Burns pt.2🔥 Flashcards
Massive cell destruction can result in ___________ immediately after a burn. ____________ can occur later in the acute phase with fluid shifts and inadequate K+ replacement
hyperkalemia; hypokalemia
surgical debridement done in a timely manner has many benefits to burn patients. Why is it one of the most important factors that contributes to survival after a burn?
-reduces complications related to infection
-shorter hospital stay
Why is the hematocrit elevated in the emergent phase of a burn?
due to plasma loss - this higher concentration of blood cells is happening because fluid is shifting out of the bloodstream and into the interstitial spaces
hyponatremia is also occurring due to this same fluid shift
How many sones are there in a burn?
3
The zone of coagulation, is the innermost zone, this is where cellular death occurs. does this zone sustain the most or least damage?
the most
The zone of stasis, is the middle zone. What are the characteristics of this zone?
-tissue injury
-compromised blood supply
-inflammation
The zone of hyperemia is the outermost zone, this zone sustains the ______ amount of damage.
least
superficial partial thickness burns are ____ degree burns. deep partial thickness burns are ____ degree burns. And full thickness burns are ____ degree burns.
1st; 2nd; 3rd
_____ degree burns are associated with scalds and flash flames.
2nd
____ degree burns are associated with sunburns.
1st
_____ degree burns are associated with direct flame, electric currents or chemical contact.
3rd
An ________ is a biologic source of skin similar to the patients, like from a cadaver.
homograft
A _________ is obtained from pigs skin, sometimes cows.
xenograft
An ______ is when the skin graft comes directly from the patients own skin.
autograft
How would you describe the appearance of a full thickness burn?
pale white
leathery
dry
charred
How much protein does a burned patient need to meet nutritional needs?
1.5 -2g/kg/ day
How soon is the dressing changed after an autograft surgery is performed?
2-5 days post op
Snug fitting dressings or garments are worn 23 hours a day to apply continuous pressure. This can __________ burn scars and help to smooth the skin.
minimize
About how long will it take for a deep partial thickness burn to heal?
2-4 weeks
Why should elastic bandages be wrapped distally to proximally on dependent areas?
(from extremities, inward to the center of the body)
-limits edema
-decreases bleeding
-promotes graft acceptance
(pushes fluid back to the heart to prevent accumulation)
Burns should be wrapped ________ to _______ because it promotes venous return and prevents edema.
proximal to distal
(from the center of the body, out to the extremities)
After a serious burn, what is the most serious complication related to the GI system?
paralytic ileus
What is Biobrane?
a nylon silicone membrane that is coated with protein
What is Mederma?
a topical gel used to reduce scarring
What is Integra?
a 2 layered membrane; 1 layer is a synthetic epidermis and the other later is made of collagen fibers to mimic the dermis
true or false?
Transcyte is made by culturing human fibroblasts and a nylon mesh layer to make a double layered skin substitute.
true
When does the greatest amount of fluid loss occur after a burn?
24-36 hours after the burn
When a patient is using mafenide acetate it is important to educate them to __________ before application because it can cause a severe burning pain.
premedicate
Silver Nitrate stains everything ______.
black
What 2 electrolytes need to be monitored while a patient is using silver nitrate?
sodium and potassium
What are 4 of the complications to monitor for related to burns?
1.sepsis
2. MSOF
3.Shock
4. Delirium
During fluid resuscitation, how much fluid is given over 8 hours, and what it given in the remaining 16 hours?
half of the total fluids needed to be given is delivered in the first 8 hours, then the second half of fluids is given over the remaining 16
How will a severe burn cause the kidneys to become clogged?
the severe burn can cause damage to your muscles which will cause excess myoglobin to be released, which will overload the kidneys
Monitor for compartment syndrome!! what should we be assessing for?
-pain
-redness
-swelling
-tightness/ firmness
-paresthesia
-weak/ absent pulse
Why do we need to be monitoring GI function and assessing bowel sounds in burn patients?
paralytic ileus is a huge complication common in burns
A _______ ulcer is a specific kind of peptic ulcer that’s a complication of severe burns or trauma (induced by stress) - may require gastric decompression w/ an NG tube
curling’s
What are the 2 procedures called when a dr. needs to cut through eschar or fascia to correct compartment syndrome and relieve pressure ?
escharotomy + fasciotomy
What 4 factors contribute to thrombocytopenia and prolonged clotting + PTT with severe burns?
inflammation
vascular damage
fluid loss
infection/ sepsis
What are the priorities in the rehabilitation phase of a burn?
-wound healing
-psychosocial support
-self image + lifestyle
-restoring maximum function for best quality of life
-possible reconstructive surgery
-counseling
What are the 3 different types of debridement?
mechanical
natural
surgical
______ _______debridement is your body producing enzymes to produce healthy tissue and a special hydrogel dressing is used to cover.
natural autolytic
_________ ________ debridement is the use of a variety of chemicals to dissolve nonviable tissue, but this method can also affect viable tissue.
chemical enzymatic
________ ________ aka “maggot therapy” is when larvae are applied to the wound and consume only dead tissue.
Biological debridement
Mechanical debridement is when a ______ is used to remove dead tissue.
scalpel
Surgical debridement is when the patient is under anesthesia where a graft is placed or a _______ ______ is placed to suck the dead tissue away to promote wound healing.
wound vac
When caring for a autograft site post op, after how many days is the dressing changed?
3-5 days
exercise will begin 7-14 days post op, to careful not to disrupt the graft site
The donor site (after an autograft) will need to be cared for as a partial thickness wound. About how long should it take to be healed?
7-14 days
Homograft’s and xenografts are used as temporary wound coverage to protect against
1.
2.
3.
fluid loss
protein loss
infection
The ________ will become raised as the re-epithelialization occurs and it will just need to be cut away.
xenograft
Biosynthetic and synthetic dressings are good for pain management and fluid balance, but have issues with _______.
infection
true or false?
skin donations (cadaver) need to match the blood type of the recipient?
true
What are ways were preventing a paralytic ileus while taking care of a burn patient?
-repositioning/ activity
-non narcotics
-fluids
why are homograft’s the biggest risk of infection?
because the donor could have pathogens that the recipient’s body doesn’t have immunity to/ introducing new agents
Hydrotherapy can not be used as treatment until the patients wounds are _______ healed.
completely
