Week 8 burns Flashcards
The 3 priorities in emergent stage
Airway- respiration
Circulation - Fluid status
Kidneys - dysuria/anuria
On a pathalogical level, what specifically makes HIV a problem?
It enters CD4+ T-cells and stops them from being a part of the immune response
What are the 4 ways HIV is transmitted?
- Blood
- Semen
- Vaginal secretions
- Breast milk
What CD4 level are HIV infections asymptomatic and can fight infection?
> 500
What are the characteristics of stage 1 HIV?
- acute stage
- CD4 count >500
- Maybe has viral symptoms
- short lasting
What are the characteristics of stage 2 HIV?
1.long stage (can last 10+ yrs untreated)
2. Few symptoms
3. CD4 count 200-499
What stage of HIV do we most commonly see in hospital?
Stage 2- early chronic stage
What are the characteristics of stage 3 HIV?
- late chronic infection
- CD4 count <200
- profound reduction in immunity
- susceptible to opportunistic infections and malignancies
What stage of HIV is considered AIDS and what is the CD4 count?
stage 3
<200 CD4
What stage of HIV is susceptible to opportunistic infections and malignancies?
Stage 3
What two interventions help when immune system is weakening in patients with HIV?
- prophylaxis - immunizations
- drug therapy for opportunistic diseases
What are the 6 opportunistic infections/diseases for someone with HIV?
- Oropharyngeal candidiasis
- Shingles
- Pneumonia
- Tuberculosis (TB)
5.Kaposi sarcoma - Cryptosporidiosis
What are the symptoms of PN?
fever
chills
productive cough
dyspnea
What is the treatment for PN?
Antibiotics (Septra)
What are the 3 things we can do/monitor for PN?
- resp assess
- DB & C
- supplimental O2
What are the symptoms of TB?
fatigue
malaise
anorexia
night sweats
weight loss
crackles
cough- blood sputum
What is the treatment for TB?
isonizaid/rifampin/pyrazinabmide
What are the things we monitor/do for someone with TB?
Airborn pecuations
Good hand washing
proper soiled tisse disposal
What are the symptoms of oropharyngeal candidas- thrush?
White patches/cottage cheese
pain
What is the treatment for oral thrush?
antifungal - Nystatin swish or swallow
what are 3 ways to prevent getting oropharayngeal candidiasis?
- Rinse mouth after liquid antibitotics
- use spacer for inhalers
- Good hand washing
- good oral hygiene
What are the symptoms of cryptosporidiosis? (parasitic infection)
Diarrhea
What are the precautions for TB?
airborne - negative air room
What is the treatment for cryptospoidiosis?
Anti-protozoals
What are 3 things nurses can do/monitor for cryptospoidiosis?
- Monitor I &O
- Electrolytes
- nutritional status
What are the symptoms of karposi sarcoma?
small, purplish-brown lesions on skin and mucous membranes
What is the treatment for karposi sarcoma?
chemo
immunothearpy
What do we teach people with karposi sarcoma?
- elevate limbs if swollen
- compression stockings
- protect skin - like if gardening
What is the symptom of shingles- varicella zoster virus?
painful rash along a nerve pathway (often around torso)
What is the treatment for shingles?
antiviral (acyclovir)
What can nurses do for someone with shingles-varicella zoster?
- Manage pain & Itching
- Educate about virus transmission when blisters burst
What are the 6 things nurses should teach someone who is immunocompromised?
- Adequate nutrition (good protein & calories)
- Adequate fluid intake- avoid dehydration
- Rest & manage fatigue - naps
- Infection control - contact, airborne, aerosol, etc
- Skin integrity - protection from infection
What are the 3 questions to answer for “Classification of burn?”
- what kind of burn?
- How extensive?
- How deep ?
What are the 3 “stages of a burn?”
- emergent
- acute
- rehabilitative
What are the 5 kinds of burn?
- Thermal
- Chemical
- Electrical
- Smoke-related
- Radiation
What is the most common type of burn?
Thermal burns
How do we measure “extent of burn?”
%
TBSA (total body surface area)
rule of 9’s (%)
What burn extent is considered a major burn?
partial or full thickness burn
>20% TBSA
How many stages (classification) are there of burn and what are they called?
1st degree - superficial partial thickness
2nd degree- deep partial thickness
3rd & 4th degree- full thickness
What stages can a person regenerate their skin when burned and what is the condition required for this?
Superficial partial thickness and deep partial thickness
IF there is some dermis left to regenerate
What stage burn is skin glossy, red, blisters/swelling?
Deep partial- thickness burn
what does Full thickness burn look like?
dry, dark skin
looks charred
no blisters
dermal layer is gone
Which type of burn does not have pain and why?
Full thickness burn b/c nerve endings are destroyed
What is escharotomy and why is it performed?
A cut through eschar tissue b/c of inflammation that causes compartment syndrome under the eschar
- circumferential burn (all the way a round a limb/torso)
When we talk about burns, what is the difference between “extent”,”kind” , and “classification” ?
kind = thermal, chemical etc. (cause)
Extent = TBSA % burned
classification - degree
How long is the emergent (resuscitation) phase of a burn?
24-48 hours
What is the goal during the emergent burn phase?
Save their life
What is the major problem in the emergent stage we are concered with?
capillary leak = fluid shifts
Leaks OUT of the vascular system so BP plummets = changes in vitals
How long is the acute stage of burn?
48-72 hours
What is the major problem in the acute stage we are concerned with?
Capillary leak stops = diuresis
- vital changes
- fluid overload (HF careful)
- lytes imbalance
How long is the rehabilitative phase of burn?
2 weeks up to 7-8 months
What is the major issue in rehabilitative burn?
Adjusting to living
What is important to observe around the face of someone in the emergent phase and why?
-Soot/smoke around their face.
-singed facial hair
Respiratory can still be compromised
What are 5 warning signs during emergent phase that there’s a change in resp.?
1.SOB
2. wheezing and/or stridor
3. voice change-hoarsness
4. drooling
5. swallowing difficulty
Do we assess circulatory system first or Airway first and why in emergent stage?
Airway. b/c you can have blood circulating well but if there’s no gas exchange, we have useless blood
what HR do we want to stay under in burns in emergent phase?
<120 bmp
what systolic BP do we want to stay under in burns during emergent stage?
> 90
during the emergent stage, will K+ be high or low and why?
High b/c of tissue damage
Put on heart monitor
during emergent stage, will Na be high or low?
Na will be low because water leaves the vascular system and Na follows
What are the priorities during the emergent stage?
- Airway
- fluid therapy
3 &4. Wound care & analgesia & immunization tetanus - infection
What type of AKI can happen in burns and why?
intrarenal AKI d/t rabdo because of the intense tissue damage in the body
What are the 2 goals of the acute stage of burn?
- fighting infection
- support wound healing (nutrition)
Why is nutrition important for someone in the acute phase of burn ?
because they are hypermetabolic
Which phase of burn can require multiple trips to the OR for debridement/grafting?
Acute phase
In what phase do we get the burn patient moving to avoid contracture?
Acute phase
What phase of burn is psychological care especially important?
Acute phase
What phase is pain management very important?
acute phase
What does acticoat have in it and how many days does it stay on?
Acticoat
has silver
Sterile water activates the silver and that kills broad spectrum of bacteria
3-7 days then change
What do nurses focus on in the acute stage of burn?
Wound care:
prevent infection
promote healing
Clean/debride
take care of donor site
What is Flamazine?
An anti-microbial cream that is sometimes used
What is the gold standard for burn dressing?
Acticoat
What two dressings are most used for burns?
- Acticoat
- Adaptic
What is debridement?
removing necrotic tissue
What are the 5 types of skin grafts?
- *autograft
- CEA (cultured epithelian grafts - slow, 8-12 weeks)
- artificial skin
- Allograft (human cadaver skin)
- Xenograft (animal)
What is used in the rehabilitation phase to help prevent lifting and scaring?
compression garment
What dressing are donor sites covered with?
Hydrophillic foam dressing after harvesting
What type of nutrition is required in the rehabilitation phase of burn?
normal diet as tolerated
How long should people keep their grafts out of the sun for?
at least the first year
What are the primary goals of rehabilitation phase?
- wound care as required
- functional support
What disease affects wound healing for those with burns?
Diabetes melitis
What disease affects fluid status for those with burns?
heart issues - fluid overload
What are the 5 things we do for frostbite?
- soak in lukewarm bath slowly
- Analgesics
- Elevate affected limb - b/c inflammation
- monitor for compartment syndrome
- Antibiotics - if infection/tetanus shot
What 2 things do we not do for frost bite?
- do not rub the skin
- no heavy blankets or hot water
What is demarcate?
the end of healthy tissue and the beginning of dead tissue
What is sepsis?
An extreme response to infection that can cause tissue damage, organ failure and death if not treated quickly
What can sepsis lead to if not treated quickly?
septic shock
What are the possible signs of sepsis?
low O2
Fast RR
dysuria/anuria
cognition and affect changes
Fever
signs of infection
BP drops b/c fluid shifts out of cells = lack of tissue perfusion = shut down
Who are 5 patients at high risk for septic shock?
- Immunocompromised
- Large open wound- burns
- Invasive procedures- burns
- Age over 80
- Chronic illness
what is the MAIN problem in septic shock?
Low perfusion = organ ischemia = organ shut down
What are early signs of septic shock?
Elevated HR, decreased BP
Skin warm and flushed – body is trying to compensate by increasing CO
Restless, confused
What are the late signs of septic shock?
Cold, clammy
Mottled- purple dusky colour
Bradycardia and decreased BP
Lactate increase (anaerobic metabolism that kidneys can’t deal with) = acidosis
Anuria = no urine output
What are the 5 things we do for someone in septic shock in the first hour?
1.Measure Lactate level
2.Obtain blood cultures
3.Administer broad-spectrum antibiotics
4. Rapid administration of IV crystalloid fluid for hypotension
5. Vasopressor if blood pressure low after fluid resuscitation
