[Exam 4] Chapter 62 - Management of Patients with Burn Injury Flashcards
Skin: What is the largest organ of the human body?
The skin
Skin: What are the three layers?
Epidermis (Top)
Dermis (Middle)
Subcutaneous Tissues (Lowest)
Skin: Epidermis forms what
Outlayer of skin
Skin: Epidermis is important why
Helps prevent pathogens from entering the body and helps prevent fluid loss from the body
Skin: Dermis does what?
Largest portion of skin. Skin gets structure and strength here. Contains blood and lymph vessels.
Skin: What vessels are located here?
Hair follicle, sweat glands, sebaceous glands. Contains a lot of nerve endings.
Skin: SQ tissues are what?
Fat, adipose tissue. some have more or less.
Skin: Why is SQ important?
Provides cushion between skin and muscles and bone. Important factor in body temperature regulation
Functions of the Skin: What are the main functions of the skin?
Protection Sensation Fluid Balance Temp Regulation Vitamin Production Immune Response Function
Functions of the Skin: Protection helps with what
invasion of bacteria
Functions of the Skin: Sensation important why
nerves present. Helps with temperature, pain, light touch, pressure. Skin on finger tips more sensitive than skin on back
Functions of the Skin: Temp regulation important why
Body continuously produces heat and dissipates through skin. Has to do with SQ tissue layer.
Functions of the Skin: Which vitamins are produced
Vitamin D
Functions of the Skin: How do you produce vitamin D?
By making sure that you get 5-30 mins of sun exposure twice a week.
Functions of the Skin: What do Meissner’s Corpuscle do?
Senses touch
Functions of the Skin: What does niciceptors do?
Senses pain
Functions of the Skin: What do pacinon corpuscle do?
senses pressure
Functions of the Skin: Fluid balance works how?
Skin can absorb water. When damaged, we can lose large quantities of fluid and electrolytes through this.
Also have perspiration through skin surface. Up to 600 mL per day.
Aging Effects on Skin: What changes occur as we age?
Dryness
Thinning of Skin
Loss of SQ Tissue Substance
Sweat and Sebaceous Glands Decrease
Aging Effects on Skin: Why is dryness a big issue?
Due to loss of sweat and sebaceous glands. Prevents it from being hydrated
Aging Effects on Skin: What thins in the skin?
Dermis and epidermis . Causes wrinkles and sagging eventually.
Aging Effects on Skin: Loss of SQ tissue importrant why?
They lose the ability to regulate heat. They don’t have as much fat.
They also lose protection for bones and muscles underneath.
How many people treated annually for burns?
486000 with 40,000 being admitted to burn center.
Who is more likely to get burned?
Men are 2x more likely to get burned than women
When the Hendrick fall score is taken, who always gets a point?
Men because they are more risk-takey.
Burn Prevention: What is the nurses responsibility here?
To teach the community on how to prevent this. Especially the elderly about their safety in the home. So that they are not more at risk for a fire.
Burn Prevention: What may be a bad combo for this?
Alcohol and smoking. They could pass out while smoking and could cause their house to catch on fire.
Burn Prevention: What are some things that can be done to prevent burns?
Educate about installing smoke detectors.
Keep objects out of objects for kids.
Water heater no higher than 120 degrees.
Burn Severity: What multiple factors play a role in this?
Age, Burn Depth, Body Surface,
Inhalation Injury?
Where is the burn at?
Previous burn history. If they have a lot of comboridites, they may not be able to heal as easily
Burn Severity: Simple criteria for superficial burns?
Painful
No Edema
Redness
Blanches with Pressure
Burn Severity: Simple criteria for partial thickness burn?
Blistered
Moist
Painful
Burn Severity: Simple criteria for full thickness burn?
Dry
Discolored
No Pain
Burn Severity - Age: This mainly deals with who?
Younger children and older adults will be more affected due to thin skin levels will lead to deeper burns
Burn Severity - Burn Depth: Classified how?
By their depth
Burn Severity - Burn Depth: First degree burn is what?
Superficial. Involves outermost layer of skin. May see redness, erythema. Epidermis remains intact.
Burn Severity - Burn Depth: Examples of first degree burns?
Sun burns, superficial scald, grabbing something that is too hot.
Burn Severity - Burn Depth: What is a second-degree burn
This involves entire epidermis and some portion of dermis. Blisters, painful
Burn Severity - Burn Depth: What can cause a second-degree burn?
Scalds, direct contact injury, flash flame that gets more into electrical burns
Burn Severity - Burn Depth: What is a third-degree burn?
Total destruction of epidermis and dermis. Nerve fibers damaged. Skin appears leathery. Hair follicles and sweat glands destroyed
Burn Severity - Burn Depth: Examples of third degree burns?
Full thickness type burn.
Burn Severity - Burn Depth: Description of burn stages in ATI book?
Superficial, Partial Thickness, Full Thickness
Burn Severity - Burn Depth: What is a fourth-degree burn?
Deep burn, necrosis, injury extends depe into tissue muscle tissue and bone.
Burn Severity - Burn Depth: How is the body in a fourth degree?
Completely destroyed. Often leads to amputation because there is not much available to do for them
Burn Severity - Systemic vs Local: What is this?
Once burn gets past 30% , you might see systemic effects from the burns. Includes wound edema, generalized edema, increased oxygen and glucose consumption
Burn Severity - Burn Depth: Second-degree involves what part of skin
Entire epidermis and part of dermis.
Burn Severity - Burn Depth: Key indicator of second-degree burn?
Blistering is a key indicator of this.
Burn Severity - Burn Depth: Third degree invovles what part of s kin
total destruction of epidermis and dermis. Skin will appear like leather.
Extent of Body Surface Area Injured: What are the different methods to determine this?
Rule of Nines
Lund and Browder Method
Palmer Method
Extent of Body Surface Area Injured: What is the Rule of Nines?
Head and Each Arm = 9%
Anterior and Posterior Chest = 18%
Each Leg = 18%
Groin = 1%
Extent of Body Surface Area Injured: If Right Anterior lower Portion of leg burned, what percentage would be burned using Rule of Nines?
4.5%
Extent of Body Surface Area Injured: Using rule of nines, if entire right arm and whole anterior cheest burn, what percentage has been burned?
27%
Extent of Body Surface Area Injured: What is the Lund and Browder Method?
This is a detailed map that gives specific information as to what was burned. Can also breakdown based on someones age
Extent of Body Surface Area Injured: What is the Palmer Method?
Has to do with size of the patient’s hand and fingers and thats approximately 1% of patiends body surface area. Will estimate hand size and calculate how much percentage of body has been burned.
Extent of Body Surface Area Injured: Lund and Brownder Method would be more likely to be used when?
When the burns have to be approximate and also age has to be accounted for as well.
Zones of Burn Injury: What are the different zones?
Zone of Coagulation
Zone of Stasis
Zone of Hyperemia
Zones of Burn Injury: What is the zone of coagulation
This will be the site nearest to the burn, right in the middle.
Zones of Burn Injury - Zone of Coagulation: What does this equal?
Cell death. This is necrotic tissue.
Zones of Burn Injury - Zone of Stasis: what is this?
These are injured cells that may remain viable. If they don’t get persistent O2 flow and not able to reperfuse area, will die off in 24-48 hours.
Zones of Burn Injury - Zone of Stasis: Where does this sit?
Round around zone of coagulation
Zones of Burn Injury - Zone of Hyperemia: What is this?
Minimal injury may occur here. They are likely to have full recovery of that skin tissue. Is the outermost layer.
Zones of Burn Injury: What should we be aware of about skin and mucosa of upper airway?
They are the most common sites of tissue destruction.
Electrical Burns: Why are these devasting?
They can be complex. You can necessarily tell the extent of the damage from a visual point.
Electrical Burns: What is something important to consider with burns?
That some of the burn may be occuring anteriorly and its hard to just pick up on visual exam
Electrical Burns: What are the three types?
Flash Injury
Conductive Injury
Lighting Injury
Electrical Burns - Flash Injury: What is this?
Has to do with light and heat without current. Heat up to 2000 degrees and may come out as ball of fire. Quick and hot.
Electrical Burns - Flash Injury: Complications with this compared to others?
This has the fewest complications versus compared ot others. Its just like a fireball put off of a electrical panel or something.
Electrical Burns - Conductive Injury: What is this?
This is where there is actual electrical current that travels through body and can damage everything a long its path
Electrical Burns - Conductive Injury: What problems can this cause?
Skeletal muscle injury , compartment syndrome,
Electrical Burns - Conductive Injury: Why may compartment syndrome occur?
Swelling would occur around the bone. Anything distal to the injury would not get any blood supply because there is edema that has formed around injured tissue and large volume of fluid accumulating there.
Electrical Burns - Conductive Injury: How will you be able to tell if patient has developed compartment syndrome?
If distal extremity is not getting any blood supply. Assessments would show not having any capillary refill, will have pale and cool extremity
Electrical Burns - Conductive Injury: Patients with compartment syndrome are at huge risk for what?
Peripehral neurovascular dysfunction
Electrical Burns - Conductive Injury: How do you treat compartment syndrome
With Escharotomy or Fasciotomy
Electrical Burns - Conductive Injury: What is a Escharotomy?
This means they cut through the escar. The tissue that is not viable anymore. This opens up the skin and relieves teh pressure and now blood flow can get down to hand.
Electrical Burns - Conductive Injury: What is a Fasciotomy?
Surgical incision that is going through fascia to relieve the constricted muscle. Fascia is the lining around the muscle. Relieves pressure and saves extremities.
Electrical Burns - Lighting Injury: What is this?
This is a direct strike of lighting or it could be a side flash of lighting. This is electrical current messing with electrical system of heart.
Electrical Burns - Lighting Injury: This can cause what to happen to patient
Cause them to go into cardiac arrest or respiratory arrest. This could pause the brain for a moment causing breathing to stop.
Electrical Burns - Lighting Injury: If a patient has this, what should you be worried about?
The electrical system of the heart.
Electrical Burns: Where can these cause damage?
Can cause damage internally and can also cause a lot of damage to the muscles through compartment syndrome.
Electrical Burns: What labs will we look for?
CK levels - tells you about damage to muscle.
Electrical Burns: If muscles are damaged, what can this cause to happen to the kidneys?
Muscles would release myoglobulin and cause excess damage to the kidneys by plugging them up.
Electrical Burns: How can you tell if kidneys are damaged
Decreased urine output
If myoglobulin increased, will see burgundy colored urine showing muscle breakdown
Electrical Burns: How can you treat the decreased urine output and burgundy colored urine?
We will flush out the kidneys by giving fluids and help treat this.
Systemic Burns: What alterations will occur do to this?
Cardiovascular alterations Fluid and Electrolyte Alterations Pulmonary Alterations Kidney Alterations Immunologic Alterations Thermoregulatory Alterations GI Alterations
Systemic Burns: When would systemic burns come into play?
When more than 30% of the body has been burned
Systemic Burns: What physiologic changes occur in cardiovacular system?
Cardiac depression, edema, hypovolemia
Systemic Burns: What physiologic changes occur in pulmonary system?
Vasoconstriction, edema
Systemic Burns: What physiologic changes occur in GI system?
Impaired motility and absorption, vasoconstriction, loss of mucosal barrier function , increased pH
Systemic Burns: What physiologic changes occur in kidneys?
Vasoconstriction
Systemic Burns: What physiologic changes occur throughout the body?
Altered thermoregulation, immunodepression, hypermetabolism
Systemic Burns - Cardiovascular Alterations: Immediate decrease with what?
Cardiac output
Systemic Burns - Cardiovascular Alterations: Decreased plasma volume in system will lead to what?
Hypovolemia, which will lead to hypotension
Systemic Burns - Cardiovascular Alterations: Increased workload on heart why?
Heart is trying to get oxygenated blood out to the rest of the body because of increased O2 demand
Systemic Burns - Cardiovascular Alterations: Inflammatory process kicks in, leading to what?
Capillary leaking
Systemic Burns - Cardiovascular Alterations: This also acts like shock, which is why they call it burn-shock. What is this?
A type of hypovolemic shock. This is due to loss of fluid
Systemic Burns - Cardiovascular Alterations: If adequate fluid resuscitation isn’t given, what can patients develop?
More of a distributive shock. This is because there will be massive pooling in periphery due to loss of sympathetic tone of these patients.
Systemic Burns - Cardiovascular Alterations: A lot of changes has to do with what?
Systemic inflammation kicking in and basically causing vessels to be leaking causing fluid shifts.
Systemic Burns - Fluid/Electrolyte Alterations: Superifical burn injury will cause what to form?
Edema formation to occur, which can usually occur within four hours.
Systemic Burns - Fluid/Electrolyte Alterations: Deep burns can cause what to form?
Edema to form for up to 18 hours.
Systemic Burns - Fluid/Electrolyte Alterations: What happens as these inflammatory mediators are getting released?
This is causing fludis and electrolytes to shift into the interstitium.
Systemic Burns - Fluid/Electrolyte Alterations: Fluid shifting from burns often leads to what?
Compartment syndrome which leads to escharotomy or fasciotomy
Systemic Burns - Fluid/Electrolyte Alterations: Big part of this is what is happening to cells, leading to what?
A lot of cells are going to be destroyed, which lead to increased potassium levels that happen immediately.
Systemic Burns - Fluid/Electrolyte Alterations: What happens to potassium as time goes on?
Fluid will begin to shift and you will start to see lower potassium levels
Systemic Burns - Pulmonary Alterations: This are either going to involve what?
The upper or lower airway
Systemic Burns - Pulmonary Alterations: The upper airway typically involved when
when there is a direct thermal injury to the head or the neck
Systemic Burns - Pulmonary Alterations: When is the lower airway typically involved?
There has usually been inhalation injury. Happens below the glottis and vocal cords
Systemic Burns - Pulmonary Alterations: Upper airway assessments include?
Assess trachea if it becomes edematous, if stridor present , if patients are drooling, difficulty swallowing
Systemic Burns - Pulmonary Alterations: What would be some indicators of a lower airway injury?
This deals with alveoli. May see impaired gas exchange because alveoli collapsing. May see inflammation causing mucus production causing crackles. Bronchi might constrict.
Systemic Burns - Pulmonary Alterations: A big issue for this , especially in lower airway is what?
Patients might be taking in CO poisoning, which is a big factor in fatalities.
Systemic Burns - Pulmonary Alterations: Why does carbon monoxide poisoning occur?
Happens because CO is wanting to combine with hemoglobin. Hemoblogin likes CO more than oxygen, having 200% greater affinity for it. Kicks off oxygen molecules.
Systemic Burns - Pulmonary Alterations: What does CO do to RBCs?
Attaches to the RBC and bumps off the O2, leading to no oxygen on red blood cell leading to hypoxemia.
Systemic Burns - Pulmonary Alterations: How can you treat CO poisoning?
Give them 100% oxygen. By giving them this, it tries to displace the carbon monoxide molecule.
Systemic Burns - Kidney Alterations: Why does AKI occur?
Because of low volume, Patients hypertensive and not enough volume getting to kidneys
Systemic Burns - Kidney Alterations: What is acute tubular necrosis?
Form of AKI that is intra-renal .
Systemic Burns - Kidney Alterations: Why do you see acute tubular necrosis?
Myoglobulin in the urine is blocking up all of the kidneys
Systemic Burns - Kidney Alterations: What signs do you look for here?
Signs of AKI. Decreased urine output, increased BUN/Creatinine. Burgundy colored urine.
Systemic Burns - Immunologic Alterations: Patient loses what after their skin layers are lost?
They lose their protection and are more at risk for infection.
Systemic Burns - Thermoregulatory Alterations: What changes occur here as you lose skin?
Patient loses the ability to regulate body temperatures. May become hypothermic.
Systemic Burns - GI Alterations: What are the three major alterations that occur?
- Paralytic Ileus -> decreased nerve impulses
- Curlings Ulcer
- Translocation of bacteria
Systemic Burns - GI Alterations: What occcurs with paralytic ileus?
This is related to decreased GI motility because the gut is not getting perfused.
Systemic Burns - GI Alterations: What does decreased nerve impulses lead to?
This leads to decrease in bowel sounds and no bowel sounds. If no bowel sounds, you get paralytic ileus.
Systemic Burns - GI Alterations: How do you fix paralytic ileus?
You put GI tube in on low intermittent suction to fix this
Systemic Burns - GI Alterations: What is a Curling Ulcer?
This has to do with erosion of GI tract from ischemia
Systemic Burns - GI Alterations: How do you fix curling ulcer?
Get patient started on H2 blocker or PPI.
Systemic Burns - GI Alterations: YOu will see curlign ulcer mentioned with what?
Specifically with burns as a major complciation
Systemic Burns - GI Alterations: What is translocation of bacteria?
Think about bowel. It is ischemic and bowel becomes more permeable. May see stool shift into the peritoneal space. Can see peritonitis develop or severe sepsis.
Systemic Burns - GI Alterations: With translocation of bacteria, you will see signs and symptoms of what?
Peritonitis, pain, fever, nausea, and vomiting. Also board like abdomen due to bacteria in gut has eroded through bowel into abdominal cavity.
Systemic Burns - GI Alterations: Why can abdominal compartment syndrome occur?
Because we are giving patients all of these fluids and this fluid is beginning to shift into the interstitial space of abdomen. Causes pressure within abdomianl cavity, which can lead to abdominal organ ischemia.
Systemic Burns - GI Alterations: How cna you monitor abdomanial pressure?
There is a instrument that can be hooked up to a catheter to a monitor
Systemic Burns - GI Alterations: what are signs of abdominal compartment syndrome?
Abdominal distention, oligura because kidneys affected, may be intubated and on a vent having difficulty ventilating with pressure pushing on lungs.
Phases of Burn Care: What are the three main phases?
Emergent or Resuscitative Phase
Acute or Intermediate Phase
Rehabilitation Phase
Emergent Mx of Burn Injury: What phase is this?
This is done during the first phase
Emergent Mx of Burn Injury: What kind of care is this?
On the scene care
Emergent Mx of Burn Injury: What is the first thing the fireman will do?
Will remove person from source of injury, establish airway, supply oxygen, start IV, and then cover wound.
Emergent Mx of Burn Injury: What can the wound be covered with?
With a clean dry cloth or gauze
Emergent Mx of Burn Injury: What will be done if this is a chemical burn?
Irrigate the wound
Emergent Mx of Burn Injury: How long does this period las?
From onset of injury to completion of fluid resuscitation
Emergent Mx of Burn Injury: What are the priorities during this phase?
ABCDE Prevent Shock Prevent Respiratory Distres Cool the Burn Cover or Irrigate Wound
Emergent Mx of Burn Injury: What can be used to help smother the flames?
Blanket, rug, or coat
Emergent Mx of Burn Injury: What happens to the burned area after the flames are extinguished?
Burn area and clothing are soaking with cool water briefly to cool the wound and halt process
Emergent Mx of Burn Injury: What should you NEVER do for a person with burns?
Never apply ice directly, never wrap person in ice, and never use cold soaks longer than a couple of minutes
Emergent Mx of Burn Injury: What is the benefit of covering the wound as quickly as possible?
To minimize bacterial contamination, maintain body temperature, and decrease pain by prevent air from coming into contact
Emergent Mx of Burn Injury: What should be done if chemical burn occurs at home?
Brush off chemical agent, remove clothes, and rinse all areas of the body that have come in contact with agent
Emergent Mx of Burn Injury: What does ABCDE refer to?
Monitoring Airway Breathing Circulation Disability - Checking for neurologic deficitic Expose and Examine the wound
Emergent Mx of Burn Injury - Med Mx: What will always remain the priority?
The ABCs
Emergent Mx of Burn Injury - Med Mx: What will you want to encourage the patient to do?
Cough
Emergent Mx of Burn Injury - Med Mx: What will you get a baseline of
Their weight, because of the fluid they will be given . A long with labs
Emergent Mx of Burn Injury - Med Mx: What will be the fluid of choice for these patients
Lactated Ringers. This most closely resembles the plasmality of what our blood is.
Emergent Mx of Burn Injury - Med Mx: What are the two formulas for Fluid Resuscitation?
ABA Formula
Parkland Formula
Emergent Mx of Burn Injury - Med Mx: What is the ABA Formula?
You get 2 mL of LR x Weight x Total Body Surface Area
Emergent Mx of Burn Injury - Med Mx: ABA Formula is it is a thermal or electrical burn?
4 mL x Weight x Total Body Surface Area
Emergent Mx of Burn Injury - Med Mx: What is the Parkland Formula?
4 mL x Total Body Surface Area Burned x Kg
First half over 8 hours. Second half over next 16 hours.
Emergent Mx of Burn Injury - Med Mx: Parkland formula is only appropriate for what type of burns?
Second and third degree burns
Emergent Mx of Burn Injury - Med Mx: Since we are giving these patients so much fluid, what must we watch out for?
Know the signs and symptoms of fluid overload, urine output above 30, hypothermia.
Also monitor respiratory and cardiac (pulses, vital signs)
Acute/Intermediate Phase: What is the duration for this?
From beginning of diuresis to near completion of wound closure
Begins 48-72 hours after burn injury
Acute/Intermediate Phase: Priorities for this stage?
Wound care and closure
Prevent or treatment of complications including infection
Nutritional Support
Acute/Intermediate Phase - Med Mx: What must we monitor for?
Infection, since they are now immunocompromised . If they have necrotic tissue as well
Acute/Intermediate Phase - Med Mx: What actions will be taken on the wound?
You will want to make sure you are cleaning the wound.
Wound debridement of non-viable tissue, grafting may also occur
Acute/Intermediate Phase - Med Mx: What will be used for wound cleaning?
Soap with water and washcloth to do any wound cleaning.
Acute/Intermediate Phase - Med Mx: What are topical antibacterial therapies?
This includes Antimocrobial Ointment Sulver Sulfadiazine Mafenide Acetate Silver Nitrate Silver-Impregnated Dressings
Acute/Intermediate Phase - Med Mx: What are antimicrobial ointments used for
Antibacterial coverage and promotion of moist wound environment
Acute/Intermediate Phase - Med Mx: What is silver sulfadiazine used for
Bactericidal agent for many gram-positive or gram-negative organisms .
Minimal penetration of eschar
Acute/Intermediate Phase - Med Mx: What is mafenide acetate used for?
Antimicrobial agent for gram positive and negaive organisms.
Diffuses through eschar and avascular tissue
Acute/Intermediate Phase - Med Mx: What is silver ntirate used for?
Effective againsts S. and Psueudomas.
Doesn’t penetrate eschar
Acute/Intermediate Phase - Med Mx: what is silver impregnated dressings used for
Broad antimicrobial.
Acute/Intermediate Phase - Med Mx: Why is silver used?
Because it helps from escar from these wounds and treat them
Acute/Intermediate Phase - Med Mx: Dressing changes determined by what
Location, what specifically is going on with wound.
Burn Wound Care: Wound cleaning consists of
debridegement of non-viable tissue.
Clean with mild soap and water
Burn Wound Care: What different things can be done for this?
Wound cleaning
Topical Agents
Wound Debridement
Wound Dresing
Burn Wound Care - Wound Debridement: What is a natural debridement
When non-viable tissue separates from viable tissues spontaneously. There are enzymes in body that can cause this.
Burn Wound Care - Wound Debridement: What are the different types?
Natural Debridement
Mechanical Debridement
Surgical Debridement
Burn Wound Care - Wound Debridement: What is mechanical debridement?
Surgical tools separate and remove eschar. Dressing changes will aid in this and is considered this as well
Burn Wound Care - Wound Debridement: what is surgical debridement?
Excision of full thickness of the skin down to the fascia (muscle) or down to wherever we start to see viable tissue
Burn Wound Care - Wound Debridement: How do you know if you have viable tissue?
If the tissue starts to bleed.
Burn Wound Care - Wound Debridement: Why do you need viable tissue?
To put skin grafts on.
Burn Wound Care - Wound Debridement: What is usually done for surgical debridement?
Will remove until you see bleeding and them immediately cover with a skin graft dressing
Burn Wound Care - Wound Debridement: What is topical wound debridement?
Antimicrobial agents used in conjunction with antibacterial. Have to be careful because silver in them causes them to have enzyme effect and can cause a lot of debridements.
Burn Wound Care - Wound Debridement: What is a biobrane dressing?
A nylon and silicone material . Helpful because its a porous semi-transparent material and protect their wound from fluid loss and bacterial invasion. DEcrease pain at site of wound.
Burn Wound Care - Wound Debridement: What are biobrane dressings removed?
Until patient has spontaneous growth of skin adn re-epilization of wound healing and wound healing begins to occur.
Burn Wound Care - Wound Debridement: Topical agents should be used carefully why
They can be debridements and have interactiosn with each other
Wound Grafting: What are the different types of grafts that can be used
Autografts
Hemografts/Xemografts
Biosynthetic and Synthetic Dressings
Wound Grafting: When would this be done?
Patient with partial and full-thickness burns may be candiates
Wound Grafting: This helps with what
Decrease risk of infection, prevent loss of fluid and electrolytes, and proteins.
Minimizes evaporated heat loss.
Helps minimize contractures. Patient start to gain more fuctional mobility
Wound Grafting - Autografts: These are preferred why
This is the patients own skin.
Less likely to be rejected and more likely that skin will take this
Wound Grafting - Autografts: what do these require
Adequate circulation on skin that has been burned. If not, graft will be injured.
Wound Grafting - Autografts: What type of autograft us used?
Cultured Epithelial Autograft and is used in burns that cover more than 90% TBSA
Wound Grafting - Autografts: Care of graft site includes
Need to be occlusive dressing that helps protect graft
Need to keep site elevated to help reduce edema and help graft take better.
Wound Grafting - Autografts: When is first dressing change done
2-5 days after graft placement
Wound Grafting - Autografts: What care is done on donor site?
Need to make sure that the site is being cared for. Clean, dry dressing.
Wound Grafting - Autografts: After surgery, how will donor sites be after and what can be given
Thrombostatic agent applied to help relieve bleeding and may also need to hold pressure .
May take 7-14 days for donor site to heal
Wound Grafting - Biosynthetic: What is included here?
Biologic Dressing (Biobrain because it is nylon and silicone). Temporary WOund Coverage
Wound Grafting - Biosynthetic: Temporary wound coverages help why
when there is no viable skin at the moment and need to protect skin in meantime
Wound Grafting - Homografts/Xenografts: What is a hemograft?
This is cadaver skin . Can also take living skin off of another patient
Wound Grafting - Homografts/Xenografts: What are xenografts
These are taken from animals
Wound Care - Pain Management: This can coem from what?
Background
Breakthrough
Procedureal
Wound Care - Pain Management: Why is this painful?
Nerve endings exposed.
Debridements
Wound dressing changes.
Wound Care - Pain Management: What is background pain?
Pain that is always there .
Wound Care - Pain Management: How to fix background pain?
They usually take a long acting analgesic to help with this
Wound Care - Pain Management: what is breakthrough pain?
This is related to activity, movement, acute intense pain
Wound Care - Pain Management: How to treat breakthrough pain?
WIll need short acting agents. IV pushes like morphine, fentanyl, dilated.
Wound Care - Pain Management: Wht is procedural pain?
This is due to daily dressing changes. PT/OT.
Wound Care - Pain Management: How to fix procedural pain?
Plan to treat patients 30-60 minutes before dressing changes or therapy.
Wound Care - Modulation of Hypermetabolism: What is this?
Exaggerated stress response to these patients.
Wound Care - Modulation of Hypermetabolism: what is necessary for this
early nurition. Will get feeding tub placed and will give them two feeds that are high in carbs because it helps with energy as well as protein.
Wound Care - Modulation of Hypermetabolism: Protein helps with what
healing. That is why high protein and high calorie meals are given.
Nursing Mx: What are ways we can prevent infection?
Monitoring for infection. Isolation/neutropenic precautions.
Clean Sheets
D/C Foley ASAP
No fresh flowers
Nursing Mx: How to monitor for restoring fluid balance?
Monitorng fluid volume excess, monitor electrolytes
Nursing Mx: With Modulating Hypermetabolism, what can you do?
Make sure they are getting the nutrition they need
Nursing Mx: What are teh diferent things we can manage here?
Resotre fluid balance Prevent Infection Modulating Hypermetabolism Promote Skin Integrity Relieving Pin Physical Mobility Strengtehening Coping Strats
Nursing Mx - Collaborative Problems: What are some problems that can occur?
Acute Respiratory Failure Distributive Shocok AKI Compartment Syndrome Paralytic Ileus Curling's Ulcer
Rehabilitation Phase: What is done here?
Psychological Support
Abnormal Wound Healing
Rehabilitation Phase: What can be done for psychological support?
Patients outlook and motivation system are important
Rehabilitation Phase: What type of abnormal wound healing can occur
Hypertrophic and Keloid SCars
Prevention and Treatment of Scars.
Help them deal with scars and how them deal with their lifestyle change. Help them cope with that.
Rehabilitation Phase: How can you prevent and treat scars?
Compression sleeves promote circulation
Scar Massage
Constructive surgery can help with disturbed body image that they have.
