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Nursing 283 > Week 4 Burns > Flashcards

Week 4 Burns Flashcards

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1
Q

Problems resulting from burns

A

fluid and protein loss, changes in metabolic, endocrine, respiratory, cardiac, hematologic and immune function

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2
Q

Healing of burns to the epidermis

A

Can grow back
epidermal cells surrounding sweat and oil glands and hair follicles extend into dermal tissue and regrow to heal partial thickness wounds

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3
Q

Does the epidermis have blood vessels?

A

no

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4
Q

What is found in the dermis?

A

blood vessels, sensory nerves, hair follicles, lymph vessels, sebaceous glands, and sweat glands

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5
Q

Healing of burns to the dermis

A

if any more than the first 3rd is burned, the skin can no longer restore itself

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6
Q

Temperature skin can tolerate without injury

A

104

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7
Q

Temperatures above what cause rapid cell destruction

A

158

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8
Q

Superficial burn description

A

Pink to red, mild edema, painful, no blisters, no eschar, 3-6 day healing time, ex- sunburn

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9
Q

Superficial partial thickness burn description

A

pink to red color, mild to mod edema, painful, blisters present, no eschar, 2 week healing time, ex- scalds, flames

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10
Q

Deep partial thickness burn description

A

Red to white color, mod edema, painful, blisters unlikely, soft dry eschar, 2-6 week healing time, possible grafts, ex- flame, grease, and chemicals

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11
Q

Full thickness burn description

A

Black, brown, yellow, red or white color, severe edema, intermittent pain, no blisters, hard and inelastic eschar, weeks to months to heal, requires grafts, ex- flame, tar, grease, electricity

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12
Q

Deep full thickness burn description

A

Black color, no edema, no pain, no blisters, hard and inelastic eschar, weeks to months healing requiring grafts, ex- flame, electricity, grease, chemicals

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13
Q

Fluid shift occurring with burns

A

3rd spacing occurs in the first 12 hours until 24-36 hours

Imbalances in fluids, electrolytes and acid-base

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14
Q

Hemoconcentration in burns

A

elevated blood osmolarity, hematocrit, and hemoglobin from vascular dehydration and increases blood viscosity

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15
Q

Fluid remobilization

A

begins 24 hours after injury (when fluid shift stops) diuresis increases to remove excess fluid and edema subsides

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16
Q

Cardiac Changes Resulting from Burn Injury

A

Initially HR increases and CO decreases because of the initial fluid shifts and hypovolemia

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17
Q

Burns and GI changes

A

decreased motility and blood flow, peristalsis/paralytic ileus, ulcer development

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18
Q

Prevention of ulcer development after a burn

A

give H2 blockers or PPI’s early

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19
Q

Inflammatory compensation after a burn

A

can trigger healing
causes problems with fluid shift
helpful in the short term

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20
Q

Sympathetic nervous system response to burns

A

Stress response: increased thirst, HR and RR, catecholamine, aldosterone and metabolic rate, slowed GI motility, release of glycogen stores, fluid retention, vasoconstriction, decreased urine and hematocrit positive stools.

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21
Q

Factors that increase death from burns

A

age over 60
over 40% TBSA burned
inhalation injury

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22
Q

Factors that improve outcome from burns

A

vigorous fluids, early wound excision, improved critical care monitoring, early enteral nutrition, antibiotics, and the use of burn centers

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23
Q

Resuscitation/ emergent phase

A

occurs after injury until 24-48 hours

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24
Q

Priority care in the resuscitation/ emergent phase

A

Airway, circulation (fluid replacement), comfort with analgesics, prevent infection, maintain body temp and provide emotional support.

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25
Q

General management for all burns

A

Assess airway, Administer O2, Cover with a blanket, Keep NPO, Elevate extremities, Obtain VS, IV access, and begin fluid replacement, Administer tetanus for prophylaxis, Perform a head-to-toe assessment.

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26
Q

Electrical Burns Management

A

Smother any flames, Initiate CPR, and Obtain an ECG

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27
Q

Signs of pulmonary injury

A

hoarseness, brassy cough, drool or difficulty swallowing, audible wheezes or stridor on exhalation

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28
Q

Cardiovascular assessment in burns

A

Monitor edema, measure central and peripheral pulses, BP, cap refill, and pulse ox

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29
Q

Rate of fluid resuscitation

A

whatever rate is needed to have urine output greater than 30-50 ml/hour

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30
Q

S/Sx of paralytic ileus

A

nausea, vomiting, and abdominal distention

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31
Q

Hemoglobin normal and what is expected after a burn

A

12-16g/dL (women) 14-18g/dL (men) Elevated as a result of fluid volume loss

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32
Q

Hematocrit normal and what is expected after a burn

A

37%-47% (women) 42%-52% (men) Elevated as a result of fluid volume loss

33
Q

BUN normal and what is expected after a burn

A

10-20mg/dL Elevated as a result of fluid volume loss

34
Q

Glucose normal and what is expected after a burn

A

70-105mg/dL Elevated as a result of the stress response and altered uptake across injured tissues

35
Q

Na+ normal and what is expected after a burn

A

136-145mEq/L Decreased; sodium is trapped in edema fluid and lost through plasma leakage

36
Q

K+ normal and what is expected after a burn

A

3.5-5.0mEq/L Elevated due to disruption of the sodium-potassium pump, tissue destruction, and RBC hemolysis

37
Q

Cl- normal and what is expected after a burn

A

98-106mEq/L Elevated as a result of fluid volume loss and reabsorption of chloride in urine

38
Q

PaO2 normal and what is expected after a burn

A

80-100mmHg Slightly decreased

39
Q

PaCO2 normal and what is expected after a burn

A

35-45mmHg Slightly increased from respiratory injury

40
Q

pH normal and what is expected after a burn

A

7.35-7.45 Low as a result of metabolic acidosis

41
Q

Carboxyhemoglobin normal and what is expected after a burn

A

0%-10% Elevated as a result of inhalation of smoke and carbon monoxide

42
Q

Total protein normal and what is expected after a burn

A

6.4-8.3g/dL Low; protein exudate is lost through the wound

43
Q

Albumin normal and what is expected after a burn

A

3.5-5.0g/dL Low; protein is lost through the wound and through vascular membranes because of increased permeability

44
Q

The priority problems in the resuscitation/ emergent phase for Pts with burns greater than 25% of the TBSA

A 
Potential for inadequate oxygenation 
Hypovolemic shock 
Potential for organ ischemia 
Pain 
Potential for ARDS
45
Q

When does upper airway edema become pronounced?

A

8-12 hours after fluid recuscitation

Vigorous suctioning is performed after chest physiotherapy and aerosol treatments

46
Q

Ways to monitor for gas exchange

A

ABGs, assessing for cyanosis, disorientation, and increased HR

47
Q

Priority intervention for b. Preventing Hypovolemic Shock and Inadequate Oxygenation

A

Rapid infusion of IV fluids (fluid resuscitation)

48
Q

Best practices for fluid resuscitation

A

Administer one half of the total 24-hour prescribed volume within the first 8 hours post burn and the remaining volume over the next 16 hours, monitor VS, urine and fluid status hourly

49
Q

Acute phase of burn injury time frame

A

36-48 hours until wounds are closed, begins when diuresis is noted

50
Q

Leading cause of death during acute phase of resocery

A

infection

51
Q

Priority problems for patients with burn injuries greater than 25% TBSA in the acute phase of recovery

A 
Wound care management 
Potential for infection 
Excessive weight loss 
Reduced mobility 
Reduced self-image
52
Q

Nursing interventions for maintaining patient mobility

A

neutral body position to prevent contractures, ROM 3x daily, ambulation, pressure dressings

53
Q

Opioid administration during the resuscitation phase

A

IV only

54
Q

Burn % of severe burns

A

over 20% TBSA

55
Q

Poisonous bi-product of burning material

A

carbon monoxide

56
Q

Healing time of superficial partial thickness burn

A

1-3 weeks

57
Q

Chief characteristics of superficial partial thickness burn

A

blister formation

epidermis is gone and the upper third of the dermis is gone

58
Q

Deep partial thickness burn and hypoxia

A

wound can progress to a full thickness

59
Q

Deep partial thickness burn healing time

A

1-3 months

60
Q

Zone of hyperemia

A

least damaged area of the burn, heals in 3-5 days

61
Q

Zone of stasis

A

where tissue perfusion is compromised, vasoconstriction and thrombosis with lots of debris, can regenerate with tx

62
Q

Zone of coagulation

A

permanent burn injury with cell death

63
Q

Burn criteria for going to a burn center

A

Partial thickness burns >= 20% TBSA in patients 10 - 50 years old or >=10% TBSA in children < 10 or adults > 50
Full-thickness burns >= 5% TBSA in any age.
Patients with partial or full-thickness burns of the hands, feet, face, eyes, ears, perineum, and/or major joints
Electrical, chemical, inhalation, trauma, co-morbid illnesses

64
Q

Body temperature after a burn injury

A

often develop a low grade fever, if the fever is high, an infection may be present (hypothalamus regulates temp and is not working well)

65
Q

Immune response to burn

A

severe causes bone marrow suppression, shorter RBC lifespan, decreased/ ineffective WBC production

66
Q

Rehabilitative phase of burn injury

A

begins after wound closure and can last a lifetime

67
Q

Pulmonary fluid overload/ pulmonary edema

A

can occur even if no damage to lungs occurred due to histamine release and inflammatory response, can also be from over hydrating by IV

68
Q

Vasoconstriction after a burn

A

occurs initially, body is trying to shunt blood from burned area and there is no blood there, may lead to vessel thrombosis (causing ischemia)

69
Q

Vasodilation after a burn

A

occurs after vasoconstriction, leads to capillary leak/ 3rd spacing

70
Q

How to manage hyperkalemia

A

give fluids so kidneys will get rid of it, kayexalate, or insulin + dextrose 50%

71
Q

Common cause of death to burn patients in the emergent phase

A

shock, need to keep circulating blood volume up

72
Q

During the initial stage of burns, where does the primary fluid imbalance/ shift occur?

A

from the plasma to the interstitial space

73
Q

How do we know if fluid resuscitation is working?

A

Urine output is #1

BP is #2

74
Q

Myoglobin release

A

released from damaged muscle, it can circulate to the kidneys and clog them

75
Q

Background burn pain

A

pain from the actual burn and damage to your body

76
Q

Why does hyponatremia develop in burn patients?

A

Displacement of sodium in edema fluids and loss through denuded areas of skin

77
Q

How often are wound dressings changed?

A

cleaned and dressed daily or more frequently depending on the amount of exudate or weeping or if they have an infection (with infection, it’s 2x a day)

78
Q

Most common surgical management for burn injury

A

skin grafting

79
Q

How to calculate how much fluid to give

A

wt in kg x TBSA % burned

Nursing 283 (10 decks)

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