Week 11 TUES

Question 1

During acute phase of a burn, a nurse should assess:

Answer 1

circulatory status

Question 2

Which type of burn is similar to a sunburn

Answer 2

superficial partial thickness burn

Question 3

Common complication of an electrical burn injury

Answer 3

cardiac dysrhythmias

Question 4

Type of shock that is common w/ extensive burns

Answer 4

hypovolemic shock

Question 5

What fluids are preferred w/ burns

Answer 5

lactated ringers

Question 6

Burns due to an extreme external heat source (flame, scald, contact)

Answer 6

thermal burns

Question 7

burns due to prolonged exposure to ultravoilet rays of the sun or other sources of radiation such as x-ray

Answer 7

radiation burn

Question 8

Burns due to strong acids, alkalis, detergents or solvents

Answer 8

chemical burns

Question 9

Burns from electrical current, either alternating or direct

Answer 9

electrical burns

Question 10

occur when skin is exposed to freezing temperatures and the tissue is damaged

Answer 10

extreme cold burn

Question 11

Prognosis variables for burn mortality

Answer 11

• age
• size and depth of burn
• inhalation injury
• other trauma

Question 12

How to stop the burning process

Answer 12

• dry sheets
• warm blanket over dressings

Question 13

Airway considerations for burn pts

Answer 13

• 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

Question 14

breathing for burn patients

Answer 14

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)

Question 15

circulation for burn patients

Answer 15

• 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

Question 16

disability for burn patients

Answer 16

AVPU> Alert, voice, pain, unresponsive
Burns alone will NOT cause disability

Question 17

expose for burn patients

Answer 17

• 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

Question 18

fluid resuscitation for burn patients

Answer 18

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

Question 19

Why should we fluid resuscitate burn patients

Answer 19

• 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

Question 20

burn that affects the epidermis

Answer 20

first degree burn

Question 21

burn that Affects the epidermis and parts of the dermis

Answer 21

superficial second degree burn

Question 22

burn that affects the epidermis and all of the dermis

Answer 22

deep second degree burn

Question 23

Damages all layers of the skin and go into the fat and muscle tissue

Answer 23

full-thickness burn

Question 24

what degree burns do you calculate iv fluid resuscitation for

Answer 24

2nd and 3rd