T2 - Burn Injuries Lecture (Josh) Flashcards
How are burns classified?
by degree
First Degree Burn =
Second Degree Burn =
Third Degree Burn =
1 = through epidermis/dermis
2 = through hair follicles, sweat glands, nerves, blood vessels
3 = through fat, muscle, to bone
Second Degree burns heals within —- days
5-30
Second Degree burns cause skin to be —
mottled (white to cherry red)
Third Degree burns case skin to be —
white, leathery, charred
Results from direct contact w/ flames.
Third Degree Burn
Causes tissue coagulation with no pain.
Third Degree Burn
Which degree of burns has NO pain?
Third Degree (b/c nerve endings are destoyed)
Blisters are seen in which degree of burns?
second degree
Along w/ severity, burns are also classified by —
thickness
extent/location
Types of Burns
- Thermal Burns (most in kids)
- Chemical Burns
- Electrical Burns
- Radiation Burns
Assessing Burn Injuries
1) % of BSA affected
2) depth of burn
3) location of burn injuries
What are local responses to burns?
- Edema
- Fluid Loss
- Circulatory Stasis
- Burn Wound
Systemic responses to burns?
- Circulatory (shock)
- Anemia
- Renal (decreased urine output to maintain fluid vol)
- Metabolism
- Growth Changes
Nursing Responsibilities in Emergent Phase of Burn
1) put out (stop drop and roll)
2) cover burn w/ sterile/clean cloth or gauze
3) transport child to medical care
4) NPO
5) Provide reassurance
To prevent hypovolemic shock in burns, what do we do?
maintain circulating fluid volume
2-4 mL/kg x TBSA
In — —, the wound remains exposed to air after cleaning.
Exposure Therapy
In — —-, wound is resurfaced after cleaning.
Occlusive Dressing
Which rule is used to classify burn extent or location?
Rule of 9s
Why would you get anemia with a burn?
destruction of RBCs
A sign of facial burns is — — —.
singed facial hairs
Type of Burn:
- Pink-Red color (no blisters)
- blanches w/ pressure
- heals within 5-10 days
- no scarring
First Degree (Superficial)
Type of Burn:
- Pink-Red color (w/ blisters)
- blanches w/ pressure
- heals within 14-21 days
- some scarring
Second Degree (Superficial Partial Thickness)
Type of Burn:
- Red to tan, black, brown, or white in color
- dry, leathery appearance
- no blanching
- heals within weeks to months
- grafting required
Third Degree (Full Thickness)
Type of Burn:
- color variable
- dull and dry
- charring
- possible visible ligaments/bones/tendons
- NO PAIN
Fourth Degree (Deep Full Thickness)
Why would the burn injury to an infant be deeper than a normal child?
their skin is thinner
Should we use ice on a burn wound?
NO
cool water only
Avoid using —- or —- on burns.
greasy lotions
butter
Which IV fluids are used during the early stage of burn recovery?
Isotonic Crystalloids (0.9% NS, Ringer’s Lactate)
Maintain urine output of —.
1-2 mL/Kg/hr if less than 30 kg
30 mL/hr if more than 30 kg
Topical Meds for Burns:
- silver sulfadiazine
- mafenide acetate
- bacitracin
A nurse is caring for a client who has a superficial partial thickness burn. Which of the following is an appropriate action for the nurse to take?
a) Administer an IV infusion of 0.9% sodium chloride
b) Apply cool, wet compress to affected area
c) Clean the affected area using a soft-bristle brush
d) Administer morphine sulfate
b) Apply cool, wet compress to affected area
A nurse is caring for a client who has major burns and suspected septic shock. Which of the following finding are consistent w/ septic shock? (select all that apply)
a) Increased Body Temp
b) Altered sensorium
c) Decreased capillary refill
d) Decreased urine output
e) Increased bowel sounds
a) Increased Body Temp
b) Altered sensorium
d) Decreased urine output
A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following is an appropriate nursing intervention to manage the client’s pain?
a) Administer morphine sulfate IV via continuous infusion
b) Administer meperidine IM as needed
c) Administer acetaminphen PO every 4 hr
d) Administer hydrocodone PO every 6 hr
a) Administer morphine sulfate IV via continuous infusion
A nurse is caring for a client who has a skin graft. Which of the following clinical manifestations indicate infection. (select all that apply)
a) Green color to subcutaneous fat
b) Unstable body temp
c) Generation of granulation tissue
d) Subeschar hemorrhage
e) Change in skin color around infected area
a) Green color to subcutaneous fat
b) Unstable body temp
d) Subeschar hemorrhage
e) Change in skin color around infected area
A nurse is caring for a client who has a moderate burn. Which of the following is an appropriate action for the nurse to take?
a) Maintain immobilization of the affected area
b) Expose affected area to the air
c) Initiate a high-protein, high-calorie diet
d) Implement contact isolation
c) Initiate a high-protein, high-calorie diet
needed to meet increased metabolic demands and promote healing
A scald is an example of which type of burn?
Second Degree
Nursing Care re: Burns.
- Prevent heat loss
- Fluid balance and adequate hydration
- Prevent infection
- Pain management
- Promote nutrition (increase protein and calories)
- Dressings and ointments
Phase of Burn:
First 24-48 hrs
Acute Phase (Fluid Resuscitation Phase)
Phase of Burn:
Completion of adequate resuscitation through wound coverage
Management Phase
Phase of Burn:
Begins once the majority of the wounds have healed.
Rehabilitation Phase
Vaseline on burns?
NO, nothing w/ petroleum
COOL WATER!!!
Why cover the burn w/ gauze?
- to prevent contamination
- to alleviate pain by avoiding air contact
To maintain an adequatge area, the nurse can administer what?
anti-inflammatory agent such as DECADRON (dexamethasone)
Parkland Formula
The Parkland formula is a burn formula used to estimate the amount of replacement fluid required for the first 24 hours in a burn patient so as to ensure they remain hemodynamically stable.
2-4 mL/kg x TBSA
If necessary, which vaccine should be administered?
Tetanus
Methods of Wound Care:
Wound remains exposed to air after cleaning.
Exposure Therapy
Methods of Wound Care:
Wound is resurfaced after cleaning.
Occlusive Dressing
Methods of Wound Care:
Immediate debridement of necrotic eschar
Natural process of proteolytic degradation of tissues by body and bacterial enzymes
Primary Excision
The immediate postburn period is marked by dramatic alterations in —
circulation (50% decrease circulation)
called burn shock,
Why are children younger than 2 at an increased risk for dehydration when burned?
lack of ability to concentrate urine due to immaturity of kidneys
Why are kidneys affected in burns?
Loss of fluid from the intravascular compartment causes renal vasocronstriction that in turn leads to reduced renal plasma flow and depressed GFR
Why GI problems in burns?
Loss of blood volume decreases Blood Flow to GI system by 1/3 even when cardiac output is maintained by fluid resuscitation
Ischemia results, causing painful ulcers, enterocolitis
How can we support the increased metabolism needs of burn victims?
increase protein and carbohydrates
Most reliable indicators for assessing how well fluid resuscitation has workd?
Cap refill
alterations in sensorium
urinary output
Grafts:
—- come from people (ex: cadavers or foreskin)
— come from different species (pigskin, etc.)
Allografts (homografts)
Xenografts (heterografts)
NOTE: Transcyte — come from bioengineered foreskin tissue (temporary)
Types of Temporary Grafts:
- Allografts (Homografts)
- Xenografts (Heterografts)
- Synthetic Skin Coverings
When do burn scars become HYPERtrophic?
when no pressure was put on the skin graft
Permanent Grafts
Autograft (from own body)
Isograft (from twin)
Common antibiotics for burn victims.
Tobramycin
Dicloxacillin
Methcillin
— is the removal of dead tissue to speed up healing.
Debridement
Remember —- before procedures.
Pain Control Meds
For 25% burns TBSA, give — feedings.
enteral
2 grams protein/Kg
Vitamins — and — for increased growth of epithelial cells
Vitamin — for wound healing
A and C
Zinc
