Unit 3: Burns Flashcards
1
Q
Where are Patients with burns managed?
A
- optimally at burn centers; advantage of providers skilled in the specialized tx for burn injuries
- d/t limited number of burn centers, they receive their care at local hospitals prior to transfer to a specialized burn center
2
Q
American Burn Association’s Burn Center Referral Criteria
A
- partial-thickness burns equal to or greater than 10% of the total body surface area
- burns that involve the face, hands, feet, genitals, perineum, or major joints
- full-thickness burns in any age group
- electrical injury, including lightning injury
- chemical injury
- inhalation injury
- burn injury in patients with pre-existing medical conditions that may complicate management, prolong recovery, or affect mortality
- any patients w/ burns and concomitant trauma (e.g. fractures) in which the burn injury poses the greatest risk if morbidity and mortality; in these cases, if the trauma poses the greater immediate risk, the patients condition may be stabilized initially in a trauma center before transfer to a burn center; provider judgement
- burned children in hospitals w/o qualified personnel or equipment for the care of children
- burn injury in patients who require special social, emotional, or rehabilitative interventions
3
Q
Risks for Burn Injuries
A
- Fires (structural, outdoor, vehicle)
- people with limited physical and mental abilities at a higher risk of fire death
- the lower- socioeconomic groups have highest risk of fire injury
4
Q
Most commonly reported reasons for burn injury
A
- fire/flame
- scald injuries
5
Q
Burn Prevention Inside the Home
A
- Install and maintain working smoke alarms on each level of the home and inside each sleeping area; each month, check that they are working, and change the batteries q 6 months unless the alarm is hardwired into the home or has a 10-year lithium battery
- Install and maintain working carbon monoxide detectors on each level of the home
- Develop and practice a home fire escape plan; make sure everyone in the home knows the meeting place and knows never to return into a burning home for any reason
- keep all windows and doorways free of clutter in case of the need to escape quickly
- keep telephone and flashlight near the bedside
- keep a working fire extinguisher on each level of the home; know how to use properly
- never set water heater above 120 degrees F
- teach children stop, drop, and roll
- keep matches and lighters out of reach of children
- never leave a child unattended in a bathtub or near fire/fireplace
- never smoke in bed or while drowsy
- never smoke while receiving oxygen therapy
- never leave burning candles unattended; try not to burn candles on low surfaces for risk of being knocked or bumped
- caution while cooking; do not leave anything unattended on the stove
- avoid long sleeves or flowing clothing while cooking
- never let a child play near the stove/oven while cooking; always turn pot handles inward and use the rear burners
- never use a kitchen oven as a means to heat the home
- avoid running electrical cords under carpets
- avoid using space heaters in the bedroom or while asleep
- while a space heater is in use, should be a minimum of 3 feet of clearance around the heater in all directions
- avoid falling asleep while using a heating pad
- be sure to use proper protection and ventilation while working with chemicals in the home, including cleaning products; read all product labels before use
- never store flammable liquids inside the home or near a source of heat
6
Q
Burn Prevention Outside the Home
A
- always store flammable liquids outside the home in clearly labeled, airtight containers in well ventilated areas (garage or shed)
- never refill a hot engine (i.e. lawnmower or weedwhacker); wait until thoroughly cooled before refilling w/ gasoline
- never use flammable liquid to start a campfire or grill
- never throw flammable liquids onto an already burning fire
- use caution w/ campfires; do not leave children unattended
- fireworks should be used only by adults and w/ caution
- be careful of overhead and underground electrical wires while working outside
- if downed electrical wires are found, do not touch!; call local electric company to report immediately
- caution children never to play near or on electrical boxes or climb trees w/ electrical wires passing through the branches
- always use sunscreen w/ SPF of at least 30 when outdoors; reapply often; consider wide-brimmed hat and sunglasses
7
Q
How are Burns Classified?
A
in terms of:
- etiology
- depth of tissue damage
- total body surface area (TBSA) involved
- severity
8
Q
Burn Etiology
A
a burn injury results when the tissues of the body are damaged by a heat source
-Heat source: Thermal, Electrical, Chemical, Radiation
9
Q
Heat Sources of Burns
A
- Thermal
- Electrical
- Chemical
- Radiation
10
Q
Thermal Burns
A
- a result of flash, scald, or contact with hot objects or flames
- common causes: house fires, car fires, cooking accidents, or injuries of careless smoking
- associated accelerant use (gasoline, kerosene, or propane) may increase the severity of the burn and associated inhalation injury b/c this adds a chemical insult in addition to the thermal injury
- contact burns also thermal in nature; associated w/ cooking or heating incidents
- scald injuries prevalent among the young; associated w/ accidents or abuse
- factors to determine depth of thermal injury: temperature to which the skin is heated and duration of contact w/ the heat
11
Q
Electrical Injuries
A
- result of work-related accidents, such as gas and electric workers injured while working on breaker boxes or overhead power lines
- electrical injuries can be linked to other types of ensuing trauma d/t subsequent falls and potential cardiac injury
- as electricity passes through the body, it has the potential to cause damage to multiple organs, which then must also be addressed and treated in conjunction w any burns that have occurred
- can also be associated w/ extensive burns that may require amputation
- may present w/ cardiac and/or neurological problems as well ass associated trauma and/or flame burns
- may occur by direct contact w/ the source, by an arc between two objects, or as a result of flame injury caused by ignition of the surroundings
- effects of electricity on the body depend on certain factors; type and strength of the current, duration of contact, the pathway of flow through the body, and local tissue resistance
- when a person comes in contact with alternating current, the body becomes part of the circuit
12
Q
When a person comes in contact w/ alternating current
A
- the body becomes part of the circuit
- in alternating current, the movement of an electrical charge sporadically changes direction, creating a tetany effect, or involuntary state of muscle contraction that interferes with the person’s ability to easily break free from the source
- this muscle contraction enables the electric current to flow continuously back and forth between the person and the source, which may either throw the person or draw the person into continual contact w/ the source; as a result, the current may pass through the body for a greater period of time, exacerbating the severity of associated injury
13
Q
Direct Current
A
- one-directional constant flow of electricity
- direct current injuries occur from lightning strikes, contact with car or boat batteries, and contact w/ railway train lines
- electrical current disrupts the electrical activity of the body and may result in immediate cardiac and/or pulmonary arrest on scene
14
Q
High-Voltage Injuries
A
- occurs when a person comes into contact w/ 1,000 volts or greater
- often work-related; common in men
- patients who sustain high-voltage injuries often present w/ very deep burns and sequela from associated trauma
- flash injuries and/or flame burns may also occur as a result of possible ignition of clothing
15
Q
What are the most frequently injured sites for low-voltage electrical injuries in children?
A
- the hands and mouth
- d/t oral contact w/ electrical cords or sockets
16
Q
Chemical Burns
A
- 3 subclasses: acids, alkalines, and organic compounds
- ex: those caused by cement, gasoline, lime, hydrofluoric acid, and bleach
- extent of injury dependent on: the chemical agent, the mechanism of action, the concentration and volume of the agent, and duration of contact w/ the agent
17
Q
Radiation Burns
A
- least common type
- complications dependent on type, dose, and length of exposure
- often associated w/ the industrial use of ionizing radiation, nuclear accidents, and therapeutic radiation treatment
- sunburn is considered a radiation burn b/c it is caused by ultraviolet radiation
- localized radiation injuries often appear similar in nature to thermal burns b/c they are characterized by erythema, edema, blisters, and pain
- prolonged full-body exposure to ionizing radiation often causes nausea, vomiting, diarrhea, fatigue, headache, and fever
18
Q
Connection Check: The nurse recognizes which etiology as consistent with a thermal burn? A. Direct current B. Scalding C. Exposure to organic compounds D. Ionizing radiation
A
B. Scalding
19
Q
Classification: Burn Depth
A
- Superficial
- Superficial-partial thickness
- Deep-partial thickness
- Full thickness
20
Q
Burn Depth: Superficial
A
- affect only the epidermal layer of the skin
- mild erythema and hypersensitivity
- resolves in 24 to 72 hours
- most common type: sunburn
- these burns heal quickly, do not require medical intervention or admission to a burn center, and do not usually result in scarring
21
Q
Burn Depth: Superficial-partial thickness
A
- involves epidermis and the superficial or minimal layers of the dermis
- very painful; d/t the exposed nerve endings located within the dermal layer of the skin
- patient extremely sensitive to touch and even to air currents when the wound dressing is removed and the burn is exposed
- often have wet, weeping blisters and are pink in color
- heal in 1 to 2 weeks with minimal or no scarring
- depending on the location and extent of the burn, medical management and admission to a burn center may be warranted for wound care and pain management
22
Q
Burn Depth: Deep-partial thickness
A
- involves the epidermis and extends into the deeper portions or bottom layers of the dermis
- reports of varying areas of pain and decreased sensation
- burns appear waxy; do not weep
- entire epidermis and majority of the dermis has been damaged
- burn may appear light pink or cherry red in color, and capillary refill is decreased or absent
- engage in close observation of the burn wound to monitor for potential progression from deep-partial to full thickness
- take more than 2 weeks to heal; risk of infection is paramount b/c patients with burn injuries are immune-compromised w/o the skin a s a barrier to infection
- burn surgeon decides whether or not to operate or try to let the burn heal on its own
23
Q
Burn Depth: Full Thickness
A
- involves destruction of the epidermis, the dermis, and portions of the subcutaneous (fat) tissue
- all epidermal and dermal structures are destroyed, including hair follicles, sweat glands, and nerve endings
- do not heal spontaneously; require skin grafting
- as a result of the extensive damage to the nerve endings, burns are insensate
- this absence of pain is often misleading for patients, and many do not comprehend the severity of their injury
- no blister formation
- burns take on a variety of colors
- burns are very dry and feel like leather to touch
- full-thickness burn tissue referred to = eschar
- burns that extend beyond the subcutaneous layer into muscle and/or bone is also full thickness
24
Q
Full-thickness burn tissue is referred to as?
A
eschar
25
Q
Connection Check: The nurse correlates which clinical manifestation with superficial-partial thickness burns? A. Eschar B. Dry, leathery appearance C. Blisters D. Waxy appearance
A
C. Blisters
26
Q
Care of The Superficial Burn
A
- Do not apply ice or submerge in ice water
- Apply cool compress or run under cool water
- A dressing should not be required b/c there are no open blisters
- Lotion should be applied liberally once or twice per day
- Lotion that is aloe based and/or fragrance free
- Ibuprofen, acetaminophen, or aspirin may be necessary for pain and discomfort
- Drink plenty of fluids to rehydrate
- Rest
27
Q
Care of Partial Thickness burns
A
- If one to three quarter-sized or smaller blisters appear, try not to open (pop) the blisters; allows for moist healing environment, decreased risk of infection, and less discomfort
- If the blister(s) are broken, wash the area w/ mild antiseptic soap and warm water
- Apply a thin layer of bacitracin ointment and cover with a nonadherent bandage
- The wound should be thoroughly cleansed and the dressing changes at least once/day
- Patient may continue with usual activities; dependent extremities should be elevated to prevent edema and encourage venous return
- Patient should be aware of any clinical manifestations of infection; fever, increased pain, redness or swelling, purulent drainage, or red streaks radiating from the wound; if noted, patient should see primary care provider right away
- encouraged to follow-up w/ primary care provider
