Exam 1: Burns

Question 1

A patient with burns requires the room to be warmer, why?

Answer 1

they have lost the ability to regulate body temperature due to the damage to the skin.

Question 2

The extremities of a burn patient would be described as what?

Answer 2

pale and cool

Question 3

describe the cap refill for a patient with burns? why?

Answer 3

slow; >3 sec; due to blood being pulled from the extremities to the 3 major organs.

Question 4

a burn patient would most likely have hemocult _______ stool.

Answer 4

positive

Question 5

why does the blood thicken in a burn patient?

Answer 5

there is an increase in amount of glucose in the blood

Question 6

what are the 3 types of burn phases?

Answer 6

emergent
acute
recovery

Question 7

the emergent burn phase is aka as which phase?

Answer 7

resuscitation phase (fluid resuscitation)

Question 8

when does the emergent phase begin?

Answer 8

24-36 hours

Question 9

describe the sodium and potassium levels during the emergent phase?

Answer 9

sodium decreases due to loss of fluid; potassium increases as the fluid shifts into cells

Question 10

3 ways to stop the injury for burns

Answer 10

extinguish flames, cool the burn, irrigate chemical burns

Question 11

what measurement is vital to monitor during the emergent phase?

Answer 11

urine output

Question 12

how do we ensure accurate measurement of urine output during emergent phase?

Answer 12

insert Foley catheter

Question 13

what 5 things needs to be done asap for burn patients in emergent phase?

Answer 13

ABGs
Foley cath
start O2
Large bore IV
remove restrictive clothing, cover the burn

Question 14

why do we need a large bore IV for burn patients in emergent phase?

Answer 14

fluids run at a very high rate for fluid resuscitation

Question 15

BP and urine output need to be maintained at what levels during emergent phase?

Answer 15

SBP = >100
urine output = 30 - 50 mL/hr

Question 16

why is it important to maintain urine and BP levels during emergent phase?

Answer 16

maintain serum sodium levels at near-normal levels

Question 17

is potassium high or low during emergent phase? why?

Answer 17

high; trauma causes a release of K+ into the extracellular fluid

Question 18

how do we ensure adequate nutrition during emergent phase?

Answer 18

TPN or enteral feeding

Question 19

why can’t we have burn patients obtain nutrition PO during emergent phase?

Answer 19

decrease in GI function

Question 20

if a patient has burns exceeding 20-25% of their body, what should be done?

Answer 20

NG tube insertion + placed to suction

Question 21

how should pain medications be administered during emergent phase? why?

Answer 21

IV meds only; decreased GI function

Question 22

what should be obtained for a patient with an electrical burn?

Answer 22

EKG

Question 23

what vaccine/booster should be given for all patients if unable to confirm previous administration?

Answer 23

tetanus

Question 24

during emergent phase, a patient is in what acid-base balance?

Answer 24

metabolic acidosis

Question 25

why does glucose increase in burn patients?

Answer 25

burns = stress = cortisol = increased glucose

Question 26

what are the signs of a burn patient in GI distress?

Answer 26

pain, vomiting, blood in stool, Curlings ulcer

Question 27

what are potential complications that can occur with burn patients in emergent phase?

Answer 27

acute respiratory failure (facial edema) distributive shock AKI compartment syndrome paralytic ileum

Question 28

the acute/diuresing phase begins approximately around what time post-burn?

Answer 28

48-72 hours

Question 29

describe the K+ and Na+ levels during the diuresing phase

Answer 29

Na+ = low, but improving K+ = normal or LOW

Question 30

how do we ensure adequate nutrition during the diuresing phase?

Answer 30

enteral feeding

Question 31

complications that can occur during the diuresing phase?

Answer 31

heart failure, pulmonary edema sepsis acute respiratory failure visceral damage (electrical burns)

Question 32

key nursing interventions during diuresing phase?

Answer 32

prevent infection burn wound care pain management regulation of hyper metabolic response early positioning/mobility promote skin integrity

Question 33

describe urine output during the diuresing phase

Answer 33

urine output = increased

Question 34

describe the glucose levels during diuresing phase

Answer 34

elevated or back to normal

Question 35

what is the last stage of burns?

Answer 35

recovery/ rehabilitation phase

Question 36

describe K+, Na+, and urine output during the recovery phase

Answer 36

K+ = normal Na+ = normal urine = 30 mL/hr

Question 37

describe the diet/ nutrition of patient in recovery phase

Answer 37

advance as tolerated, as GI function increases may need long term enteral feedings

Question 38

how often do we assess a burn patients response to fluid therapy?

Answer 38

every hour

Question 39

what components do we monitor to assess response to fluid therapy?

Answer 39

HR BP urine output

Question 40

what do we do during all phases of burns to protect from ulcers?

Answer 40

pantoprazole (PPI)

Question 41

what is Parklands burn formula?

Answer 41

4 x weight in kg x TBSA 1/2 = first 8 hours from when the burn OCCURRED 1/2 = second 16 hours

Question 42

what is the biggest concern if a patient has burns on the chest or higher?

Answer 42

AIRWAY

Question 43

what do we do if the airway is affected?

Answer 43

incubation/ mechanical vent

Question 44

what do we assess to determine smoke inhalation?

Answer 44

soot in spit, mouth, nares signs of respiratory distress voice changes