Burns

Question 1

Where do most burns occur?

Answer 1

home

Question 2

Why does plasma seep out into the tissue?

Answer 2

increased capillary permeability

Question 3

When does majority of the plasma seep out into the tissue?

Answer 3

first 24 hours

Question 4

What do you worry about with plasma seeping into the tissues?

Answer 4

shock

Question 5

Why does the pulse increase with burns?

Answer 5

Burns can cause FVD, which causes the pulse to increase

Question 6

Why does the cardiac output decrease with burns?

Answer 6

There is less volume to pump out

Question 7

Why does the urine output decrease with burns?

Answer 7

kidneys are trying to hold on to the fluid that is left or the kidneys are not being perfused well

Question 8

Why is epinephrine secreted with burns?

Answer 8

This causes vasoconstriction and shunts blood to the vital organs.

Question 9

anytime the systolic BP drops below what number means the organs are not being adequately perfused?

Answer 9

90

Question 10

Why are ADH and aldosterone secreted with burns?

Answer 10

ADH retains water and aldosterone retains sodium and water. This is to try and increase the blood volume.

Question 11

What percentage is the head and neck in the rule of 9’s?

Answer 11

9%

Question 12

what percentage is the trunk in the rule of 9’s?

Answer 12

Front: 18%
Back: 18%

Question 13

What percentage is the genital area in the rule of 9’s?

Answer 13

1%

Question 14

What percentage are the arms in the rule of 9’s?

Answer 14

9% each

Question 15

What percentage are the legs in the rule of 9’s?

Answer 15

18% each

Question 16

What is another name for partial thickness burns?

Answer 16

first and second degree burns

Question 17

What is another name for full thickness burns?

Answer 17

third and fourth degree burns

Question 18

What are ways to stop the burning process?

Answer 18

wrap the client in a blanket
cool water (no longer than 10 minutes)

Question 19

Why should you remove a clients jewelry?

Answer 19

swelling will occur

metal gets hot

Question 20

what is the number one cause of death with burns?

Answer 20

inhalation injury

Question 21

What are burn injuries caused by?

Answer 21

inhaling carbon monoxide or hydrogen cyanide

Question 22

What is treatment for carbon monoxide poisoning and hydrogen cyanide?

Answer 22

100% oxygen

Question 23

Why is it important to determine if the burn occurred in an open or closed space?

Answer 23

a closed space could lead to more carbon monoxide and/or hydrogen cyanide being inhaled and could cause more complications

Question 24

What should you focus on when a client has burns to the neck/face/chest?

Answer 24

airway

Question 25

What might a primary care provider do prophylactically for a client with facial area burns?

Answer 25

endotracheal tube

Question 26

indications of inhalation injury

Answer 26

``` singed nose hair/facial hair soot on face coughing up secretions with dark specks difficult swallowing wheezing blisters on the oral/pharyngeal mucosa hoarseness substernal/intercostal retractions stridor ```

Question 27

what is one of the most important aspects of burn management?

Answer 27

fluid replacement

Question 28

how many large bore IV's will the client need for fluid replacement?

Answer 28

2

Question 29

What will be used for fluid replacement?

Answer 29

crystalloids (LR) and colloids (albumin)

Question 30

Why is it important to know what time the burn occured?

Answer 30

fluid replacement therapy is based on the time that the injury occurred.

Question 31

how much of the total fluid needed for the first 24 hours do you give within the first 8 hours?

Answer 31

1/2 of total volume

Question 32

what do you need to know to properly calculate fluid replacement?

Answer 32

clients weight in kilograms

Question 33

What is the formula for fluid replacement for the first 24 hours?

Answer 33

(2-4 mL of LR) X (body weight in kg) X (% of total body surface area burned)

Question 34

what is the goal urinary output for an electrical burn client?

Answer 34

75-100 mL/ hr

Question 35

what is the required urinary output for a child?

Answer 35

1 mL/kg/hr

Question 36

why is albumin a medication for burns?

Answer 36

Holds fluid in the vascular space

Question 37

Why is albumin administered after the first 24 hours?

Answer 37

capillary permeability is normal again

Question 38

What is a potential complication of albumin?

Answer 38

FVE

Question 39

what could be measured hourly to monitor for FVE with albumin?

Answer 39

CVP

Question 40

what is the drug of choice for pain management with burns?

Answer 40

opioids

Question 41

what are common topical drugs used with burns?

Answer 41

``` mafenide acetate (Sulfamylon) silver nitrate antimicrobial ointments ```

Question 42

why should antibiotic drugs be alternated?

Answer 42

bacteria will build resistance or tolerance

Question 43

why are broad spectrum antibiotics avoided with burns?

Answer 43

could lead to super infections or secondary infections or even sepsis

Question 44

what should be collected before antibiotics are started?

Answer 44

cultures

Question 45

how do you apply topical agents to a burn?

Answer 45

apply a thin layer with sterile gloves

Question 46

What are two types of debridement?

Answer 46

enzyme debridement | hydrotherapy

Question 47

What is important to remember before sending a client to hydrotherapy?

Answer 47

pain management

Question 48

what is an autograft?

Answer 48

using the client own skin for a skin graft

Question 49

after how long can a surgeon re-harvest from the same donor site if the client is well nourished?

Answer 49

12-14 days

Question 50

what would it mean if the graft becomes blue or cool?

Answer 50

poor circulation

Question 51

will the client need more or less calories?

Answer 51

more

Question 52

what two things are needed in the diet to promote healing?

Answer 52

protein | vitamin C

Question 53

what lab work checks to ensure proper nutrition and positive nitrogen balance?

Answer 53

Pre-albumin

Question 54

what are complications of burns?

Answer 54

``` circulation renal failure electrolyte imbalance stress ulcers paralytic ileus contractures infections ```

Question 55

how many wounds are there with electrical burns?

Answer 55

2 (entrance and exit)

Question 56

what is the first thing you do for an electrical injury?

Answer 56

heart monitoring for 24 hours

Question 57

what kind of arrhythmia is an electrical burn client at risk for?

Answer 57

v fib

Question 58

why are amputations common with electrical burn clients?

Answer 58

circulatory system is destroyed