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Flashcards in Burn Notes Deck (81)
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1

Superficial partial-thickness burn signs & symptoms

erythema (redness)
blanching on pressure (whitens with applied pressure)
pain
mild swelling
can blister and peel after 24 hours

2

Superficial partial-thickness burn involved structures

epidermis
Epithelization (Skin growth) can occur

3

Deep partial-thickness burn signs & symptoms

blisters
severe pain due to nerve damage or death
mild to moderate edema

4

Deep partial-thickness burn involved structure

Epidermis and dermis

5

Full-thickness burn signs & symptoms

Leathery skin that can be dry or waxy
You can see burst vessels
Visible tendons, fat, muscles and bones
No pain due to nerve death
Possible skin necrosis

6

Full-thickness burn involved structures

Destroyed skin & local nerves

7

Who are the high risk factors of burns?

Children younger than 4 and adults over 65.

8

What are the types of burn injuries?

Thermal - most common
Chemical
Electrical
Smoke inhalation - most deadly
Cold Thermal

9

How do you determine the severity of burns?

Rule of Nines - initial assessment
Lund-Browder chart - more accurate

10

Rule of Nine: Give the parts and their percentage

Head - 9%, 4.5 each for front and back
Trunk (includes chest, back, and butt) - 36%, 18 each for front and back
Arm - 9%, 4.5 each for front and back
Perineal - 1%
Leg - 18%, 9 each for front and back

11

Lund-Browder: Give the parts and percentage

Face- 3.5
Back of head - 3.5
Front Neck - 1
Back of Neck - 1
Chest- 13
Back- 13
Shoulder & Upper Arm- 2
Lower Arm- 1.5
Wrist and Palm- 1.5
Perineal- 1
Butt- 2.5 each buttcheek
Upper leg- 4.75
Lower leg- 3.5
Ankle and feet - 1.75

12

How do you prevent hypothermia for large burns?

Do not cool for more than 10 min.
Do not soak
Do not cover with ice

13

How do you care for a patient with burns for prehospitalization?

Ensure ABCs
Provide 100% Humidified O2
Remove clothing gently
Wash chemical burns with water for 20 min to 2 hours
Wrap burned area with clean sheet or dry blanket to prevent infection

14

Tissue destruction can occur for how many hours after burn exposure?

72 hours

15

What are the phases of burn management?

Emergent
Acute (Wound Healing)
Rehabilitative

16

What are the main concerns in emergent phase?

Hypovolemic shock and edema formation

17

Fluid & Electrolyte shifts in Emergent phase

Water, Electrolyte and proteins move into interstitial spaces due to increased capillary permeability.
Protein pressure within blood stream (Colloidal osmotic pressure) decreases.
Third spacing occurs
RBCs are depleted but high Hct is shown due to hemoconcentration
Potassium shifts first, then sodium

18

Hypovolemic shock signs & symptoms

Decreased BP and increased HR

19

What signifies the end of emergent phase?

Diuresis and urine has low specific gravity

20

C/M of Emergent phase

Evidence of partial or full thickness burns (pain, blister formation, etc.)
Paralytic ileus (absent bowel sounds)
Shivering
Unconsciousness or altered mental status due to hypoxia

21

What three major organ systems are susceptible for complications during the Emergent phase?

Cardiovascular
Respiratory
Renal

22

Cardiovascular complications in Emergent phase

Dysrhythmias
Hypovolemic shock
Impaired circulation - sludging (poor circulation in capillaries)
Venous thromboembolism (VTE)

23

Respiratory complications in Emergent phase

Pneumonia (PNA) - leading cause of death
Upper Airway injury
Lower Airway injury
Metabolic Aphyxiation
Respiratory distress
Pulmonary Edema
Sputum has carbon

24

Signs & Symptoms of Respiratory Distress

Increased agitation
Restlessness
Abnormal breathing patterns: tachypnea or bradypnea

25

Urinary complications in Emergent phase

Myoglobinuria
Acute Kidney Injury (AKI)
Acute Tubular Necrosis (ATN)
RBC breakdown

26

What is the "Iceberg effect" of electrical burns?

More damage in the skin than what is shown.

27

List in order of priority for Nursing management in Emergent phase.

ABC
Fluid therapy
Wound Care
Manage pain
Nutrition therapy
Rehab with PT or OT

28

How do you manage airway?

Intubate- especially with facial and neck burn
Escharotomy of chest wall - especially with neck and chest burns
Fiberoptic bronchoscopy - 6-12 hours after injury to check lower airway
Humidified air 100% oxygen - CO posioning
High Fowlers - reposition every 2 hours
deep breathing and coughing
PEEP (positive end-expiratory pressure)
Monitor CO with SpCO2 device

29

Parkland Formula

It is used for fluid replacement therapy for first 24 hours.
4ml LR x wt in kg x TBSA (%body burn)

30

What is the application of the parkland formula?

1/2 total volume first 8 hours
1/4 total volume second 8 hours
1/4 total volume third 8 hours