Ch 55 Nursing Care of Patients with Burns PPT Flashcards
What is a burn?
A wound caused by energy transfer from a heat source to the body, leading to tissue damage.
What factors influence the amount of skin damage in a burn?
Temperature of the burning agent, duration of exposure, conductivity of tissue, thickness of involved dermal structures.
What percentage of body involvement is considered a major burn?
Burns covering 45% or more of the body.
List the major causes of burns.
Flame, contact, scald, chemical, electrical, radiation.
What type of burn is commonly associated with inhalation injury?
Flame burns.
Why are electrical burns particularly severe?
They can cause internal injuries, possible limb loss, and cardiac issues.
What is the “Palmar method” for burn assessment?
A quick estimation where the patient’s palm (including fingers) represents 1% of body surface area.
What is the “Rule of Nines”?
A method that divides the body into multiples of 9% for estimating burn extent.
What is the Lund and Browder method?
A more exact way to calculate burn percentages by anatomic regions.
Describe a superficial (first-degree) burn.
Affects only the epidermis, is pink/red, has no blisters, and heals in 3-6 days. Example: sunburn.
Describe a superficial partial-thickness (first-to-second degree) burn.
Damage to epidermis + part of dermis, pink/red, blisters, heals in 2-3 weeks.
Describe a deep partial-thickness (second-degree) burn.
Damage to entire epidermis + deeper dermis, red/white, rare blisters, may need grafting.
Describe a full-thickness (third-degree) burn.
Damage through epidermis, dermis, subcutaneous tissue, red/black/brown/yellow/white, no sensation, requires grafting.
Describe a deep full-thickness (fourth-degree) burn.
Damage extends to muscles, tendons, and bones, black, no pain, requires months to heal.
What systemic response occurs due to fluid imbalance in burns?
Increased capillary permeability → fluid loss, edema, hypovolemia.
Why does hypovolemic shock occur in burn patients?
Due to plasma loss, decreased cardiac output, and fluid shifts.
How does thermoregulation change in burn patients?
Heat loss leads to hypothermia; sweat glands may be destroyed.
Why do burn patients have high metabolic demands?
The body requires extra energy for healing, preventing weight loss, and managing hyperglycemia.
What are common GI complications in burn patients?
Gastric dilation, peptic ulcers, paralytic ileus from stress, opioids, and dehydration.
Why is renal function at risk in burn patients?
Hypovolemia can lead to acute kidney injury. Myoglobin casts from muscle destruction can cause renal failure.
How do burns affect pulmonary function?
Smoke inhalation can lead to hyperventilation, increased oxygen consumption, and airway obstruction.
How do burns affect the immune system?
Depressed IgA, IgG, and IgM levels increase infection risk.
What are signs of inhalation injury?
Singed eyebrows, sooty sputum, hoarseness, wheezing, stridor.
What is the most critical initial treatment for inhalation injury?
Airway management (ABCs) takes precedence.
What are major complications of burns?
Inhalation injury, infection, sepsis, shock, compartment syndrome, PTSD.
What age-related factors affect burn recovery in elderly patients?
Thinner skin, comorbidities (diabetes, hypertension), vision/hearing impairments, mobility issues.
What diagnostic tests are done for burns?
CBC, BUN, electrolytes, serum glucose, ABGs, bronchoscopy, wound cultures, clotting studies.
What are the three stages of burn care?
Emergent, Acute, Rehabilitation.
What is the goal of the emergent stage of burn care?
Fluid resuscitation, airway stabilization, pain control, prevent shock.
What is the Parkland formula for fluid resuscitation?
4 mL LR × weight (kg) × % burned.
How should the Parkland formula fluids be administered?
½ in first 8 hours, remainder over 16 hours.
What is the goal of the acute stage of burn care?
Wound closure, infection prevention, pain control, fluid balance.
What is an escharotomy?
Incision through eschar to relieve pressure and restore blood flow.
What is a fasciotomy?
Deeper incision through fascia if escharotomy is insufficient.
What are common topical burn treatments?
Silvadene, silver nitrate, bacitracin, mafenide acetate, gentamicin, Bactroban, Neosporin.
What are biological dressings?
Cadaver skin or pigskin used for temporary wound coverage.
What is an autograft?
Patient’s own skin used for grafting.
What is the difference between split-thickness and full-thickness skin grafts?
Split-thickness includes epidermis + partial dermis, full-thickness includes epidermis + full dermis.
What is the goal of the rehabilitation stage?
Restore function, prevent contractures, psychological support.
Why is contracture prevention important in burn recovery?
Flexion contractures can limit mobility.
What are key health promotion strategies for burn prevention?
Fire safety, water heater below 120°F, proper use of electrical devices, no smoking in bed.
What are critical nursing interventions for impaired gas exchange in burn patients?
Monitor respiratory status, ABGs, SpO2, suctioning, incentive spirometer.
How should burn wounds be initially treated?
Cool with tepid water, cover with clean sheets, remove clothing/jewelry, no ice application.
What is the priority when treating burn patients?
Airway, Breathing, Circulation (ABCs).
What is the primary function of the skin?
Protection, temperature regulation, sensation, fluid balance, and secretion/excretion.
How does a burn injury impact the skin’s function?
Loss of thermoregulation, increased infection risk, fluid loss, impaired sensation.
What are the three zones of a burn injury?
Zone of coagulation, zone of stasis, zone of hyperemia.
What happens in the zone of coagulation?
Tissue is completely destroyed, irreversible damage.
What happens in the zone of stasis?
Decreased perfusion, can become necrotic without proper treatment.
What happens in the zone of hyperemia?
Inflamed but viable tissue, full recovery possible.
What is the leading cause of death in burn patients?
Inhalation injury.
Why does a full-thickness burn often lack pain?
Nerve endings are destroyed.
What are signs of carbon monoxide poisoning?
Cherry-red skin, confusion, headache, dizziness, unconsciousness.
How is carbon monoxide poisoning treated?
100% oxygen therapy or hyperbaric oxygen chamber.
What is the most immediate concern for patients with facial burns?
Airway compromise due to swelling.
Why do burn patients develop hypovolemia?
Plasma leaks into interstitial spaces due to capillary permeability.
What electrolyte imbalances occur in the emergent phase of burns?
Hyperkalemia (initially), then hypokalemia, hyponatremia.
What type of IV fluid is preferred for burn resuscitation?
Lactated Ringer’s solution.
What is the “Rule of Palms”?
The patient’s palm (with fingers) represents about 1% of total body surface area (TBSA).
What does the Wallace Rule of Nines assess?
Percentage of total body surface area (TBSA) affected by burns.
Why are older adults at higher risk for complications from burns?
Thinner skin, decreased immune function, comorbidities.
What are early signs of burn wound infection?
Increased pain, redness, swelling, foul odor, fever.
What is a hypertrophic scar?
Thick, raised scar that remains within the burn area.
What is a keloid scar?
Excessive scar tissue that extends beyond the burn wound.
What is an eschar?
Hard, inelastic dead tissue covering a burn wound.
What is the function of an escharotomy?
Relieve pressure and restore circulation.
Why might a fasciotomy be needed in burn patients?
If escharotomy is not sufficient to relieve pressure.
What are early signs of compartment syndrome?
Severe pain, decreased pulses, numbness, swelling, tight skin.
What is the primary goal of wound debridement?
Remove dead tissue to promote healing.
What are the types of wound debridement?
Mechanical, enzymatic, surgical, autolytic.
What is the advantage of enzymatic debridement?
Uses topical agents to break down dead tissue without harming healthy tissue.
Why are burns considered an immunosuppressive condition?
Loss of skin barrier, decreased WBC function, increased risk of infection.
What PPE should be worn when treating burn wounds?
Sterile gloves, gown, mask, eye protection.
Why is early enteral feeding important in burn patients?
Prevents catabolism, maintains gut integrity, reduces infection risk.
What type of diet is needed for burn patients?
High-protein, high-calorie diet to support healing.
Why is glucose monitoring necessary in burn patients?
Burn stress increases catecholamines and glucagon, leading to hyperglycemia.
What is a major psychological impact of burns?
PTSD, depression, body image issues.
What interventions help prevent contractures in burn patients?
Splinting, ROM exercises, early mobilization.
Why is skin grafting performed?
To promote wound healing and reduce scarring.
What is the difference between an autograft and an allograft?
Autograft: patient’s own skin; Allograft: donor skin.
What is a xenograft?
Skin graft from another species (e.g., pig).
What is the most effective pain management method for burn patients?
IV opioids (e.g., morphine, fentanyl).
Why are IM injections avoided in burn patients?
Impaired absorption due to altered circulation.
What are common complications of the acute phase of burn recovery?
Infection, sepsis, pneumonia, ileus, renal failure.
Why do burn patients require deep vein thrombosis (DVT) prophylaxis?
Immobilization increases risk of blood clots.
What is the role of pressure garments in burn recovery?
Prevents hypertrophic scarring, improves cosmetic outcome.
How often should burn wounds be assessed?
At least once per shift or as needed.
What are signs of sepsis in burn patients?
Fever, hypotension, tachycardia, altered mental status.
What are common sources of infection in burn patients?
Wound infections, pneumonia, urinary tract infections.
What is a key indicator of adequate fluid resuscitation in burn patients?
Urine output of at least 0.5 mL/kg/hr.
How are burns diagnosed?
Physical assessment, lab tests, imaging for inhalation injury.
What lab values are monitored in burn patients?
CBC, electrolytes, BUN, creatinine, glucose, ABGs.
Why should burn patients avoid sun exposure?
Sun can worsen scarring and increase skin sensitivity.
What are signs of hypovolemic shock in burn patients?
Low BP, tachycardia, cold/clammy skin, decreased urine output.
Why are tetanus vaccinations given to burn patients?
Burns increase risk of tetanus infection.
How can burns be prevented in the home?
Fire alarms, childproof outlets, safe water heater settings, avoid smoking in bed.
What is the recommended maximum water heater temperature?
120°F (49°C).
What is the primary goal of burn rehabilitation?
Restore function, improve quality of life, prevent complications.
What is the most common cause of burns in children?
Scald burns from hot liquids.
What is the most common cause of burns in adults?
Flame burns from house fires or accidents.
Why are chemical burns dangerous?
They can continue to cause damage until fully neutralized.
How should a chemical burn be treated?
Remove contaminated clothing and flush with copious amounts of water.
Why are electrical burns particularly dangerous?
Internal injuries may be more severe than external damage.
What complications are common with electrical burns?
Cardiac arrhythmias, muscle damage, renal failure.
What is a radiation burn?
Burns caused by exposure to UV rays or radiation therapy.
What are the two phases of burn shock?
Emergent (fluid loss) and diuretic (fluid mobilization).
Why does hyperkalemia occur early in burn injuries?
Cell destruction releases potassium into circulation.
Why does hypokalemia occur later in burn recovery?
Potassium is lost through urine and wounds.
Why is sodium balance disrupted in burns?
Fluid shifts cause hyponatremia in the emergent phase.
What happens to hematocrit levels in burn patients?
Initially elevated due to plasma loss, then decreases with fluid resuscitation.
What is the leading cause of death in burn patients after the emergent phase?
Infection/sepsis.
What does a positive wound culture indicate?
Possible infection that requires treatment.
Why do burn patients have increased glucose levels?
Stress response leads to increased cortisol and catecholamine release.
What are the three types of inhalation injuries?
Carbon monoxide poisoning, upper airway injury, lower airway injury.
Why is early intubation recommended for severe facial burns?
Airway edema can progress rapidly and obstruct breathing.
Why should burn patients receive stress ulcer prophylaxis?
Burn stress increases risk of Curling’s ulcers.
What medications are used for stress ulcer prophylaxis in burn patients?
Proton pump inhibitors (PPIs) or H2 blockers.
What is the primary goal of fluid resuscitation?
Maintain organ perfusion and prevent hypovolemic shock.
What vital sign changes indicate inadequate fluid resuscitation?
Tachycardia, hypotension, low urine output.
How can compartment syndrome occur in burn patients?
Increased edema in a circumferential burn restricts circulation.
What is the most common type of skin graft?
Split-thickness skin graft (STSG).
What are the advantages of full-thickness skin grafts?
Better cosmetic result, more durable, less contraction.
What are indications for an escharotomy?
Tight, constricting eschar impeding circulation or breathing.
What is the purpose of a fasciotomy?
To release deep pressure when escharotomy is insufficient.
What is the purpose of silver sulfadiazine (Silvadene)?
Broad-spectrum antimicrobial cream for burn wounds.
Why is bacitracin used for facial burns?
Non-staining, non-irritating antimicrobial with good healing properties.
What is mafenide acetate (Sulfamylon) used for?
Effective against Pseudomonas but can cause metabolic acidosis.
What type of isolation is required for burn patients?
Protective isolation to prevent infection.
Why is early mobility encouraged for burn patients?
Prevents contractures, reduces risk of pneumonia and DVT.
What are signs of inhalation injury?
Hoarseness, wheezing, singed nasal hair, soot in sputum.
What is the first step in burn wound care?
Cleansing the wound with mild soap and water.
What is mechanical debridement?
Removal of dead tissue using forceps, scissors, or scrubbing.
What is enzymatic debridement?
Uses topical enzymes to break down necrotic tissue.
What is surgical debridement?
Excision of necrotic tissue to prepare for grafting.
What is autolytic debridement?
Uses the body’s own enzymes and moisture to dissolve dead tissue.
Why are pressure dressings used in burn care?
To prevent hypertrophic scarring and contractures.
Why is pain management a priority in burn care?
Burn injuries and procedures are extremely painful.
What are the preferred pain medications for burn patients?
IV opioids such as morphine or fentanyl.
Why is IV pain management preferred over oral in acute burns?
GI function may be impaired, and IV provides faster relief.
What non-pharmacologic pain relief methods are helpful in burn patients?
Distraction, relaxation techniques, music therapy.
What is the most comfortable position for burn patients?
The position of contracture (flexion), but it should be avoided.
How can contractures be prevented in burn patients?
Stretching, splints, and positioning.
Why is early enteral nutrition recommended in burn patients?
Maintains gut integrity and reduces risk of infection.
What are common nutritional deficits in burn patients?
Protein, calories, vitamins (C, D, E), zinc.
Why is vitamin C important in burn healing?
Promotes collagen synthesis and tissue repair.
What are common psychological effects of burns?
Depression, PTSD, body image issues.
How can family members support burn patients?
Encouragement, active involvement in care, emotional support.
What is the most effective way to prevent burns?
Education on fire and burn safety measures.
Why should burn patients avoid direct sunlight?
Newly healed skin is more sensitive and prone to damage.
Why is it important to keep a burn wound moist?
Prevents drying and promotes healing.
How often should burn dressings be changed?
Usually once or twice a day, depending on wound status.
Why should loose-fitting clothing be worn over burn wounds?
Prevents irritation and allows for air circulation.
Why is an NG tube used in severe burn patients?
To prevent gastric dilation and provide early nutrition.
What are signs of respiratory distress in burn patients?
Increased respiratory rate, use of accessory muscles, retractions.
How long does the rehabilitation phase of burn care last?
Months to years, depending on severity.
What is the goal of burn rehabilitation?
Maximize function and quality of life.
What are the three layers of the skin?
Epidermis, dermis, subcutaneous tissue.
What is the main function of the epidermis?
Protects against infection and water loss.
What is the role of the dermis?
Contains blood vessels, nerves, and connective tissue.
What is the purpose of the subcutaneous tissue?
Insulation and cushioning.
Why is burn depth assessment important?
Determines treatment and healing potential.
What is the difference between first-degree and second-degree burns?
First-degree affects only the epidermis; second-degree extends into the dermis.
What are the signs of a third-degree burn?
No pain, leathery texture, charred appearance.
What are the signs of a fourth-degree burn?
Involves muscle, bone, and tendons; skin appears blackened.
What is the purpose of the Rule of Nines?
Quickly estimates total body surface area (TBSA) burned.
Why is the Lund and Browder method more accurate than the Rule of Nines?
Accounts for age-related body proportion differences.
What is the first step in treating a thermal burn?
Remove the heat source and cool the area with lukewarm water.
Why is ice not recommended for burns?
Can cause further tissue damage and vasoconstriction.
What is the primary focus in the emergent phase of burn care?
Airway, breathing, circulation (ABCs).
Why should jewelry and tight clothing be removed from burn victims?
Prevents constriction due to swelling.
What does “fluid shift” mean in burn patients?
Plasma leaks from blood vessels into tissues, causing edema.
Why do burn patients develop metabolic acidosis?
Fluid loss and tissue hypoxia lead to acid buildup.
What is the main cause of hypothermia in burn patients?
Loss of skin barrier and inability to regulate temperature.
What is the purpose of the Parkland formula?
Guides fluid resuscitation in burn patients.
How is the Parkland formula calculated?
4 mL × weight (kg) × % TBSA burned.
How should fluids be administered in the first 24 hours post-burn?
½ in first 8 hours, remainder over next 16 hours.
What type of IV fluid is preferred for burn resuscitation?
Lactated Ringer’s solution.
What is the best indicator of adequate fluid resuscitation?
Urine output of at least 0.5 mL/kg/hr.
What complications can arise from fluid overload?
Pulmonary edema, heart failure.
Why is albumin sometimes used in burn patients?
Helps pull fluid back into the vascular space.
What is a key nursing priority in the acute phase of burn care?
Preventing infection and promoting wound healing.
Why are burn wounds prone to infection?
Loss of skin barrier and suppressed immune response.
What are common signs of a burn wound infection?
Increased redness, swelling, pus, fever.
What are common systemic complications of burns?
Sepsis, pneumonia, renal failure, compartment syndrome.
What is the most common cause of death in burn patients after the emergent phase?
Sepsis.
Why is enteral feeding preferred over TPN in burn patients?
Maintains gut integrity and reduces infection risk.
What vitamin is most important for wound healing?
Vitamin C.
Why are burn patients at risk for gastric ulcers?
Stress response increases stomach acid production.
What medications prevent stress ulcers in burn patients?
Proton pump inhibitors (PPIs) or H2 blockers.
What is an important psychosocial concern for burn patients?
Body image disturbances and PTSD.
What are signs of inhalation injury?
Singed nasal hair, hoarseness, carbonaceous sputum.
Why is early intubation recommended for inhalation injuries?
Prevents airway obstruction from swelling.
What is the function of pressure garments?
Reduces scarring and helps skin heal smoothly.
What are the benefits of early ambulation in burn patients?
Prevents contractures, improves circulation, reduces DVT risk.
What is a common long-term effect of severe burns?
Joint contractures and limited mobility.
Why are physical therapy and ROM exercises important for burn patients?
Prevent stiffness and maintain function.
What is the purpose of debridement?
Removes dead tissue to promote healing.
What are the four types of debridement?
Mechanical, enzymatic, surgical, autolytic.
What is the main goal of the rehabilitation phase of burn care?
Maximize function and quality of life.
Why should burn patients avoid direct sun exposure?
New skin is fragile and prone to damage.
What is the best way to prevent burns at home?
Fire safety, proper handling of hot liquids, smoke detectors.
