Chapter 50 Flashcards
The rule of nines is used to estimate burn percentage.
What are the percentage for the following?
AP head AP chest AP arms Perineum AP LEG
Remember this is for one side. It is anterior and posterior. Respectively
Ap head- 4.5% Ap arms- 4.5% Chest----18% Perineum 1% Ap legs-- 9%
Describe the following thickness burn.
Injury only occurs to the epidermis, blood supply intact, pink or red colored, no blisters, skin blanches, painful tingly sensation, discomfort last 48 hours, healing in about 3 to 6
Superficial thickness burn
Describe the following thickness burn.
Injury to the deeper dermis blood supply is affected large blisters come about edema is present models pink to red color to 21 days no scaring graft maybe use
Superficial partial thickness burn
Identify the following thickness burn.
Expense deeper into the skin dermis blisters are are not form because there’s too much dead tissue. Wound areas are red and white. No blanching and edema is moderatecan convert to court thickness burn if there’s infection hypoxia or ischemia.
Deep partial thickness burn
Identify the following thickness burn.
Injury and destruction of the epidermis and dermis, wound will not heal with reepethelialization grafting is necessary. Skin is hard and dry a lot of eschar.appears waxy deep red yellow or brown or black. Wound contraction may occur this happens as the scarring heels and contracts everything else or shortens it.
Full thickness burn
What percentage does major burns for adults and for children?
Adults 25% and children 10%
Identify the following thickness burn.
Injury extends to underlying tissues muscle bone and tendons are damaged appears black and there’s no sensation, eschar tissue is hard and inelastic, no pain on nerve endings because have been destroyed healing will take months graphs are required.
Deep full thickness burns
Burns of the head neck and chest are associated with what type of complications
Pulmonary
What burns are associated with corneal abrasion’s?
Face it affects the eyes
_________________ Burns are associated with our auricular chondritis. Which is the inflammation of the cartilage of the auricular portion of the ear.
Ear burns
Burns in the _____________ area can cause autocontamination by urine and feces
Perineal
__________________ Burns of the extremities can produce a tourniquet like effect and lead to vascular compromise it is called compartment syndrome.
Circumferential burns
_______________ __________ Burns can lead to inadequate chest expansion and pulmonary insufficiency.
Circumferential thorax
This compound reversibly binds to hemoglobin to form carboxyhemoglobin. And tissue hypoxia occurs in other words oxygen is prevented from entering organs and other tissues.
Carbon monoxide
Internation of steam or aspiration of extremely hot liquids, which causes injury to the upper airways due to mucosal edema that can lead to upper airway obstruction especially during the first 24 to 48 hours. What is this called?
Direct thermal heat injury
What are the normal levels of carbon monoxide in the blood?
1- 10%
What type of carbon monoxide poisoning is a patient experiencing if the symptoms are headache flushing decreased visual acuity and decreased cerebral function SOB?
Mild poisoning 11-20% carbon monoxide in the blood
What type of carbon monoxide poisoning is a patient experiencing if they have headache nausea and vomiting drowsiness. Tinnitus (ringing of the ears) vertigo confusion pale reddish purple skin decreased blood pressure increase and irregular heart rate.
Moderate poisoning of carbon monoxide 21 to 40%
What what type of poisoning of carbon monoxide is when a patient has seizures and is in a coma
Severe poisoning 41 to 60% carbon monoxide in the blood
How much carbon monoxide in the blood is needed to cause death
61 to 80% fatal poisoning carbon monoxide in the blood
Which patients should be monitored closely for development of airway obstruction and considered immediately for endotracheal intubation if obstruction occurs.
Face and neck burn victims
Why does an extensive burn victim have decreased circulating intravascular blood volume
Due to edema
In a burn victim what will happen to the fluid and tissue perfusion?
There will be a lot of fluid loss and tissue perfusion will decrease
What will happen to a burn victim’s heart rate cardiac output and blood pressure
The heart rate will increase cardiac output will decrease in blood pressure will drop
In a burn victim what would happen to the sodium in the blood and the potassium in the blood
Hyponatremia and hyperkalemia
What will increase as a result of possible loss this initial increase falls to below normal the 3rd to 4th day after the burn as a result of red blood cell damage.
Hematocrit levels
What would happen initially to the kidneys and then what will happen over the next days to weeks
Blood will be shunted away from the kidneys causing oliguria then the body will be into rehab for fluid and diuresis of excess fluid will occur in the next days two weeks
What happens as the G.I. does not receive blood in a burn victim
Intestinal ileus- which is a blockage due to no peristalsis
In a burn victim _____________________ can develop resulting in decreased arterial oxygen tension level and a decrease in lung compliance
Pulmonary hypertension
What happens at IV fluids are not administered to a burn victim who is having evaporative fluid loss
Hypovolemic shock and death can follow.
Prehospital care for a burn victim begins at the scene of the accident what is the first thing you do to help this type of patient
Removing them from fire and then assess the ABC’s
With a burn victim what does the body need to conserve and how do you do it
The body needs to conserve heat cover the problems with sterile for cleaning cloths
After the burn victim is covered up to conserve heat what do you do next
Start IV and transfer to the hospital to the ER department
In the emergency departments what actions must be taken for a client with Burns State 1- 6 in order
1 assess airway 2 oxygenate 100% 3 assess vital signs 4 start IV line and begin fluid 5 elevate extremities if no fracture 6 cover theThe client to conserve body
In a major burn victim you have to administer _________% oxygen via a tight fitting nonbreathing facemask as prescribed until the carboxyhemoglobin levels fall below ____________%
100% and 15%
In a major burn victim what are you initiate to prevent hypovolemia and maintain fluid balance
Initiate IV urine output should not be under 30 or over 50ml/h per hour
When a patient has adequate urine output stable vital signs palpable peripheral pulses and intact level of consciousness what has been successful?
Fluid resuscitation
__________output is the most reliable and most sensitive noninvasive assessment parameter for cardiac output and tissue perfusion
Urine
After monitoring the pulse oximetry and you have checked the arterial blood gas how much do you elevate the head if there’s burns to the face and head?
30°
For a patient that has major burns you have to wash your hands use sterile sheets and linens and use gloves Mask shoe covers scrub clothes and plastic apron, this is called what type of technique
Protective isolation technique
For a burn victim What do you do to the body here around wound margins?
For a major burn victim expected weight gain for the first 72 hours should be
Clip it
15-20 lbs
For a major burn victim they will have gastric output and pH levels discomfort which will be a stress ulcer so what do you administer?
Anti-acids receptor antagonist antiulcer medication H2
How should the temperature be in a burn victim?
_______________ bed is needed and use a _____ ______________ to keep the sheets off the client skin
Warm
Air- fluidized
Bed cradle
Paying management should be giving through the IV route why must we avoid the oral route?
Because of the possibility of gastrointestinal dysfunction
Remember to medicate the patient before any painful procedure
Which routes must be avoided for medication due to absorption through the soft tissue being unreliable when hypokalemia and large fluid shifts occur
Intramuscular or subcutaneous
Maintain patient NPO until
The diet should consist of
Vowel sounds return
High protein carbohydrates fats and vitamins
___________________ is a length wise incision made to the burn body part to relieve construction it is perform for circulatory compromise caused by circumferential burns it is done without anesthesia because the nerve endings have burned off
Escharotomy
__________________Is an incision me extending through the subcutaneous tissue and fascia is perform if adequate tissue perfusion does not return following and escharOtomy
Fasciotomy
_______________ - wounds are cleansed by immersion showering or spraying it. done 30 minutes or less to prevent sodium loss and loss of heat, patient must be premedicated cannot be done to patients with skin grafts.
Hydrotherapy - it’s a type of mechanical debridement
_________________- is the removal of this car or necrotic tissue to prevent bacterial proliferation under the eschar and to promote wound healing.
Debridement more commonly done on partial thickness and full thickness burns
How many types of debridement
Mechanical enzymatic surgical tangential technique fascial technique
Performed during Hydro therapy involves washcloths sponges to debrief eschar and the use of scissors and forceps to lift and trim away those eschar, may include wet to dry or wet to wet dressing, painful procedure
What type of debridement is this?
Mechanical
Application of topical enzyme agents directly to the wound the agents digest collagen in necrotic tissue
What type of debridement is this?
Enzymatic
Excision of eschar the surgical procedure what type of debridement?
Thin layers of necrotic burn surface are excised until bleeding occurs which indicates that healthy dermis has been reached what type of debridement is this?
Surgical
Tangential technique
The burn wound is excised to the level of superficial fascia this technique is usually reserved for very deep and extensive Burns
What type of debridement is this?
Fascial technique
What days is the wound closure routinely performed
Days five through 21 following the injury depending on the extent of the burn
When the patient receives an autographed how many days should they mobilize the part
When will it heal
What should they avoid on their clothes
What environmental hazards that they protect themselves against
3 to 7
7 to 14 days
Softener and harsh detergents
Sun
When dealing with a skin graft roll a cotton tipped applicator to remove extra date because exudate can lead to
Infection and non-skin graft adherence
Elastic wraps and bandages that apply continuous pressure to heal skin during the time in which the skin vulnerable can also help control
Scarring
Anti-burn scar support garments should beware ———– hours a day for a total of ——— to ——- months
23 hours a day and 18 to 24 months
