Ch. 32: Burns Flashcards by Melissa Johnson

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

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What are risk factors for burns?

Lack of supervision
Abuse, neglect
Developmental growth of the child

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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

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What do the objective findings tell us?

The physical assessment findings: depth, appearance, sensation/healing

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What is the depth of a superficial (first-degree) burn?

Damage to epidermis

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How does a superficial (first-degree) burn appear?

Pink to red in color
No blisters
Mild edema
No eschar
Blanches with pressure

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What is the sensation/healing for a superficial (first-degree) burn?

Painful

Heals within 5-10 days
No scaring

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What is the depth for a superficial partial thickness (second-degree) burn?

Damage to entire epidermis

Dermal elements intact

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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!

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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

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What degree burn is deep partial thickness?

Second degree

BOTH superficial partial thickness and deep partial thickness are classified for second degree burns!

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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

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How does a deep partial thickness (2nd degree) burn look?

Red-white in color
Blisters
Moderate edema
Blanches with pressure

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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

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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

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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

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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

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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!

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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

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What is the color of a deep full thickness burn (4th degree)?

Color variable
Dull and dry
Charring
Possible visible ligaments, bone, or tendons

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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

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What burn has a dry, leathery appearance?

Full thickness (3rd degree)

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What burn is pink to red but has no blisters?

Superficial (1st degree)

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What burn is pink to red and has blisters?

Superficial partial thickness (2nd)

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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?

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?

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?

1. Initiate IV access with large-bore catheter 2. Fluid replacement is important during first 24 horus 3. 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?

1. Silver sulfadiazine - apply to cleansed, derided area - wear sterile gloves - apply thickness of 1/16th inch or 2. 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