Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

NUSC 2P14 > Week 11: Burns & Respiratory Distress > Flashcards

Week 11: Burns & Respiratory Distress Flashcards

1
Q

Burns

A

Occur when injury to the tissues of the body is caused by:
-Heat
-Chemicals
-Electric current
-Radiation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Types of Burn Injury (Thermal Burns)

A

-caused by flame, flash, or contact with hot objects
-the most common type of burn injury

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Types of Burn Injury (Chemical Burns)

A

-results from tissue injury and destruction from acids, alkalis, and organic compounds

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

Types of Burn Injury (Smoke Inhalation Injury)

A

-results from inhalation of hot air or noxious chemicals (i.e CO poisoning)
-cause damage to the tissues respiratory tract
-responsible for up to 77% of deaths, largely related to carbon monoxide poisoning

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

Types of Burn Injury (Electrical Burns)

A

-caused by intense heat generated from an electric current
-May result in direct damage to nerves and vessels, causing tissue anoxia and death
-severity depends on the amount of voltage, current pathways, surface area in contact with the current, and length of time that the current flow was sustained
-Can be difficult to determine since most of the damage is below the skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

Classification of Burn Injury

A

SEVERITY is determined by:
-Depth of burn
-Extent of burn
-Location of burn
-Client risk factors

GOALS of care:
-wound healing
-prevention of infection
-pain management
-return to preinjury function

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Classification: Depth

A

Burns are defined by degrees
1st DEGREE- superficial partial thickness burn
-involves the epidermis (sunburn)
2nd DEGREE- deep partial-thickness burn
-Involves the dermis
3rd&4th DEGREE- full thickness burn
-involves fat, muscle, bone
-significant damage to the dermis-remaining skin cells are insufficient to regenerate new skin

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

Classification: Extent

A

Lund–Browder Chart:
-Considered more accurate
-Considers the client’s age, in proportion to relative body-area size, is taken into account

The Rule of Nines:
-Easier to remember
-Considered adequate for initial assessment of an adult burn client
-Commonly used in emergency

*extent of a burn is often revised after edema has subsided

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

Classification: Location

A

Location of burn related to the severity of the injury
-Face, neck, chest → respiratory obstruction
-Hands, feet, joints, eyes → self-care
-Ears, nose, buttocks, perineum → infection

Circumferential burns of the extremities can cause circulatory compromise

Potential for compartment syndrome from direct heat damage to the muscles and subsequent edema and/or pre-burn vascular problems

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

Patient Risk Factors

A

-Older adults heal more slowly than younger adults
-Pre-existing cardiovascular, respiratory, & renal diseases contribute to poorer prognosis
-Diabetes or peripheral vascular disease contributes to poor healing
-Concurrent fractures, head injuries, or other trauma also lead to poor prognosis
-Physical debilitation renders client less able to recover:
a.)alcoholism/drug abuse
b.)malnutrition

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

Phases of Burn Management (Pre-Hospital Care)

A

-At the injury scene, priority is to remove the person from the source of the burn and stopping the burning process

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

Phases of Burn Management (Emergent)

A

RESUSCITATIVE
-The period of time required to resolve the immediate, life- threatening problems resulting from the burn injury
-Lasts up to 72 h

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

Phases of Burn Management (Acute)

A

WOUND HEALING
-Begins with mobilization of extracellular fluid & subsequent diuresis, and concludes when the burned area is completely covered by skin grafts or when the wounds are healed
-This may take weeks or many months
-Longest stage

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

Phases of Burn Management (Rehabilitative)

A

RESTORATIVE
-Begins when the patient’s burn wounds have healed and the patient is able to resume a level of self-care activity

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

Emergent Phase (Resuscitative)

A

Greatest threat is hypovolemic shock & subsequent edema
-caused by a massive shift of fluids out of the blood vessels due to ↑ capillary permeability
Toward the end of the phase:
-capillary membrane permeability is restored
-fluid loss & edema formation cease
-interstitial fluid gradually returns to the vascular space

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

Capillary Permeability- Hypovolemia

A

-Inflammation
-↑ capillary permeability
-Massive shift of H2O, Na+, albumin
-Interstitial space (second spacing)
-↓ osmotic pressure
-↑ fluid shifting (third spacing)
-Intravascular volume depletion
-Hypovolemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
17
Q

Emergent Phase- Clinical Manifestations

A

Pain
-Areas of full-thickness & deep partial-thickness burns are initially anaesthetic because the nerve endings are destroyed
-Superficial to moderate partial-thickness burns are extremely painful

Most Patients are Alert & Often Frightened
-benefit from calm reassurance & simple explanations by health care providers
-If inhalation injury has occurred-the upper airway is vulnerable to edema formation and airway obstruction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
18
Q

Emergent Phase Inflammation & Healing

A

-Neutrophils and monocytes accumulate at the site of injury
-Fibroblasts & collagen fibrils begin wound repair within the first 6–12h

Immunological Changes:
-widespread impairment of the immune system
-Skin barrier is destroyed
-Bone marrow is depressed
-Circulating levels of immune globulins are decreased
-WBC’s defects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
19
Q

Emergent Phase (Cardiovascular System)

A

-Dysrhythmias & hypovolemic shock
-Impaired circulation to extremities
-Tissue ischemia
-Necrosis: escharotomy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
20
Q

Emergent Phase: Respiratory Phase

A

-URT injury: inhalation of hot air, steam, smoke
-Edema formation: mechanical airway obstruction & asphyxia
-LRT injury: inhalation of toxic chemicals or smoke
-Pulmonary edema

Lower respiratory tract injury is concerned with impaired gas exchange

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
21
Q

Emergent Phase (Urinary System)

A

-Acute tubular necrosis (ATN)
-Hypovolemia: decreased kidney blood flow: renal ischemia: AKI
-Full-thickness & electrical burns: myoglobin & hemoglobin are released into the bloodstream: occlude the renal tubules
-Decreased blood flow to kidneys causes renal ischemia

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
22
Q

Emergent Phase: Collab & Nursing Care
(airway management)

A

PRIORITY:
airway management, fluid therapy, wound care

Frequently requires endotracheal (ET) intubation:
-extubation may be indicated when the edema resolves, usually 3 to 6 days after burn injury

Respiratory Distress
-r/t circumferential burns to neck & truck (escharotomy)

Bronchoscopy
-To assess lower airway

CO poisoning
-100% O2

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
23
Q

Emergent Phase: Collab & Nursing Care
(Fluid Therapy)

A

-Critical for fluid resuscitation & meds
-Establish IV access to accommodate large volumes of fluid
-Type of fluid determined by size/depth of burn, pt’s age, & pre-existing conditions
a.) lactated ringers, colloids, combo (isotonic soltn)
Adequacy of fluid replacement
-Urine output – 0.5-1 ml/kg/h
-Cardiac factors
-Mean arterial pressure > 65 mmHg
-Systolic BP >90 mmHg
-HR < 120 bpm

23
Q

Emergent Phase: Collab & Nursing Care
(Wound Care)

A

-Full-thickness burn wounds are dry and waxy white to dark brown or black
-have minor, localized sensation because nerve endings have largely been destroyed
-Partial-thickness burn wounds appear pink to cherry red and are wet and shiny with serous exudate
-Cleansing & gentle debridement to prevent infection
-Necrotic skin removed
-Coverage is the primary goal
-Moist wound healing and use dressings to cover
-Moisture allows the movement of cells to start knitting together

24
Q

Emergent Phase: Collab & Nursing Care

A

-The face is highly vascular and subject to a great amount of edema
-Arterial blood gases (ABGs) are measured to determine adequacy of ventilation & perfusion with inhalation or electrical injury
-Physiotherapy is begun immediately to facilitate mobilization of the extravasated fluid back into the vascular bed
-Maintains function, prevents contracture
-Opioids are the drugs of choice for pain control
-Analgesic requirements can vary tremendously from one patient to another
-The extent and depth of burn may not be correlated with pain intensity
-Lower extremity burns: risk for venous thromboembolism (VTE)
-Low-molecular-weight heparin as prophylaxis

25
Q

Emergent Phase: Nutrition Therapy

A

Huge caloric needs – metabolism may ↑ 50-100%!
-Inadequate calories & protein: malnutrition & delayed healing
Early & aggressive nutritional support can:
-decrease mortality risks & complications
-optimize healing of the burn wound, and
-minimize the negative effects of hypermetabolism & catabolism
Enteral Feedings

26
Q

Acute Phase (Wound Healing)

A

-Diuresis from fluid mobilization occurs, and the client is less edematous
-Bowel sounds return
-Healing begins when:
a.) WBCs surround the burn wound, phagocytosis occurs
b.) Necrotic tissue begins to slough
c.) Granulation tissue forms
-Full-thickness burns must be covered by skin grafts

27
Q

Acute Phase: Collab & Nursing Care

A

The predominant therapeutic interventions in the acute phase are:
-Wound care
-Excision & grafting
-Pain management
-Physiotherapy & occupational therapy
-Nutritional therapy
-Psychosocial care

28
Q

Acute Phase: Collab & Nursing Care

A

GOALS
-prevent infection
-promote wound reepithelialization / skin grafting
EXCISION
GRAFTING

29
Q

Excision

A

-Eschar is removed down to the subcutaneous layer

30
Q

Acute Phase Nursing Care (Pain Management)

A

-Individualized & ongoing pain assessment & mgmt
-One of the most critical functions a nurse performs on behalf of a patient with burn injuries

31
Q

Acute Phase Nursing Care
(Physical & occupational therapy)

A

-To maintain muscle strength & optimal joint function

32
Q

Acute Phase Nursing Care (Nutritional Therapy)

A

-provide adequate calories & protein to promote healing

33
Q

Acute Phase Nursing Care (Psychosocial Care)

A

-support during the often lengthy, unpredictable, & complex course of care
-SW & nursing play an important role

34
Q

Rehabilitation Phase (Restorative)

A

GOALS:
-assist the patient in resuming a functional role in society
-rehabilitation after functional and cosmetic reconstructive surgery
MANIFESTATIONS:
-new skin appearing flat & pink
-then raised and hyperemic
-itching occurs with healing

Complications are skin & joint contractures and hypertrophic scarring:
-mgmt includes positioning, splinting, and exercise to minimize this

35
Q

Rehabilitation Phase- Nursing Care

A

-Patient teaching using return demonstration (show-back) for dressing changes & ongoing wound care is essential to ensure good post-discharge wound healing
-Continuous exercise and physical & occupational therapy cannot be overemphasized
-Encouragement & reassurance are necessary for patient morale, attaining independence, and returning to pre-burn activities

36
Q

Alveolus: Gas Exchange

A

-Only the alveoli function in the exchange of the respiratory gases between the outside air and the blood

37
Q

Respiratory Failure

A

Respiratory failure is the state in which one or both gas-exchanging functions are inadequate
-Either the amount of O2 transferred to the blood is insufficient
-the amount of CO2 removed from the lungs is inadequate

38
Q

Respiratory Failure

A

-With inadequate gas exchange, the metabolic demands of the tissues are not met, and body systems begin to rapidly fail

Hypoxemia: low O2 in blood
-↓ partial pressure of O2 (PaO2 <60 mmHg)
-↓ arterial O2 sats (SaO2)

Hypercapnia: high CO2 in blood
-↑ partial pressure of CO2 (PaCO2)

39
Q

Respiratory Failure

A

-Though respiratory failure is determined by the PaO2 & PaCO2, the major threat is the inability of the lungs to meet the oxygen demands of the tissues
-May develop suddenly or over several days
-Important to monitor trends in ABGs & SaO2
Initial Symptoms
-Change in pt’s mental status
-cerebral cortex is very sensitive to changes in oxygenation & acid-base balance
-Tachycardia & mild hypertension
-Heart Tries To Compensate

40
Q

Diagnostics

A

ABGS necessary to determine:
-oxygenation (PaO2) & ventilation (PaCO2) status
-acid–base balance

Chest X-Ray
Pulse oximetry (SaO2)

Pulmonary Artery Catheter to Measure Pressures:
-on the right side of the heart and cardiac output
-mixed venous oxygen saturation

41
Q

Acid Base Imbalance: Respiratory

A

Acidosis: (hypoventilation)
Increased CO2 in blood & increased carbonic acid
-COPD
-Overdose
-Severe pneumonia

Alkalosis: (hyperventilation)
Decreased CO2 in blood / decreased carbonic acid
-Hypoxia, PE
-Anxiety, fear, pain
-Septicemia, encephalitis

42
Q

Arterial Blood Gases- ABGs

A

PaO2: partial pressure of oxygen
(75-100 mmHg)
-Measures O2 pressure in blood
-Reflects how well O2 is able to move from lungs to blood

PaCO2: partial pressure of carbon dioxide
(35-45 mmHg)
-Measure CO2 pressure in blood
-Reflects how well CO2 is able to move out of the body

HCO3: bicarbonate (22-26 meq/L)
-Chemical buffer that keeps the blood pH stable

pH (7.4)
-Measures hydrogen ions (H+) in blood

43
Q

Oxygen

A

-The fraction of inspired oxygen (FiO2) is the concentration of oxygen in the gas mixture
-The gas mixture at room air has a FiO2 of 21%, meaning that the concentration of oxygen at room air is 21%
(But, this is not the amt that participates in O2 gas exchange at the alveolar level)
-For every litre of O2 flow, the FiO2 increases by 4%

44
Q

Oxygenation

A

-The primary goal of O2 therapy is to correct hypoxemia
-O2 delivery: nasal cannula, face mask, Venturi mask
Maintain PaO2 at 55-60 mmHg
Maintain SaO2 at 90%
* At lowest O2 concentration possible
High O2 concentration** : adverse effects
Intubated patients who receive >50% FiO2 for >24h are at risk to develop O2 toxicity

45
Q

Artificial Airways

A

Endotracheal Intubation (ET)
-via mouth or tracheotomy
Indications for Use
-Upper airway obstruction
-Secondary to burns, tumour, bleeding
-Apnea
-Respiratory distress
-Inability to maintain the airway
-ineffective clearance of secretions, altered or decreased level of consciousness

46
Q

Artificial Airways- Nursing Management

A

-Maintaining correct tube placement
-Maintaining proper cuff inflation
-Monitoring oxygenation & ventilation
-Maintaining tube patency
-Assessing for complications
-Providing oral care & maintaining skin integrity, and
-Fostering comfort and communication

47
Q

Mechanical Ventilation

A

-The process by which ventilation and oxygenation is supported or conducted by a machine
Indications for Use
-Apnea or impending inability to
-Acute respiratory failure
-Severe hypoxia, and,
-Respiratory muscle fatigue

48
Q

Mechanical Ventilation: Types

A

Negative Pressure Ventilation
Positive Pressure Ventilation (PPV)

Non-Invasive (NPPV)
- Continuous positive airway pressure (CPAP)
-Bilevel positive airway pressure (BiPAP)
Invasive
-Spontaneous mode
-Control mode

49
Q

Non-Invasive (NPPV): CPAP

A

-One pressure setting that is set
-Keeps the airways & alveoli open during inspiration & expiration and prevents collapse

50
Q

Non-Invasive (NPPV): BiPAP

A

-Two pressure settings

Inspiratory (I-PAP): PCO2 levels
-Improves ventilation

Expiratory (E-PAP): PO2 levels
-Improves oxygenation

51
Q

Invasive (PPV)- Modes

A

-Respiratory therapists assume a key role in determining optimal ventilator settings

SPONTANEOUS
-The patient is able to determine the respiratory rate and the ventilator assists the patient

CONTROL
-The number of breaths, the size of the breaths, and the pressure generated are all controlled and preset

52
Q

Positive End-Expiratory Pressure (PEEP)

A

-a ventilatory setting in which positive pressure is applied to the airway during exhalation
-the major purpose of PEEP is to maintain or improve oxygenation while limiting risk for O2 toxicity
-the equivalent of E-PAP in non-invasive (NPPV)

53
Q

Acute Respiratory Distress Syndrome (ARDS)

A

-Sudden & progressive form of acute respiratory failure in which the alveolar-capillary membrane becomes damaged and more permeable by intravascular fluid

The alveoli fill with fluid, resulting in:
-severe dyspnea
-hypoxemia refractory to supplemental O2
-reduced lung compliance
-diffuse pulmonary infiltrates

Despite supportive therapy, the rate of mortality from ARDS is approximately 50%

54
Q

ARDS- Progression

A

Injury or Exudative Phase
-occurs 24-48 h
-interstitial and alveolar edema

Reparative or Proliferative Phase
-Begins 1-2 weeks later
-Lung is defined by dense, fibrous tissue

Fibrotic Phase
-Occurs 1 week after previous phase
-Lung is completely remodelled with diffuse scarring and fibrosis
-PROGNOSIS IS POOR at this stage

55
Q

ARDS PROGRESSION

A

-As ARDS progresses, it is associated with profound respiratory distress that necessitates endotracheal intubation and PPV
-Severe hypoxemia, hypercapnia, & metabolic acidosis, with symptoms of target organ or tissue hypoxia, may ensue if without prompt treatment
-The major cause of death in ARDS is MODS, often accompanied by sepsis

56
Q

ARDS Nursing Care

A

GOAL
PaO2 of at least 60 mmHg & adequate lung ventilation to maintain normal pH

CORRECT THE HYPOXEMIA
-Pts commonly need intubation with mechanical ventilation because the PaO2 cannot otherwise be maintained at acceptable levels

Positive End-Expiratory Pressure (PEEP)
-It is a ventilator setting
-Keeps alveoli open to maximize O2 exchange

Prone Position
-Demonstrated improvement in PaO2
-Changes the dynamic of ventilation

NUSC 2P14 (7 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions