Exam 3 burns blueprint

Question 1

what are the types of burns?

Answer 1

thermal, chemical, smoke inhalation injury, electrical, and cold thermal injury.

Question 2

what are the treatments for burns?

Answer 2

Airway management:
Early endotracheal intubation
Escharotomies of the chest
Fiberoptic bronchoscopy
Humidified air and 100% O2
High fowlers position
Suction, chest PT
Bronchodilators

Fluid therapy

Question 3

what is the rule of 9’s?

Answer 3

Often used for initial assessment of a burn pt bc it is easy to remember.

For irregular or odd shaped burns, the pts hand (including fingers) is 1% TBSA.

Question 4

what are the classification of burns?

Answer 4

Severity of injury determined by: depth of burn, extent of burn in % of TBSA, location, and age of pt, pre-burn medical history, and circumstances or complicating factors.

Depth of burn: burns are defined by degrees (1st, 2nd, 3rd, and 4th)

ABA classifies burns according to depth of skin destruction: partial thickness and full thickness burns.

Question 5

what is important to know about the location of burns?

Answer 5

Severity of burn injury is determined by location of burn wound: face, neck, chest (respiratory obstruction from edema, eschar), hands, feet, joints, eyes (self-care difficult), ear, nose, butt, perineum (high risk for infection)

Circumferential burns of extremities can cause circulation problems distal to burn. Treat with an escarotomy - circulation prob due to stiffness from burn

Possible nerve damage to affected extremities: pts may also develop compartment syndrome.

Question 6

what are the phases of burn management?

Answer 6

emergent (resuscitative), acute (wound healing), rehab (restorative).

Question 7

what is the emergent phase of burn management?

Answer 7

Emergent (resuscitative) phase is time required to resolve immediate probs resulting from injury. Up to 72H, main concerns = hypovolemic shock and edema. Ends when fluid mobilization and diuresis begins.

Question 8

what is important to know about labs associated with burns?

Answer 8

potassium (hyperkalemia may occur if the pt has: renal failure, adrenocortical insufficiency, massive deep muscle injury.) large amounts of K+ are released from damaged cells, assess for CM of hyperkalemia.

Question 9

what are the burn thicknesses?

Answer 9

superficial partial thickness
deep partial thickness
full thickness

Question 10

involves epidermis (ex. Sunburn). First degree.

Answer 10

superficial partial thickness

Question 11

involves dermis and second degree.

Answer 11

deep partial thickness

Question 12

involves all skin elements, nerve endings, fat, muscle, bone. Third and forth degree.

Answer 12

full thickness burn

Question 13

what is parkland?

Answer 13

to calculate the IV fluids needed for the 1st 24H after a burn injury > 20% of TBSA

Question 14

what is the formula for parkland?

Answer 14

4mL x pt weight in kg x % of TBSA burned = 24H volume of IV fluid

1st 8H give 1/2 of the 24 total volume of fluid
2nd 8H give 1/4 of the total volume
3rd 8H give 1/4 of the total volume

Question 15

what is important to know about fluid therapy for burns?

Answer 15

2 large bore IV lines for greater than 15% TBSA

For burns greater than 20% TBSA central line may be considered

Arterial line placed if frequent ABGs or invasive BP monitor is needed

Parkland (baxter) formula for fluid replacement.

Question 16

what are the nursing priorities/ABCs for burns?

Answer 16

Wound care: cleansing and mental debridement. Can be done on a shower cart, in a shower, or on a bed or stretcher

Surgical debridement: may need to be done in the OR, necrotic skin is removed, and releasing escharotomies and fasciotomies may be done

Shower: once daily, dressing change in the morning and evening (newer antimicrobial dressings can be left in place from 3-14 days.)

When open burn wounds are exposed, staff should wear PPE (disposable hats, masks, gowns, gloves) use sterile gloves to apply antimicrobial ointment and sterile dressings.