Exam 3 Burn Injuries Flashcards
Most common places in the home for a fire to take place
Kitchen & Bathroom
What should you do if you are out of the hospital and someone is burned?
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.
What is the difference between a localized burn and a systemic burn?
What is the rule of nine’s? Be able to tell the percentages of the body burned.
What is the Parkland Formula?
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.
Components of Parkland Formula
- 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
Know what the most important nursing intervention is in the immediate emergent phase of burn care.
- 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
Signs and symptoms that would indicate someone has smoke inhalation
*Upper Airway Injury*
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
Signs and symptoms that would indicate someone has smoke inhalation
*Lower Airway Injury*
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)
Smoke Inhalation Injuries
- 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
Nursing Intervention & Treatment for someone suspected of smoke inhalation
Keep them in the hospital and monitor them closely for any signs and symptoms of deterioration related to smoke inhalation
What type of ulcer do patients with burn injuries usually have?
- Acute ulceration: duodenum/ stomach
- Caused by profound physiological stress
- Clinical Manifestations:
- Abdominal pain, acidic gastric pH, Hematemesis, melanotic stool
***Check stool for occult blood***
Why is a burn victim given TPN?
May need TPN initially if paralytic ileus is present.
COMPLICATIONS OF SEVERE BURNS
Burn Shock
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.
COMPLICATIONS OF SEVERE BURNS
BURN SHOCK
Hypovolemic Stage
- 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.
COMPLICATIONS OF SEVERE BURNS
Escharotomy
- 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.
COMPLICATIONS OF SEVERE BURNS
Hypertrophic Scarring
- 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
