MS CH 55 Nursing Care of Patients With Burns Flashcards
What causes burns?
Energy transfer from a heat source to the body, causing tissue damage.
What are the three zones of a burn injury?
Zone of coagulation, zone of stasis, zone of hyperemia.
What is the function of the skin?
Protection, temperature regulation, sensation, fluid balance, and secretion/excretion.
What systemic changes occur after a burn?
Fluid imbalance, cardiovascular effects, metabolic changes, immune suppression, pulmonary issues.
How does a burn affect fluid balance?
Increased capillary permeability leads to plasma and protein leakage, edema, and hypovolemia.
What causes hypovolemic shock in burn patients?
Fluid loss from capillary leakage, decreased circulating volume.
What electrolyte imbalances occur after a burn?
Hyperkalemia initially, then hypokalemia and hyponatremia.
Why does hematocrit increase after a burn?
Loss of plasma volume concentrates red blood cells.
How does a burn affect cardiac function?
Initial decrease in cardiac output due to plasma loss.
Why is hypermetabolism common in burn patients?
Increased metabolic rate due to stress response and tissue repair.
What GI complications occur in burn patients?
Paralytic ileus, gastric dilation, peptic ulcers.
What is Curling’s ulcer?
A stress ulcer caused by burns and decreased gastric mucosal blood flow.
How do burns affect renal function?
Hypovolemia decreases renal perfusion, leading to acute kidney injury.
What is myoglobinuria?
Muscle breakdown releases myoglobin, which can clog renal tubules and cause kidney failure.
How do burns affect pulmonary function?
Smoke inhalation can lead to airway edema, hypoxia, and respiratory distress.
What are signs of inhalation injury?
Singed nasal hair, soot in sputum, hoarseness, wheezing, stridor.
What are the leading causes of death in burn patients?
Sepsis and inhalation injury.
How is burn severity determined?
Depth, percentage of body surface area burned, cause, age, and comorbidities.
What is the Rule of Nines?
A method to estimate body surface area burned, dividing the body into multiples of 9%.
Why is the Lund and Browder method preferred in children?
It adjusts for different body proportions in children.
What is the Parkland formula?
4 mL × weight (kg) × %TBSA burned (½ given in first 8 hours, rest over 16 hours).
What is the primary goal of fluid resuscitation?
Maintain organ perfusion and prevent hypovolemic shock.
What is the best indicator of adequate fluid resuscitation?
Urine output ≥ 0.5 mL/kg/hr.
What type of IV fluid is preferred for burn resuscitation?
Lactated Ringer’s solution.
Why is albumin used in burn patients?
It helps pull fluid back into the vascular space.
What electrolyte imbalance is most concerning in burn patients?
Hyperkalemia can cause cardiac arrhythmias.
What is an escharotomy?
A surgical incision through eschar to relieve pressure and restore circulation.
What is a fasciotomy?
Deeper incision through fascia if escharotomy is insufficient.
Why are burn patients at high risk for infection?
Loss of skin barrier and immune suppression.
What is the most common cause of death after the emergent phase of burns?
Sepsis.
What PPE should be worn when treating burn wounds?
Sterile gloves, gown, mask, eye protection.
What are early signs of burn wound infection?
Increased redness, swelling, foul odor, fever.
What is the purpose of debridement?
Removes dead tissue to promote healing.
What are the types of debridement?
Mechanical, enzymatic, surgical, autolytic.
Why is early enteral feeding important in burn patients?
Maintains gut integrity, prevents catabolism, reduces infection risk.
What are common nutritional deficits in burn patients?
Protein, calories, vitamins (C, D, E), zinc.
What vitamin is essential for wound healing?
Vitamin C.
What is the most effective pain management for burn patients?
IV opioids (morphine, fentanyl).
Why is IV pain management preferred in acute burns?
GI function may be impaired; IV provides faster relief.
What non-pharmacologic pain relief methods are helpful?
Distraction, relaxation techniques, music therapy.
Why is early mobility encouraged for burn patients?
Prevents contractures, improves circulation, reduces DVT risk.
What are the three stages of burn care?
Emergent, acute, rehabilitation.
What is the goal of the emergent phase?
Stabilize ABCs, prevent shock, begin fluid resuscitation.
What is the goal of the acute phase?
Wound healing, infection prevention, pain control, fluid balance.
What is the goal of the rehabilitation phase?
Restore function, improve quality of life.
What is the purpose of pressure garments?
Reduce hypertrophic scarring and contractures.
What is an autograft?
A skin graft from the patient’s own body.
What is the difference between split-thickness and full-thickness skin grafts?
Split-thickness: epidermis + partial dermis; Full-thickness: epidermis + full dermis.
What are the benefits of full-thickness skin grafts?
Better cosmetic result, more durable, less contraction.
How often should burn wounds be assessed?
At least once per shift or as needed.
Why are burn patients prone to gastric ulcers?
Stress response increases stomach acid production.
What medications prevent stress ulcers in burn patients?
PPIs or H2 blockers.
How can burns be prevented at home?
Fire alarms, safe water heater settings, avoiding loose clothing near flames.
What is the maximum safe water heater temperature?
120°F (49°C).
What is the recommended positioning for burn patients?
Avoid flexion contractures; use splints and ROM exercises.
What is the leading cause of burns in children?
Scald burns from hot liquids.
Why are older adults at higher risk for burn complications?
Thinner skin, slower healing, comorbidities.
What is the best way to prevent contractures?
Stretching, splints, positioning, early mobilization.
What is the first priority in burn management?
Airway, Breathing, Circulation (ABCs).
What are the common causes of burns?
Flame, scald, chemical, electrical, radiation.
What are signs of carbon monoxide poisoning?
Cherry-red skin, confusion, headache, dizziness, unconsciousness.
How is carbon monoxide poisoning treated?
100% oxygen therapy or hyperbaric oxygen chamber.
Why should jewelry be removed from burn patients?
Prevents constriction due to swelling.
What is the purpose of a urinary catheter in burn patients?
Accurate urine output measurement for fluid resuscitation.
What does a positive wound culture indicate?
Possible infection requiring treatment.
What is the primary concern with electrical burns?
Internal injuries, cardiac arrhythmias, muscle damage, renal failure.
What are the three phases of burn injury?
Emergent, Acute, Rehabilitation.
What are the signs of airway compromise in burn patients?
Hoarseness, stridor, wheezing, singed nasal hair.
Why is early intubation recommended for severe facial burns?
Airway edema can rapidly obstruct breathing.
What is the role of an escharotomy?
Relieves pressure and restores circulation.
What is the function of pressure garments?
Prevents hypertrophic scarring and contractures.
What is the best way to assess fluid resuscitation effectiveness?
Urine output of at least 0.5 mL/kg/hr.
What is the purpose of debridement?
Removes necrotic tissue to promote healing.
What type of dressing is used in burns?
Sterile, non-adherent, moist dressings.
Why are burn patients at risk for pneumonia?
Immobility, inhalation injury, and immune suppression.
What are signs of sepsis in burn patients?
Fever, hypotension, tachycardia, confusion, decreased urine output.
Why are IV pain medications preferred over oral in burn patients?
More effective due to impaired GI absorption.
What is the goal of burn rehabilitation?
Maximize function, mobility, and psychological recovery.
Why is early enteral nutrition important in burn patients?
Prevents catabolism, maintains gut integrity.
What is a xenograft?
A skin graft from another species (e.g., pig).
Why are burn patients at risk for deep vein thrombosis (DVT)?
Immobility and hypercoagulability.
What electrolyte imbalance can cause cardiac dysrhythmias in burn patients?
Hyperkalemia.
How does albumin help in burn resuscitation?
Pulls fluid back into the vascular system.
Why do burn patients experience metabolic acidosis?
Tissue hypoxia and fluid loss.
What are the major systemic responses to burns?
Fluid shifts, immune suppression, hypermetabolism, cardiovascular changes.
Why should burn patients avoid sun exposure?
New skin is fragile and prone to damage.
What is an autograft?
A skin graft from the patient’s own body.
What is the purpose of skin grafts?
Promotes wound healing and reduces scarring.
What is the difference between a sheet graft and a meshed graft?
Sheet grafts are used for cosmetic areas, meshed grafts cover larger wounds.
What are the common topical burn treatments?
Silvadene, bacitracin, mafenide acetate, silver nitrate.
What is the most common cause of burns in children?
Scald injuries.
What age group is most at risk for burn injuries?
Children under 5 and adults over 65.
Why are older adults at higher risk for burn complications?
Thinner skin, slower healing, comorbidities.
What does hypermetabolism in burn patients cause?
Increased caloric needs, muscle breakdown, delayed healing.
Why are vitamin C and zinc important for burn patients?
Promote collagen synthesis and wound healing.
What does a circumferential burn indicate?
Risk for compartment syndrome.
What is the function of a biological dressing?
Protects the wound and promotes epithelialization.
Why are immunosuppressive medications avoided in burn patients?
Increases the risk of infection.
How long does the rehabilitation phase last?
Months to years, depending on severity.
Why is physical therapy essential in burn recovery?
Prevents contractures and maintains mobility.
What does blanching skin in a burn indicate?
Superficial burn with intact circulation.
Why are tetanus vaccines given to burn patients?
Burns increase the risk of tetanus infection.
Why are NG tubes used in severe burn patients?
Prevents gastric dilation and supports nutrition.
Why is a humidified oxygen mask used in inhalation injuries?
Prevents drying of mucosa and helps remove secretions.
What are signs of hypovolemia in burn patients?
Low BP, tachycardia, cold/clammy skin, decreased urine output.
What is the importance of psychological support in burn patients?
Burn injuries can lead to PTSD, depression, and anxiety.
Why is weight monitored closely in burn patients?
Measures fluid balance and nutritional status.
What is the major cause of delayed wound healing in burns?
Infection.
How are burns diagnosed?
Physical assessment, lab tests, imaging for inhalation injury.
What are the benefits of early mobilization in burn patients?
Reduces pneumonia risk, prevents contractures, improves circulation.
What is the role of compression therapy in burn recovery?
Minimizes hypertrophic scarring.
What is the first aid for a chemical burn?
Remove contaminated clothing and flush with copious amounts of water.
What is the best intervention for pruritus in burn patients?
Antihistamines, oatmeal baths, moisturizers.
Why should burn patients avoid ice application?
Causes vasoconstriction and worsens tissue damage.
What is the most important factor in preventing burns at home?
Education on fire and burn safety.
What are the three layers of skin?
Epidermis, dermis, subcutaneous tissue.
What is the primary function of the epidermis?
Protects against infection and water loss.
How do burns affect thermoregulation?
Loss of skin leads to heat loss and hypothermia.
What type of burn is most painful?
Partial-thickness burns (nerve endings are exposed).
What type of burn is least painful?
Full-thickness burns (nerve endings are destroyed).
What are the classifications of burns by depth?
Superficial, partial-thickness, deep partial-thickness, full-thickness, deep full-thickness.
What is the first-degree burn appearance?
Red, dry, no blisters (e.g., sunburn).
What does a second-degree burn look like?
Blisters, pink to red, moist, very painful.
What is the hallmark sign of a full-thickness burn?
Leathery, white, brown, or charred skin with no pain.
What is a fourth-degree burn?
Burns extending into muscle, bone, or tendons.
Why is electrical burn damage difficult to assess?
Tissue damage occurs internally along the path of electricity.
What are early signs of hypovolemia in burns?
Low blood pressure, rapid pulse, reduced urine output.
What does tachycardia indicate in burn patients?
Possible fluid loss or hypovolemia.
What causes metabolic acidosis in burn patients?
Tissue hypoxia and fluid shifts.
Why are burn patients hypermetabolic?
Increased energy demand for healing.
What is the “fluid creep” phenomenon?
Over-resuscitation causing fluid overload and pulmonary edema.
What is the “Rule of Palms”?
A patient’s palm (including fingers) represents about 1% TBSA.
What lab values indicate fluid shifts in burn patients?
Increased hematocrit, hyperkalemia, hyponatremia.
What is the best way to prevent renal failure in burn patients?
Adequate fluid resuscitation.
Why is myoglobinuria dangerous in burn patients?
Can lead to acute kidney injury due to muscle breakdown.
What is the primary cause of death in the first 48 hours post-burn?
Hypovolemic shock.
What is the primary cause of death after 48 hours post-burn?
Sepsis.
What does “burn shock” refer to?
A combination of hypovolemic and distributive shock.
What is the “Parkland formula”?
4 mL × kg × %TBSA burned (½ in first 8 hours, rest over 16 hours).
What is a major risk factor for inhalation injury?
Burns sustained in an enclosed space.
What is an early sign of inhalation injury?
Hoarseness or difficulty speaking.
What diagnostic test confirms inhalation injury?
Bronchoscopy.
What does carbonaceous (black) sputum indicate?
Smoke inhalation injury.
Why are enteral feedings preferred over TPN in burn patients?
Maintains gut integrity and reduces sepsis risk.
Why is protein intake crucial for burn patients?
Prevents muscle wasting and promotes wound healing.
What vitamin is most important for collagen synthesis?
Vitamin C.
What trace mineral is important for wound healing?
Zinc.
Why are omega-3 fatty acids beneficial in burn patients?
Reduce inflammation and promote healing.
What electrolyte imbalance can occur due to excessive fluid resuscitation?
Hyponatremia.
What is the most common complication of burn wound healing?
Infection.
What PPE is required for dressing burn wounds?
Sterile gloves, gown, mask, eye protection.
Why is an NG tube inserted in burn patients?
Prevents gastric distention and aspiration.
What is the primary goal of wound debridement?
Remove dead tissue and reduce infection risk.
Why are silvadene and bacitracin used in burns?
Prevent bacterial infection and promote healing.
What is a sign of successful skin grafting?
Good adherence without necrosis.
What is a hypertrophic scar?
Thick, raised scar within the burn area.
What is a keloid?
Excessive scar tissue extending beyond the original wound.
What therapy helps minimize scarring?
Pressure garment therapy.
Why are physical therapy and ROM exercises essential in burn recovery?
Prevent contractures and improve mobility.
What is the major psychological issue in burn survivors?
PTSD and body image disturbances.
What is the function of a biological dressing?
Protects wounds and promotes epithelialization.
What is the best intervention for itching in burn patients?
Antihistamines, moisturizing, and cold therapy.
Why are escharotomies performed?
To relieve pressure and restore blood flow.
What is the primary long-term complication of burn injuries?
Contractures.
What are signs of compartment syndrome in burns?
Severe pain, decreased pulses, numbness, tight skin.
Why should burn patients avoid tight clothing?
Prevents restriction and irritation of healing skin.
What is the maximum safe water heater temperature?
120°F (49°C).
Why is exercise important in burn rehabilitation?
Prevents stiffness and maintains function.
What are the three major stages of burn care?
Emergent, acute, rehabilitation.
What is the goal of the emergent phase?
Stabilize patient and prevent shock.
What is the goal of the acute phase?
Promote healing, prevent infection, manage pain.
What is the goal of the rehabilitation phase?
Maximize function and psychological well-being.
What is the leading cause of burns in older adults?
Flame and scald burns.
What is the most common site for pressure ulcers in burn patients?
Heels and sacrum.
Why are anti-embolism stockings used in burn patients?
Prevents DVT and improves circulation.
What are signs of systemic infection in burn patients?
Fever, increased WBCs, hypotension, confusion.
Why is wound culture important in burn care?
Identifies bacterial infection and guides treatment.
What is the first aid for chemical burns?
Flush with copious water for at least 20 minutes.
