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Integumentary > Lesson 4: Burns > Flashcards

Lesson 4: Burns Flashcards

1
Q

Etiology of Burn Injuries

A

Thermal
Chemical
Electrical

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2
Q

What do thermal burns result from?

A

Result from direct/indirect contact with flame, hot liquid, or steam

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3
Q

Severity of thermal burns influenced by:

A

Contact time
Temperature
Type of insult

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4
Q

Chemical Burn Injuries

A

Acids, bases, industrial accidents, assaults

More likely to cause full-thickness damage

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5
Q

Severity of Chemical burns influenced by:

A

Alkaline burns are more severe than acidic
Contact time (burning continues until removed/diluted, therefore thoroughly irrigate
for 20–30 min)
Chemical concentration
Amount of chemical

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6
Q

Electrical Burn Injuries

A

Low- and high-voltage currents
Entrance wound – depressed or charred
Exit wound – larger, explosive
Skin may not be severely damaged despite deep tissue injury due to differences in resistance

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7
Q

Concomitant injuries with electrical burns:

A

Fractures, muscle necrosis, neurological injuries

Cardiac, pulmonary, other organ failure

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8
Q

Severity of electrical burns influenced by:

A

High-voltage current causes more damage
AC burn injuries are more severe
Contact time

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9
Q

How long do chemical burns take to develop?

A

24–72 hours

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10
Q

Superficial Burns

A

First-degree burns”/Integumentary Pattern B
Dry, bright red, or pink skin that blanches upon pressure
No dermal vessel damage
Epidermis damaged

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11
Q

Types of superficial burns:

A

Sunburn, minor flash burn

Erythema, significant pain, lack of blisters, sunburn

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12
Q

Superficial Partial-Thickness Burns

A

Superficial second-degree burns”/Integumentary Pattern C
Painful, moist, weeping, blistered skin with local erythema and edema
Blanches to pressure with immediate capillary refill
Epidermis and part of dermis damaged

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13
Q

Examples of Superficial Partial-Thickness Burns

A

Brief contact burns, flash burns, brief contact with dilute chemicals

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14
Q

Deep Partial-Thickness Burns

A

Deep second-degree burns”/Integumentary Pattern C
Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity/reduced sensation
Blanches to pressure with slow capillary refill
Scarring, pigment changes, contractures possible

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15
Q

Examples of Deep Partial-Thickness Burns

A

Severe sunburn, scald, flash burn, brief contact with dilute chemicals

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16
Q

Time to heal for Deep Partial-Thickness Burns:

A

May take 3 or more weeks to heal

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17
Q

Time to heal for Superficial Partial-Thickness Burns

A

Heal within 10–14 days with minimal or no scarring

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18
Q

Time to heal for Superficial Burns

A

Resolves within 3–5 days without scarring

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19
Q

Full-Thickness Burns

A

Third-degree burns”/Integumentary Pattern D
Initially look red then become mottled white/black, dry, leathery eschar, very painful
Burned areas insensate to light touch
Scarring and contractures likely
Most require surgical debridement and grafting

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20
Q

Examples of Full-Thickness Burns

A

Prolonged contact with flame, immersion scald injury

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21
Q

What layers affected with full-thickness burn:

A

Epidermis, Dermis, and complete destruction to subcutaneous fat

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22
Q

Subdermal Burns

A

“Fourth-degree burns”/Integumentary Pattern E
Charred, mummified appearance
Exposed deep tissues
Burned areas insensate to light touch
May have permanent nerve damage
Require surgery (fasciotomy, escharotomy, grafting) and possible amputation

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23
Q

Examples of subdermal burn:

A

Electrical burn, strong chemical burn

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24
Q

Rule of Nines:

A

Divides the integument into areas roughly equivalent to 9% of TBSA

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25
Q

9% of TBSA:

A

Head, front and back of each UE, front of each LE, back of each LE

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26
Q

Perineum is:

A

1% of TBSA

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27
Q

Lund-Browder Classification

A

Takes into account variation of body proportion from child to adult
Appropriate for children under age 16
Preferred by pediatric burn units

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28
Q

Palmar Method

A

Uses the area of palmar surface of the hand to determine burn size
Highly unreliable, inaccurate

29
Q

What is burn severity determined by:

A

Burn size
Burn depth
Age (child vs. adult)

30
Q

Minor burn:

A

generally treat as out-patient

31
Q

Moderate burn:

A

generally treat as in-patient

32
Q

Major burn:

A

generally treat in specialized burn unit

33
Q

Pathophysiology of Burn Injuries

A

Zone of coagulation
Zone of stasis
Zone of hyperemia

34
Q

Zone of coagulation

A

Central portion, irreparable damage

Characterized by coagulation, ischemia, necrosis

35
Q

Zone of stasis

A

Area of cellular injury and compromised perfusion

Conversion: widening and deepening of necrosis

36
Q

Zone of hyperemia

A

Outer edges, minimal cellular injury

37
Q

Be aware of

A

Bandages that are too tight
Undue pressure from splints
Improper patient positioning

38
Q

Burn shock

A

massive fluid shift causing hypovolemia and edema
Results in decreased blood volume
Tissue necrosis, organ failure, and death are possible

39
Q

Who is at high risk for burn shock?

A

Patients with >15% TBSA burns at high risk for burn shock

40
Q

Cardiovascular system:

A

Fluid resuscitation is of primary importance
Blood pressure generally decreases as a result of hypovolemia
Resting heart rate 100–120 bpm for adults
Monitor peripheral pulses
Must monitor and manage edema

41
Q

Pulmonary System

A

Suspect lung involvement if singed facial hair, carbonaceous sputum, closed space injury, burns to face/neck/torso
Monitor for signs of breathing difficulties
Monitor oxygen saturation
Encourage aggressive pulmonary hygiene

42
Q

Metabolism

A 
Basal metabolic rate doubles or triples
Increase in core temperature
Sustained hyperglycemia
Increased fat catabolism
Decrease in body mass
43
Q

When does metabolism peak after a burn injury?

A

7–17 days post major burn injury

44
Q

What percentage of burn patient death are due to infection?

A

75%

45
Q

Why is sepsis and infection common?

A

Endogenous and exogenous bacteria
Decreased tissue perfusion reduces immune system effectiveness
Neutrophils less effective
Eschar, blister fluid, residual topical agents excellent medium for bacterial growth
Open wound for extensive periods of time

46
Q

Clinical should be aware of what consequences to immune system?

A

Aggressive debridement and rapid skin coverage necessary to reduce risk of infection
Follow infection-control guidelines
Prophylactic topical antimicrobials

47
Q

Complications to other systems possible

A

Multi-organ system dysfunction
CNS dysfunction
Acute kidney failure
GI dysfunction/peristalsis/ileus/ulcers

48
Q

Psychological Dysfunction

A

Posttraumatic stress disorder
Anxiety/depression/disturbed sleep
Extremely common

49
Q

Coordination, Communication, and Documentation

A

Reinforce goals set by other disciplines
Participate in patient rounds
Patient education
Give patients control over their rehabilitation

50
Q

Patient/Client-Related Instruction

A

Instruct patients in ways to control pain
Tell patients what to expect prior to procedures
Instruct how to care for wounds including positioning techniques
Educate patients on the importance of
skin care/scar management

51
Q

Precautions

A 
Screen for domestic violence
Anticipate/prevent complications when possible
Contractures
Infections
Deconditioning
Pulmonary dysfunction
Pressure ulcers
Ensure adequate pain control
52
Q

Keys to Local Wound Care:

A

Debridement
Infection Control
Dressings
Scar Management

53
Q

Debridement

A

Debride
Foreign debris, residual topical agents, exudate, hair, necrotic tissue
Remove blisters (open and closed)
Consider enzymatic debridement if appropriate

54
Q

Infection Control:

A

Use sterile technique for large TBSA burns
Topical antimicrobials are standard
Signs of infection

55
Q

Topical antimicrobials are standard

A

Silver sulfadiazine
Mafenide acetate
Bacitracin

56
Q

Signs of infection

A

Increasing erythema/pain, foul odor, purulence

Increase in necrosis, fever, increased tachycardia

57
Q

Dressings

A

Topical antimicrobial covered with nonadherent impregnated gauze, bulky gauze dressing
Limit bulk to allow/encourage movement, splint use
Short-stretch compression wrap to decrease edema and scarring

58
Q

Scar Management

A

Moisturize
Protect from friction and shear
Scar mobilization
Compression – mandatory if wound takes 3+ weeks to close
Consider silicone gel sheets/pads, ultrasound, paraffin
Darker-skinned individuals > incidence of hypertrophic scarring and keloids

59
Q

Vancouver Scar Scale

A 
Rates 4 scar qualities
Vascularity
Pliability
Pigmentation
Height
Scores range from 0–14, lower scores indicate less severe scar tissue
60
Q

Procedural Interventions

A

Range of motion
Mobility training – assistive device as needed
Breathing exercise
Aerobic exercise – target HR 50–70% of maximum predicted HR

61
Q

Physical Agents and Modalities

A 
Whirlpool
Remove necrotic tissue/topical agents, 
soften eschar 
Easier ROM
Pulsed lavage with suction – smaller wounds
Ultrasound
Paraffin
62
Q

Medical Interventions

A

Pharmacological management
Ensure adequate control of pain and anxiety
Time procedures with medications

63
Q

Surgical Interventions

A

Debridement

Early debridement often performed on patients with medium and large full-thickness burns

64
Q

Graft failure may be due to:

A

Infection
Eschar
Insufficient immobilization
Fluid collection under graft

65
Q

Skin substitutes

A

Bilayered dressings with epidermal and dermal analog
Used on donor sites and wounds
Examples: AlloDerm, Biobrane, Integra

66
Q

Cultured epithelial autografts

A

Cultures patients’ own cells

Grown in lab and stapled/sutured in place

67
Q

Intervention Goals

A

Superficial wounds heal spontaneously within the first 2 weeks with pain management and topical dressings to prevent infection
Deeper wounds take longer than 2 weeks to heal and may require surgical intervention.
Need to prevent infection- topical antibiotic creams, Vaseline gauze to prevent trauma to tissue
After initial injury, cooling of burn site important

68
Q

Escharotomy

A

Incision through eschar and subcutaneous tissue to release tissue constricting circulation

69
Q

Fasciotomy

A

Incision through fascia to release pressure/improve distal circulation

Integumentary (18 decks)

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