Burn Complications

Question 1

A client has circumferential burns. What does this mean?

Answer 1

Burn around like a circle; check circulation!

Question 2

What is a circulatory check?

Answer 2

Pulse
Cap refill
Skin temp
Skin color

Question 3

What is turgor?

Answer 3

Hydration check

Question 4

What check is sensation?

Answer 4

Neurovascular

Question 5

What if the vascular check in the arm is bad, how do you relieve pressure?

Answer 5

Escharotomy

Fasciotomy

Question 6

What pressure relief?

Relieves the pressure and restores the circulation, cuts through eschar

Answer 6

Escharotomy

Question 7

What pressure relief?

Relieves the pressure and restores circulation but cut is much deeper into tissue; cuts through fascia of muscle

Answer 7

Fasciotomy

Question 8

Renal system

An indwelling catheter is inserted to measure UO. How often?

Answer 8

Hourly

Question 9

Renal system

T/F: May put in catheter and no UO

Answer 9

T

Kidneys may be trying to hold with little fluid is there or they aren’t being perfused adequately

Question 10

Renal system

What do you do if UO is brown or red?

Answer 10

Call doc

Question 11

Renal system

What drug may be given to flush out kidneys?

Answer 11

Mannitol

Question 12

Renal system

T/F: No diuretics given to burn patients

Answer 12

T and F; may give mannitol only to flush out kidneys

Question 13

Renal system

What about Mannitol to know

Answer 13

It crystalizes

Do not refridgerate; don’t give if it has crystals

Question 14

Renal system

If there is no UO or if it is less than 30mL/hr, what to worry about

Answer 14

Kidney failure

Question 15

Renal system

After 48 hours, what does client begin to do?

Answer 15

Diurese because fluid is going back to vascular space and now we worry about fluid volume excess

Question 16

Electrolyte imbalance

What happens here?

Answer 16

Burns cause cells to break. Cells have K. If cells break, K leaks and that causes HYPERkalemia

Question 17

Electrolyte imbalance

S/s of hyperkalemia?

Answer 17

Muscle twitching
Muscle weakness
Flaccid paralysis
Cardiac dysrhythmias

Question 18

GI system

What may be ordered to prevent stress ulcer?

Answer 18

Magnesium carbonate
Pantoprazole
Famotidine

Question 19

GI system

What ulcer is common with burns?

Answer 19

Stress ulcer (Curlings)

Question 20

GI system

Why would doc want client to be NPO and have NG hooked to suction?

Answer 20

Could develop paralytic ileum because decrease vas. volume, decreased GI motility, and HYPERkalemia

Question 21

GI system

How to help with GI motility to prevent paralytic ileum?

Answer 21

Rocking chair

Question 22

GI system

What happens if client doesnt have bowel sounds

Answer 22

Abdominal girth increases

Question 23

GI system

Burns patients need more what?

Answer 23

Calories
Vit C
Protein

Question 24

GI system

When is NG tube removed?

Answer 24

When you hear bowel sounds

Question 25

GI system When you start GI feedings, what should be measured?

Answer 25

Residuals

Question 26

GI system When to hold next feed?

Answer 26

If residual is more than 50 mL *still give back the residual so you don't cause any imbalances, just don't give next feed

Question 27

GI system How to check proper nutrition and positive nitrogen balance?

Answer 27

Pre-albumin levels

Question 28

Integumentary-Contractures Damage only to epidermis

Answer 28

Superficial thickness

Question 29

Integumentary-Contractures Damage to entier epidermis and varying depth of dermis

Answer 29

Partial thickness

Question 30

Integumentary-Contractures Damage to entire dermis and sometimes fat

Answer 30

Full-thickness

Question 31

Integumentary-Contractures If they have burns on hands, what are good ways to prevent contractors?

Answer 31

Wrap each finger separately | Use splints

Question 32

Integumentary-Contractures What if neck burns?

Answer 32

Hyperextend neck | No pillows--to promote chin-to-chest contracture

Question 33

Integumentary-Infections What is #1 complication with perineal burn?

Answer 33

Infection

Question 34

Integumentary-Infections What is eschar?

Answer 34

Dead tissue *if not removed, new tissue doesnt regenerate

Question 35

Integumentary-Infections What likes to grow in eschar?

Answer 35

Bacteria

Question 36

Integumentary-Tretament What type of isolation?

Answer 36

Protective

Question 37

Integumentary-Tretament What agents to remove necrotic, dead tissue?

Answer 37

Sutilains or collagenase *both enzymatic drugs

Question 38

Integumentary-Tretament Rules for the enzymatic drugs?

Answer 38

Don't use on face Don't use if pregnant Don't use over large nerves Don't use if area is opened to body cavity

Question 39

Integumentary-Tretament What is also used to debrid?

Answer 39

Hydrotherapy * give pain med before * worry about cross contamination with immersion hydrotherapy

Question 40

Integumentary-Tretament Mafenide acetate

Answer 40

Can cause acid base problems Stings If rubs off, apply more

Question 41

Integumentary-Tretament Silver nitrate

Answer 41

Keep dressing wet | Can cause electrolyte problems

Question 42

Integumentary-Tretament Providone-iodine

Answer 42

Stings and stains Can cause allergies Can cause acid-base problems

Question 43

Integumentary-Tretament Why to alternate antibiotic drugs?

Answer 43

Bacteria can build resistance or tolerance

Question 44

Integumentary-Tretament Broad spectrum antibiotics are avoided why?

Answer 44

To prevent superinfection or secondary infections *broad spectrum antibiotics may be used until wound cultures have returned--always get culture before starting antibiotic

Question 45

Integumentary-Tretament Mycin drugs

Answer 45

Worry about BUN or Cr increasing (neprotoxicity) | Worry about hearing (ototoxicity)

Question 46

Integumentary-Grafting How much to remove of burn tissue?

Answer 46

Till you see healthy tissue

Question 47

Integumentary-Grafting What is an autograft?

Answer 47

Autograft uses own skin Good skin taken from healthy donor site and placed over burned area --donor site= open wound and dressing applied till bleeding stops --then donor site is left open to air

Question 48

Integumentary-Grafting If client is well nourished, how often can the surgeon reharvest from same donor site?

Answer 48

Every 12-14 days

Question 49

Integumentary-Grafting If skin graft becomes blue or cool, what does this mean?

Answer 49

Poor circulation

Question 50

Integumentary-Grafting Why would doc want you to roll sterile Q-tips over graft with steady gentle pressure from center of graft out to edges?

Answer 50

To get fluid out between graft and tissue to keep graft site intact (aka keep graft to adhere)