burns + transplant Flashcards
what are the types of burns?
- thermal
- chemical
- smoke inhalation injury
- electrical
- cold thermal
what are the common causes of thermal burns?
- flame
- flash
- scald
- contact with hot objects
thermal burns are the most common type of burn injury
true
what are the factors that affect the severity of burn injury?
- temperature of burning agent
- duration of contact
partial thickness burn
full thickness burn
what are the common causes of chemical burns?
contact with
* acids
* alkalis
* organic compounds
why are alkali burns more difficult to manage?
leads to protein hydrolysis & melting
where are alkalis most commonly found?
- cement
- oven cleaners
- drain cleaners
- heavy metal cleaners
which organic compounds can be found in alkalis?
- phenols
- petroleum products
a patient arrives in the ED following an accidental fall in wet cement at a construction site, what type of burn injury does the nurse expect to be sustained?
chemical burn
what are the causes of smoke inhalation injury?
inhaling
* hot air
* noxious chemicals
what types of complications following a smoke inhalation injury can rapidly develop?
- airway compromise
- pulmonary edema
what are the types of smoke inhalation injuries?
(3)
- upper airway
- lower airway
- metabolic asphyxiation
how does metabolic asphyxiation occur?
CO & hydrogen cyanide are inhaled
metabolic asphyxiation can lead to what complications?
- hypoxia
- elevated carboxyhemoglobin levels
carboxyhemoglobin levels of greater than 20% leads to imminent death
true
definition
upper airway injury
injury to mouth, oropharynx, & larynx
a physical assessment of a patient in the ED reveals their oral mucosa is red, blistered, & edematous, what type of injury did they sustain?
upper airway injury from smoke inhalation
why is the nurse’s priority in caring for a patient with an upper airway injury from smoke inhalation to ensure patent airway?
eschar & edema from the injury will quickly obstruct the airway and compromise breathing
definition
lower aiway injury
injury to
* trachea
* bronchioles
* alveoli
how long does it typically take for pulmonary edema to manifest following a lower airway injury?
12-48 hours
pulmonary edema from lower airway injury first manifests as
ARDS
definition
electrical burns
injury from intense heat generated from an electric current
electrical burns will result in damage to nerves & vessels
true
what are the categories that are included in the depth of burn?
- partial thickness (superficial & deep)
- full-thickness
what are factors that determine the severity of injury?
- depth
- extent (TBSA)
- location
- age(young & elderly pt’s most likely critical)
- pre-burn medical Hx
characteristics
superficial partial-thickness burn
- epidermis
- first-degree
characteristics
deep partial-thickness
- dermis
- second degree
characteristics
full-thickness burn
- involves skin elements, nerve endings, fat, muscle, bone
- third/ fourth degree
how is TBSA determined?
rule of nines
Rule of Nines
- 18% (torso)
- 9% (lower extermities)
- 4.5% (upper extremities, head)
- 1% (genitals)
burns to the ears, nose, & genitals pose a higher risk for infection
true
what are the phases of burn management?
- emergent
- acute
- rehabilitative
definition
emergent phase of burn management
time required to resolve immediate problems resulting from injury
how long does the emergent phase of burn management take?
72 hours
what are the main concerns during the emergent phase (1) of burn management?
- hypovolemic shock
- edema
- paralytic ileus
what are the resuscitative measures taken during the emergent phase of burn management?
- fluid mobilization (counter hypovolemic shock)
- diuresis
what are the common clinical manifestations of burns?
- hypovolemic shock
- paralytic ileus (no bowel sounds)
- pain
- blisters
- AMS
- shivering
what is the nursing management for partial-thickness burn during the acute phase?
- escharotomy
- facilitate skin re-epithelization
what is the medical management for full-thickness burn during the acute phase (2)?
- skin grafting
- surgical debridement
what are the nursing actions for airway management regarding burns?
- high fowlers
- CPT
- bronchodilation
- escharotomies of the chest
- humidified 100% O2
- fiberoptic bronchoscopy
- intubation
what are the nursing actions for fluid therapy?
- use Parkland Burn formula
- initiate central lines or 2 large bore IV lines
when is it appropriate to initiate 2 large bore IV lines?
fo TBSA of greater than 15%
when is a central line appropriate?
for burns greater than 20% of TBSA
what are the purposes of starting arterial lines in burn patients?
- invasive BP monitoring
- drawing frequent ABGs
what is the purpose of the Parkland Burn formula?
to calculate the amount of IV fluids needed for the first 24 hours after a burn injury of greater than 20% ONLY
Parkland Burn formula
(4mL) x (weight) x (% TBSA) = volume of fluids w/in 24 hours
what are the guidelines for appropriately following the Parkland burn formula in administering the correct amount of fluids?
- first 8 hrs: 1/2
- second 8 hrs: 1/4
- third 8 hrs: 1/4
FIRST 8 IS CRUCIAL!!
patients who suffered from burns are allowed to take showers once daily
true
how often do dressing changes occur for patients who suffered from burns?
twice a day in the morning and night
for how long are antimicrobial dressings left in place?
3-14 days
nurses need to don PPE when caring for patients with open burn wounds
true
nurses must use strerile gloves when applying antimicrobial ointment & sterile dressings on a burn patient
true
why can hyperkalemia occur in a burn patient?
large amounts of potassium are released into the bloodstream by damaged cells from burns
what happens during the acute phase of burn management?
mobilization of extracellular fluid & subsequent diuresis
when does the rehabilitative phase in burn management begin?
- partial thickness wounds have healed
- full thickness burns are covered by skin grafts
what are the signs of organ rejection?
- flu-like symptoms
- fatigue
- fever
- organ specific symptoms
what indicates successful fluid resus during the emergent phase of burn management?
diuresis
what are the types of organ rejection?
- hyperacute rejection
- acute rejection
- chronic rejection
characteristics
hyperacute rejection
- within 24 hours of transplant
- must remove organ
characteristics
acute rejection
- within 6 months of transplant
- must increase immunosuppressants
why is there a need to increase immunosuppressants in organ rejection?
prevent further rejection & save the organ
characteristics
chronic rejection
within months or years; typically irreversible
