Management of Patients with Burn Injury Flashcards
Risk Factors to patients with burn injuries
Pre-existing heart, lung, and kidney diseases
DM
Peripheral vascular diseases
Physical weaknesses like alcoholism, malnutrition
Concurrent fractures
Head injuries
Goals of Burn Care
Lifesaving measures
Prevention of disability and disfigurement
Rehabilitation
First degree burns AKA
superficial
Second degree burns AKA
partial thickness
Third degree burns AKA
full thickness
Classification of burn that involves outermost layer of skin and stays intact. It is painful.
First degree
Classification of burn that involves entire epidermis and varying portions of the dermis. Painful with blisters
2nd degree
Classification of burn that involves destruction of epidermis, dermis, and underlying tissue Painless.
3rd degree
Classification of burn that involves necrosis of tissue extending into deep tissue, muscle, or bone.
4th degree
Types of burns
Thermal
Chemical
Electrical
Thermal burns can be caused by
flame, flash, scald, or contact with hot objects
What is the most common type of burn?
Thermal
The severity of a thermal burn depends on what factors?
Temperature of the burning agent
Duration of contact time
Chemical burns can result in injuries to?
skin, eyes, respiratory system, liver and kidneys
What MUST be done with every patient who has an electrical burn?
Stabilize C spine
Patients with an electrical burn are at risk for?
Dysrhythmias or MI
Myoglobinuria
Why does myoglobinuria happen in patients with an electrical burn?
Injured muscle tissues release myoglobin which travels to the kidneys and blocks the renal tubules
Electrical burns are known to cause what phenomena?
Iceberg effect
Myoglobinuria can lead to?
Acute tubular necrosis
Acute kidney injury
Factors to consider in determining burn depth
How the injury occurred
Causative agent
Temperature of causative agent
Duration of contact w causative agent
Thickness of skin at site of injury
Clues of smoke inhalation injury to lower airway
Facial burns
Singed nasal hair
Hoarseness
Painful swallowing
Dark mucosal membranes
Carbonaceous sputum**
Enclosed space
Clothing burns around neck and chest
What is the cardinal sign of a lower airway injury?
Carbonaceous sputum
What is carbonaceous sputum?
Dark colored sputum
3 Zones of Burn Injury
Zone of coagulation
Zone of stasis
Zone of hyperemia
Which zone of burn injury has the most damage?
Coagulation
Which zone of burn injury may be viable or turn necrotic within 24 hrs?
Stasis
Which zone of burn injury has the least amount of damage?
Hyperemia
Burns more than __% may produce a local and systemic response and are considered major burns
30%
Major burn injuries cause fluid shifts and shocks that result in what?
Tissue hypoperfusion and organ hypofunction
Effects of a Major Burn Injury
Fluid and electrolyte shifts
CV effects
Pulmonary injury
Renal and GI alterations
Immunologic alterations
Effect on thermoregulation
What type of pulmonary injuries may occur with a major burn?
Upper
Lower
CO2 poisoning
Restrictive defects
List the emergency response to an on-the-scene burn injury scenario
- Prevent injury to self - safety check
- Stop injury - extinguish flame, cool burn, irrigate chemical burn
- ABCs
- Start O2 and large bore IVs
- Remove restrictive objects and cover wound
- Do head-to-toe assessment and obtain med hx
Phases of Burn Injury
Emergent or resuscitative phase
Acute or intermediate phase
Rehabilitation phase
Describe the emergent phase of a burn injury
Generalized dehydration
Reduced blood volume
Decreased urine output
Hyperkalemia
Hyponatremia
Metabolic acidosis
When does the emergent phase of a burn injury begin and end?
At the time of injury to completion of fluid resuscitation
When does the acute or intermediate phase of a burn injury begin and end?
From beginning of diuresis to wound closure
When does the rehabilitation phase of a burn injury begin and end?
From wound closure to return to optimal physical and psychosocial adjustment
Why is a foley catheter inserted during the emergent phase of a burn injury?
To carefully monitor I & O
Nursing management of the patient during the emergent/resuscitative phase of a burn injury
Fluid resuscitation begins
Foley cath is inserted
NG tube inserted if burns exceed 20%
ECG if electrical burn
IV pain medications as appropriate
Psychosocial needs and support
ABCs
VS and hemodynamic status
Monitor for fluid volume deficit
Assess extent of burnP
Potential complications during emergent phase of burn injury
Acute Resp Failure
Shock
AKI
Compartment syndrome
Paralytic ileus
Curlings ulcer
When a burn injury occurs, immediate _______ in CO precedes loss of plasma volume
Decrease
Vasoconstrictive compensatory means that the workload of the heart and O2 demand ________ but there is a _______ in CO
Increases
Decreases
Hypovolemia due to plasma loss results in?
Decreased perfusion and oxygen delivery
Burn shock is a type of what kind of shock?
Hypovolemic shock
Appropriate fluid resuscitation does what for our burn patients?
Maintains the blood pressure in the low to normal range and improves CO
The greatest volume of fluid leak occurs when after a burn injury?
The first 24-36 hrs, peaking by 6-8 hrs
If fluid resuscitation is too vigorous, the patient will show s/s of?
Heart failure or pulmonary edema
Superficial burns cause edema how many hours after injury?
within 4 hrs
Deeper burns can continue to form edema up to how many hours post injury?
18 hrs
What electrolyte imbalance forms in burn patients due to massive cell destruction?
Potassium
An incision through full-thickness eschar to relieve pressure
Escharotomy
3 common GI alteration in burn patients
Paralytic ileus
Curlings ulcer
Translocation of bacteria
Your burn patient has absence of intestinal peristalsis and decreased bowel sounds, what may they be developing?
Paralytic ileus
Your burn patient has developed gastric bleeding and is regurgitating coffee ground material from the stomach, what do they have?
Curlings ulcer
What is the ABA fluid resuscitation formula for adults with a chemical or thermal burn?
2 mL x kg (weight) x %TBSA
One half of the fluid is given in the first 8 hrs from time of injury
The rest is given in the next 16 hrs
What is the ABA fluid resuscitation formula for adults with an electrical burn?
4 mL x kg (weight) x %TBSA
One half of the fluid is given in the first 8 hrs from time of injury
The rest is given in the next 16 hrs
Adequacy of urine output for a thermal or chemical burn is
0.5-1 mL/kg/hr or 30-50 mL/hr
Adequacy of urine output for an electrical burn is
75-100 mL/hr
Nursing Interventions for Acute/Intermediate Burn Injury Phase
Continue to assess and maintain respiratory and circulatory support
Fluid and electrolyte balances
GI and renal function
Infection prevention
Burn wound care
Pain management
Early positioning and mobility
Potential complications during the acute/intermediate phase of burn injury
Acute Resp Failure
ARDS
Heart failure
Pulmonary edema
Sepsis
Delirium
Visceral damage
Describe the Acute/Intermediate Phase of a burn injury
Fluid reenters vascular spaces
Increased urinary output
Hyponatremia
Hypokalemia (potential)
Metabolic acidosis
Goals of burn wound care
Infection prevention
Promote tissue growth or successful skin grafting
Types of burn pain
Background/resting
Procedural
Breakthrough
Nonpharmacologic pain control for burns
Relaxation breathing
Distraction - itching
Guided imagery
Music
Hypnosis
Therapeutic touch
Humor
