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N362: Practice of Nursing III > Week 7 - Burns > Flashcards

Week 7 - Burns Flashcards

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1
Q

___ are known to be one of the most complex traumas

A

Burns

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2
Q

Why are burns often the most complex traumas

A

they usually involve multiple systemic trauma (psychosociophysio)

the mechanism of injury is also varied: it can be thermal, radioactive, electrical, chemical, and a mixture of mechanisms

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3
Q

Where do most burns occur

A

in the home

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4
Q

Which people are more likely to get burn injuries

A

young children

older adults

disabled patients

men > women

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5
Q

Layers of skin from superficial to deepest

A
  1. Epidermis
  2. Dermis
  3. Subcutaneous Tissue
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6
Q

In what ways does the body use the skin

A

as a protective barrier from outside elements

helps with thermoregulation

gives us our good looks and recognition

helps with vitamin D synthesis

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7
Q

Epidermis

A

most superficial layer of skin

contains cells that produce pigment and protect the immune system

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8
Q

Dermis

A

second most superficial layer of skin and the largest

contains nerve endings, oil and sweat glands, and hair follicles

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9
Q

Subcutaneous Tissue

A

deepest layer of skin

made up of fat, connective tissue, and larger blood vessels

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10
Q

What is some education nurses can provide to prevent burns

A

information on:

sun exposure

supervising children

smoke and carbon monoxide detectors

water heat temperature checks

smoking in bed

curling irons

running cords under rugs

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11
Q

Burns are ____

A

preventable!

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12
Q

Nursing Goals Related to Burns

A
  1. PREVENTION
  2. Lifesaving measures for the severely burned person
  3. Prevention of disability and disfigurement through early specialized care - really impacts physical self
  4. Rehabilitation through reconstructive surgery and programs - prevent contractures and ability to move muscles
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13
Q

First Degree Burns

A

superficial injuries that often involve the outermost layer of the skin (Epidermis)

ex: Sunburn

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14
Q

Second Degree Burns

A

involve the entire epidermis and portions of the dermis

painful with blisters

can be felt and most painful feeling burn

a deep 2nd degree hurts more than a 2nd superficial

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15
Q

Third Degree Burn

A

full thickness

destruction of the epidermis, dermis, and underlying tissue - lack of sensation occurs

cannot be felt

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16
Q

Fourth Degree Burn

A

Full thickness

deep burn necrosis - extends into deep tissue, muscle, and bone

cannot be felt

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17
Q

TBSA

A

Total Body Surface Area

Methods of estimation on how much of the body has been burned

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18
Q

Rule of Nines

A

the most common method of estimating total body surface area

based on anatomic regions split into percentages based on if you are a child or an adult

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19
Q

What are the percentages of the anatomic regions for a child in the rule of nines

A

18% head
18% front
18% back
14% left leg
14% right leg
9% left arm
9% right arm

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20
Q

What are the percentages of the anatomic regions for an adult in the rule of nines

A

9 % head
1% neck
18% front
18% back
18% left leg
18% right leg
9% left arm
9% right arm

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21
Q

What is the Palmer Method & Lund and Browder Method

A

two alternative measures for estimating TBSA like the rule of nines

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22
Q

A burn of ___% or more becomes a systemic problem and are considered major burns

A

30%

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23
Q

What is the systemic response to a major burn like

A

Burn of 30%+ –> release of cytokines and other mediators into systemic circulation –> Fluid shifting and shock states –> Potential hypoperfusion and organ hypofunction

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24
Q

What sort of secondary injuries and issues can occur from major burns (30%+)

A

fluid and electrolyte shifts

cardiovascular effects

pulmonary injury: upper and lower airway, CO poisoning, restrictive defects

Renal and GI alterations

Immunologic alterations

Effect on thermoregulation

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25
Q

What are the phases of burn injury

A
  1. Emergent or Resuscitative Phase
  2. Acute or Intermediate Phase
  3. Rehabilitation Phase
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26
Q

What is the time period for emergent or resuscitative phase of burn injury

A

onset of injury to completion of fluid resuscitation (since they are risk for hypovolemia)

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27
Q

What is the time period for the acute or intermediate phase of a burn injury

A

from the beginning of diuresis until wound closure

28
Q

What is the time period for the rehabilitation phase of burn injury

A

from wound closure to return to optimal physical and psychosocial adjustment (think of the psychological and skin graft self concept effects)

29
Q

What on the scene care is done during the emergent or resuscitative phase of a burn injury

A

prevent injury to rescuer - gotta help yourself before helping others

stop the injury: extinguish flames, cool the burn, irrigate chemical burns

ABCs: Establish airway breathing and circulation

Start O2 and large bore IV fluids

Remove restrictive objects (since people swell with burns) and cover the wound

Do assessment surveying all body systems and obtain a hx of the incident and pertinent patient

30
Q

What is important to keep in mind with on the scene burn care if the patient may have fallen or had an electrical injury

A

to treat them as potential cervical spine injuries/patients

31
Q

What care is done during the emergent or resuscitative phase

A

pt moved to ED

fluid resuscitation begins

foley catheter inserted

NG tube if indicated for suction

pt stabilized and condition continually monitored

ECG

address pain

psychosocial considerations and emotional support give to patient and family

32
Q

Patients with burns exceeding what percentage should have an NG tube inserted and placed to suction

A

20-25%

33
Q

Patients with electrical burns need to have a ____

A

ECG

34
Q

When addressing pain for an emergent or resuscitative phase burn, only give meds how?

A

Via IV Administration

35
Q

Acute or Intermediate Phase of burn injuries occurs ___ to ___ hours after injury

A

48-72 hours after injury

36
Q

Management in the Acute or Intermediate Phase

A

continue assessment, maintain resp and circ support, fluid and electrolyte balance, GI and renal function

Prevent infection

Burn wound care, pain management, modulation of hypermetabolic response

Early positioning and mobility

Watch for hypovolemia

37
Q

____ is begun at all stages of burn injuries technically

A

rehabilitation

38
Q

What is the focus and management like in the Rehabilitation Phase of Burn Injuries

A

Focus is on wound healing, psychological support, self image, lifestyle, and restoring maximal functional abilities

Patient may need reconstructive surgery to improve fxn and appearance

Vocational, psychological counseling, and support groups may assist the patient

Include family as indicated

39
Q

What nursing interventions of the burn patient are done in the acute phase

A

Restoring fluid balance

preventing infection

modulating hypermetabolism

promoting skin integrity

relieving pain and discomfort

promoting mobility

strengthening coping strategies

40
Q

What nursing interventions are done for the burn patient in the intermediate and rehabilitation phases

A

strengthening coping strategies

support patient and family processes

monitoring and managing complications

41
Q

T/F: Breathing must be assessed and a patent airway established immediately during the initial minutes of emergency burn care?

A

True - think of the ABCs

42
Q

Why is fluid resuscitation so important in burn patients

A

Fluid shifts occur from intravascular to interstitial d/t the inflammatory response

move from cells to other body parts and fluid loss occurs causing general dehydration s/s intracellularly

fluid also evaporates from a burn injury

43
Q

Management of Fluids / Fluid Replacement is required in adults with burns greater than ___%; in children with burns greater than ___%; and any burn in ages less than ___ or greater than ___

A

adults - 20%

children 10%

in any burn less than 2 yo or greater than 60 yo

44
Q

Fluid replacement goals for adult burns include a BP of what? A pulse of what? and urinary output of what?

A

BP >100 systolic

Pulse <110

UO >30 cc/hr adults

45
Q

What is usually the basis for the formula for fluid replacement with burns

A

TBSA (total body surface area)

46
Q

How fast are fluids usually instilled for burn fluid resuscitation

A

50% of the fluids are given in the first 8 hours - since most fluid lost, shifts, and evaporation occur then

the next 50% of fluids are given in the 16 hours following that (25% given in first half of the 16 and 25% given in second half)

47
Q

What may be used for fluid resuscitation of a burn victim

A

Usually its an isotonic solution like lactated ringers solution

May replace PRBCs with blood loss so blood transfusion potential exists

48
Q

Other Criteria for Adequate Fluid Resuscitation

A

appropriate sensorium

appropriate BP and pulse

relief of nausea and ileus after 24 hours

49
Q

Signs and Symptoms of Fluid Loss/Burn Shock

A

decreased BP

decreased LOC

decreased UO

Increased pulse

Increased Hct

edema at burn site

Na deficit

K excess (cell destruction)

Metabolic acidosis

50
Q

Management of Shock - Fluid Resuscitation

A

maintain a BP of greater than 100 sys and UO of 30-50 mL/hr

Maintain serum sodium at near normal levels

Pick your fluid based on several formulas like consensus, evans, brooke army, parkland baxter, hypertonic saline formulas

51
Q

What are some s/s of the fluid and electrolyte shifts occurring in the burn emergent phase

A

generalized dehydration

reduced blood volume and hemoconcentration

decreased UO

trauma causes release of K into extracellular fluid - Hyperkalemia

sodium trapping in edema fluid and shifts into cells as K is released - Hyponatremia

Metabolic Acidosis

52
Q

S/S of fluid and electrolyte shifts in the acute/intermediate phase

A

fluid re enters the vascular space from the interstitial space

hemodilution

increased UO

Na loss with diuresis and due to dilution as fluid enters vascular space - Hyponatremia still

K shifts from extracellular fluid into cells - Potential Hypokalemia

Metabolic Acidosis

53
Q

Formulas are only a guide for burn care fluid resuscitation. How often must the patient’s response to fluid therapy (HR, BP, UO) be evaluated?

A

At least hourly

54
Q

What is involved in burn wound care

A
  1. Wound cleaning with hydrotherapy, antibacterial products, and wash solutions
  2. Use of numerous topical agents - very common - antibacterial creams for example
  3. Wound debridement: autolytic, mechanical, surgical
  4. Wound dressing, dressing changes, and skin grafting / monitoring
55
Q

What is considered one of the most severe forms of acute pain

A

Burn pain

56
Q

Pain for burn injuries occurs when else other than just with the burn itself

A

pain accompanies care and treatments such as wound cleaning and dressing changes

57
Q

Types of Burn Pain

A

Background or Resting Pain

Procedural Pain

Breakthrough Pain

58
Q

One of the hardest areas of burn wound care is

A

Managing the pain - it is hard to have under control

59
Q

Methods of Pain management in burn victims

A

Analgesics - IV during emergent/acute phases, Morphine, Fentanyl, Other Drugs

Role of Anxiety in Pain - Relieve Anxiety

Effect of Sleep Deprivation on Pain - Promote sleep + environment

Nonpharmacologic Measures

60
Q

What is important to know about nutrition and burns

A

Burn injuries produce profound metabolic abnormalities

Patients with burns have great nutritional needs related to stress response, hypometabolism, and for wound healing

61
Q

The goal of nutritional support for burn patients is what

A

to promote a state of nitrogen balance and match nutrient utilization

62
Q

Nutritional support of burn patients is based on what

A

patient pre burn status AND % of TBSA burned

63
Q

What is the preferred route of nutritional support for burn patients?

A

Enteral route; A jejunal feeding is often used to maintain nutritional status with a lower risk of aspiration in a patient with poor appetite, weakness, or other problems

64
Q

What is some important aspects of home care management of the burn patient once they return home

A

mental health

skin and wound care

exercise and activity

nutrition

pain management

sexual issues

pulmonary care

psychological support of patient and family

patient and family education

restoration of function

thermoregulation and clothing

(VERY HOLISTIC APPROACH WHEN CARING IN THE HOME)

65
Q

What is the recommended fluid resucitation amount for children

A

6 mL/kg/% burned

N362: Practice of Nursing III (15 decks)

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