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Pediatrics-MJ > T2-Burns PPT > Flashcards

T2-Burns PPT Flashcards

1
Q

What is an example of a first degree burn? Scarring?

A

Sunburn; heals without scarring

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2
Q

What degree burn is superficial?

A

First

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3
Q

What degree burn is superficial partial thickness or deep partial thickness?

A

Second

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4
Q

Second degree (partial or deep partial)

  1. Affects?
  2. Caused by?
  3. Pain type?
  4. Appearance?
  5. Blistering?
  6. Healing time?
A
  1. Affect epidermis, dermis, hair follicles, nerves, and sweat glands
  2. Caused by contact with hot liquids, flames, or chemicals
  3. Severe pain on surface; loss of sensation if deeper
  4. Moist, mottled skin–white to cherry red
  5. Yes, blisters
  6. Heals within 5-30 days
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5
Q

What degree is a full thickness burn?

A

3rd

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6
Q

Full thickness burns

  1. Affects?
  2. Results from?
  3. Appearance?
  4. Destroys?
  5. Causes?
A
  1. Affects epidermis, dermis, hair follicles, sweat glands, nervers, blood vessels, fat, muscle, and bone
  2. Results from direct contact with flames
  3. White, leathery, charred skin
  4. Destroys hair follicles, blood vessels, and nerve endings
  5. Causes tissue coagulation, with no pain; heals slowly, with scarring
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7
Q

Example of superficial burn?

A

Sunburn

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8
Q

Example of partial thickness burn?

A

Scalds

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9
Q

Example of full thickness burn?

A

Flame

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10
Q

What is nursing care we can provide to patients with burns? (6)

A
  • Prevent heat loss
  • Prevent infection
  • Pain management
  • Promote nutrition
  • Dressings and ointments
  • Fluid balance and adequate hydration
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11
Q

What are 4 types of burns?

A

Thermal
Chemical
Electrical
Radiation

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12
Q

Example of thermal burn?

A

Flames, scalds, boiling water, ramen noodles

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13
Q

Example of chemical burn?

A

Ingestion

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14
Q

Example of electrical burn?

A

Kid sticks something in electrical outlet and gets shocked; kid chews on electrical wire and gets shocked

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15
Q

Examples of radiation burns?

A

Radioactive–chemo

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16
Q

Cigarette lighter burn, scalded milk, dipped in hot water scalds, burn from grates, are all examples of ____ burns

A

Child abuse

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17
Q

Who asses what % of the body the burn is?

A

Doctor

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18
Q

How do doctors assess burn injuries?

A
  • % of BSA affected
  • depth of injury
  • location of burn injury
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19
Q

What are 5 systemic responses to burn injuries?

A
  • Circulatory
  • Anemia
  • Renal
  • Metabolism
  • Growth changes
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20
Q

What are 4 complications of burn injuries?

A
  • Pulmonary
  • Wound sepsis
  • Curlings ulcer
  • CNS
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21
Q

What is a sign of facial burns?

A 
Singed nasal hairs
Wheezing 
Hoarsness
Wet crackles
Nasal secretions
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22
Q

What are signs of curlings ulcers?

A

Abdominal pain
Bleeding
Coffee ground emesis
Abdominal distention

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23
Q

What are the 3 phases for the management of burns?

A
  1. Acute
  2. Management
  3. Rehabilitative phase
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24
Q

The acute phase is the first ____ hours.

A

24-48 hours

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25
Q

Emergent phase

A

Acute

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26
Q

Fluid resuscitative phase

A

Acute

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27
Q

Completion of adequate resuscitation through wound coverage (taking care of the wound still)

A

Management phase

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28
Q

Begins once the majority of the wounds have healed. What is predominant focus?

A

Rehab phase;

rehab

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29
Q

During the acute stage of management, there is an emergent phase. What happens here?

A

STOP THE BURNING PROCESS (smother the fires; stop, drop, and roll!)

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30
Q

In the emergent phase, if the fire or burn is off contact, what do we do to stop the burning process?

A
  • 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
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31
Q

Is it ok to put vaseline or petroleum on a burn?

A

No, don’t do this

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32
Q

Why do we cover the burn and what do we cover it with?

A

Cover with sterile or clean cloth/gauze to prevent contamination and alleviate pain by avoiding air contact

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33
Q

Acute: Emergent phase

____ temporarily for extensive burns

A

NPO

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34
Q

Acute: Emergent phase

Why do we provide reassurance?

A
  1. Reduce anxiety

2. Conserve energy

35
Q

Management phase:

Where are minor burns taken care of? Major burns?

A

Minor: outpatient wound care (teach parents about wound care & follow up care)

Major: hospitalization

36
Q

What is the first priority for a burn patient?

A

Establish and maintain an adequate airway!!

37
Q

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?

A

Get the endotracheal tube in BEFORE THE AIRWAY SWELLS (especially for facial or inhalation types of injuries)

Monitor blood gases

38
Q

What is the second priority concern a nurse has for a burn patient?

A

Maintain circulating fluid volume to prevent hypovolemic shock

39
Q

Maintaining circulating fluid volume: what is the goal of urine output for children under 30 kgs? What about for all other patients?

A

Under 30 kg: 1 mL/kg/hr

Other patients: 0.5 mL/kg/hr

40
Q

What is the third priority nursing concern for a burn patient? Why?

A

Care of the wound

  • prevent infection
  • facilitate wound healing
  • restore max. function as possible
  • Give tetanus if indicated
41
Q

What are 3 types of methods of burn wound care?

A
  1. Exposure therapy
  2. Occlusive dressing
  3. Primary excision
42
Q

Burn wound care type?

Wound remains exposed to air after cleaning

A

Exposure

43
Q

Burn wound care type?

Wound is resurfaced after cleaning

A

Occlusive

44
Q

Burn wound care type?

Immediate debridement of necrotic eschar; natural process of proteolytic degradation of tissues by body and bacterial enzymes

A

Primary excision

45
Q

How is primary excision burn wound care enhanced?

A

Dressing changes and gentle cleansing

46
Q

What are the types of closure and resurfacing techniques?

A

Temporary grafts

Permanent grafts

47
Q

What are the 3 types of temporary grafts?

A

Allograft (homograft)
Xenograft (heterograft)
Synthetic skin covering

48
Q

What type of temporary graft:

Genetically different members of the same species (cadavers)

A

Allograft

49
Q

With allografts, there must be no signs of rejections up to ___ days.

A

14

50
Q

What type of temporary graft: skin substitute, bioengineered from newborn foreskin tissue

A

Transcyte (a type of allograft)

51
Q

What type of temporary graft:

Members of different species (pigskin)

A

Xenograft

52
Q

How often are xenografts changed?

A

1-3 days

53
Q

These are all examples of what?

  • Elastic films
  • Hydroactive and colloidal materials
  • Nylon fabric
  • Beta glucagons
  • Biobranes
  • Jobst or pressure garmets
A

Temprary grafts–synthetic skin coverings

54
Q

Why are permanent grafts used?

A

To achieve maximum functioning and for cosmetic appearance

55
Q

What are the 2 types of permanent grafts?

A

Autografts

Isografts

56
Q

Type of permanent graft: From undamaged parts of patients own body. Examples?

A

Autograft

Ex: Mesh, sheet, ACE wrap

57
Q

What type of permanent graft: histocompatible tissues from identical twins

A

Isograft

58
Q

What would we rather use on burns: temporary or permanent grafts?

A

Permanent

59
Q

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?

A

Escharotomy or fasciotomy

60
Q

What are some common topical preparations for burns?

A 
Silver Nitrate
Sulfamylon
Silvadene
Garamycin
Betadine
61
Q

What is the leading cause of death in burn patients?

A

Infection (after the resuscitative phase)

62
Q

What are some main portals of entry for infections? (5)

A 
Wound
Resp. tract
GI tract
GU tract
IV sites
63
Q

What are some common organisms that get into the wound and cause infections?

A
  • Staph

- Pseudomonas

64
Q

Wound care: Management phase

Removal of dead tissue to speed healing

A

Debridement

65
Q
  • How is debriedment enhanced?
  • What can PT do to help?
  • What do topical enzymes do?
  • How is this done–like by who?
A
  • Enhanced by dressing change and gentle cleansing
  • PT does hydrotherapy
  • Topical enzymes destroy dead tissue
  • Removed with scalpel by physician
66
Q

What should we do FIRST before starting debridement?

A

GIVE PAIN CONTROL MEDS BEFORE PROCEDURES!!!

67
Q

Pain control is an important goal during the management of burn care. Why

A
  • Promote rest and sleep
  • Decrease anxiety and fear
  • Increase compliance and cooperation
  • Prevent burn injury induced hypermetabolism
68
Q

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

A

Morphine sulfate via PCA pump

69
Q

Management of care: Pain control

What is a short acting opioid?

A

Fentanyl

70
Q

Management of care: pain control

Rapid onset and quick return to baseline. What drug?

A

Propofol

71
Q

Management of care: Pain control

Used to increase threshold for pain

A

Nitous oxide

72
Q

Management of care: pain control

Combo drug used for procedural pain

A

Demerol-thorazine phenergan

73
Q

Management of care: Nutrition

Increase stress= ____

A

Increase metabolism

74
Q

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!

A

^ stress= ^metabolsism, which causes ^ in NUTRITIONAL NEEDS, leading to ^ in CATABOLISM, therefore an ^ in CALORIES AND PROTEINS are needed to prevent further protein breakdown

75
Q

Management of care: Nutrition

How much protein needed?

A

2 g/kg

76
Q

Management of care: Nutrition

When do you get an enteral feeding?

A

Enteral feedings for 25% burns TBSA!!!

77
Q

Enteral feedings are preferred over _____ because of greater benefits, such as blood flow to GI tract and preserves GI function

A

PREFERRED OVER HYPERALIMENTATION

78
Q

Management of care: Nutrition Review

What kind of diet do burn patients need?

A

A diet high in calories and high in protein!!

79
Q

Management of care: Nutrition review

What is preferred: enteral feeding or hyperalimentation

A

ENTERAL FEEDING

80
Q

Management of care: Nutrition

What is Vit. A and C needed for?

A

Increased growth of epithelial cells

81
Q

Management of care: Nutrition

What is zinc used for?

A

Wound healing

82
Q

Another goal during the management phase is prevention of other complications. What are examples of other complications?

A

Keloids
Contractures
Developmental delays
Ulcers

83
Q

Management phase: Support the family unit

What does this mean?

A

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

84
Q

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?!

A

120 F is the magic number

*MAKE SURE you check this, especially if you’ve recently moved into a new home!!

Pediatrics-MJ (61 decks)

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