxy
  • wont heal on own
34
Q

full thickness burn management

A
  • May involve fat, muscle &/or bone
  • Systemic fluid support
  • Nutritional support
  • Requires excision and skin grafts
  • Functional support/positioning
35
Q

what causes the red urine with burns

A
  • with muscle damage there is release of creatinine kinase and myoglobulin which are products of muscle breakdown that occlude renal tubules and are in urine
36
Q

burn conversion

A
  • area of the burn that is most at risk for conversion if the patient does not receive adequate resuscitation.
  • Inadequate resuscitation may cause the burn to become deeper because of limited blood flow, causing the zone of stasis to convert into the zone of coagulation
37
Q

inhalation trauma

A
  • Consider in patients with facial burns, or Injury that occurs in an enclosed spaces
  • 25-50% of burn patients will experience this
  • Independent predictor of death
  • Complications associated with carbon monoxide poisoning, injury above & below glottis
  • Inhalation injury: increases incidence: Respiratory complications
38
Q

carbon monoxide poisoning with inhalation injury

A
  1. Inhalation: heated gases/smoke = Carbon monoxide poisoning
  2. Asphyxiation
    - CO binds selectively to Hgb molecule = hypoxia
    - Treat with 100% FiO2
    - injury in enclosed space; cherry red face
    - Pulse ox considerations
39
Q

above the glottis

A
  • More common

-Protective reflex
Oral mucosa burns

  • Lung parenchyma not injured
  • Facial/airway edema primary nursing concern
40
Q

below the glottis

A
  • Patient possibly unconscious at the scene
  • Injury to airway (intubation?)
  • Injury lung parenchyma
41
Q

complications of injury above and below the glottis

A

Atelectasis; pneumonia ; ARDS ; death

42
Q

inhalation injury causes…

A
  • Loss of cilia
  • Respiratory epithelial cells
  • Neutrophil infiltration from inflammation process
  • Atelectasis: occlusion by debris
  • Pseudomembranous CASTS
  • Bacterial colonization@72 hr&raquo_space; pneumonia
  • ARDS
  • Asphyxiation
43
Q

with inhalation injury primary concern is

A
  • maintaining airway
  • intubation
  • Airway patency: High Fowlers HOB > 45–No pillow
  • Suctioning (✓ carbon in sputum)
44
Q

suspect inhalation injury when

A 
Facial burns 
Wheezing (47%)
Carbonaceous sputum ,  Soot 
Rales 
Dyspnea ;  Tachypnea 
Hoarseness (voice chnages) 
Cough  (lots of coughing!)
Singed facial hair, nasal,  
Painful swallowing
45
Q

inhalation injury and swelling

A
  • greatest 2-96 hours
  • Anticipate Intubation *airway care !!
  • Early intubation 1-2 hrs post injury
  • 6-12 hours bronchoscopy if not intubated Recheck airway
46
Q

electrical injuries

A
  • Electrical energy converts to heat
  • Current travels: path of least resistance
  • Least: nerves, blood, fluid
  • Most: bone, skin
  • Majority of tissue destruction is “internal”
47
Q

electrical burns

A
  • Injuries are “hidden”: Small surface injuries or Devastating internal injuries
  • Generated heat damages adjacent muscle and tissues
  • Deep muscle & nerve injury may occur when superficial muscle appears normal
  • Difficult to assess internal injury
48
Q

high voltage injury consequences / risks

A
  • Loss of Consciousness
  • Cardiac Arrhythmias
  • Muscle contractions: Clenched fists
  • Myoglobinuria and CK: Product of Muscle breakdown
  • Mummified extremities
49
Q

care for electrical burn pt

A

-Fluid resuscitation based on TBSA injury

  • *EKG-cardiac monitoring for 24 hours
  • Assess: compartment syndrome with neurovascular checks q 1hr
  • Detailed *Neurological exam q1hr : note changes over time
  • Assess for *rhabdomyolysis and myloglobinuria (ATN): if have red urine give fluids Goal: UOP to > 100 – 150 cc/hr
50
Q

compartment syndrome

A
  • Increased pressure within body compartments
  • Causing inadequate perfusion and inadequate nerve conduction
  • Result is tissue and nerve necrosis beyond site of increased pressures
  • Limb threatening and life threatening
  • compartments swell and become edematous and compress nerves (NO SENSATION) and arteries (DECREASED PERFUSION)
51
Q

what area of burns are we most worried about compartment syndrome

A
  • electrical (inside)

- circumfrential bun (all the way around the skin in that area)

52
Q

chemical burn

A

-Do not look for chemical antidote
-Do not try to neutralize chemical
-Protect yourself!
-Brush off any powder, remove clothing
-Irrigate: copious amounts of water :Irrigation > 20 minutes
-Identify the causative agent
without delaying patient care)
-Chemical burn alone meets referral criteria to a burn center

53
Q

SJS and TENS

A

-severe cutaneous hypersensitivity reactions
-Rash: exfoliative
skin and mucous membranes
-Cause: Drug Reaction (50%)

54
Q

DIFFERENCE BETWEEN SJS AND TENS

A

SJS < 10 TBSA & TENS > 30 % TBSA

- TENS = higher mortality rate

55
Q

similaritites of SJS and TENS

A
  • All Epidermal cells: skin & mucous membranes: eyes, mouth, GI , GU , periareas
  • Macules: Red, tender blisters coalesce, into blisters
56
Q

SJS/ TENS common causitive agnets

A
  • Antiepileptics (AED)
  • Antibiotics
  • sulfa meds
  • anti gout meds
57
Q

frostbite

A

-Tissue destruction from cold is similar to burns
-Depth of tissue damage:
Assessed when extremities are warm and perfused
-cells are destoryed from the lack of 02 and h20
-linning of blood vessels are damaged = blood leaks when re warming

58
Q

frostbite tx

A
  • Topicals: Antimicrobials
  • Or allow tissue to desiccate and mummify
  • possible amputation
  • Some can heal without surgery
  • Refer to Burn Center within 24 hrs for tPA
  • -Pain management (IV)

Complex care final (8 decks)

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