Infection, Immunity, & Inflammation: Burns Flashcards
Classify this burn: skin is pink to red, mild edema, painful, no blisters, no eschar (sunburn, flash burns)
Healing time? Graft needed?
- superficial-thickness wound
- desquamation: 2-3days after
- healing time: 3-6days
- no graft needed
Classify this burn: skin is pink to red, mild to moderate edema, painful, blisters, no eschar (scalds, flames, brief contact with hot objects)
Healing time? Graft needed?
Partial-Thickness Wound
- healing time: about 2weeks
- no grafts, may scar
- blanchable, large blisters may need opening and debrided to promote healing
- intense pain
Classify this burn: red to white, moderate edema, painful(not terrible), rare blisters, eschar soft and dry (scalds, flames; prolonged contact with hot objects, tar, grease, chemicals)
Healing time? Graft needed?
Deep Partial Thickness
- Healing time: 2-6wks
- Grafts can be used if healing is prolonged
- blanches slowly if at all
- hydrate the patient
- risk for infection, hypoxia, or ischemia
Classify this burn: skin is black/brown/yellow/white/red, severe edema, painful or not, no blisters, hard and inelastic eschar, leather like (scalds; flames; prolonged contact with hot objects, tar, grease, chemicals, electricity)
Healing time? Graft needed?
Full-thickness burns
- Healing time:weeks to months
- Grafts are required
- may require eshcarotomies or fasciotomies to relieve pressure and allow normal blood flow and breathing
- no nerve endings, heat coagulated blood vessels = avascular
- thrombosed vessels may be visible beneath surface of burn
Classify this burn: skin is black, Absent edema, absent pain, no blisters, hard and inelastic eschar (Flames, electricity, grease, tar, chemicals)
Healing time? Graft needed?
Deep Full-thickness
- Healing time: weeks to months
- muscle, bone, and tendons are damaged and exposed
- need early excision and grafting
- amputation may be needed
occurs after initial vasoconstriction as a result of blood vessels near the burn dilating and leaking fluid into the interstitial space.
causes edema in burn and surrounding areas
fluid shift/third spacing, capillary leak syndrome
electrolyte imbalance that occurs as a result of direct cell injury
cell injury releases large amounts of potassium
Hyperkalemia
within 24hours of burn is the patient usually have hyponatremia or hypernatremia?
the body is stressed from burn so sodium is retained, aldosterone is secreted leading to more absorption of the kidney. The sodium however whickly passes into the interstitial space and sodium deficit occurs.
Hyponatremia
What happens to h&h after a burn injury?
hemoconcentration (elevated blood osmolarity, hematocrit, and hemoglobin) develops from vascular dehydration
Fluid remobilization started about 24h after burn. Its been 48-72h from initial burn, what changes are happening as the diuretic stage begins?
- edema fluid shifts from interstitial to intravascular
- blood volume increases
- increase in kidney blood flow, diuresis
- return of normal body weight
- hyponatremia
- hypokalemia
- anemia (hemodilution)
- may need transfusion
- metabolic acidosis
Respiratory failure with burn injuries can result from:
- airway edema during fluid resuscitation, pulmonary capillary leak
- chest burns that restrict chest mvmt
- carbon monoxide poisoning
Cardiac changes resulting from Burn Injury:
- heart rate increases
- cardiac output decreases (fluid shift and hypovolemia)
- may remain low for 18-36h after
Respiratory damage from an inhalation can occur from:
- smoke or irritants cause edema nd obstruct trachea
- irritants often cause reflez closure of vocal cords
- heat causes inflammation/edema of mouth ant throat
- lung tissue injuries/edema can occur immediately or as late as 1wk
sweat and oil glands, and hair follicles
dermal appendages
does not transmit sensation
anesthetic
without blood supply
avascular
incision of the burn crust used to treat inadequate tissue perfusion (relieve pressure)
escharectomy
elevated blood osmolarity, hemoglobin, and hematocrit
hemoconcentration
fat and protein breakdown
catabolism
(related to metabolic acidosis)
incision through the eschar and fascia (allow for expansion)
fasciotomy
living, capable of working successfully
viable
Why does is GI motility reduced after a burn injury?
- hypovolemic, blood flow goes to most vital (brain, heart, and liver)
- sympathetic stress response increase epinepherine and norepinephrine (inhibit GI motility)
*may cause curling’s ulcer from reduced GI blood flow and mucosal damage
What can you do to prevent Curling’s ulcer?
- H2 histamine blocker
- proton pump inhibitors
- drugs that protect GI tissues
- early enteral feeding
Priorities for management during resuscitation phase:
- secure the airway
- support circulation by fluid replacement
- keep the patient comfortable with analgesics
- prevent infection
- maintain body temp
- provide emotional support
Pt in resuscitation phase of burn injury that becomes:
- progressivly hoarse
- developed a brassy cough
- drool or have difficulty swallowing
- produce sounds on exhalation that include audible wheezes, crowing, and stridor
Pt is about to lose his or her airway!
leading cause of death from a fire:
carbon monoxide (CO)
- pother damaged tissues release such large amounts of histamine and other inflammatory mediators causing capillary leak into pulmonary tissues
- Circulatory overload from fluid resuscitation may cause left sided heart failure (fluid pushed into lung tissue spaces
Risks of Pulmonary Fluid Overload after Burn:
Rule of nines for estimating burn percentage:
- head: 4.5% (x2)
- chest: 18% (x2)
- L.arm: 4.5% (x2)
- R.arm: 4.5% (x2)
- L.leg: 9% (x2)
- R.leg: 9% (x2)
- deep partial thickness burns less than 15%TBSA
- full thickness burns less than 2%TBSA
- no burns of eyes, ears, face, hands, feet, or perineum
- no electrical burns
- no inhalation injury
- no complicated additional injury
- pt is <60yo, no chronic cardiac, pulmonary or endocrine disorder
Minor Burns - emergency care, no special burn center necessary
- deep partial thickness burns 15-25%TBSA
- full thickness burns less than 2-10%TBSA
- no burns of eyes, ears, face, hands, feet, or perineum
- no electrical burns
- no inhalation injury
- no complicated additional injury
- pt is <60yo, no chronic cardiac, pulmonary or endocrine disorder
Moderate Burns - recieve emergency care at scene and be transferred to designated burn center
- deep partial thickness burns > 25%TBSA
- full thickness burns >10%TBSA
- Any burn involving eyes, ears, face, hands, feet, or perineum
- electrical burns
- inhalation injury
- complicated additional injury
Major Burns - emergency care at nearest emergency department and be taken to burn unit ASAP
normal range of hemoglobin
12-18g/dl
*elevated = fluid loss
normal range of hematocrit
37-52%
*elevated = fluid volume loss
Normal range ABGs
pH
PaCO2
HCO3
PaO2
- pH: 7.35-7.45
- PaCO2: 35-45
- HCO3: 22-26
- PaO2: 80-100
rapid infusion of IV fluids needed to maintain sufficient blood volume for normal cardiat output, mean arterial pressure, and tissue oxygenation
fluid resuscitation
Fluid resuscitation of the burn patient protocol:
- initiate large-bore IV
- administer half of the total 24h prescribed volume w/in first 8hrs postburn and the remaining volume over the next 16h
- assess:
- VS +voice quality
- urine output q1h
- fluid overload
Signs of fluid overload:
- formation of dependent edema
- engorged neck veins
- rapid, thready pulse
- presence of lung crackles or wheezes on auscultation
Why do you rarely offer more than moderate relief during painful procedures?
they depress respiratory function and reduce intestinal motility
*opiod durgs for pain are given only bt the IV route during resuscitation phase
phase of burn injury that begins about 36-48h after injury and lasts until wound closure is complete
acute phase of burn injury
Priority nursing interventions during acute phase of burn injury:
- assess and maintain respiratory and cardiovascular systems
- identify or prevent complications
leading cause of death during the acute phase of recovery
burn wound sepsis
application of water for treatment/debridement; risk for infection by auto-contamination and cross-contamination
hydrotherapy
- multiple layers of gauze (deponds on depth, amt of drainage, size, mobility)
- generally changed and reapplied every 8-24h after cleaning
standard wound dressings
- used for temporary wound coverage and closure
- skin or membranes obtained from human tissue donors or animals are applied over open wounds
- used on partial-thickness, granulating full-thickness that are free of eschar
biologic dressings (homograft/allograft{human} or heterograft/xenograft{animal})
indicators of sepsis:
- foul-smelling discharge
- fever
- blood culture colonization
- wound site colonization
- WBC count elevation
- color changes
- change in texture
- exudate
- redness at wound edges (nonburned skin)
how do you help a patient prevent contractures?
- repositioning
- practice ROM
- start walking asap
- surgery can be performed
phase that begins with wound closure and ends when pt returns to his or her highest level of functioning
rehabilitative phase of burn injury
