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MedSurge > Exam 3 Burn Injuries > Flashcards

Exam 3 Burn Injuries Flashcards

1
Q

Most common places in the home for a fire to take place

A

Kitchen & Bathroom

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2
Q

What should you do if you are out of the hospital and someone is burned?

A

The first priority at the scene of the accident is to remove the patient from the hazard/burn environment. ****Not in PPT but is part of First Responder Training. Always make sure that YOU can “as safe as possible,” remove the patient from the hazard. You are NOT required to put yourself in “imminent danger” to remove a patient from a hazard. But if you decide to do so, be sure to shield yourself.****

  • STOP the burning process
  • Remember the length of exposure to the causative agent is directly related to the severity of the burn.
  • Support vital functions- A- (airway) B- (breathing) C’s -(circulation)
  • Try to move patient minimally and be gentle- skin may peel or fall off.
  • Cover burn wound with sterile dressings if possible- prevent contamination and pain from contact with air. Use clean bandages or clothing if only available.
  • If wound from chemical spill- lavage with water.
  • Transport burn victim ASAP to hospital with burn unit.
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3
Q

What is the difference between a localized burn and a systemic burn?

A
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4
Q

What is the rule of nine’s? Be able to tell the percentages of the body burned.

A
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5
Q

What is the Parkland Formula?

A

The Parkland formula, also known as Baxter formula, is a burn formula developed by Dr. Charles R. Baxter, used to estimate the amount of replacement fluid required for the first 24 hours in a burn patient so as to ensure they remain hemodynamically stable.

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6
Q

Components of Parkland Formula

A
  • 4 ml Lactated Ringers x body weight (kg) x percent burn.
  • ½ total volume given in the first 8 hours
  • ½ the total volume given over the next 16 hours
  • Nurses regulate the infusion rate and volume based on weight and response to treatment - we assess response to treatment by BP and urine output Target point is BP no less than 80/50 and urine output at minimum of 50mL/hour
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7
Q

Know what the most important nursing intervention is in the immediate emergent phase of burn care.

A
  • Administer CPR as indicated
  • Administer 100% oxygen
  • Monitor hypovolemic shock- HR, BP, Urine output
  • Auscultate lung sounds carefully anterior and posterior
  • Assess circulation- (presence or absence of pulses), (capillary refill < 2 seconds- all four extremities)
  • Insert large bore IV needle (16-18 gauge)/line and begin aggressive fluid resuscitation/replacement.
  • Elevate burned extremities to reduce swelling
  • Elevate HOB > 30 degrees
  • Provide blankets to preserve core body temps: patient will not be able to regulate body temp
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8
Q

Signs and symptoms that would indicate someone has smoke inhalation

*Upper Airway Injury*

A

Upper Airway Injury

  • Presence of facial burns
  • Singed nasal hair or soot around nares
  • not in PPT but you can SMELL burnt hair very quickly
  • Hoarseness, painful swallowing
  • Darkened oral and nasal membranes
  • Carbonaceous (blackened) sputum
  • History of being burned in enclosed space
  • Clothing burns around chest and neck
  • Injury to mouth, oropharynx, and/or larynx
  • Thermally produced
  • Hot air, steam, or smoke
  • Swelling may be massive and onset rapid
  • Eschar and edema may compromise breathing
  • Swelling from scald burns can be lethal
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9
Q

Signs and symptoms that would indicate someone has smoke inhalation

*Lower Airway Injury*

A

Lower airway injury

  • Injury to trachea, bronchioles, and alveoli
  • Injury is related to length of exposure to smoke or toxic fumes
  • Pulmonary edema may not appear until 12 to 24 hours after burn
  • Manifests as acute respiratory distress syndrome (ARDS)
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10
Q

Smoke Inhalation Injuries

A
  • Metabolic asphyxiation:
  • Carbon monoxide (CO) poisoning
  • CO is produced by the incomplete combustion of burning materials
  • Inhaled CO displaces oxygen
  • Hypoxia
  • Carboxy-hemoglobinemia
  • Death
  • Hypoxia and ultimately death when CO levels are 20% or greater
  • Treat with 100% humidified oxygen
  • CO poisoning does not only occur with a burn injury to the skin
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11
Q

Nursing Intervention & Treatment for someone suspected of smoke inhalation

A

Keep them in the hospital and monitor them closely for any signs and symptoms of deterioration related to smoke inhalation

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12
Q

What type of ulcer do patients with burn injuries usually have?

A
  • Acute ulceration: duodenum/ stomach
  • Caused by profound physiological stress
  • Clinical Manifestations:
  • Abdominal pain, acidic gastric pH, Hematemesis, melanotic stool

***Check stool for occult blood***

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13
Q

Why is a burn victim given TPN?

A

May need TPN initially if paralytic ileus is present.

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14
Q

COMPLICATIONS OF SEVERE BURNS

Burn Shock

A

The onset of intravascular hypovolemia that results in decreased O2 delivery and decreased perfusion to all major organs. This causes a CARDIOVASCULAR RESPONSE of decreased cardiac output.

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15
Q

COMPLICATIONS OF SEVERE BURNS

BURN SHOCK

Hypovolemic Stage

A
  • Begins at time of burn injury
  • Peaks at 12-24 hours and lasts for the first 24-72 hours
  • Hypovolemia occurs as a result of the loss of intravascular fluid: increased capillary permeability
  • Fluid shift from the intravascular space to the interstitial space
  • Fluid is lost from the burn wound and accumulates in the tissues with the formation of generalized edema.
  • The patient becomes dehydrated due to a intravascular fluid volume deficit.
  • The patient has massive localized and systemic edema
  • Edema can put pressure on small blood vessels and nerves in distal extremities causing and obstruction of blood flow and ischemia which causes a complication called COMPARTMENT SYNDROME. This is relieved by surgical incision (escharotomy) into the eschar.
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16
Q

COMPLICATIONS OF SEVERE BURNS

BURN SHOCK

Diuretic Stage

A
  • Occurs 48-72 hours after burn injury
  • Capillary membranes regain their integrity
  • Edematous fluid shifts back into the intravascular spaces
  • Increased intracellular fluid and blood volume
  • Increased renal perfusion
  • Increased diuresis
17
Q

COMPLICATIONS OF SEVERE BURNS

Fluid and Electrolyte Shifts (There is a lot)

A
  • Greatest threat is hypovolemic shock
  • Caused by a massive shift of fluids out of blood vessels as a result of increased capillary permeability
  • Colloidal osmotic pressure decreases
  • More fluid shifting out of the vascular space into interstitial spaces
  • Na+ rapidly moves to interstitial spaces and remains until edema formation ceases
  • K+ shift develops because injured cells and hemolyzed RBCs release K+ into extracellular spacesDecreases circulating blood volume
  • Evaporating fluid loss through wounds can be up to 3-5L in 24 hr period until covered.
  • Early hypernatremia (water shifts from interstitial to vascular space) occurs in first 24 hours
  • Early hyperkalemia (massive cell destruction or lysis of cells) occurs in first 24 hours.
  • Anemia due to hemolysis at time of injury. Hct may be high due to plasma loss.
  • Thrombocytopenia and prolonged PT and PTT also occur with burn injury. Clotting will be prolonged.
  • Severely burned patient: loses 200 to 400 mL/hr (normal 30-50 ml)
  • Net result of fluid shift is intravascular volume depletion
    • Edema
    • ↓ Blood pressure
    • ↑ Pulse
  • RBCs are hemolyzed by a circulating factor released at time of burn
  • Thrombosis, Elevated hematocrit
18
Q

COMPLICATIONS OF SEVERE BURNS

BURN SHOCK

Hemodynamic response

A
  • Initial systemic event after a major burn injury is hemodynamic instability.
    • Results from loss of capillary integrity and shift of fluid, sodium, and protein from intravascular space into interstitial spaces.
    • As fluid loss continues and vascular volume decreases, cardiac output falls and BP drops.
19
Q

COMPLICATIONS OF SEVERE BURNS

BURN SHOCK

Hypovolemic stage: CV Response

A
  • The SNS in response, releases catecholamines, which causes ↑ peripheral resistance (vasoconstriction) and ↑ heart rate.
  • Vasoconstriction further decreases Cardiac Output.
  • Myocardial contractility is suppressed by the release of inflammatory cytokine necrosis factor.
  • Prompt fluid resuscitation maintains the blood pressure in the low-normal range and will maintain cardiac output and organ perfusion.
20
Q

COMPLICATIONS OF SEVERE BURNS

Pulmonary response

A
  • Inhalation injury is leading cause of death in fire victims.
  • Not always immediately apparent.
  • Half of all burn victims with pulmonary involvement do not show signs and symptoms immediately.
  • Any patient with suspected inhalation injuries must be observed for at least 24 hours for respiratory complications.
21
Q

COMPLICATIONS OF SEVERE BURNS

Integumentary response

A
  • Loss of skin integrity- lost ability to regulate body temperature
  • Low body temperatures in early post-burn period
  • Hyper-metabolism resets core temperature
  • Hyper-thermic state for the rest of the post-burn period if without infection
  • High temperature does not indicate infection
  • Core temperature: deep internal organ temperature
22
Q

COMPLICATIONS OF SEVERE BURNS

GI responses

A
  • Paralytic Ileus
  • Non-mechanical bowel obstruction- peristalsis stops
  • Clinical Manifestations:
  • Absent bowel sounds, abdominal distention, nausea, vomiting
  • Curlings Ulcer
  • Acute ulceration: duodenum/ stomach
  • Caused by profound physiologic stress
  • Clinical Manifestations:
  • Abdominal pain, acidic gastric pH, Hematemesis, melanotic stool

***Check stool for occult blood***

23
Q

COMPLICATIONS OF SEVERE BURNS

Escharotomy

A
  • When there is massive edema from a full thickness burn there is increased pressure on the tissue caused by the fluid.
  • This compromises blood flow and causes ischemia to the underlying muscle compartment-COMPARTMENT SYNDROME.
  • The surgeon makes a linear incision through the constricting burn eschar to give space to the underlying tissues and relieve the pressure of the fluid. If this isn’t done, the patient may lose the limb.
24
Q

COMPLICATIONS OF SEVERE BURNS

Hypertrophic Scarring

A
  • Excess scars
  • Caused by irregular, uneven collagen distribution
  • Elastic pressure garment
  • Must wear at least 23 hours per day
  • Remove for shower, cleaning only
  • Prevent thickening, buckling, nodular formation
25
Q

COMPLICATIONS OF SEVERE BURNS

Infection

A

Due to skin being burned away and the patient losing that protective layer

MedSurge (14 decks)

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