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NUR 230 > Burns > Flashcards

Burns Flashcards

(40 cards)

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1
Q

what is the epidermis

A

primary barrier
responsible for regeneration

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2
Q

what is the dermis

A

provides mechanical strength

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3
Q

what is the hypodermis

A

subq fat
protects; absorbs shock, thermal insulation,
energy stores

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4
Q

what is the resuscitative phase

A

Injury to onset of diuresis (0-2 days)
* ABC’s
* fluid resuscitation/perfusion

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5
Q

what is acute phase

A

Diuresis to near completion of wound closure (days to months)
* Wound care
* Infection control
* Healing
* Nutritional support

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6
Q

what is the rehab phase

A

Major wound closure to return to optimal level of
adjustment
* psychosocial adjustment
* minimize scarring and contractures
* reenter society

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7
Q

assessment of burn

A

Where occurred- environment
* Age
* Location
* History of the trauma
* Size
* Depth
* Severity
* Source
* Zone of injury

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8
Q

sources of burns

A

Radiation: sun or cancer therapy
* Chemical
* Electrical
* Dry and moist heat (thermal)
* Cold (frostbite)

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9
Q

1st degree burn/superficial thickness

A

above dermis (epidermis)
* Sunburn, flash burn
* Heals w/in a few days
* Dry, red,
* Some swelling
* Painful
* Tingling, itching, peeling

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10
Q

2nd degree burn/partial thickness

A

into dermis
* Scalds, flames, brief hot objects
* Heals 2-3 weeks
* Some scarring and depigmentation possible
* May require grafting
* Pink to red, blisters, weeping, pain, edema

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11
Q

3rd degree/full thickness

A

epidermis, dermis, sometimes
subcutaneous tissue; may involve connective tissue & muscle
* Scalds, flames, prolonged hot objects, tar, grease, chemicals,
electrical current
* Requires grafting
* Dry, pale, white, red, brown, leathery, or
charred
* Edema
* No pain
* Eschar may slough

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11
Q

what need to be intact for skin to regenerate

A

dermis

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12
Q

4th degree burn/deep full thickness

A

down to
muscle/bone
* Prolonged exposure, high-voltage electrical
injury
* Black, dry
* No pain
* Grafting of no benefit
* Amputations likely

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13
Q

how to estimate burn size

A
  • Calculate TBSA burned in
    percentage
  • Methods:
  • Rule of Nines
  • Palmer: size of hand=1% of bsa
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14
Q

severity of burn injury

A

Age
* Depth of burn
* TBSA- injuries that affect > 20% TBSA
considered severe
* Inhalation injury
* Concomitant injuries
* Location- face, perineum, hands, feet,
major joints
* Comorbid conditions

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15
Q

when to suspect an inhalation injury

A

closed space injury
facial injury
singed nasal hair
carbonaceous sputum
wheezing
pharyngeal edema
hoarseness

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16
Q

airway injuries

Study These Flashcards
A

carbon monoxide poisoning
inahaltion injury above the glottis: singed nasal hair, facial burn, carbonaceous sputum
inhalation injury below the glottis

17
Q

resuscitative phase of burn injury at scene

Study These Flashcards
A

At scene:
* Extinguish flames/remove
from source
* Airway maintenance
* Smoke inhalation
* CO poisoning
* High flow O2, intubation
* Cool the burn
* Remove restrictive objects
* Clothing, jewelry
* Cover the burn- infection

18
Q

resuscitative phase at facility

Study These Flashcards
A
  • Airway
  • Assess patency
  • Assess for signs/symptoms
    of inhalation injury/carbon
    monoxide exposure
  • Intubation if necessary
  • Suction- provide pain
    medication
  • Monitor for upper airway
    edema
19
Q

resuscitative pahse at facility circulation

Study These Flashcards
A

Circulation
* Assess vitals, pulses, capillary refill; watch for hypovolemic shock &
compartment syndrome
* Continuous cardiac monitoring
* 2 large-bore IVs, central line
* IV fluid resuscitation
* Foley- monitor urine output (adults: 0.5-1 mL/kg/hr; children <40kg:
1ml/kg/hr)
* Risk for AKI
* Red-colored urine- damage to RBCs and myoglobin
* Monitor I & O hourly

20
Q

resuscitative phase at facility breathing

Study These Flashcards
A
  • Breathing
  • Oxygen (high flow, humidified)
  • Lung sounds
  • Mechanical Ventilation
  • Chest Expansion- escharotomy
    needed?, avoid tight dressings
  • Monitor for pulmonary edema,
    ARDS
21
Q

what is the adult fluid resuscitation formula

Study These Flashcards
A

2mL LR x Kg x % TBSA burned for 24-
hr period
* 1st 8 hrs - 1/2 volume
* next 16 hrs- 1/2 volume

22
Q

how to care for wounds

Study These Flashcards
A
  • Cooling- stop burn process on scene of injury (remove clothing,
    tepid water/saline)
  • Cleaning
  • Covering- dressings, cover patient with dry sheet/blanket, prevent
    hypothermia
  • Comfort- pain control (pharmacologic/nonpharmacologic), warm
    room
  • Prevent infection- protective environment, aseptic technique,
    tetanus, topical antimicrobials
23
Q

initial wound treatment

Study These Flashcards
A
  • Clean with mild soap and water
  • Strip away dead, devitalized tissue
  • Burn wound culture
  • Photographs
  • Escharotomy of circumferential burns
  • Dressing
  • Fasciotomy
  • Tetanus
  • Pain control
24
pain control
* Morphine or fentanyl IV PCA Nonpharmacologic methods to enhance meds * Administer prior to procedures/suctioning * Assess for hypoxia * Protect from air currents, linens * Anxiolytics
25
gi issues
* Abdominal assessment- risk for paralytic ileus and abdominal compartment syndrome * NG tube- prevent aspiration, decompress stomach * Risk for stress ulcers- acid- reducing meds * Increased nutrition needs * May require enteral/parenteral nutrition
26
resuscitative phase- labs and diagnostics
Chest x-ray * Glucose: increased * BUN/Cr: increased * Hgb/Hct: increased * Electrolytes * Sodium: decreased * Potassium: increased * Chloride: increased * ABG: metabolic acidosis * Urinalysis: osmolality * Total protein & albumin: decreased
27
acute phase of burn injury
* Prevent Infection, organ system failure, metabolic derangement * Encourage Healing * cleanse/hydrotherapy * remove/debride * topical preparations * protection * dressings * skin coverings * grafting
28
acute phase complications
* Infection- sepsis, ventilator associated pneumonia * Heart failure, pulmonary edema * Fluid shifts back to intravascular space * Blood clots * Pressure injuries * Respiratory distress, ARDS * Delirium
29
preventing infection
● Protective environment. ● Restrict plants and flowers, fresh fruits, vegetables. ● Limit visitors ● Single use equipment ● Monitor for infection ● Administer tetanus toxoid ● Administer antibiotics to treat infection ● Use strict asepsis with wound care
30
gi concerns/nutritional support
*Paralytic ileus *Curling's ulcer *Hypermetabolic, hypercatabolic state *Increased calorie needs * Oral route- high-calorie, high-protein meals/supplements *Dietary consult
31
what does bronchoscopy do
determine extent of burn injury to airway
32
labs for acute phase
hbg/hct- decreased k+- decreased WBC- increased
33
rehab phase
can last years Minimize contractures and scarring * Splinting, positioning, exercise, ambulation, pressure dressings, surgery * Client participation in ADLs and self-care activities * Home Health Support * Psychosocial support and reintegration * Follow-up appointments
34
rehab complicatoins
Neuropathies and nerve entrapment * Wound breakdown and/or pressure injury formation * Hypertrophic scarring * Contractures * Joint instability * Complex pain
35
electrical burns
* Path of least resistance * Low voltage * High voltage * Entry and exit sites * Tetanic contractions * Burns * Arrhythmias
36
burn care resuscitation
* injury to onset of diuresis (0-2 days) * ABC’s * fluid resuscitation
37
burn care acute
* diuresis to permanent wound closure (days to months) * infection control * healing
38
burn care rehab
Extends for years after injury * minimize scarring, contractures, and other complications * reenter society
39

NUR 230 (16 decks)

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