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NUR 213 > Tissue Integrity/Burns lecture > Flashcards

Tissue Integrity/Burns lecture Flashcards

1
Q

Burn prevention tips

A
  • Working smoke and carbon monoxide detectors
  • Create emergency escape plans
  • Never leave cooking food or open flames unattended
  • Install childproof devices
  • Never leave young children unattended in kitchen/bathroom
  • Check electrical cords for damage
  • Keep fire extingushers and practice Stop, drop, and roll
  • Set home water heater to 120 degrees
  • Wear protective clothing, use suncreen, avoid tanning beds
  • Do not smoke or have flame in room with oxygen in use
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2
Q

Name the types of burns

A

Thermal
Electrical
Chemical
Radiation

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3
Q
  • Burn caused by fire, steam, scald, hot objects or liquids
  • Erythema, edema, blisters, and pain
A

Thermal

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4
Q
  • Burns caused by contact with lightning or electrical energy source
  • Can affect multiple organs, cause neuro problems, or cause sudden cardiac arrest
A

Electrical

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5
Q
  • Burns caused by contact with industrial/household chemicals
  • i.e Acids, alkalis, organic
  • PPE is needed to avoid exposure to chemicals
  • Chemical needs to be removed with continuous irrigation with water
A

Chemical

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6
Q
  • Burns caused by sunning, tanning, x-rays, radiotherapy, nuclear accidents
  • Erythema, edema, blisters, and pain
  • Prolonged exposure can cause N/V/D, HA, fever, fatigue
A

Radiation

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7
Q

What burn depth is this?

  • Pink/red
  • Pain
A

Superficial

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8
Q

What burn depth is this?

  • Blisters
  • pink/red
  • pain
  • blanches
A

Superficial partial-thickness

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9
Q

What burn depth is this?

  • Blisters
  • waxy
  • pink/cherry red
  • edema
  • no blanching
  • pain around edges
  • decreased sensation
A

Deep partial thickness

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10
Q

What burn depth is this?

  • Leathery
  • dry
  • white,tan,brown, black eschar
  • No blanching
  • No pain
A

Full Thickness

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11
Q

How long do superfical burns take to heal? Do they leave scars?

A

3-7 days no scars

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12
Q

Most common superficial burn

A

Sunburn

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13
Q

Healing time for Superficial burns

A

1-2 wks

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14
Q

Superfical and superfical partial thickness burns are considered what type of burns?

A

Minor

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15
Q

How to treat minor burns

A
  • Cool compress or cool water
  • Provide analgesics
  • Use lotion on intact skin
  • Cleans with mild soap and tepid water
  • Apply antimicrobial agent to non–intact skin
  • Apply dressing if clothing is irritating
  • Drink plenty of fluid
  • Teach to observe for infection
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16
Q

How long do partial thickness burns take to heal and do they leave a scar? How is it treated? What is a challange associated with this type of burn?

A
  • Healing can take 3-6 wks and can leave scaring
  • Surgical debreidment or skin grafting can be required
  • It is challenging to determine the true extent of the injury if it will heal or require surgical intervention
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17
Q

Full thickness burns require what? or what won’t happen?

A

Surgical excision and grafting, healing

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18
Q

Name the three phases of burn wound healing

A

Inflammation
Proliferation
Remodeling

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19
Q

Name this stage of burn wound healing

Begins immediately after injury, vasodialation, increase in capillary permeability

A

Inflammation phase

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20
Q

Name this stage of burn wound healing

2-3 days after burn, granulation tissue tissue forms, epithelial cells cover wound

A

Proliferation phase

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21
Q

Name this stage of burn wound healing

May last for years, collagen fibers reorganize, scars contract, fade

A

Remodeling phase

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22
Q

Amount of body burned that guides fluid resuscitation ____ for adults

A

less than or equal to 20%

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23
Q

Rule of Palm

Burns

A

1% to quickly estimate for scattered burns

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24
Q

Rule of nines

burns

A

Most common method with body broken into areas of 9% or multiples of 9

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25
Q

Underestimating TBSA burned can lead to what

A

pt going into shock and organ failure, burn shock

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26
Q

Overestimating TBSA burned can lead to what?

A

pt unable to tolerate and may develop pulmonary edema

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27
Q

Small burns can be ____ in older adults

A

Fatal

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28
Q

Factors that determine severity of burns

A
  • Presence of inhalation injury
  • Pt age
  • PMHx
  • Presence of contamination injury
  • Anatomical location of burn
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29
Q

Important considerations for infants and children with burns

A

Be alert to s/s of child abuse when hx does not match injury

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30
Q

Important considerations for adolescents with burns

A

Foreward about edema or changes in body from injury response

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31
Q

When treating a pregnant woman with burns the nurse should be aware of what?

A
  • Tx of mother threatens fetus
  • relationship between percentage of TBSA involved and fetal maternal survival
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32
Q

Considerations for older adults with burns

A
  • Greater risk for death
  • may not tolerate fluid resuscitation and surgery
  • Skin is less elastic and harder to heal
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33
Q

Rule of palm

A

1% to quickly estimate for scattered burns

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34
Q

Rule of nines

A

Most common method with body broken into areas of 9% or multiples

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35
Q

Lund and Browder classification

TBSA

A

Method of measuring TBSA burned used in a majority of burn centers. Takes into account surface area r/t age, are assigned to each body part.

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36
Q

Name percentages

A
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37
Q

Name percentages of body for TBSA

Head to toe

A

Head: 9%
Anterior: 18%
Posterior: 18%
each arm: 9%
Each hand: 1%
Perinium: 1%
Each thigh: 18%

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38
Q

Functional changes burn injuries are:

A
  • Long-term morbidity
  • Impaired function: burns to hands, feet, genitalia, perineum, and major joints
  • Altered appearance: burns to face
  • May require multiple lifelong plastic and reconstructive surgeries to maintain function
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39
Q

Burn injuries effect on respiratory system

A
  • Inhalation injury
  • Upperairway injury
  • Lower airway injury
  • Carbon monixide poisoning
  • Airway management
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40
Q

What increases mortality risk in burn patients?

A

Inhalation injury

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41
Q

Most important factors in burn patients

A
  1. depth/extent of burn
  2. Patient age
  3. Inhalation injury
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42
Q

How long after burn injury can inhalation injury occur?

A

24-48hrs

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43
Q

Airway management for burn patients

A
  • 100% humidified o2
  • Cough/deep breathing
  • Elevate HOB
  • ET intubation
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44
Q

What should you always suspect in a burn patient?

A

That they were injured/trapped in an enclosed space or if they have face, neck, or chest burns.

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45
Q

The following are S/S of what?

  • Facial burns
  • Singed nasal and facial hairs
  • Carbonaceous sputum (soot), hypersecretion
  • Naso- or oropharynx erythema
  • Excessive agitation/anxiety (hypoxia)
  • Tachypnea, intercostal retractions, flaring nostrils
  • Inability to swallow
  • Hoarseness, grunting, brassy voice
  • Rales, rhonchi, diminished breath sounds
A

Inhalation injury

46
Q

The following are S/S of what?
* Headache
* Confusion
* N|V
* Diziness
* Dyspnea
* Chery red discoloration of skin

A

Carbon monoxide poisoning

47
Q

THe following describes what?

  • Occurs from massive fluid shift due to increased capillary permeability (first 8-36 hours)
  • Electrolytes, water, plasma, proteins leak out into interstitial space called third spacing
  • Blood becomes more viscous and slowed, decreasing oxygen delivery and cardiac output
A

Burn Shock

48
Q

How to treat burn shock and what will happen if it is not done

A

w/o fluid resuscitation develop hypotension, tachycardia, decreased urine output, AMS, multi-organ failure

49
Q

Lab findings in a burn patient in the Emergent phase

A
  • Hyperkalemia-cardiac dysrhythmias
  • Hyponatremia
  • Metabolic acidosis
  • Elevated Hematocrit
50
Q

Describe FLuid remobilization/diuretic stage

A
  • Occurs after 24-48 hours
  • Capillary leak stops
  • Edema fluid shifts from the interstitial spaces into the vascular space
  • Blood volume increases leading to increased renal blood flow and diuresis
  • Body weight returns to normal
51
Q

GI & Metabolic effects of burn injuries

A
  • Decreased nutrient absorption
  • Decreased gastrointestinal motility
  • Use of prokinetic agents, enteral nutrition support
  • NG tube for long-term feeding and relieve initial distention
  • Constant hypermetabolic state 1-3 years post injury
  • Increased caloric need
52
Q

Integumentary effects of burn injuries

A
  • Loss of water secondary to evaporation
  • Infection secondary to loss of skin integrity
  • Difficulty maintaining body temperature
  • Patient rooms and operating rooms kept at warmer temperature with specialized equipment
53
Q

GU & Immune effects of burn injuries

A
  • Glomerular filtration rates (GFR) reduced
  • Urine output decreases
  • Serum creatinine and blood urea nitrogen increase
  • Myoglobinuria: Free hemoglobin and myoglobin from muscle damage could cause renal tubular necrosis; red/tea colored urine
  • High risk for infection and sepsis
  • SIRS (systemic inflammatory response syndrome) which may lead to sepsis
  • Sepsis leading cause of death after 24 hours
54
Q

Name the 6 P’s

A
  1. pulselessness
  2. pallor
  3. paresthesia
  4. pain
  5. paralysis
  6. poikilthermia (coolness)
55
Q

Presence of one or more of the 6 P’s indicates what?

A

Compartment syndrome

56
Q

Surgical incision through eschar to relieve pressure at bedside

A

Escharotomy

57
Q

Incision extends through muscle, performed in OR used to treat compartment syndrome

A

Fasciotomy

58
Q

Phases of burn injuries

A
  • Emergent/resusitative
  • Intermediate/acute
  • Rehabilitive
59
Q

What phase of burn injury is this?

  • First 24-48 hrs
  • Estimate extent of injury
  • Implement fluid resuscitation
  • Assess for shock and resp distress
  • Determine if transport to burn center needed
A

Emergent/resuscitative

60
Q

Goals of the emergent/resuscitative phase

A
  • Secure airway
  • Support circulation
  • Comfort/pain management
  • Maintain temp./prevent hypothermia
  • Emotional support
61
Q

Assessment of Emergent/resuscitative phase

A
  • Time and cause of injury
  • First aid treatment given
  • Past medical hx
  • Pre burn weight
  • TBSA
62
Q

What is phase of burn healing is this? and part of the phase is it?

  • Airway and C-spine stabilization
  • Breathing: 100% O2 non-rebreather
  • Circulation: Neurovascular checks, elevate extremities
  • Disability: Neurological checks
  • Expose and examine: Extent & depth of burn & assoc. trauma
  • Fluid resuscitation: 2 large bore IVs and start fluids (LR)
A

Primary survey done during the emergent/resuscitative phase

63
Q

At what burn phase does the primary survey occur? What does it include?

A

Emergent/resuscitative phase

  • Airway and C-spine stabilization
  • Breathing: 100% O2 non-rebreather
  • Circulation: Neurovascular checks, elevate extremities
  • Disability: Neurological checks
  • Expose and examine: Extent & depth of burn & assoc. trauma
  • Fluid resuscitation: 2 large bore IVs and start fluids (LR)
64
Q

What is phase of burn healing is this? and part of the phase is it?

  • Circumstances of the injury
  • Medical history & meds
  • Last food and fluid intake
  • Complete “head-to-toe” physical examination
  • Calculate TBSA
  • Cover the wounds
  • Maintain body temp
  • Pain medication
  • Tetanus
  • Labs (CBC, CMP, PT/aPTT, UA)
  • ABG and/or carboxyhemoglobin
  • 12-lead ECG, CK-MB, troponin
  • Fluid Calculation
A

Emergent/resuscitative phase, secondary survey

65
Q

What burn phase is the secondary survey part of? Name the parts of the secondary survey

A
  • Circumstances of the injury
  • Medical history & meds
  • Last food and fluid intake
  • Complete “head-to-toe” physical examination
  • Calculate TBSA
  • Cover the wounds
  • Maintain body temp
  • Pain medication
  • Tetanus
  • Labs (CBC, CMP, PT/aPTT, UA)
  • ABG and/or carboxyhemoglobin
  • 12-lead ECG, CK-MB, troponin
  • Fluid Calculation
66
Q

Is fluid resuscitation calculated from time of injury or time of arrival?

A

TIME OF INJURY

67
Q

Calculation for fluid resuscitation for an adults and children 15yrs and older

A
  • LR 2-4mL x weight(kg) x TBSA
  • 1/2 of the volume in the 1st 8 hrs
  • 1/2 of the volume in the following 16 hrs.
  • Monitor pt response
  • Urine OP goal: 0.5m;/kg/hr
68
Q

Fluid resuscitation equation for children 14yrs old and below

A
  • 3mL x weight(kg) x TBSA
  • 1/2 of the volume in the 1st 8 hrs
  • 1/2 of the volume in followinf 16 hrs
  • Monitor pt response
  • Urine OP goal of 0.5mL/kg/hr
69
Q

Formula for fluid resuscitation of electrical injuries

A
  • The same for ALL ages
  • 4 mL x weight (kg) x TBSA
70
Q

What happens after 24hrs of fluid resuscitation for burns pt

A

colloids are given based on labs i.e albumin or plasma

71
Q

What is done to ensure urine OP is adequately measured?

A

Foley is placed

72
Q

Indications of adequate fluid resuscitation

A
  • Urine OP: 0.5mL/kg/hr (or) 1mL/kg/hr if myoglobin present
  • SBP: Greater than 100 mmHg
  • HR: less than 120 bpm
  • CVP: 5-10 mmHg
  • Pulm: lungs clear, pH WNL
  • GI: abd soft, non-tender, no N|V, or ileus; bladder pressure less than 10 mmHg
  • LOC: Clear, A&Ox4
73
Q

Nursing Dx for emergent phase

A
  • Ineffective airway clearance
  • Impaired gas exchange
  • Risk for fluid volume deficit
  • Altered tissue perfusion
  • Risk for hypothermia
  • Acute pain
  • Anxiety
74
Q

Nursing interventions for Intermediate/acute phase

A
  • Wound care
  • Nutrition therapy
  • Infection prevention
  • Pain management
75
Q

Wound management

A
  • Hydrotherapy
  • Debridement
  • Dressing changes
76
Q

Ointment that helps schar separation

A

Enzymatic ointment

77
Q

What type of skin graft is this?

Temporary cadaver skin graft

A

allograft

78
Q

What type of skin graft is this?

Temporary pig skin graft

A

Xenograft

79
Q

What kind of skin graft is this?

patient’s own skin, most ideal permanent graft

A

Autograft

80
Q

What type of skin graft is this?

patient’s own skin, most ideal permanent graft. More exposed areas (face, hands) more cosmetic appearance

A

Autograft-sheet graft

81
Q

What type of skin graft is this?

patient’s own skin, most ideal permanent graft; Holes in them to expand

A

Autograft-mesh graft

82
Q

What type of skin graft is this?

Cultured epithelial autograft, patient’s skin sample grown in lab

A

Cultured epithelial Autograft (CEA)

83
Q

What type of skin graft is this?

Artificial skin of 2 layer silicone membrane

A

Integra

84
Q

Name medications used for burn care

A
  • Analgesia
  • Sedation
  • Anticoagulants
  • Nutritional support
  • GI support
85
Q

This medication class is used to manage pain in burn patients

A

Analgesia

86
Q

Give some examples of analgesics

A

Morphine sulfate (morphine)

Hydromorphone (Dilaudid)

Fentanyl (Sublimaze)

Ketamine (Ketalar)

Oxycodone (OxyContin, Tylox)

Methadone (Dolophine)

Nonsteroidal anti-inflammatory medications (ibuprofen or naproxen sodium)

87
Q

This medication class is used to treat burn patients but decreasing anxiety, treating ETOH withdrawl, hypnotic agent, amnesic effects

A

Sedatives

88
Q

Name some sedatives used to treat burn patients

A

Haloperidol (Haldol)
Lorazepam (Ativan)
Diazepam (Valium)
Midazolam (Versed)
Propofol (Diprivan)
Dexmedetomidine hydrochloride (Precedex)

89
Q

This medication class is used to promote venous return and decrease risk for thromboembolism

A

Anticoags

90
Q

Give some examples of medications given to burn patients for anticoag therapy

A
  • Lovenox
  • Heparin
91
Q

Medications given to burn patients for nutritional support with rationale

A

Multivitamins-Promote wound healing

Zinc sulfate (zinc) and ferrous sulfate (iron)-Promote hemoglobin formation and cell integrity

Oxandrolone (Oxandrin)-Preservation of lean body mass and promotion of weight gain

92
Q

Medications given to Burn patients for GI support

A

Zantac
Nexium
Protonix
Mylanta
Nystatin
Reglan
Miralaz

93
Q

What topical medication/wound dressing is this?

Broad-spectrum and Candida coverage

Partial- and full-thickness burn wounds

¼-in.-thick application with roll gauze to cover; dressing changes every 12 hours

Cooling effect when applied; easy, painless application

A

Silver sulfadiazine or silvadene

94
Q

Disadvantages of silvadene

A

May cause transient leukopenia; may also cause a wound film on partial-thickness burns, making it hard to assess healing

95
Q

Nursing considerations for silvadene

A

Avoid in patients with a documented sulfa allergy. Avoid application to face.

96
Q

What topical medication/wound dressing is this?

No gram-negative or fungal coverage

Partial-thickness burn wounds and grafts

Thin layer applied with a nonadherent gauze and an outer roll gauze; dressing changes every 24 hours

Easy, painless application; only once-per-day dressing change

A

Bacitracin

97
Q

Disadvantages of Bacitracin

A

Not as effective on full-thickness burn wounds because of minimal penetration of eschar

98
Q

Nursing considerations for Bacitracin

A

Best choice for use on a face, but left open to air. Use bacitracin ophthalmic ointment near and around eyes.

99
Q

What topical medication/dressing is this?

Broad-spectrum, effective against Pseudomonas but has little anti-fungal coverage

Creamused on full-thickness burns to ears only; solution used on partial-thickness burn wounds and grafts

Cream isapplied 1/16 in. thick and left open to air. Solution is applied to nonadherent gauzeand roll gauze. Cream is changed every 12 hours; solution dressings are changed every 24 hours and may be wet down at 12 hours.

Creampenetrates eschar. Solution is only a once-per-day dressing change.

A

Mafenide acetate 10% cream or 5% solution
or
Sulfamylon Cream or Slurry

100
Q

Disadvantages of Mafenide acetate 10% cream or 5% solution or Sulfamylon Cream or Slurry

A

Solution is awet-type dressing and may not be used on initial large burn wounds because it may cause hypothermia

101
Q

Nursing considerations for Mafenide acetate 10% cream or 5% solution or Sulfamylon Cream or Slurry

A

Some patientsmay complain of stinging upon application to partial-thickness burn wounds. Frequent sensitivities noted.

102
Q

What kind of topical treatment/dressing is this?

Broad-spectrum, effective against MRSA and fungus

Partial-thickness burn wounds, Stevens-Johnson syndrome (SJS), and patients with toxic epidermal necrolysis (TEN), donor sites

Some products are a wet application with sterile water and roll gauze. Dressing changes every 3–7 days; wet down with sterile water every 12 hours. Some products are applied dry and not wet down.

Dressing needs to be changed only every 4–7 days

A

Silver sheeting products
or
Acticoat, Silverlon, Mepilex

103
Q

Name some disadvantages to Silver sheeting products or Acticoat, Silverlon, Mepilex for treating burns

A

Expensive. Burn wounds often need to be observed daily. Solution is a wet-type dressing and may not be used on initial large burn wounds because it may cause hypothermia.

104
Q

Name nursing considerations for Silver sheeting products or Acticoat, Silverlon, Mepilex

A

This is best used in the patient with SJS/TEN as the dressing change process is extremely painful and wounds do not need to be observed daily. May also be of good use in the outpatient setting. Some patients may complain of stinging upon application. Do not use with normal saline because it will deactivate silver.

105
Q

What type of topical treatment/dressing is this?

No antimicrobial effects and thus is often mixed with other ointments and/or creams

Full-thickness burn wounds (specifically digests collagen in necrotic tissue without harming intact tissue)

Thin layer applied with a nonadherent gauze and an outer roll gauze; dressing changes every 24 hours

Easy, painless application; only once-per-day dressing change; may help penetrate and soften eschar for debridement

A

Enzymatic cream
or
collagenase

106
Q

Name some nursing interventions for Enzymatic cream or collagenase

A

Considered for use in patients with full-thickness burn wounds who are not candidates for the operating room because of age or medical condition; also considered for use in very small areas of full-thickness burns in an attempt to heal without surgery.

107
Q

Nursing interventions when managing pain for burn patients

A
  • Routine monitoring
  • Use scheduled IV opioids instead of PRN, transition to PO when tolerated
  • Avoid IM injections
  • PCA appropriate for some clients
  • Monitor for respiratory depression
  • Administer pain medications prior to dressing changes or procedures
  • Treat related anxiety
  • Add nonpharmacologic methods for pain control
108
Q

Infection prevention for burn patients

A
  • Standard/contact precautions
  • Restrict plants and flowers
  • Limit visitors
  • Use reverse isolation if prescribed
  • Monitor for s/s of infection
  • Use client designated equipment
  • Administer antibiotics if indicated
109
Q

Name some nursing DX for intermediate/acute phase

A
  • Impaired skin integrity
  • Risk for infection
  • Altered nutrition: less than body requirements
  • Impaired physical mobility
  • Self-care deficit
  • Disturbed body image
  • Powerlessness
  • Acute pain
  • Anxiety
110
Q

What phase of burn injury is this?

  • Prevention of contractures and scars
  • Splinting across major joints
  • Specialty pressure garments to prevent hypertrophic scarring
  • ROM to enhance mobility
  • Mental health treatment for PTSD, depression, anxiety, body image disorder
  • Client’s successful resumption of work, family, and social roles
A

Rehabilitative phase

111
Q

Nursing interventions r/t mobility for burn patients

A
  • Maintain correct body alignment
  • Active and passive range of motion
  • Ambulate
  • Positioning and pressure dressings to prevent contractures
  • Monitor high risk areas for pressure sores
112
Q

Nursing dx for rehabilitative phase

A
  • Activity intolerance
  • Impaired physical mobility
  • Disturbed body image
  • Moral distress

NUR 213 (29 decks)

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