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Adult Health II - (Josh) > T1 - Integument and Burns (Josh) > Flashcards

T1 - Integument and Burns (Josh) Flashcards

1
Q

— burns are the number 1 cause of burn injury to kids under 4.

A

Scald

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2
Q

What about kids make them more susceptible to scald burn injury?

A

thinner skin than adults

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3
Q

What is the temp we should keep water heaters?

A

120 degrees or less

***always test water with BACK of hand

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4
Q

Describe the patho of a burn injury.

A

Hemodynamics, lead to…

Increasced capillary permeability, leading to…

Plasma leaking into interstitial spaces, leading to…

Fluid loss, leading to…

Increased peripheral vascular tissue resistance, leading to…

Organ hypoperfusion, leading to…

Burn Shock

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5
Q

What happens about 24 hours out from a burn injury?

A

Capillary membrane integrity is restored, leading to DIURESIS

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6
Q

Patho of Burns:

Within first few hours, we have —- due to leaky capillaries creating edema and increased vascular tissue resistance.

After 24 hours, we have — due to repair of capillaries.

A

Organ Hypoperfusion

Diuresis

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7
Q

What are the different degrees of burn injuries?

A

Superficial (1st Degree)

Partial Thickness (Superficial Dermal) (2nd Degree)
Partial Thickness (Deep Dermal) (2nd Degree)

Full Thickness (3rd Degree)

Deep Full Thickness

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8
Q

Degrees of Burn Injury:

Which ones have pain?

A

First and Second Degree

***Third usually doesn’t due to nerve damage

***Deep Full Thickness never has pain

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9
Q

Degrees of Burn Injury:

Describe the appearance of a 1st Degree Burn.

A

Epidermis

Severe Erythema

Blanches

Red, pink, dry

NO BLISTER

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10
Q

Degrees of Burn Injury:

How long does a 1st Degree Burn last?

A

Pain for 48-72 hrs

Desquamation in 3-7 days

Heals in 2-7 days

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11
Q

Degrees of Burn Injury:

Describe the appearance of the two types of 2nd Degree burns.

A

Superficial Dermal

  • Large, thick walled BLISTER
  • Cherry red, edema
  • Mottled red base
  • Broken epidermis
  • Wet, shiny, weeping
  • Blistered

Deep Dermal

  • NO BLISTER
  • Red, patchy white areas that BLANCH with pressure
  • Moderate edema
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12
Q

Degrees of Burn Injury:

Describe the time frame of a 2nd Degree Superficial Dermal burn.

A

Superficial healing in 7-21 days while deeper healing takes 21-28 days

Mid-dermal healing takes 4-6 wks

MINIMAL SCARRING

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13
Q

Degrees of Burn Injury:

Describe the time frame of a 2nd Degree Deep Dermal burn.

A

2-6 wks to heal

Spontaneous healing or will require surgical excision and skin grafting

Dermal Necrosis = wound turns from white to yellow

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14
Q

Degrees of Burn Injury:

What is the appearance of a Full Thickness 3rd Degree Burn?

A

Pale, white, charred

Deep red, black, brown

Dry leathery surface

Severe edema

Fat exposed

Tissue disrupted

No blisters

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15
Q

Degrees of Burn Injury:

What is appearance of a Deep Full Thickness Burn?

A

Black

NO EDEMA

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16
Q

Degrees of Burn Injury:

Why would a 3rd Degree burn victim pee out blood?

A

hemolysis of blood leads to blood passed into urine

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17
Q

Degrees of Burn Injury:

Is a 3rd Degree burn capable of self re-epithelialization?

A

no

skin grafts required

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18
Q

Rule of 9s:

Give percentages to each part that is rated in the Rule of 9s.

A

Head and Neck = 9 percent

Anterior Trunk = 18 percent

Posterior Trunk = 18 percent

Arms = 9 percent (each arm)

Legs = 18 percent (each leg)

Perineum = 1 percent

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19
Q

Rule of 9s:

What would a burn on upper half of anterior trunk be?

A

9 percent

***remember full anterior trunk is 18 percent

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20
Q

Do peds patients use Rule of 9s?

A

No,

they use something like the Lunds-Browder which adjusts surface area for age

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21
Q

Circumferential Burns:

What is the biggest concern with burn that covers the entire circumference of an extremity?

A

circulation and respiration (if it’s the chest and back)

why? because fluid shifts create problems, especially if skin cannot stretch to account for it

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22
Q

Circumferential Burns:

What do you do with an extremity that has a burn that covers entire circumference?

A

elevate above heart

check distal pulses q hr

***may also cut into skin to relieve interior pressure

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23
Q

Circumferential Burns:

Why do a lengthwise incision with these types of burns?

A

Escharotomy-skin cannot expand

Lengthwise incision relieves constriction

NOTES:

  • little to no bleeding
  • can be done at bedside
  • treatment of choice
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24
Q

Signs and Symptoms of an Inhalation Injury

A

SOB, dyspnea

Hoarsesness

Stridor

Flaring

Tachypnea

Burns to face, neck, mouth

Sooty Sputum

Singed Facial Hair

Swelling of face, neck, trachea

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25
Explain why an Inhalation Injury leads to hypoxemia.
Carbon Monoxide binds to Hg and decreases O2 delivery to tissues
26
With an inhalation injury, what is protocol to determine O2 level?
ABG and Carboxyhemoglobin level ***pulse ox will not be accurate
27
What can smoke inhalation lead to?
ARDS Bronchospasm Atelectasis Edema Infection ***Due to the fact that smoke decreases surfactant production
28
Carbon Monoxide Poisoning: What is Normal? Mild? Moderate? Severe? Fatal?
Normal = less than 2 percent Mild = 11-20 percent Moderate = 21-40 percent Severe = 41-60 percent Fatal (death) = 61-80 percent
29
Carbon Monoxide Poisoning: Signs and Symptoms of Mild (11-20 percent) CO poisoning?
HA Decreased cerebral function Decreased visual acuity Slight breathlessness
30
Carbon Monoxide Poisoning: Signs and Symptoms of Moderate (21-40 percent) CO poisoning?
HA Tinnitus Nausea Drowsiness Vertigo Confusion Stupor Irritability Hypotension Pale to reddish purple skin
31
Carbon Monoxide Poisoning: Signs and Symptoms of Severe (41-60 percent) CO poisoning?
coma convulsions cardiac instability
32
Treatment for Inhalation Injury
100 percent FiO2 ASAP EARLY INTUBATION (to prevent swelling from keeping tube out) Rest Maintain airway PEEP
33
Phases of Burn Care: What are the 3 phases?
Resuscitation Phase Acute Care Phase Rehabilitation Phase
34
Phases of Burn Care: Which phase is the emergent phase and how long does it last?
Resuscitation Phase - it is when fluid shifts and lasts until plasma volume is restored
35
Phases of Burn Care: What happens during the Acute Care Phase?
Spontaneous Diuresis Return of Capillary integrity Mobilization of ECF Wound healing, closure, and prevention of complications
36
Phases of Burn Care: Describe the Rehabilitation Phase.
Begins at admission Long term Mobility and Function Psychological Recovery
37
Phases of Burn Care: What are the goals of the Acute Phase?
Prevent Infection (death in this stage is typically from infection) Wound Care (skin grafting) Nutrition
38
Phases of Burn Care: What are the goals of the Resuscitation Phase?
minimize the effects of fluid shifts and maintain organ perfusion ***first 24-36 hrs they'll have elevated HCT and Hgb so use LR, then, use Albumin (colloids)
39
Resuscitation Phase: During the initial 24 hrs... What happens to HCT and Hgb? What happens to Sodium? What happens to Potassium
HCT and Hgb are elevated due to loss of fluid volume as fluid shifts into interstitial space Sodium decreases (hyponatremia) due to third spacing Potassium (hypoerkalemia) increased due to cell destruction
40
Resuscitation Phase: After the initial 24 hours (48-72 hrs after injury... What happens to HCT and Hgb? What happens to Sodium? What happens to Postassium?
HCT and Hgb decrease due to fluid shift from interstitial space back into vascular space Sodium remains decreased due to renal and wound loss Potassium remains decreased due to renal loss and movement back into cells
41
Resuscitation Phase: What happens to WBC, Glucose, ABGs, Protein and Albumin, and Carboxyhemoglobin during this phase?
WBC - initial increase then decrease with left shift Glucose - elevated due to stress response ABGs - slight hypoxemia and metabolic acidosis Albumin (Protein) - low due to fluid loss Carboxyhemoglobin - elevated
42
Resuscitation Phase: What is the end result of an elevated Carboxyhemoglobin level during this phase?
Due to inhalation injury - carboxyhemoglobin competes with O2 for Hgb binding, which leads to hypoxia
43
Resuscitation Phase: What would a physical assessment of Circulatory System reveal?
Hypovolemia HR increased CO decreased Decreased CVP Decreased UOP
44
Resuscitation Phase: What would a physical assessment of the Pulmonary System reveal?
***inhalation injury Airway edema Pulmonary capillary leak Chest burns and restriction CO poisoning
45
Resuscitation Phase: What would a physical assessment of the GI System reveal?
SNS (Fight or Flight) Response - slowing of gastric motility - ileus - curling's ulcer (give H2 blockers to treat) Metabolic - stress response activated - Hypermetabolic condition
46
Circumferential Injury: What would the physical assessment be in the injured limb?
Pulsesless Paresthesia Numbness
47
Why would a burn victim be cold (hypothermic)?
heat loss through open wound ***burn units are warmer than rest of hospital
48
Resuscitation Phase: What are Airway Mgmnt goals during this phase?
Intubation Mechanical Vent 100% FiO2 if inhalation injury or head, neck, upper thorax burn
49
Resuscitation Phase: What are the goals to keep client Hemodynamically Stable during this phase?
Keep UOP 0.5-1 mL/kg/hr Keep SBP greater than 90 ECG to monitor for changes associated with electrolyte imbalance Fluid resuscitation
50
Resuscitation Phase: Management Goals
Emergent fluid resuscitation Start large bore IV away from burn area (central line prefered) Keep UOP 0.5-1 mL/kg/hr Expect to gain 15% base weight in emergent phase 1st 24-36 hrs = isotonic solutions...then switch to colloids (Plasma, Albumin, Hespan)
51
Resuscitation Phase: What is Parkland Formula and how do you use it?
formula to determine the amount of fluids to give during resuscitation phase 4 mL LR x %TBSA x weight in Kg ***%TBSA determined with rule of 9s - Give half this amount in first 8 hrs - Give 25% over next 8 hrs - Give 25% over next 8 hrs
52
Resuscitatino Phase: 70 kg Client has burn over entire anterior trunk. Use Parkland Formula to determine how much fluid to give
Rule of 9s = anterior trunk = 18 percent Parkland Formula = 4mL x 18 x 70 = 5040 mL Give 2520 in first 8 hrs Give 1260 in second 8 hrs Give 1260 in last 8 hrs
53
Resuscitation Phase: How would we manage pain?
IV Narcotic NO IM or SQ meds due to fluid shifts NO PO due to GI Distress
54
Resuscitation Phase: Which injection should we make sure they have?
Tetanus injection ***would be the only thing we give IM during this time
55
What is the most common cause of death after a burn injury?
Infection
56
Resuscitation Phase: What can we do do to manage the GI problems associated with burns?
NG Tube if paralytic ileus H2 Blockers, Antacids (maintain gastric pH greater than 5) NPO (TPN - hyperalimentation)
57
Resuscitation Phase: What would we set the NG Tube to at the beginning?
Suction first to keep stomach decompressed Once we know that there is motility occurring, then we'll give them nutrition through the tube
58
Resuscitation Phase: During first 48-72 hrs, how often are we monitoring UOP?
q 1 hr
59
Resuscitation Phase: What are signs of renal failure?
Hemoglobinuria Myoglobinuria (dark urine from muscle/tissue damage) Hypoperfusion Hypovolemia
60
Burn Shock: What is it and when would we most likely see it?
Hypovolemic shock associated with major shift of lfuids out of blood vessels usually seen during Resuscitation Phase if we do not adequately maintain fluid status
61
Burn Shock: What are the hemodynamics associated with Burn Shock?
Decreased CO Decreased BP Tachycardia Increased SVR Increased PVR
62
When is the Acute Phase? What is sign of Acute Phase? When does it end?
36-72 hrs after burn Onset of Diuresis (due to capillary repair) Ends with Wound Closure
63
Acute Phase: What are the management goals during this phase?
Control Infection Wound Closure Wound Cleansing and Debridement Promote Re-epithelialization Provide Adequate Nutrition
64
Pain Management: What can we do to manage pain?
IV Opioids (Morphine and Fentanyl) Benzos **NO IM or SubQ meds
65
Acute Phase: What are we monitoring with WBCs?
elevation and sign of sepsis ***WBCs may drop more than 5000 after 48 hrs of burn injury
66
Acute Phase: What is Pan-Culture?
when they have an increased temp, they will culture for everything (pan-culture)
67
Acute Phase: What is done prophylactically for burns with greater than 10% TBSA?
Tetanus
68
Signs of Sepsis
Decreased BP Tachycardia Shivering (Fever)
69
Types of Debridement: What are the different types? Which one can a trained nurse do? Which one will be avoided if nerves are exposed?
Types: - Mechanical - Enzymatic - Surgical Nurse can do mechanical Enzymatic will be avoided if nerves are exposed
70
Topical Ointments: What are pros and cons of Silver Sulfadiazine (Silvadene)?
Pros: - maintains joint mobility - effective against gram - bacteria, gram + bacteria, and yeast - not painful Cons: - may cause neutropenia - no sulfa allergies - does not penetrate eschar - contraindicated in newborn and pregnancy
71
Topical Ointments: What are pros and cons of Mafenide Acetate (Sulfamylon)?
Pros: - active againts gram pos and gram neg bacteria - penetrates eschar - DOC for electrical burns Cons: - painful to apply and remove - have to apply twice a day - inhibits wound healing
72
Wound Care: What does the Open Method entail?
No dressing Topical agents
73
Wound Care: What does the Semi-Open Method entail?
Topical agents Thin layer of gauze Xeroform gauze (nonadherent dressing)
74
Wound Care: What does the Closed Method entail?
Topical agents Nonadherent dressing (Xeroform) Woven gauze dressing Silver impregnated dressings
75
Wound Care: What are Silver Dressings? How do they work?
99.1 percent pure metallic silver, 0.9 percent silver oxide Interfere with bacterial enzyme systems ***moisture is required through intermittent application of sterile water
76
Skin Grafts: What are the temporary grafts?
Homografts (Allografts) - human cadaver - rejected in 2 wks Heterografts (Xenografts) - Pigs - rejected in 5-7 days
77
Acute Phase: What is preferred route of nutrition?
oral or enteral (TPN if gut not working)
78
Acute Phase: What are daily protein and calorie requirements?
Protein = 2-4 x's normal amount Calories = 8000 cal a day
79
Acute Phase: If they can eat, what type of meals and how often?
Several small meals daily with high protein and high calorie
80
Rehab Phase: How should we position client?
Fowlers without a pillow Elavate and Extend the extremity (to prevent contractures) Anti-deformity positions (with splints that are removed q 2 hrs)
81
Rehab Phase: What can be worn to prevent contractures?
JOBST Garment **wear for about a year

Adult Health II - (Josh) (13 decks)

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