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54/64 Unit 2 > Burns > Flashcards

Burns Flashcards

1
Q

Damage to skin integrity from an energy source

A

Burn

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2
Q

Degree of superficial burns

A

1st degree

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3
Q

Characteristics of 1st degree superficial burns

A

Affects epidermis, skin warm to touch, pink and painful, blanching, no scarring, heals in a few days

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4
Q

Degree of partial thickness burns

A

2nd degree

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5
Q

Characteristics of 2nd degree partial thickness burns

A

Affects epidermis and dermis, blisters (intact or ruptured), shiny, moist, painful, blanching, heals 2-6 weeks

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6
Q

Degree of full thickness burns

A

3rd degree

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7
Q

Characteristics of 3rd degree full thickness burns

A

Affects all layers (epidermis, dermis, hypodermis), white/blackened, charred leathery skin, may look black/yellow/red/wet, limited to no pain (nerve fibers destroyed), skin will not heal (need skin grafting), eschar, hypertrophic scars

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8
Q

Layers of the skin

A

Epidermis, dermis, hypodermis (subcutaneous tissue)

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9
Q

Burn caused by superficial heat source such as liquid, steam, fire

A

Thermal

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10
Q

Burn caused by toxic substances such as bleach, gasoline, paint thinner

A

Chemical

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11
Q

Burns caused by UV radiation (sunburns) and cancer treatment

A

Radiation

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12
Q

Burn caused by inhaling smoke which can cause flame injury or carbon monoxide poisoning

A

Inhalation

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13
Q

Burn caused when an object rubs off the skin such as road rash, scrapes, carpet burn

A

Friction

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14
Q

Burn caused by overexposure of the skin to cold

A

Cold (frostbite)

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15
Q

Burn by which an electrical current passes through the body, causing damage within

A

Electric

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16
Q

Inhalation injury happens most in a

A

Closed area

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17
Q

Signs of inhalation injury

A

Hair singed around the face/neck/torso, trouble talking (hoarse voice), soot in nose/mouth, bright red lips, confusion, anxiety

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18
Q

Signs of carbon monoxide poisoning

A

Hypoxia, neuro changes, drowsiness, dizziness, nausea, headache, cherry red skin and lips

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19
Q

Treatment for carbon monoxide poisoning

A

100% O2 with NRB mask until COhb level is below 10%

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20
Q

Burns to the neck, face (nose/mouth), chest and torso can lead to

A

Respiratory complications

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21
Q

Burns to the hands, eyes, feet, and joints can cause

A

Disability

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22
Q

Burns to the eyes, ears, and perineum (or anywhere considered a portal or entry/exit) places the patient at high risk for

A

Infection

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23
Q

Full thickness/circumferential burns on the extremities and torso can increase the risk for

A

Compartment syndrome

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24
Q

Intervention for circumferential burns

A

Elevate extremities above heart level to decrease edema

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25
Q

Phases of burn management

A

“EAR”: Emergent, Acute, Rehabilitative

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26
Q

The onset of injury to the restoration of capillary permeability (24-48 hrs after burn)

A

Emergent phase

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27
Q

Pathophysiology of emergent phase of burns

A

Increased capillary permeability causing fluid to shift from intravascular (blood) to interstitial (tissues) space (sodium and albumin follows). This causes fluid volume deficit in the intravascular space and edema (third-spacing)

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28
Q

Vital signs associated with emergent phase of burns

A

Increased HR, decreased BP, CO, and UO (similar to hypovolemic shock)

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29
Q

Labs associated with emergent phase of burns

A

Elevated potassium, hematocrit (hemoconcentration), and BUN/creatinine, decreased WBCs and sodium

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30
Q

Nursing interventions during emergent phase of burns

A

Establish IV access (preferably 2), fluids (LR, crystalloids), parkland formula, albumin, Foley catheter (monitor UOP), elevated extremities above heart level to decrease edema, stop burning process and stabilize, patient, infection prevention

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31
Q

Stabilization of capillary permeability to wound closure (48-72 hours after burn and until wounds have healed)

A

Acute phase

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32
Q

Pathophysiology of acute phase of burn

A

Capillary permeability restored, diuresis (increased UOP), excess fluid shifts from interstitial space back to intravascular space

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33
Q

Acute phase of burns goals

A

Prevent infection (antibiotics), proper nutrition (increased calories, protein, vit C for healing), pain relief, wound care (premedicate, debridement or grafting)

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34
Q

Renal nursing considerations during acute phase of burn

A

Diuresis is happening —> Foley catheter to monitor UOP

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35
Q

GI nursing considerations during acute phase of burn

A

Risk for paralytic ileus and curlings ulcer (d/t FVD and decreased perfusion to stomach), H2 histamine blocking agents to reduce HCL and decrease chance of ulcers, monitor bowel sounds, NG tube for suctioning

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36
Q

Burn is healed and patient is functioning mentally and physically (could be weeks - years)

A

Rehabilitative phase

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37
Q

Goals of rehabilitative phase of burn

A

Psychosocial, ADLs, PT, OT, cosmetic corrections

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38
Q

Formula used to calculate the total volume of fluids (mL) that a patient needs 24 hours after experiencing a 2nd or 3rd degree burn

A

Parkland formula

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39
Q

Parkland formula

A

4 mL x TBSA (%) x body weight (kg) = total mL of fluid needed

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40
Q

After using parkland formula to calculate fluid needed, give the first half of the solution in the first ___ hrs and the second half of the solution over the next ___ hours

A

8; 16

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41
Q

What kind of burns carry a risk for inhalation injury?

A

Chemical, thermal, and electrical (electrical can also lead to cardiac arrest)

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42
Q

Burn severity depends on several factors including

A

Depth (partial/full thickness/degree), TBSA %, age, medical hx, location

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43
Q

Populations at risk for burn complications

A

Elderly, children, HF, DM

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44
Q

Top layer of skin that protects us from environment and prevents infection

A

Epidermis

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45
Q

Layer of skin that contains blood vessels, nerve endings, sweat/oil glands, and cells that create new skin

A

Dermis

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46
Q

Patients who have endured burns that damage the dermis may be unable to

A

Make new skin cells (skin grafts may be needed to promote healing)

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47
Q

Layer of skin composed of subcutaneous tissue containing fatty tissue, veins, arteries, and nerves

A

Hypodermis

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48
Q

Function of hypodermis

A

Insulation, regulation of body temperature

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49
Q

Patients with full-thickness burns, which cause damage all the way through the hypodermis, will have problems with

A

Regulating body temperature (keep room between 85-100 degrees for these patients!)

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50
Q

Interventions for first degree burns

A

Cool compress (cool saline soak), analgesics

51
Q

Types of 2nd degree partial thickness burns

A

Superficial partial thickness, deep partial thickness

52
Q

Complications of 2nd degree burns

A

Infection, scarring, contractures

53
Q

Permanent tightening of the muscles, tendons, skin, and surrounding tissues causing joints to shorten and stiffen

A

Contractures

54
Q

Interventions for 2nd degree burns

A

Cool compress, elevation, professional care

55
Q

Complications of third degree burns

A

High risk for infection, shock, respiratory distress, organ failure, extensive scarring, contractures, functional impairment

56
Q

Interventions for 3rd degree burns

A

Fluid resuscitation (LR or NS 0.9%), wound care, early intubation recommended in patients showing signs of upper airway injury

57
Q

Oral pain medications should be administered at least ___ min before dressing changes or ___ min if given IV

A

30; 15

58
Q

Degree of deep full thickness burn

A

4th degree

59
Q

Characteristics of 4th degree burn

A

Affects all layers of skin and extends into muscle, bone, ligaments; loss of sensation, appears black and charred w/ eschar

60
Q

4th degree burn intervention

A

Skin grafting

61
Q

Interventions for partial thickness burns

A

Fluid resuscitation, cover wounds w/ antibiotic ointment (non-adherent dressings), cleanse other areas w/ mild soap and gently scrubbing to reduce infection risk

62
Q

Treatment of choice for partial thickness burns

A

Hydrocolloid dressings (moisture promotes healing)

63
Q

Characteristics of superficial partial thickness burns

A

Red, painful, may blister, heals within a few weeks with minimal scarring

64
Q

Characteristics of deep partial thickness burns

A

Red, mottled appearance with blistering, painful, may require more time to heal and scarring can be significant

65
Q

Skin grafts must be

A

Sterile

66
Q

Third degree burn priority

A

Assessment of fluid level and swelling

67
Q

Mechanical ventilator settings for patients with severe burns and respiratory failure

A

Slightly higher respiratory rates (16-20 breaths/min) and smaller tidal volumes (7-8 mL/kg); high-frequency flow interruption ventilation

68
Q

_________ ventilator may be preferred after smoke injury

A

Oscillating

69
Q

Patients with elevated COhb levels and a pH <7.4 should be treated with

A

Hyperbaric oxygenation

70
Q

Emergent phase of burn risks

A

Hypovolemic shock, respiratory distress, compartment syndrome

71
Q

S/S of hypovolemic shock

A

Weak, thready pulses, decreased CO and BP, increased HR

72
Q

Acid-base imbalance associated with acute phase of burn

A

Potential for metabolic acidosis d/t accumulation of lactic acid and metabolic byproducts

73
Q

Why is increased caloric intake very important for burn patients?

A

Burns cause the body to adopt a hypermetabolic state to maintain body heat as a result of burn injury and tissue damage

74
Q

Diet during acute phase of burns

A

High protein and fats (central line lipids may be used to supplement metabolic demands)

75
Q

Caloric intake formula for adults

A

(25 x body weight [kg]) + (40 x TBSA%)

76
Q

Caloric intake formula for children

A

(60 x body weight [kg]) + (35 x TBSA%)

77
Q

S/S of paralytic ileus

A

Decreased bowel sounds, lime green vomit

78
Q

Paralytic ileus interventions

A

NPO, NGT, TPN once bowel sounds return, high calorie/protein/carb for healing

79
Q

Holes in the GI tract that develop after a person experiences great physical stress

A

Curlings ulcer

80
Q

S/S of curlings ulcer

A

Gnawing pain, N/V, blood

81
Q

Curlings ulcer interventions

A

May require NGT, colostomy

82
Q

Burns <20% TBSA treatment

A

Combination of oral and IV fluids

83
Q

Burns >20% TBSA treatment

A

IV fluid resuscitation (using parkland formula) due to GI ileus

84
Q

Moderate burn victims should have at least ___ large-bore IV line through _________ skin

A

1; unburned

85
Q

Severe burn victims should have at least ___ IV lines and venous catheters may be placed through _____ skin or via _________

A

2; burned; venous cutdown

86
Q

When considerable fluid resuscitation or cardiopulmonary disease is present, use a

A

Central venous line

87
Q

In patients with massive burns, respiratory injury, elderly patients with severe burns, or cardiac disease, monitor fluid volume with a

A

Pulmonary artery catheter (swan-ganz)

88
Q

Albumin administration during acute phase of burn

A

5% albumin at 0.5 mL/kg/% TBSA

89
Q

Medication used to restore renal and splanchnic blood flow

A

Low-dose dopamine

90
Q

In patients with major burn injuries requiring fluid resuscitation, insert _____ for initial evacuation of fluid and air from the stomach and feeding access

A

NGT

91
Q

Adequate resuscitation is evidenced by

A

Normal sensorium, stable vital signs, normal UOP

92
Q

UOP indication adequate resuscitation in children younger than 2 years

A

1 mL/lb/hr

93
Q

UOP indicative of adequate resuscitation in older children

A

0.5/lb/hr

94
Q

UOP indicative of adequate resuscitation in adults

A

> /= 30-40 mL/hr

95
Q

Referring to the parkland formula, the first 8 hours is

A

From the time of the burn injury

96
Q

Method that uses the patient’s palm to measure body surface area burned

A

Palmer method (palm of patient is about 1% of the BSA)

97
Q

Rule of nines entire head and neck percentage

A

9% (anterior and posterior each 4.5%)

98
Q

Rule of nines entire arm percentage

A

9% (anterior and posterior each 4.5%)

99
Q

Rule of nines entire leg percentage

A

18% (anterior and posterior each 9%)

100
Q

Rule of nines anterior trunk percentage

A

18%

101
Q

Rule of nines posterior trunk percentage

A

18%

102
Q

Rule of nines genitalia percentage

A

1%

103
Q

Layers involved with first degree frostbite

A

Epidermis

104
Q

Layer involved with second degree frostbite

A

Epidermis and dermis

105
Q

Layers involved with third degree frostbite

A

Hypodermis

106
Q

Layers involved with fourth degree frostbite

A

Skin, muscles, tendons, and bones

107
Q

S/S of first degree frostbite

A

Erythema and edema

108
Q

S/S of second degree frostbite

A

Hard edema and clear blisters

109
Q

S/S of third degree frostbite

A

Hemorrhagic bullae, pale grey extremity

110
Q

S/S of fourth degree frostbite

A

Insensate, black/grey

111
Q

Rewarming effects of first degree frostbite

A

Minimal pain with rewarming

112
Q

Rewarming effects of second degree frostbite

A

Mild to moderate pain with rewarming

113
Q

Rewarming effects of third degree frostbite

A

Severe pain with rewarming

114
Q

Rewarming effects of fourth degree frostbite

A

Painless during rewarming

115
Q

Guidelines for rewarming frostbite

A

Gentle, gradual rewarming using body heat or the warmth of another person’s body

116
Q

Burn treatment

A

Cool water, cover the area (clean and dry), remove clothing, wrap fingers with individual dressings so they don’t adhere, non-adherent hydrocolloid dressing, tetanus immunization

117
Q

Burn treatments to avoid

A

Ice, creams, antibiotic ointments to open skin. Do not remove anything adhering to skin

118
Q

Assessment of fluid resuscitation in emergent phase (first 24 hrs)

A

Urine output >30, SBP > 90, HR < 120

119
Q

Only IV pain meds during _________ phase of burn

A

Emergent

120
Q

inhalation injury treatment

A

100% O2 with NRB mask until COHgb falls below 15%

121
Q

Calculation used to calculate the total body surface area percentage of the body that is burned

A

Rule of nines 

122
Q

Interventions for acute phase of burn

A

Antibiotics, increase calorie intake, pain management, intubation, if respiratory complications 

123
Q

Topical antibiotics for burn injuries

A

Silver sulfadiazine and mafenide acetate (mafenide acetate penetrates eschar)

54/64 Unit 2 (8 decks)

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