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NSG 430 - Critical Care > T14: Burns & Skin Infections > Flashcards

T14: Burns & Skin Infections Flashcards

1
Q

burns

A

an injury to the tissues of the body caused by heat, chemicals, electrical current or radiation

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2
Q

When you break skin barrier it is a

A

MASSIVE RISK FOR INFECTION

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3
Q

Decreased circulating intravascular blood volume leads to

A

fluid loss can cause decrease in organ perfusion : HR increases, CO and BP decrease

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4
Q

why do we need fluids in burn patients

A

the fluid is extravascular but the blood in the vessel is THICK so we are worried about a DVT!!!

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5
Q

thermal burns

A

caused by flame, flash, scald or contact with hot objects; this would even be considered as a sunburn

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6
Q

chemical burns

A

Result of contact with acids, alkalis, and organic compounds
Alkali burns are hard to manage because they cause protein hydrolysis and liquefaction

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7
Q

immediate care of chemical burns

A

o Chemical should be quickly removed from the skin (lavage with water *think about eye wash stations)
o Clothing containing chemical should be removed
o Tissue destruction may continue up to 72 hours after chemical injury

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8
Q

smoke inhalation injury

A

injury occurs with inhaling of products of combustion during fire

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9
Q

clinical manifestations smoke inhalation injury

A

facial burns, SINGED NASAL HAIRS, swelling of oropharynx and nasopharynx, stridor, wheezing, dyspnea, hoarse voice, sooty (carbonaceous) sputum and cough

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10
Q

electrical burns can cause

A

“Iceberg effect;” muscle spasms strong enough to FRACTURE BONES

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11
Q

with electrical burns patients are at risk for

A

o Dysrhythmias or cardiac arrest –>VF, cardiac standstill (place on a monitor)
o Seizures (place on seizure precautions)
o Muscle movement is affected (heart, intercostals, diaphragm, walking)
o Severe metabolic acidosis
o Myoglobin and hemoglobin from damaged RBCs travel to kidneys
- Acute tubular necrosis (ATN)
- Eventual acute kidney injury

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12
Q

superficial partial thickness burn

A

Involves the epidermis

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13
Q

deep partial thickness burn

A

involves the dermis

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14
Q

full thickness burn

A

involves all skin elements, nerve endings, fat, muscle, bone

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15
Q

rule of nines

A

a method used in calculating body surface area affected by burns

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16
Q

Face, neck, chest burns risk for

A

respiratory obstruction

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17
Q

Hands, feet, joints, eyes burn risk for

A

self-care deficit and mobility

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18
Q

Ears, nose, buttocks, perineum burn risk for

A

infection

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19
Q

Circumferential burns of extremities can cause

A

circulation problems distal to burn

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20
Q

compartment syndrome check

A

6 Ps

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21
Q

6 P’s

A

Pain
Pulse
Pallor
Paresthesia
Paralysis
Pressure

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22
Q

pre hospital care for burns

A
  • Remove person from source of burn and stop burning process
  • Rescuer must be protected from becoming part of incident
  • ASSESS ABCs
  • Cover burns with sterile or clean clothes and remove constricting jewelry and clothing
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23
Q

at the hospital care for burns

A

o O2 100%
o IV access to non-burned skin or central line
o Fluids for hypovolemia
o Insert foley to manage fluid resuscitation of 30-50mL/hr
o NPO
o NG tube to remove gastric secretions and prevent aspiration
o TETANUS

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24
Q

interventions for electrical burns

A
  • Removal of current source must be done by trained personnel with special equipment to
    prevent injury to rescuer
  • Assess and tx pt after removal from source of current
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25
Q

intervention for chemical burns

A

o Brush solid particles off skin
o Use water lavage
o Tissue destruction may continue for up to 72 hours after

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26
Q

small thermal burn interventions

A

o Cover with clean, cool, tap water—dampened towel

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27
Q

large thermal burn interventions

A

o Circulation (check for presence of pulse), airway (patency), breathing
o Cool burns for no more than 10 minutes (in order to prevent hypothermia)
o Do not immerse in cool water or pack with ice-hypothermia
o No ice-vasoconstriction
o Remove burned clothing
o WRAP IN CLEAN, DRY SHEET OR BLANKET
§ DRY OTHERWISE WET WILL DRY AND PULL OF SKIN

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28
Q

how to wrap burns

A

o WRAP IN CLEAN, DRY SHEET OR BLANKET
- DRY OTHERWISE WET WILL DRY AND PULL OF SKIN

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29
Q

inhalation injury intervention

A

o Watch for signs of respiratory distress
o Treat quickly and efficiently
o 100% humidified oxygen via non-rebreather if CO poisoning is suspected

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30
Q

emergent stage begins

A

at time of the injury

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31
Q

emergent stage ends

A

when fluid mobilization and diuresis begin

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32
Q

clinical manifestations of emergent stage

A
  • Shock from HYPOVOLEMIA
  • Blisters
  • Paralytic ileus
  • Shivering
  • Altered mental status
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33
Q

goal of emergent stage

A

maintain patent airway, administer IV fluids to prevent hypovolemic shock and preserve vital organ functioning

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34
Q

Normal insensible fluid loss

A

30-50 mL/hr

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35
Q

severely burned patient fluid loss

A

200 to 400 mL/hr

36
Q

As RBCs are destroyed more K+ gets in blood so

A

WATCH K+ AND NA+ LEVELS

37
Q

burn shock

A

a type of hypovolemic shock; if not corrected, can result in DEATH

38
Q

IMMUME SYSTEM IS CHALLENGED WHEN BURN OCCURS because

A

the skin barrier is destroyed, bone marrow is depressed, circulating level of immune globulin are decreased, WBC develop defects

39
Q

burns and CV system

A

Dysrhythmias and hypovolemic shock, increased blood viscosity (sludging)

40
Q

escharotomy

A

§ (a scalpel or electrocautery incision through the full-thickness eschar) is frequently done after transfer to a burn center to RESTORE CIRCULATION TO COMPROMISED EXTREMITIES.

41
Q

burns and respiratory system

A

Edema formation, mechanical airway obstruction and asphyxia, pneumonia, pulmonary edema

42
Q

burns and urinary system

A
  • ↓ Blood flow to kidneys causes renal ischemia
  • Acute tubular necrosis (ATN) due to myoglobin from muscle damage ->myoglobinuria and hemoglobinuria-PINK urine that is not formed RBCs
    · Would need to be on CRRT
43
Q

fluid therapy

A
  • TWO LARGE BORE IV LINES FOR >15 %
  • > 30% CENTRAL LINE
  • 0.9 NS
    -LR and albumin
    -DAILY WEIGHTS TO DETERMINE ADEQUATE FLUID REPLACEMENT
44
Q

Wound care should be delayed until

A

patent airway, adequate circulation, and adequate fluid replacement have been achieved

45
Q

Hydrotherapy (burns)

A

cleansing can be done on a shower cart in a shower or on a bed
· Once daily shower, dressing change in morning and evening, preemedicated before procedure

46
Q

debridement

A

loose necrotic skin is removed

47
Q

open method

A

burn is covered with topical antibiotic with NO dressing over wound

48
Q

open method of wound care

A

· STERILE gauze dressing are laid over topical antibiotic
· APPLICATION OF SILVER SULFADIAZINE TO MOISTENED GAUZE

49
Q

autografting

A

surgical removal of a thin layer of clients own skin which is then applied to the excised burn wound

50
Q

Other Care measures for burns

A

Ears should be kept free of pressure
· No use of pillows
Hands and arms should be extended and elevated on pillows or foam wedges
Perineum must be kept as clean and dry as possible
· Indwelling catheter
· Perineal care
Routine laboratory tests
Early ROM exercises
· Early PT to prevent complications and facilitate fluid mobilization and healing

51
Q

pain management drugs

A

analgesics, sedatives, morphine, ect

52
Q

Antimicrobial drugs

A

silver sulfadiazine, mafenide acetate

53
Q

Tetanus immunization or ImmuneGlobulin

A

o routinely given to all burn patients

54
Q

nutrition therapy for burns

A

High protein, carb, fat and vitamins; lots of calories (5000+)

55
Q

acute phase for burns begins with

A
  • mobilization of extracellular fluid and subsequent diuresis weeks to months HEMODYNAMICALLY STABLE
  • DIURESIS from fluid mobilization OCCURS, and patient is less edematous
  • Bowel sounds return
  • Healing begins as WBCs surround burn wound and phagocytosis occurs
56
Q

acute phase for burns ends with

A
  • Partial thickness wounds are healed and/or
  • Full thickness burns are covered by skin grafts
  • Necrotic tissue begins to slough
57
Q

GI complications for burns

A

-Paralytic ileus: things like fluid status and stool softeners
- CURLING’S ULCER: PPI and H2 BLOCKERS, prevention is helped if patient feeding occurs as soon as possible after the burn injury

58
Q

dermatome

A

Donor skin is taken from the patient for grafting by means of a DERMATOME, which removes a thin (14/1000 to 16/1000 inch) split-thickness layer of skin from an unburned site.

59
Q

dermatome intervention

A

Nurse has to take care of donor and graft site MUST STAY MOIST AND STERILE

60
Q

hyperbaric oxygen therapy

A

flood that part of body with O2 to promote healing

61
Q

How to put on compression sleeve

A

roll down then roll up the extremity

62
Q

rehabilitative stage of burns begins when

A
  • Wounds have healed
  • Patient is engaging in some level of self-care
63
Q

rehab stage ends

A

o Rehab goes on FOREVER
-Consider emotional and psychological needs as well

64
Q

parkland formula for burns

A
  • TBSA x 4mL x wt (kg) = 24 hour volume
    o Then divide in half
  • 1st ½ over 8 hours divided by 8
    2nd ½ over 24 hours divided by 16
65
Q

Staphylococcus aureus

A

o Impetigo, folliculitis, cellulitis, and furuncles
o MRSA-verify by culture

66
Q

Group A β-hemolytic streptococci

A

o Impetigo, erysipelas, cellulitis, and lymphangitis

67
Q

Erysipelas-red demarcated (RED HOT AND CAN BECOME SYSTEMIC) clinical manifestations

A

Fever, HA, INCREASED WBC, toxic

68
Q

Erysipelas treatment

A
  • Possible Bacteremia
  • Antibiotics-PCN based
69
Q

Cellulitis clinical manifestations

A

Fever, chills, malaise

70
Q

Cellulitis Treatment

A
  • Moist heat, immobilization, elevation
  • IV antibiotics
    -Vancomycin, linezolid-Zyvox, daptomycin-Cubicin
71
Q

Impetigo intervention

A

o SOAP/WATER TO LOOSEN CRUSTS THEN PAT DRY THEN PUT OINTMENT mupirocin topical

72
Q

medications for herpes simplex

A

ACYCLOVIR, valacyclovir

73
Q

herpes zoster clinical manifestations

A

o Unilaterally clusters skin vesicles along the peripheral sensory nerves, burning and pain

74
Q

herpes zoster interventions

A

o Isolate client, prevent rubbing and scratching, light weight clothing
o Medications-Same but sooner to prevent neuralgia
o Neuralgia-gabapentin, pregabalin
o VACCINE-ZOSTAVAX FOR >50 YO

75
Q

Candida

A

white cheese like discharge (thrush/ yeast infection)
o MOUTH IN BETWEEN FINGERS, ALL OVER BODY, IT ITCHES LIKE CRAZY

76
Q

interventions for candida

A

CAN GIVE ANTIHISTAMINE LIKE BENYDRYL
o Keep skin folds clean and dry, frequent mouth care

77
Q

Tinea clincial manifesations

A

scaly surfaces, nail beds

78
Q

Tinea interventions

A

o Keep areas dry
o Medications-topical or systemic Azoles, fluconazole, ketoconazole»Watch liver enzymes

79
Q

management for skin infections

A

Þ Wet compresses-quality or sterile water
o Warm/tepid or cool for antinflammatory
Þ Baths
Þ Topical medications
o Gels, lotions, creams, ointments
o Occlusion with plastic wrap increases absorption and blood levels-caution
Þ Control of pruritus
o Break the itch/scratch cycle: KNUCKLE SCRATCH
o Cool environment
o Hydration, wet compresses, moisturizers
o Topical drugs
Þ Prevention of spread
o Careful hand washing and the safe disposal of soiled dressings
Þ Prevention of secondary infections-scratching

80
Q

Steven Johnson Syndrome (SJS)

A

COMMON SEVERE DRUG REACTION/CHANGE IN MEDICATION

81
Q

If untreated SJS

A

TEN (toxic epidermal necrolysis- tissue is actually dying)

82
Q

clincial manifestations of SJS

A

o Fever, flulike, erythema and blisters 24-96 hours
o Eye, mucus membranes, GI tract, urogentital
o Immunosuppression and opportunistic infections
- Sepsis and PNA common
- NO CORTICOSTEROIDS
- Immuneglobulin may help
o Prevent progression to deeper tissues

83
Q

interventions for SJS

A

o STOP SUSPECTED AGENT IMMEDIATELY

o Silver based and biologic dressings
o ICU care
- Fluid resuscitation
- Enteral or parenteral nutrition

84
Q

Necrotizing Fasciitis

A

a severe infection caused by Group A strep bacteria inflammation of fascia producing death of the tissue

85
Q

Clincial Manifestations of Necrotizing Fasciitis

A

o Localized, painful, edema, induration, crepitus, EXTREME PAIN

NSG 430 - Critical Care (42 decks)

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