Ch. 32: Burns Flashcards
What kind of burn can result in severe damage, including loss of organ function, tissue destruction with the subsequent need for amputation of a limb, and cardiac and/or respiratory arrest
Electrical burns
What are risk factors for burns?
Lack of supervision
Abuse, neglect
Developmental growth of the child
During assessment, if a child has a burn, what are some subjective data we need to document?
- Type of burn (dry heat, moist heat, chemical, electrical, ionizing radiation)
- Duration of contact
- Area of the body to which burn occured
What do the objective findings tell us?
The physical assessment findings: depth, appearance, sensation/healing
What is the depth of a superficial (first-degree) burn?
Damage to epidermis
How does a superficial (first-degree) burn appear?
Pink to red in color No blisters Mild edema No eschar Blanches with pressure
What is the sensation/healing for a superficial (first-degree) burn?
Painful
Heals within 5-10 days
No scaring
What is the depth for a superficial partial thickness (second-degree) burn?
Damage to entire epidermis
Dermal elements intact
What is the appearance of a superficial partial thickness (second degree) burn?
Pink to red in color BLISTERS* Mild-Moderate edema No eschar Blanches with pressure
*superficial thickness and superficial partial thickness burns appearance= similar, the BLISTERs indicates the difference!
What is the sensation/healing for a second degree burn (superficial partial thickness)?
Pain is present
Heals within 14-21 days
Variable amounts of scaring
Sensitive to temperature changes and light touch
What degree burn is deep partial thickness?
Second degree
BOTH superficial partial thickness and deep partial thickness are classified for second degree burns!
What is the depth of a deep partial thickness (2nd degree) burn?
Damage to entire epidermis and some parts of the dermis
Sweat glands and hair follicles remain intact
How does a deep partial thickness (2nd degree) burn look?
Red-white in color
Blisters
Moderate edema
Blanches with pressure
What is the big difference in appearance between superficial partial thickness and deep partial thickness?
The color–superficial partial thickness is pink to red in color with blisters and deep partial thickness is red-white in color with blisters
What is the sensation/heeling for a deep partial thickness burn?
Pain present
Sensitive to temp changes and light touch
Healing time may extend beyond 21 days
Scaring is likely
What is the depth of a full thickness (3rd degree) burn?
- Damage to the entire epidermis and dermis and possible damage to SQ tissue
- Nerve endings, hair follicles, and sweat glands are destroyed
What is the appearance of a full thickness (3rd degree) burn?
Red to tan, black, brown, or white in color
Dry, leathery appearance
No blanching
What is the sensation/healing of a full thickness (3rd degree) burn?
As the burn heals, painful sensations return and severity of pain INCREASES
Heals within weeks to months
Scaring is present
Grafting is required!
What is the depth of a deep full thickness (4th degree) burn?
Damage to ALL layers of the skin that extends to muscle, tendons, and bones
What is the color of a deep full thickness burn (4th degree)?
Color variable
Dull and dry
Charring
Possible visible ligaments, bone, or tendons
What is the sensation/healing of a deep full thickness burn (4th degree)?
No pain is present
Heals within weeks to months
Scarring is present
Grafting is required
Amputation
What burn has a dry, leathery appearance?
Full thickness (3rd degree)
What burn is pink to red but has no blisters?
Superficial (1st degree)
What burn is pink to red and has blisters?
Superficial partial thickness (2nd)
What burn is red to white in color with blisters?
Deep partial thickness (2rd)
What burn has no pain?
Deep full thickness (4th)
What burns require grafting?
Full thickness (3rd) and deep full thickness (4th)
What burn has nerve endings, hair follicles, and sweat glands destroyed?
Full thickness (3rd)
Does scarring occur with a superficial burn?
No
What burn hurts as it heals?
Full thickness (3rd)
What are total body surface area charts?
Age-related charts that determine the extend of injury to body surface–expressed as %
In infants skin is thin, therefore a burn to an infant, the injury is likely to be _____
Deeper
How are burns classified?
Minor, moderate, major
Where are minor burns treat?
Clinic setting
Where are moderate burns treated?
In hospital with expertise in burn care
Where are major burns treated?
Burn center
Minor burns: We need to stop the burning process. How is this done?
- Remove clothing/jewelry that can conduct heat
- Apply cool water soaks or run cool water over the injury
- Flush chemical burns with large amounts of water
Minor burns: For cooling to stop the burning, is it okay to use ice?
No
Minor burns: Why do we cover the burn with a clean cloth?
To prevent contamination
Minor burn: How do we cleanse the burn?
Mild soap and tepid water (avoid excess friction)
Minor burn: Should we remove the blisters?
Controversial on this
Minor burn: What type of ointment? What type of dressing may we apply?
Antimicrobial; nonadherent, hydrocolloid
Minor burn: What should we provide?
Provide warmth
Provide analgesia
Minor burn: We check immunization status. At what point would we want to administer the tetanus vaccine?
If it has been more than 5 years since the last immunization
Minor burn: How do we educate family?
- Tell them not to use greasy lotions or butter on burns
- Tell them about signs of infections so they can monitor it
Moderate and major burns: What do we maintain first? What do we provide? What do we monitor?
Airway and ventilation
Provide 100% supplemental oxygen as prescribed
Monitor VS
Moderate and major burns: What are 3 ways to maintain CO?
- Initiate IV access with large-bore catheter
- Fluid replacement is important during first 24 horus
- Monitor for manifestations of septic shock
What fluid replacement is used during the early stage of burn recovery?
Isotonic crystalloid solutions (0.9% sodium or lactated ringers)
What fluid replacement is used after the first 24 hours of burn recovery?
Colloid solutions (albumin or synthetic plasma expanders)
What should urine output if the child weighs less than 30 kg (66lb)?
1-2 ml/kg/hr
What should urine output be if the child weighs more than 30 kg (66lb)?
30 mL/hr
Moderate-major burns: What are manifestations of septic shock we need to monitor for?
- Alterations in sensorium (confusion)
- Increased cap refill
- Spiking fever
- Decreased bowel sounds and urine output
Manage pain: Ok to give IM or SQ injections for burns?
No, avoid this
Manage pain: What IV opioids should be use?
- Morphine sulfate
- Hydromorphone
- Fentayl
*monitor for resp. depression tho!
Manage pain: When should we administer the pain meds?
Prior to dressing changes or procedures
Prevent infections: What should be restricted in the clients room and why?
Plants and flowers–risk of contact with pseudomonas
Prevent infections: Why should positions be changed frequently?
-Prevent contractures and prolonged pressure
Prevent infections: Any rule on visitors?
Limit them
Nutritional support: Why do we increase caloric intake?
To meet the increased metabolic demands and prevent HYPOglycemia
Nutritional support: What is needed to prevent tissue breakdown and promote healing?
Protein
Nutritional support: What should we give to facilitate cell growth? What about for wound healing?
Vit. A and C for cell growth
Zinc for wound healing
What topical agent is applied to second and third degree burns?
- Silver sulfadiazine
- apply to cleansed, derided area
- wear sterile gloves
- apply thickness of 1/16th inch
or
- Mafenide acetate
- apply to cleansed, derided area
- wear sterile gloves for application
- apply thickness of 16 mm
What topical agent is used for prevention of secondary infection? When and how do we apply?
Bacitrcin
Apply thin film 2-4 times per day
How would we administer morphine sulfate?
Continuously IV with boluses prior to procedures
What IV meds to we give prior to the start of a procedure for sedation and analgesia?
Midazolam
Fentanyl
Propofol
Nitrous oxide
