final study guide: burns

Question 1

where do most burns occur

Answer 1

At home

Question 2

Classification of burns and examples (4)

Answer 2

*1st degree: sunburns
*2nd degree: blister (touching stove)
*3rd degree: damage to entire epidermis and sometimes fat
*4th degree: burns through both skin layers, fat, and into muscle and bone

Question 3

Patho (3)

Answer 3

*plasma seeps out into tissue d/t increased capillary permeability
*leaking tissue
*vascular vol decreases and increase in hypovolemic shock

Question 4

How are vitals/ hemodynamics affected (4)

Answer 4

*HR: increases
*CO: decreased
*UO: decreased
*vasoconstriction to promote shunting to vital organs

Question 5

Rule of 9s

Answer 5

divides the body into sections, each representing approximately 9%
*head and neck: 9%
*anterior trunk 18%
*posterior trunk 18%
*arms: 9%
*legs 18% each

Question 6

parkland formula

Answer 6

*(4ml of LR) x (body wt in kg) x (% of TBSA burned) = total fluid replacement fir the first 24 hrs
*1st 8 hrs = 1/2 of total vol
*2nd 8hrs = 1/4 total vol
*3rd 8 hrs = 1/4 of total vol

Question 7

a pt was wrapped in a blanket to stop the burning process. Since the flames are gone does that mean the burning process has stopped

Answer 7

No

Question 8

What can be done to slow/stop the burning process

Answer 8

cool fluids

Question 9

what do blankets do to help burn victims

Answer 9

hold in the body heat and keep out the germs

Question 10

do we want to use ice for burn patients

Answer 10

No: vasoconstriction stops blood flow

Question 11

You have a burn victim with three rings on her hands. Do you remove them?

Answer 11

Yes: metal will get hot and continue to burn pt and become harder to move as pt swells

Question 12

Do I want to remove my pt’s clothing?

Answer 12

yes: remove and replace with clean/dry cloth/blanket

Question 13

Your burn pt has shallow resps. What are they retaining?

Answer 13

Co2

Question 14

Which acid-base imbalance will this pt have?

Answer 14

resp acidosis

Question 15

is there more death with upper or lower body burns

Answer 15

Upper: d/t airway

Question 16

What are signs of an injured airway in burn pts (4)

Answer 16

*singed nose/facial hair
*soot
*dark flecked sputum
*Blisters in mouth

Question 17

Med management: what are we giving (3)

Answer 17

*albumin
*Pain meds
*broad spectrum abx

Question 18

Albumin (6)

Answer 18

*keeps fluids in the vascular space
*increases vascular vol
*increased kidney perfusion
*increased BP
*increased CO
*assists with correcting fluid vol deficits (but watch for fluid vol overload)

Question 19

Pain meds

Answer 19

IV pain meds are preferred route for fast relief: fentanyl, morphine, dilaudid

Question 20

ABX

Answer 20

Burn victims are at a greater risk for infection so give broad spectrum abx

Question 21

Burn complication managements: 2

Answer 21

Escharotomy
fasciotomy

Question 22

Escharotomy (2)

Answer 22

relieves pressure and restores the circulation, It cuts through the eschar (dead tissue)
*LAID(longitudinal incisions, axial planes, into normal skin, down to subQ fat)

Question 23

Faciotomy

Answer 23

relieves the pressure and restores the circulation, but the cut is MUCH DEEPER into the tissue and the cut goes through the eschar (dead tissue) AND fascia

Question 24

How does a nurse assess circulation (5)

Answer 24

*pulse check
*skin turgor
*cap refill
*skin temp
*skin color

Question 25

with burns, what is important to monitor Q1hr for kidneys

Answer 25

UO

Question 26

is it possible that when you insert the FC there could be no urine return

Answer 26

Yes, could be d/t shock, hypovolemia, urine retention

Question 27

What would you do if a burn patient’s urine turns brown or red? What would you be worried about?

Answer 27

*call MD
*worried about rabdo

Question 28

after 48hrs, the burn pt will start to diurese. Why?

Answer 28

fluid is returning to the vascular space, so now you worry about fluid vol excess

Question 29

If there is no UO or less than 30 ml/hr, what would you start to worry about

Answer 29

renal failure

Question 30

with burns, what happens to cells

Answer 30

burst, lyse, rupture

Question 31

what happens to the number of K+ ions in the serum/vascular space

Answer 31

increases

Question 32

are we concerned about hyper or hypokalemia in burn pts

Answer 32

hyperkalemia

Question 33

what type of diet for burn pts

Answer 33

high protein, fat

Question 34

how many wounds do electrical burns have

Answer 34

2

Question 35

what are electrical burn pts at risk for

Answer 35

vfib