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Adult Health 3 > Thermal Injuries > Flashcards

Thermal Injuries Flashcards

1
Q

What are the four causes of thermal burns?

A

Flame
Flash
Scald
Contact with hot objects

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2
Q

What are the three causes of chemical burns?

A

acids
alkalis
organic compounds

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3
Q

What are three injuries associated with smoke and inhalation injury?

A

Metabolic asphyxiation
upper airway injury
lower airway injury

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4
Q

Contact with electric current can cause ______ ______ strong enough to ____ long bones and vertebrae

A

muscle contractions; fracture

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5
Q

Possible complications from an electrical burn

A

dysrhythmias
severe metabolic acidosis
myoglobinuria

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6
Q

What are the 5 different types of burns?

A

Thermal, chemical, smoking/inhalation injury, electrical and cold thermal injury

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7
Q

How are burn injuries classified?

A

Depth of burn
Extent of burn
Location of burn

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8
Q

At the scene of the (burn) injury, priority is given to ______ & _______

A

removing the person from the source of the burn; stopping the burning process

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9
Q

Small thermal burns should be ______ for the patient’s comfort and protection until medical care is available

A

covered with a clean, cool, tap-water dampened towel

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10
Q

To prevent hypothermia cool large burns for no more than ____ minutes

A

10

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11
Q

What are the three phases of burn management

A

1) Emergent
2) Acute
3) Rehabilitation

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12
Q

What are the primary concerns during the emergent phase?

A

hypovolemic shock

edema formation

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13
Q

Major electrolyte shifts of ____ & _____ occur during the emergent phase

A

sodium; potassium

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14
Q

A _____ shift develops first because injured cells and hemolyzed RBCs release _____ into circulation

A

potassium; potassium

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15
Q

What type of burns are painless at first?

A

full-thickness and deep partial-thickness

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16
Q

What type of burns are usually painful at first

A

superficial to moderate partial-thickness

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17
Q

What can a patient with a larger burn area develop?

A

paralytic ileus

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18
Q

What three body systems are most susceptible to complications during the emergent phase?

A
  1. cardiovascular
  2. respiratory
  3. urinary
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19
Q

What are cardiovascular complications in the emergent phase?

A

dysrhythmias
hypovolemic shock
sludging
VTE

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20
Q

What are complications associated with deep circumferential burns?

A

ischemia
paresthesia
necrosis

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21
Q

What is the treatment for a deep circumferential burn?

A

escharotomy

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22
Q

What are respiratory complications in the emergent phase?

A

upper airway distress

airway injury

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23
Q

True or False. There is a correlation between the percentage TBSA and the severity of inhalation

A

False

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24
Q

How soon do patients with burns to the face and neck need to be intubated?

A

Within 1-2 hours after injury

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25
Q

At least 2 large-bore IVs must be in place for patients with burns that are ___% TBSA or more

A

15

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26
Q

For patients with burns greater than ___ % TBSA consider a central line

A

30

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27
Q

Fluid replacement is achieved with ______, _____ solutions or a combination of the two

A

crystalloid (LR); colloid (albumin)

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28
Q

What is the most common formula used for fluid replacement?

A

Parkland (Baxter)

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29
Q

Patients with an ______ injury have greater than normal fluid needs

A

electrical

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30
Q

What is the recommended fluid therapy for the first 24 hours?

A

2-4 mL LR/kg/% TBSA burned

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31
Q

When are colloids administered after a burn injury?

A

after the first 12-24 hours

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32
Q

What is the colloid fluid replacement formula?

A

0.3-0.5 mL/kg/% TBSA burned

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33
Q

Urine output parameters after a burn injury

A

0.5-1 mL/kg/hr

for ELECTRICAL burns = 75-100 mL/hr

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34
Q

Cardiac parameters after a burn injury

A

MAP > 65 mmHg
SBP > 90 mmHg
HR < 120 bpm

35
Q

What is given priority once a patent airway, effective circulation and adequate fluid replacement have been achieved?

A

wound care

36
Q

How do partial-thickness burn wounds appear?

A

pink to cherry-red; wet, shiny, serous exudate; painful; minor, local sensations

37
Q

What is the source of infection in burn wounds most likely from?

A

Patient’s own flora; skin, respiratory, GI systems

38
Q

What should the nurse do if the patient’s burn wounds are exposed?

A

Always wear PPE

39
Q

What should the nurse do with the room’s temperature with a burn patient?

A

Keep the room warm

40
Q

What should not be used with patients with ear burns?

A

Pillows

41
Q

Early in the post-burn period ___ pain medications should be given

A

IV opioid

42
Q

What is given routinely to all burn patients because of the likelihood of anaerobic burn wound contamination?

A

tetanus

43
Q

What do many burn antimicrobial creams contain?

A

Sulfa

44
Q

What are clinical manifestations of the acute phase?

A

eschar removed; red/pink scar tissue

45
Q

How to prevent curling’s ulcer?

A

feeding the patient ASAP after burn injury; H2 blockers; PPIs

46
Q

What can help speed up the removal of dead tissue from the healthy wound bed?

A

enzymatic debriding agents (collagen)

47
Q

What are the complications during the rehabilitation phase?

A

skin and joint contractures; hypertrophic scarring

48
Q

What areas are most susceptible to skin and joint contractures?

A

anterior/lateral neck areas, axillae, antecubital fossae, fingers, groin, popliteal fossae, knees, ankles

49
Q

What are the three different types of hyperthermia?

A

heat cramps
heat exhaustion
heatstroke

50
Q

When do heat cramps occur?

A

during rest after exercise or heavy labor

51
Q

Who is usually affected by heat cramps?

A

healthy, acclimated athletes with inadequate fluid intake

52
Q

How are heat cramps resolved?

A

rest and oral/parenteral replacement of sodium/water; elevation, gentle massage, analgesia

53
Q

Patient education for heat cramps

A

avoid strenuous activity for at least 12 hr; salt replacement during strenuous exercise in hot, humid environments; sports drinks/pedialyte

54
Q

Clinical Manifestations of heat exhaustion

A

fatigue, nausea, vomiting, extreme thirst, anxiety, hypotension, tachycardia, fever, dilated pupils, confusion, ashen color, profuse sweating

55
Q

First action of nurse with heat exhaustion?

A

place patient in cool area and remove restrictive clothing

56
Q

What do you not use with a patient experiencing heat exhaustion?

A

salt tablets - potential gastric irritaiton and hypernatremia

57
Q

True or False. Heatstroke is a medical emergency

A

True

58
Q

When does the core temperature increase with a heatstroke?

A

within 10-15 minutes

59
Q

Heatstroke nursing interventions

A

100% O2, BVM or mechanical ventilation; ECG monitoring; correct fluid/electrolytes

60
Q

What are the cooling methods for heatstroke?

A

removing clothing, covering with wet sheets, placing patient in front of large fan; immersing patient in a cool water bath; apply ice packs to groin and axillae; peritoneal lavaging with iced fluids

61
Q

Do you want a patient with hyperthermia to shiver?

A

No

62
Q

What medication can we give to control shivering?

A

chlorpromazine IV

63
Q

What complication do we need to monitor for with hyperthermia?

A

rhabdomyolysis

64
Q

What body parts are usually affected by superficial frostbite?

A

ears, nose, fingers, toes

65
Q

How is the skin affected with superficial frostbite

A

waxy pale yellow, blue, mottled; feels crunchy, frozen; tingling, numbness, burning sensation

66
Q

What should be avoided with frostbite?

A

heavy blankets and clothing

67
Q

What body parts are affected with deep frostbite?

A

muscle, bone, tendon

68
Q

How is the skin affected with deep frostbite?

A

hard, insensitive to touch; mottling progressing to gangrene

69
Q

What is the body’s first attempt to conserve heat?

A

Peripheral vasoconstriction

70
Q

As cold temperatures persist, ____ & ____ are the body’s only mechanisms for producing heat

A

shivering; movement

71
Q

Clinical Manifestations of mild hypothermia

A

shivering, lethargy, confusion, rational to irrational behavior, minor heart rate changes

72
Q

Clinical Manifestations of moderate hypothermia

A

rigidity, bradycardia, slowed respiratory rate, BP only obtainable by Doppler, metabolic and respiratory acidosis, hypovolemia

73
Q

At what core temperature does shivering diminish or disappear?

A

89.6

74
Q

Cold blood becomes _____ and acts as a _______

A

thick; thrombus

75
Q

Severe hypothermia makes the person appear _____

A

dead

76
Q

Clinical Manifestations of severe hypothermia

A

metabolic rate, heart rate, respirations so slow they may be difficult to detect; reflexes absent; pupils fixed and dilated; profound bradycardia, ventricular fibrillation, asystole

77
Q

True or False. With severe hypothermia every effort must be made to rewarm the patient to at least 86 F before the person is pronounced dead

A

True

78
Q

What are some passive or spontaneous rewarming methods for hypothermia?

A

moving patient to a warm, dry place; removing damp clothing; radiant lights; warm blankets

79
Q

What are some active external or surface rewarming methods for hypothermia?

A

fluid- or air-filled warming blankets, warm water immersion

80
Q

When do you use active internal or core rewarming methods?

A

moderate to severe hypothermia

81
Q

Active internal or core rewarming techniques

A

heated humidified O2; warmed IV fluids; peritoneal lavage with warmed fluids; extracorporeal circulation with cardiopulmonary bypass, rapid fluid infuser, hemodialysis

82
Q

Which portion of the body do you rewarm first with hypothermia?

A

Core warmed first before the extremities

83
Q

When do you discontinue active rewarming?

A

Once the core temperature reaches 89.6-93.2 F

Adult Health 3 (4 decks)

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