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Adult III > Exam 3 - Burns > Flashcards

Exam 3 - Burns Flashcards

1
Q

Classification of Burns

A

Thermal - Fire/scald
Chemical
Electrical
Radiation

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2
Q

Rule of 9’s for Sizing burns

A 
Head & Neck = 9
Arm = 9 ea.
Leg = 18 ea.
Trunk (Anterior) = 18
Trunk (Posterior = 18
Perineum = 1
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3
Q

Superficial Partial thickness (first degree)

A

Epidermis

  • Red
  • No Blisters
  • Very painful
  • Similar to sunburn
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4
Q

Moderate Partial thickness (second degree)

A

Epidermis and upper third of dermis

-Blisters

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5
Q

Full thickness (third degree)

A

All skin layers, including subcutaneous tissue

-Not painful because nerves damaged

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6
Q

Shock Phase of Burn Injury

A
  1. Shock: hypovolemic, emergent resuscitation
  2. Rapid fluid shift from the vascular compartments into the interstitial spaces
  3. Fluids, electrolytes and protein lost; oliguria, HYPERKALEMIA, hyponatremia, hypoproteinemia, and nitrogen losses occur
  4. Decreased tissue perfusion results in anaerobic metabolism = METABOLIC ACIDOSIS
  5. Priorities for care: tx inhalation injuries, airway management, fluid resuscitation, maintain tissue perfusion and thermoregulation
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7
Q

Acute (Diuretic) Phase

A

Follows shock stage and lasts through complete wound closure. Characterized by return of vascular integrity, fluids and electrolyte shifts, anemia, malnutrition, potential for infection and sepsis.

  • Fluid shifts from interstitial space back to vascular space; hemodilution and diuresis may occur as renal flow improves
  • Sodium & potassium are lost w/diuresis, protein lost via catabolism: HYPONATREMIA, HYPOKALEMIA
  • Rehabilitation
  • Wound healing
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8
Q

Rehabilitation

A

recuperation and healing, physical and emotional may last several years. restoration of function to the greatest extent possible, support of nutrition.
-Priorities of care: physical remobilization, continued wound care, reconstructive surgery, resocialization

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9
Q

Wound healing

A

Inflammatory phase: injury to 3-4days post injury

Proliferative: 4-20 days post injury

Maturation: 20 days to 1yr or more post injury

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10
Q

Chemical burn Assessment

A

Burning, redness, swelling, pain, resp distress if inhaled,
-Inhalation: Hoarsness, cough, singed nasal/facial hair, dark carbonaceous sputum, burning in throat, rapid/shallow respirations, low saO2

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11
Q

Carbon monoxide poisoning Assessment

A

HA, nausea, dizziness, confusion, dysrhythmias, CHERRY RED COLORING to buccal membranes and skin

Need 100% O2

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12
Q

Electrical burn Assessment

A

Charred skin, arrhythmias, entrance/exit wound, other injuries (falls, breaks), MYOGLOBINURIA

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13
Q

Myoglobinuria

A

dark ink urine

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14
Q

Nursing DX for burns

A

Fluid Volume deficit

Impaired Gas Exchange

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15
Q

Burn outcomes

A

Adequate Airway

F&E balance

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16
Q

Parkland Formula

A

Determines fluid need based on % BSA burned

4mL of LR X kg X %BSA burned

  • 1st 8hr: 1/2 of total amount
  • 2nd 8hr: 1/4 of total amount
  • 3rd 8hr: 1/4 of total amount
17
Q

Burn interventions

A

-Fluid resuscitation (parkland formula)
LR 1st, then colloid after first 24hr
-Maintain UO at 30-50mL/hr (for adults)
-Maintain SBP >90-100

18
Q

Renal intervention for burns

A

Foley to monitor I/O

Monitor for myoglobinuria

19
Q

GI interventions for burns

A

-Place NG (unless facial fx then OG), bc paralytic ileum common
-H2 blockers
-Nutrition initiated after fluids replaced
HIGH CALORIE, HIGH PROTEIN

20
Q

Pain management interventions for burns

A

IV MEDS ONLY (GI, IM not absorbed)

21
Q

Extremity Management

A
  • Circumferential burns- monitor pulses, venous return, numbness and pain
  • Escharotomy may be needed
22
Q

Wound care interventions for burns

A
  • Cleansing (Hubbard tank)
  • Debridement: manual, enzymatic, surgical
  • Topical antimicrobial agents, control bacterial proliferation and promote tissue granulation
23
Q

Silvadene

A

Use with caution with renal/hepatic impairment
PAINLESS
Now use aqua gel

24
Q

Sulfamylon

A

Most effective, penetrates eschar
May cause metabolic acidosis
PAINFUL

25
Q

Silver Nitrate

A

Wet dressing 2-3x/ day
Stains black
May lower Na and Chloride

26
Q

Open wound care

A

antimicrobial over wound

27
Q

Closed wound care

A

antimicrobial coved with gauze, held in place with net dressing

28
Q

Wound closure and coverage

A

Donor site care- moist dressings

Elevate extremity with graft, maintain immobility, monitor drainage, compression garment (Jobst suit) to decrease hypertropic scarring

Adult III (14 decks)

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