Final - 7 Tissue Integrity/Burns

Question 1

Use the Parkland formula to calculate the resuscitation fluids: Lactated Ringer’s at 4 mL x weight in kg x TBSA burn (use number not percentage) (TBSA = 27%). The patient is 176 pounds. How many mLs will be infused in the first 8 hours? What is the amount for each hour? The Parkland formula will tell you how much of the total resuscitation fluid should be used for your starting rate.

Answer 1

4320 mL first 8 hours
2160 mL 2nd 8 hrs
2160 mL 3rd 8 hrs

Question 2

Best crystalloid solution for burns

Answer 2

LR

Question 3

amt. of fluid required to resuscitate the pt

Answer 3

TBSA%

Question 4

how are fourth degree burns treated

Answer 4

surgical amputation

Question 5

explain TBSA Rule of 9’s

Answer 5

Head: 9%
Anterior: 18%
Posterior: 18%
R arm: 9%
L arm: 9%
Genitals: 1%
R leg: 18%
L leg 18%

Question 6

Lund & Browder:

- palm of pt’s hand =

Answer 6

1% TBSA

Question 7

s/s of injury above glottis

Answer 7

• singed hair
• facial burn
• carbonaceous sputum

Question 8

injury below gottis…

Answer 8

may not be immediate

Question 9

• superficial burn of epidermis (ex. sunburn)
• epidermis
• not include in TBSA%

Answer 9

First degree (superficial)

Question 10

• bright red moist surface
• Tense, fluid-filled blisters
• Tactile & pain sensors intact VERY painful
• Heals in 10-14 days
• Bacetracin covers gram+ agents

Answer 10

second degree (partial/superficial)

Question 11

• Dermis & epidermis
• dry waxy-white or dull red
• dry skin slough

Answer 11

Second degree (deeper partial)

Question 12

• Full Thickness Injury
• all layers of skin
• dry surface
• often leathery
• Tight swelling
• relatively painless
• color is unreliable

Answer 12

Third Degree

Question 13

• all structures are unable to be healed or grafted:
  
  • blood vessels
  • bone
  • Tendons
  • Muscles

Answer 13

Fourth Degree

Question 14

priorities of burns

Answer 14

• airway & circulation (fluid status/imbalances)

- pain

Question 15

3 steps to healing process of burn

Answer 15

1. inflammation: begins immediately when burn occurs
2. proliferations: beings 2-3 days post burn
3. remodeling: may last for years

Question 16

burns less than _____ TBSA produce primarily a local response

Answer 16

20%

Question 17

burns more than _____ TBSA may produce a local and systemic response and are considered major burns

Answer 17

20%

Question 18

the greatest fluid volume leak occurs in the first _____-_____ hours

Answer 18

24-36 hrs

Question 19

Parkland Baxter Formula

Answer 19

2-4 mL X TBSA% pt’s wt

• 1/2 given in 1st 8 hrs from time of injury
• 1/4 given in 2nd 8 hrs
• 1/4 given in 3rd 8 hrs

Question 20

urine output:

• adults
• children

Answer 20

adults: 20-30 ml/hr
children: 1 mL/kg/hr

Question 21

Formulas are only a guide for burn care fluid resuscitation. How often must the patient’ s response to fluid therapy (urine output, heart rate, and blood pressure) be evaluated?

Answer 21

every 1 hr

Question 22

3 phases of burn injury

Answer 22

• emergent/resuscitative
• acute/intermediate
• rehabilitation

Question 23

emergent or resuscitative phase

Answer 23

onset of injury to completion of fluid resuscitation

Question 24

acute or intermediate phase

Answer 24

48-72 hrs after injury occurs

specifically at the beginning of diuresis and ends with wound closure

Question 25

rahabilitation phase

Answer 25

begins with wound closure to return to optimal physical and psychosocial adjustment

Question 26

in what burn injury phase does hemodilution occur

Answer 26

acute/intermediate phase

Question 27

initiate _____ feedings asap

Answer 27

enteral feedings