final study guide: burns Flashcards
where do most burns occur
At home
Classification of burns and examples (4)
*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
Patho (3)
*plasma seeps out into tissue d/t increased capillary permeability
*leaking tissue
*vascular vol decreases and increase in hypovolemic shock
How are vitals/ hemodynamics affected (4)
*HR: increases
*CO: decreased
*UO: decreased
*vasoconstriction to promote shunting to vital organs
Rule of 9s
divides the body into sections, each representing approximately 9%
*head and neck: 9%
*anterior trunk 18%
*posterior trunk 18%
*arms: 9%
*legs 18% each
parkland formula
*(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
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
No
What can be done to slow/stop the burning process
cool fluids
what do blankets do to help burn victims
hold in the body heat and keep out the germs
do we want to use ice for burn patients
No: vasoconstriction stops blood flow
You have a burn victim with three rings on her hands. Do you remove them?
Yes: metal will get hot and continue to burn pt and become harder to move as pt swells
Do I want to remove my pt’s clothing?
yes: remove and replace with clean/dry cloth/blanket
Your burn pt has shallow resps. What are they retaining?
Co2
Which acid-base imbalance will this pt have?
resp acidosis
is there more death with upper or lower body burns
Upper: d/t airway
What are signs of an injured airway in burn pts (4)
*singed nose/facial hair
*soot
*dark flecked sputum
*Blisters in mouth
Med management: what are we giving (3)
*albumin
*Pain meds
*broad spectrum abx
Albumin (6)
*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)
Pain meds
IV pain meds are preferred route for fast relief: fentanyl, morphine, dilaudid
ABX
Burn victims are at a greater risk for infection so give broad spectrum abx
Burn complication managements: 2
Escharotomy
fasciotomy
Escharotomy (2)
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)
Faciotomy
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
How does a nurse assess circulation (5)
*pulse check
*skin turgor
*cap refill
*skin temp
*skin color
with burns, what is important to monitor Q1hr for kidneys
UO
is it possible that when you insert the FC there could be no urine return
Yes, could be d/t shock, hypovolemia, urine retention
What would you do if a burn patient’s urine turns brown or red? What would you be worried about?
*call MD
*worried about rabdo
after 48hrs, the burn pt will start to diurese. Why?
fluid is returning to the vascular space, so now you worry about fluid vol excess
If there is no UO or less than 30 ml/hr, what would you start to worry about
renal failure
with burns, what happens to cells
burst, lyse, rupture
what happens to the number of K+ ions in the serum/vascular space
increases
are we concerned about hyper or hypokalemia in burn pts
hyperkalemia
what type of diet for burn pts
high protein, fat
how many wounds do electrical burns have
2
what are electrical burn pts at risk for
vfib
