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From Flashcardlet > (2) Exam 1- Burns > Flashcards

(2) Exam 1- Burns Flashcards

0
Q

What is a common cause of death in the emergent phase

A

Hypovolemic shock

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1
Q

Ulcerative gastrointestinal disease may develop within ____ hours after a severe burn as a result of

A

24

Increased hydrochloric acid production and decreased mucosal barrier

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2
Q

Types of burn injuries

A

Thermal
Chemical
Smoke and Inhalation
Electrical

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3
Q

Types of burn injuries

Thermal burns are caused by

A

Flame, flash, scald, or contact with hot objects

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4
Q

Types of burn injuries

Chemical burns are caused by

A

Contact with acids, alkalis, and organic compounds

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5
Q

Types of burn injuries

Smoke and inhalation injuries are caused by

A

Breathing hot air or noxious chemicals

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6
Q

Three types of smoke inhalation injuries

A

Metabolic asphyxiation, upper airway injury, lower airway injury

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7
Q

Smoke and inhalation injury

What is metabolic asphtxiation

A

Inhaling carbon monoxide and or hydrogen cyanide

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8
Q

Smoke and inhalation injury

Upper airway injury

A

Injury to the mouth, oropharynx, and/or larynx

Mucosal burns- redness, blistering and Edema

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9
Q

Smoke and inhalation injuries

Lower airway injury

A

Injuries to the trachea, bronchioles, and Alvioli

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10
Q

Pulmonary edema may not appear until 12–24 hours after the burn. It then manifest as

A

Acute respiratory distress syndrome

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11
Q

Types of burn injuries

Electrical burns are caused by

A

Electrical current doing direct damage to nerves and vessels

Severity is difficult to determine

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12
Q

Types of burn injuries

Cold thermal injury is caused by

A

Frostbite

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13
Q

Electrical injuries put the patient at risk for

A

Dysrhythmias or cardiac arrest, severe metabolic acidosis, and myoglobinuria

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14
Q

Classification of burn injuries

A

Depth- thickness (Full or partial)
Extent- Lund Browder & Rule of 9’s
Location
Patient risk factors- pre-existing health

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15
Q

What burns may interfere with breathing

A

Face, neck, and circumferential buns to chest or back

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16
Q

Burns two hands, feet, joints, and as can cause

A

Difficult self-care and jeopardize future function

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17
Q

Burns to ears and nose are susceptible to

A

Infection because of poor blood supply

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18
Q

Burns to the buttocks or perineum area are susceptible to

A

Infection from urine or feces contamination

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19
Q

Circumferential buns can cause

A

Circulation problems

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20
Q

Patient risk factors that can delay burn wound healing

A

Cardiovascular, respiratory, renal disease, diabetes mellitus, peripheral vascular disease

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21
Q

Appearance of superficial partial thickness burns

A

Erythema and blanching on pressure
Tenderness

No vesicles or blisters, may blister/pill after 24 hours.
The dermis is not involved

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22
Q

Possible causes of superficial partial thickness burns

A

Sunburn or quick heat flash

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23
Q

Appearance of deep partial thickness burns

A

Fluid filled vesicles and severe pain

Shiny, wet

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24
Q

Possible causes of deep partial thickness burns

A

Contact Burns

Flame, flash, scald, chemical, tar, electric current

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25
Q

Appearance of full thickness burn

A

Dry, waxy white, leathery eschar, heart scan, insensitivity to pain, nerve distraction, strong burt odor

No skin to replicates. Nerve endings destroyed

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26
Q

Possible causes of full thickness burns

A

Flame, it’s called, chemical, target, electric current

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27
Q

Initial interventions for a burn

A
  • assess airway breathing and circulation
  • stabilize cervical spine
  • assess for inhalation injury
  • provide supplemental O2
  • anticipate intubation with circumferential full thickness burns
  • Monitor VS, LOC, respiratory status, O2 sat, heart rhythm
  • remove nonadherent clothing
  • Cover with dry dressing or clean sheet
  • > 15% TBSA, establish IV access with two large bore catheters
  • began fluid replacement
  • > 15% TBSA, insert urinary catheter
  • elevate burned lambs above heart
  • administer IV analgesia
  • identify and treat other associated injuries
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28
Q

Ongoing monitoring for Burns

A
  • Monitor airway
  • VS, heart rhythm, LOC, respiratory status and O2 sat
  • urine output
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29
Q

Fluid and electrolyte shifts that occurred during the early emergent phase of a burn injury include

A

Fluid shifts out of blood vessels
Capillary walls become more permeable
Water sodium and plasma proteins move into interstitial spaces
Osmotic pressure decreases

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30
Q

To maintain positive nitrogen balance in a burn the patient must

A

High-protein, high carb, low-fat

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31
Q

Preventative strategy for nurse to focus on when teaching about fire safety

A

Encourage regular home fire exit drills

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32
Q

To determine fluid resuscitation the nurse should assess which measurements of cardiac parameters

A
  • heart rate less than 120
  • arterial line systolic BP greater than 90
  • arterial line mean arterial pressure greater than 65
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33
Q

Indications of hyperkalemia

A

ECG changes, muscle weakness, cardiac dysrhythmias

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34
Q

Signs and symptoms of upper airway injury

A

Hoarseness, sans nasal hair, difficulty in swallowing

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35
Q

Signs and symptoms of lower airway injury

A

Dyspnea, wheezing

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36
Q

Options for permanent grafting

A

Integra
Alloderm
Autograft

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37
Q

Assessment findings that would alert presence of inhalation injury

A

Sentient nasal hair
Generalized pallor
Painful swallowing
History of being involved in a large fire

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38
Q

What fluid and electrolyte shifts occur during the emergent stage

A

Third spacing
Elevated hematocrit caused by hemoconcentration
Movement of water and sodium to the interstitial fluid

39
Q

How long does the emergent phase last

A

72 hours

40
Q

What is the primary concern in the emergent phase

A

Hypovolemic shock and Edema formation

41
Q

When does the emergent phase end

A

When fluid mobilization, diuresis begin and urine has low specific gravity

42
Q

Clinical signs of hypovolemic shock

A

Decreased blood pressure and increased heart rate

43
Q

What three major organ systems are most susceptible to complications during the emergent phase of a burn

A

Cardiovascular, respiratory, and urinary systems

44
Q

What cardio vascular system complications can happen in a burn

A

Dysrhythmias and hypovolemic shock

45
Q

In subsequent edema formation what must be done to restore circulation

A

Escharotomy

46
Q

What are signs of impending respiratory distress

A

Increased agitation, anxiety, restlessness, or change in breathing

47
Q

In an inhalation injury how long is it before respiratory changes occur

A

24 to 48 hours

48
Q

What is the leading cause of death in patients with an inhalation injury

A

Pneumonia

49
Q

What is the most common complication of the urinary system in the emergent phase

A

Acute tubular necrosis

50
Q

At what percentage of TBSA do you consider a central line

A

30%

51
Q

What is used for fluid resuscitation in the emergent phase

A

Lactated ringers, colloids or a combination of the two

52
Q

What type of burn injury requires greater than normal fluid requirements

A

Electrical injury

53
Q

Escharotomy’s and fasciotomy’s are carried out in what phase

A

Emergent

54
Q

What is done during debridement

A

Necrotic skin is removed

55
Q

What is the open method in burnt wound treatments

A

Topical anti-microbial and no dressing

56
Q

What is the close method and burn wound treatment

A

Topical anti-microbial with sterile gauze laid over it

57
Q

Sterile gloves are required when applying what to a wound

A

Ointments and sterile dressings

58
Q

What type of ointment is included in the care for corneal burns and edema

A

Antibiotic

59
Q

Why are range of motion exercises performed in emergent phase

A

Prevent contractures, and reassures the patient that movement is still possible

60
Q

After a wound is cleaned what type of agent is applied and covered with a light dressing

A

Topical anti-microbial agent

61
Q

What specific allergy do you want to check for in burn patients

A

Sulfa because it is in anti-microbial creams

62
Q

Systemic antibiotic therapy is indicated when what diagnosis is made

A

Sepsis or other source of infection is identified

63
Q

What is an oral infection treated with

A

Nystatin mouthwash

64
Q

When a normal diet is resumed what can be given by mouth to reintroduce the normal intestinal flora that was destroyed by the anabiotic therapy

A

Yogurt or lactinex

65
Q

What is given to prevent venous thromboembolism (VTE)

A

Heparin

66
Q

When does the acute phase end

A

When partial thickness wounds are healed or full thickness burns are covered by skin grafts

67
Q

A partial thickness burn will heal completely if kept free from

A

Infection and desiccation/dryness

68
Q

In full thickness burns what must be surgically removed and applied in order to heal

A

Remove eschar surgically and apply skin graft

69
Q

In the acute phase which serum electrolyte levels should you follow closely

A

Sodium (hyponatremia, hypernatremia) potassium (hyperkalemia, hypokalemia)

70
Q

Manifestations of hyponatremia

A

Weakness, dizziness, muscle cramps, fatigue, headache, tachycardia, and confusion

71
Q

Manifestations of hypernatremia

A

Dried/furry tongue, lethargy, confusion, and possible seizures

72
Q

Manifestations of hypokalemia

A

Fatigue, muscle weakness, leg cramps, cardiac dysrhythmias, paresthesias, decreased reflexes

73
Q

Manifestations of hyperkalemia

A

Cardiac dysrhythmias and arrest, muscle weakness, cramping, paralysis

74
Q

Signs and symptoms of hypo or hyper thermia

A

Increased heart and respiratory rate, decreased BP and urine output

75
Q

In what phase may ROM be a limited and contractures occur

A

Acute phase

76
Q

What is curlings ulcer

A

Type of gastroduodenal ulcer

Caused by decreased blood flow to the G.I. tract

77
Q

How do you prevent curlings ulcer

A

Feeding the patient as soon as possible after the burn injury

78
Q

What are the predominant therapeutic interventions in the acute phase

A 
Wound care
Excision and grafting
Pain management
Physical and occupational therapy
Nutritional therapy
79
Q

The goals of donor site care are too

A

Promote rapid, moist when healing. Decreased pain at the site.
Prevent infection

80
Q

What is the average healing time for a donor site

A

10 to 14 days

81
Q

When do you use cultured epithelial autograft

A

When limited skin is available for harvesting

82
Q

When is a good time for ROM And exercise

A

During and after one cleaning when the skin is softer and bulky dressing are removed

83
Q

When a patient is extubated, what does a speech Pathologist need to perform before an oral diet of started

A

Swallowing assessment

84
Q

Ideally, The percentage of weight loss compared to Preburn weight should be what

A

10%

85
Q

When does the rehabilitation phase begin

A

When’s have healed and patient is engaging in some level of self-care

From 2 weeks or as long as 7 to 8 months

86
Q

What are the goals for the patient in the rehabilitation phase

A
  • work toward resuming a functional role in society

- rehabilitate from any surgery

87
Q

If adequate range of motion is not in steel, the new tissue will shorten and Will cause

A

Contractures

88
Q

When should pressure garments never be worn

A

Over unhealed wounds

89
Q

How long are pressure garments worn

A

Up to 24 hours a day as long as 12 to 18 months

90
Q

How long should the patient protect healed burned areas from direct sunlight

A

About three months to prevent hyperpigmentation and sunburn injury

91
Q

What are the most common complications during the rehabilitation phase

A

Scan and joint contractures and hypertrophic scarring

92
Q

What should be used routinely on healed areas to keep skin well moisturized

A

Water-based cranes that penetrate into the dermis

example Vaseline

93
Q

What is an escharotomy

A

Removes burned tissue

94
Q

What is a fasciotomy

A

Relieves pressure from extensive swelling by cutting into skin

From Flashcardlet (47 decks)

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