Week 11 TUES Flashcards
Adult Burns
During acute phase of a burn, a nurse should assess:
circulatory status
Which type of burn is similar to a sunburn
superficial partial thickness burn
Common complication of an electrical burn injury
cardiac dysrhythmias
Type of shock that is common w/ extensive burns
hypovolemic shock
What fluids are preferred w/ burns
lactated ringers
Burns due to an extreme external heat source (flame, scald, contact)
thermal burns
burns due to prolonged exposure to ultravoilet rays of the sun or other sources of radiation such as x-ray
radiation burn
Burns due to strong acids, alkalis, detergents or solvents
chemical burns
Burns from electrical current, either alternating or direct
electrical burns
occur when skin is exposed to freezing temperatures and the tissue is damaged
extreme cold burn
Prognosis variables for burn mortality
- age
- size and depth of burn
- inhalation injury
- other trauma
How to stop the burning process
- dry sheets
- warm blanket over dressings
Airway considerations for burn pts
- be aware of edema
- s/s of impending disaster; singed nasal hair, blistering about the mouth, soot on tongue or in pharynx, wheezing, carbonaceous sputum, hoarse voice, difficulty swallowing, labored respirations, restlessness, confusion, combative behavior
- Intubate> endotracheal tube only> if pt O2 drops, pt unconscious,flame/ smoke inhalation
- edema> fluid resuscitation> more swelling can be caused
- Carbon monoxide inhalation> treatment 100% oxygen
breathing for burn patients
I- nhalation of hydrogen cyanide> results from burning synthetic fibers, plastics, polymers, wool & silk
- Suspected w/ structure fires, cardiac dysfunction, decreased LOC
- Shuts down cellular ATP production (higher lactate levels)> can’t use oxygen in tissues ( high venous O2) > causes hyperglycemia
- Treatment: cyanokit; may repeat dose once, may turn urine red
- Cuts in chest wall if chest and back are burned to help the chest (lungs)move up and down with each breath
- Treatment of smoke inhalation; supportive resp care, avoid antibiotics, avoid steroids(increases mortality)
circulation for burn patients
- If no pulse, check for other causes > no pulse is NOT from the burns!!
- Fix why they don’t have a pulse!
- Do CPR, maintain spinal stability
IV
-Get access ASAP, large bore IVs better in field and unitil pt can get central line
-“1 in field, 2 in ED”
Fluids
-Crystalloid fluid is recommended for burns
LR or NS
-NS is fine for transport, LR is better overall
- <5y.o. 125ml/hr, 6-13y.o. 250ml/hr, >14y.o. 500ml/hr
disability for burn patients
AVPU> Alert, voice, pain, unresponsive
Burns alone will NOT cause disability
expose for burn patients
- Remove all clothing and jewelry
- Protect from hypothermia
- Warm blankets or warming lights
- rm temp 90-95 degrees
- Avoid prolonged use of wet dressing - warmed fluids
- Uncovers for short amounts of time - look for additional injuries
fluid resuscitation for burn patients
ONLY for adults >20% BSAB, ONLY for children >15% BSAB
- Estimate burn size and depth
- Calculate IV fluid resuscitation needs> DON’T calculate 1st degree!! ONLY 2nd & 3rd degree
- Nurse driven resuscitation protocol;
- Start w/ the adjusted fluid rate, nurses will adjust Q1hr
- Avoid bolus of crystalloid fluids, colloids earlier
- Accept lower range for UO (0.3-0.5), if UO falls below increase fluids, if UO falls higher decrease fluids
- Standardize vasoactive Rx> vasopressin protocol
Why should we fluid resuscitate burn patients
- Burn shock is both hypovolemic and cellular
- Increase in total body capillary permeability
- Primary goal is to preserve and restore tissue perfusion to prevent ischemia
burn that affects the epidermis
first degree burn
burn that Affects the epidermis and parts of the dermis
superficial second degree burn
burn that affects the epidermis and all of the dermis
deep second degree burn
Damages all layers of the skin and go into the fat and muscle tissue
full-thickness burn
what degree burns do you calculate iv fluid resuscitation for
2nd and 3rd
