Module 5 - Burns

Question 1

Burns result in

Answer 1

cute inflammatory response & release chemicals with in the body

Question 2

As severity of burns increase tissue and underlying organs have an increased risk at being …

Answer 2

destroyed

Question 3

thermal burns

Answer 3

result from direct contact with a heat source (fire, sun, water)

Question 4

nonthermal burns

Answer 4

result from exposure to an electric or chemical source, radiation, light, or friction (fug burns, radiation therapy, etc)

Question 5

Pediatric and geriatric burns are more concerning because

Answer 5

their skin is thinner and more susceptible to heat

Question 6

Burns are classified based on

Answer 6

Burns are classified based on depth and how much surface area the burn effects on the body

Question 7

Partial thickness

Answer 7

(first degree) - affects the epidermis and part of the dermis - often with no scarring

Question 8

Deep partial thickness

Answer 8

(second degree) - that destroy the epididymis and parts of the dermis - area is red, swollen, blistered, and cause a lot of pain

Question 9

Full thickness burns

Answer 9

(Third degree)- destroys all skin layers and underlying tissue - wound appears hard and dry and charred (eschar)

Question 10

Blisters

Answer 10

Frequently seen in deep partial thickness burns
Surrounding skin may be red
Area is often hypersensitive and painful

Question 11

Edema

Answer 11

Seen in deep partial thickness and full thickness burns
Results from fluids shifting
Dead skin slowly sloughs off with healing occurring when cells along the edges regenerate

Question 12

Dark coloring

Answer 12

Seen in full thickness burns; often painless initially, but pain increases as inflammation continues
As eschar shrinks, pressure is placed on tissues beneath, which could further compromise circulation
If on a limb, escharotomy (surgical cuts through the charred area) may be required to ease pressure and restore circulation
Requires skin graft for healing

Question 13

Hypovolemic shock

Answer 13

Chemical mediators release and cause fluid shifts when the inflammatory response is invokes, meaning that if a burn is larger the shift can cause too much water, protein, and electrolytes to move into the surrounding tissues leading to edema, decreased blood pressure, and hypovolemic shock
Hematocrit increases due to the concentration of RBCs in circulating fluid in a decreasing circulating fluid volume deficit (FVD), or hemoconcentration
Albumin also moves out of the capillaries lowering osmotic pressure, making it difficult to correct and maintain circulating blood volume until the inflammation subsides

Question 14

Inflammation process and healing of burns

Answer 14

Burns cause coagulation necrosis (an alteration in cell proteins).
Neutrophils and monocytes collect along the injury to destroy and remove microorganisms and destroy foreign material.
Fibroblasts and new collagen fibrils appear and start wound repair within 6-12 hours of the initial injury.

Question 15

Immunologic Changes Resulting from a Burn Injury

Answer 15

Burns destroy the body’s first layer of defense—the skin barrier.
The bone marrow function becomes suppressed leading to a decrease in the amount of immunoglobulins circulating in the blood.
As the bone marrow function is suppressed, the white blood cells (WBCs), which are formed in the bone marrow, do not function adequately.
The inflammatory process affects the functioning of lymphocytes, monocytes, and neutrophils, placing the patient at an increased risk for infection.

Question 16

Non-stick Dressing

Answer 16

This is used for small areas or superficial burns

Question 17

skin graft

Answer 17

Grafts are used for larger burns since few cells are available to regenerate new skin.
They may be stretched to cover a greater area.
Temporary skin coverings (pig/xenograft or cadaver/allograft) may be used but are temporary because they will be rejected in time.
Cultured epithelial autograft (grown from the patient’s own skin cells) may be an option.
Biosynthetic skin substitutes are used when severely burned patients have little skin to use for grafts. These are strong and elastic and allow for the use of a thin skin graft. These skin substitutes reduce the number of surgeries required, decreasing scarring, and improving healing. Examples include Biobrane; Integra, or Matriderm (from cows); AlloDerm (from donated human skin); OrCel or Apligraf (donated neonatal foreskin)

Question 18

Elastic Pressure Sleeve

Answer 18

This is used to control scarring, which may impact function and appearance.
Long-term use is often required.

Question 19

burn complications - shock

Answer 19

explanation -
Fluid shift leading to edema and a loss of circulating intravascular fluid volume and eventually hypovolemic shock
May result in renal failure and organ damage
Hypotension
Tachycardia
Decreased urinary output (<30 mL/hr)
treatment -
Infusions of fluids
Electrolytes
Plasma expanders

Question 20

burn complications - respiratory

Answer 20

Explanation-
Immediate inhalation of toxic fumes or gasses (carbon monoxide/cyanide), leading to respiratory damage
Fatal if inhaled in an enclosed space
Mucosal damage when hot air, steam, or chemicals are inhaled
Leads to damage to the lining of the trachea and bronchi
Airway obstruction
Inflammation within the lungs leading to pneumonia
treatment-
Requires administration of high levels of oxygen
Close observation of the patient for respiratory difficulties

Question 21

burn complications - pain

Answer 21

Explanation-
Extremely painful throughout the healing process
Results from the actual injury, movement, and skin grafting procedures
treatment-
Administration of analgesics

Question 22

burn complications - infection

Answer 22

Explanation-
Infection can extend into the burn from partial thickness to full thickness
Destruction of the skin barrier leads to an easy entry point for bacterial infection from normal microbes on the skin as well as opportunistic bacteria
Common bacteria in burn infections include Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella, and Candida
treatment-
Prescription of antimicrobial drugs
Proper use of appropriate therapy to decrease likelihood of the development of drug-resistant organisms

Question 23

serious infection

Answer 23

Explanation-
Serious infections result in septic shock and organ failure
treatment-
Rapid removal of the infected tissue
Administration of antimicrobial drugs
Replacement with skin grafts

Question 24

burn complications - pediatric-specific complication

Answer 24

Explanation-
Growth is affected during recovery
Metabolic needs are not met
Huge stress is placed on child
treatment-
Additional surgeries may be needed in the future to allow for growth and decrease the effects of scarring