T2-Burns PPT Flashcards
What is an example of a first degree burn? Scarring?
Sunburn; heals without scarring
What degree burn is superficial?
First
What degree burn is superficial partial thickness or deep partial thickness?
Second
Second degree (partial or deep partial)
- Affects?
- Caused by?
- Pain type?
- Appearance?
- Blistering?
- Healing time?
- Affect epidermis, dermis, hair follicles, nerves, and sweat glands
- Caused by contact with hot liquids, flames, or chemicals
- Severe pain on surface; loss of sensation if deeper
- Moist, mottled skin–white to cherry red
- Yes, blisters
- Heals within 5-30 days
What degree is a full thickness burn?
3rd
Full thickness burns
- Affects?
- Results from?
- Appearance?
- Destroys?
- Causes?
- Affects epidermis, dermis, hair follicles, sweat glands, nervers, blood vessels, fat, muscle, and bone
- Results from direct contact with flames
- White, leathery, charred skin
- Destroys hair follicles, blood vessels, and nerve endings
- Causes tissue coagulation, with no pain; heals slowly, with scarring
Example of superficial burn?
Sunburn
Example of partial thickness burn?
Scalds
Example of full thickness burn?
Flame
What is nursing care we can provide to patients with burns? (6)
- Prevent heat loss
- Prevent infection
- Pain management
- Promote nutrition
- Dressings and ointments
- Fluid balance and adequate hydration
What are 4 types of burns?
Thermal
Chemical
Electrical
Radiation
Example of thermal burn?
Flames, scalds, boiling water, ramen noodles
Example of chemical burn?
Ingestion
Example of electrical burn?
Kid sticks something in electrical outlet and gets shocked; kid chews on electrical wire and gets shocked
Examples of radiation burns?
Radioactive–chemo
Cigarette lighter burn, scalded milk, dipped in hot water scalds, burn from grates, are all examples of ____ burns
Child abuse
Who asses what % of the body the burn is?
Doctor
How do doctors assess burn injuries?
- % of BSA affected
- depth of injury
- location of burn injury
What are 5 systemic responses to burn injuries?
- Circulatory
- Anemia
- Renal
- Metabolism
- Growth changes
What are 4 complications of burn injuries?
- Pulmonary
- Wound sepsis
- Curlings ulcer
- CNS
What is a sign of facial burns?
Singed nasal hairs Wheezing Hoarsness Wet crackles Nasal secretions
What are signs of curlings ulcers?
Abdominal pain
Bleeding
Coffee ground emesis
Abdominal distention
What are the 3 phases for the management of burns?
- Acute
- Management
- Rehabilitative phase
The acute phase is the first ____ hours.
24-48 hours
Emergent phase
Acute
Fluid resuscitative phase
Acute
Completion of adequate resuscitation through wound coverage (taking care of the wound still)
Management phase
Begins once the majority of the wounds have healed. What is predominant focus?
Rehab phase;
rehab
During the acute stage of management, there is an emergent phase. What happens here?
STOP THE BURNING PROCESS (smother the fires; stop, drop, and roll!)
In the emergent phase, if the fire or burn is off contact, what do we do to stop the burning process?
- Cover burning area
- Rinse chemical burns with cool running water
- Slow immersion in cool water to relieve pain, slow process of heat damage and edema formation
Is it ok to put vaseline or petroleum on a burn?
No, don’t do this
Why do we cover the burn and what do we cover it with?
Cover with sterile or clean cloth/gauze to prevent contamination and alleviate pain by avoiding air contact
Acute: Emergent phase
____ temporarily for extensive burns
NPO
Acute: Emergent phase
Why do we provide reassurance?
- Reduce anxiety
2. Conserve energy
Management phase:
Where are minor burns taken care of? Major burns?
Minor: outpatient wound care (teach parents about wound care & follow up care)
Major: hospitalization
What is the first priority for a burn patient?
Establish and maintain an adequate airway!!
If we are going to have to be giving oxygen, why is it important we can get an endotracheal tube in quickly? What do we monitor?
Get the endotracheal tube in BEFORE THE AIRWAY SWELLS (especially for facial or inhalation types of injuries)
Monitor blood gases
What is the second priority concern a nurse has for a burn patient?
Maintain circulating fluid volume to prevent hypovolemic shock
Maintaining circulating fluid volume: what is the goal of urine output for children under 30 kgs? What about for all other patients?
Under 30 kg: 1 mL/kg/hr
Other patients: 0.5 mL/kg/hr
What is the third priority nursing concern for a burn patient? Why?
Care of the wound
- prevent infection
- facilitate wound healing
- restore max. function as possible
- Give tetanus if indicated
What are 3 types of methods of burn wound care?
- Exposure therapy
- Occlusive dressing
- Primary excision
Burn wound care type?
Wound remains exposed to air after cleaning
Exposure
Burn wound care type?
Wound is resurfaced after cleaning
Occlusive
Burn wound care type?
Immediate debridement of necrotic eschar; natural process of proteolytic degradation of tissues by body and bacterial enzymes
Primary excision
How is primary excision burn wound care enhanced?
Dressing changes and gentle cleansing
What are the types of closure and resurfacing techniques?
Temporary grafts
Permanent grafts
What are the 3 types of temporary grafts?
Allograft (homograft)
Xenograft (heterograft)
Synthetic skin covering
What type of temporary graft:
Genetically different members of the same species (cadavers)
Allograft
With allografts, there must be no signs of rejections up to ___ days.
14
What type of temporary graft: skin substitute, bioengineered from newborn foreskin tissue
Transcyte (a type of allograft)
What type of temporary graft:
Members of different species (pigskin)
Xenograft
How often are xenografts changed?
1-3 days
These are all examples of what?
- Elastic films
- Hydroactive and colloidal materials
- Nylon fabric
- Beta glucagons
- Biobranes
- Jobst or pressure garmets
Temprary grafts–synthetic skin coverings
Why are permanent grafts used?
To achieve maximum functioning and for cosmetic appearance
What are the 2 types of permanent grafts?
Autografts
Isografts
Type of permanent graft: From undamaged parts of patients own body. Examples?
Autograft
Ex: Mesh, sheet, ACE wrap
What type of permanent graft: histocompatible tissues from identical twins
Isograft
What would we rather use on burns: temporary or permanent grafts?
Permanent
Blood flow can become constricted due to edema and results in tissue hypoxia, so docs can do an incision into the constricting tissue to restore peripheral circulation. What is this procedure called?
Escharotomy or fasciotomy
What are some common topical preparations for burns?
Silver Nitrate Sulfamylon Silvadene Garamycin Betadine
What is the leading cause of death in burn patients?
Infection (after the resuscitative phase)
What are some main portals of entry for infections? (5)
Wound Resp. tract GI tract GU tract IV sites
What are some common organisms that get into the wound and cause infections?
- Staph
- Pseudomonas
Wound care: Management phase
Removal of dead tissue to speed healing
Debridement
- How is debriedment enhanced?
- What can PT do to help?
- What do topical enzymes do?
- How is this done–like by who?
- Enhanced by dressing change and gentle cleansing
- PT does hydrotherapy
- Topical enzymes destroy dead tissue
- Removed with scalpel by physician
What should we do FIRST before starting debridement?
GIVE PAIN CONTROL MEDS BEFORE PROCEDURES!!!
Pain control is an important goal during the management of burn care. Why
- Promote rest and sleep
- Decrease anxiety and fear
- Increase compliance and cooperation
- Prevent burn injury induced hypermetabolism
Management of care: pain control
This drug of choice is used because of its predictable analgesic effect, safety profile, and ease of reversibility with Naloxon
Morphine sulfate via PCA pump
Management of care: Pain control
What is a short acting opioid?
Fentanyl
Management of care: pain control
Rapid onset and quick return to baseline. What drug?
Propofol
Management of care: Pain control
Used to increase threshold for pain
Nitous oxide
Management of care: pain control
Combo drug used for procedural pain
Demerol-thorazine phenergan
Management of care: Nutrition
Increase stress= ____
Increase metabolism
Management of care: Nutrition
Increase stress= increase metabolism, which causes increase in _____ leading to increase in ____ therefore an increase in ____ & ___ are needed to prevent further protein breakdown!
^ stress= ^metabolsism, which causes ^ in NUTRITIONAL NEEDS, leading to ^ in CATABOLISM, therefore an ^ in CALORIES AND PROTEINS are needed to prevent further protein breakdown
Management of care: Nutrition
How much protein needed?
2 g/kg
Management of care: Nutrition
When do you get an enteral feeding?
Enteral feedings for 25% burns TBSA!!!
Enteral feedings are preferred over _____ because of greater benefits, such as blood flow to GI tract and preserves GI function
PREFERRED OVER HYPERALIMENTATION
Management of care: Nutrition Review
What kind of diet do burn patients need?
A diet high in calories and high in protein!!
Management of care: Nutrition review
What is preferred: enteral feeding or hyperalimentation
ENTERAL FEEDING
Management of care: Nutrition
What is Vit. A and C needed for?
Increased growth of epithelial cells
Management of care: Nutrition
What is zinc used for?
Wound healing
Another goal during the management phase is prevention of other complications. What are examples of other complications?
Keloids
Contractures
Developmental delays
Ulcers
Management phase: Support the family unit
What does this mean?
Family is going through disruptions in routines, and possibly putting extra demands on its members
Parents may be having feelings of guilt if neglect is an issue
120 degrees it would take 5 minutes of contact/exposure to get the same burn that you would get in 1 SECOND if it was set at 155. What is the thermostat needed to be set on?!
120 F is the magic number
*MAKE SURE you check this, especially if you’ve recently moved into a new home!!
