Unit 17 Burns

Question 1

Is water ok for burns?

What to do with chemical on body causing burn?

Answer 1

Cool/tepid water if burn is < 10%, if > 10% then no

Irrigate chemical wounds

Question 2

What are some interventions for arriving at the scene to a burn PT?

Answer 2

ABC

C-Spine protection

O2 100 non-rebreather

Prepare Intubation if needed

Remove clothing and jewelry

VS w/ neuro check

Question 3

What special consideration make burns more severe?

Answer 3

Age 70 or >

Burns > 15%

Any PT problems w/mobility

Question 4

How are burns classified?

Answer 4

Partial or full thickness

% of surface area

Question 5

Describe Superficial partial thickness (1st degree) burn.

Answer 5

• Epidermis involved, ex: of cause = sunburn
• Pain that is soothed by cooling
• Reddened, blanches

Complete recovery within a week, no scarring

Question 6

Describe Deep partial thickness (2nd degree) burn.

Answer 6

• Epidermis and dermis
• Blisters, severe pain, edema
• Some scarring, infection may progress it to full thickness burn
• Recovery in 2-4 weeks

Question 7

Describe Full thickness (3rd degree) burn.

Answer 7

• Epidermis, dermis, and subcutaneous tissue
• Dry, waxy, leather skin
• Pain free, can however turn into tourniquet effect and cut off circulation

-Eschar sloughs, Grafting necessary
Scarring and loss of contour and function;

Question 8

What does 4th degree burn involve?

Answer 8

Muscles, tendons, and bones

Black, usually loss of effected area.

Question 9

What is the emergent phase of a burn injury?

What is the primary concern during this phase?

Answer 9

Begins at time of injury and concludes w/ restoration of fluid mobilization.

• 3 to 4 days
• Systolic BP should be kept over 90

Concern:

• Onset of hypovolemic shock and edema (third spacing)
• Intravascularly PT will be dry

Question 10

What is an escharotomy and why is it performed?

Answer 10

Cutting dead skin open through full thickness burn to release pressure, which prevents compartmental syndrome.

Question 11

Describe the Acute phase of burns.

What are the interventions during this phase?

Answer 11

Hemodynamically stable, diuresis has begun

48-72 hrs after injury

Interventions:

• Pain management
• Enteral feedings
• Antibiotic therapy
• Promote mobility

Question 12

What is the nursing care during the emergent phase of a burn?

Answer 12

• ABCs
• Replace fluids (Lactated Ringers) 500ml/hr
• 2 IV’s
• Foley for I and Os
• NGT
• Pain management
• IV and topical antibiotics
• Tetanus prophylaxis

Question 13

When does the rehabilitation phase of burns begin and what is the goal?

Answer 13

Begins when PT is able to begin self-care activities.

Goal is to minimize scar tissue

Question 14

What is the Rule of 9 regarding burns?

Added bonus, what’s the palm measurement rule?

Answer 14

Head and neck = 9%
Each arm = 9%
Each leg = 18%
Each side of torso/trunk = 18%
Perineal area = 1%

palm measurement rule = 1%)

Question 15

What is the Parkland (Baxter) formula for fluid replacement in burns?

Answer 15

4mL of Lactated Ringers
x 
%TBSA (not decimal)
x
Kg body weight = 
Total fluid replacement for 24hrs from time of injury

1/2 in the first 8 hrs
1/4 in the next 8 hrs
1/4 in the last 8 hrs