Burns Flashcards
1
Q
Damage to skin integrity from an energy source
A
Burn
2
Q
Degree of superficial burns
A
1st degree
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
4
Q
Degree of partial thickness burns
A
2nd degree
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
6
Q
Degree of full thickness burns
A
3rd degree
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
8
Q
Layers of the skin
A
Epidermis, dermis, hypodermis (subcutaneous tissue)
9
Q
Burn caused by superficial heat source such as liquid, steam, fire
A
Thermal
10
Q
Burn caused by toxic substances such as bleach, gasoline, paint thinner
A
Chemical
11
Q
Burns caused by UV radiation (sunburns) and cancer treatment
A
Radiation
12
Q
Burn caused by inhaling smoke which can cause flame injury or carbon monoxide poisoning
A
Inhalation
13
Q
Burn caused when an object rubs off the skin such as road rash, scrapes, carpet burn
A
Friction
14
Q
Burn caused by overexposure of the skin to cold
A
Cold (frostbite)
15
Q
Burn by which an electrical current passes through the body, causing damage within
A
Electric
16
Q
Inhalation injury happens most in a
A
Closed area
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
18
Q
Signs of carbon monoxide poisoning
A
Hypoxia, neuro changes, drowsiness, dizziness, nausea, headache, cherry red skin and lips
19
Q
Treatment for carbon monoxide poisoning
A
100% O2 with NRB mask until COhb level is below 10%
20
Q
Burns to the neck, face (nose/mouth), chest and torso can lead to
A
Respiratory complications
21
Q
Burns to the hands, eyes, feet, and joints can cause
A
Disability
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
23
Q
Full thickness/circumferential burns on the extremities and torso can increase the risk for
A
Compartment syndrome
24
Q
Intervention for circumferential burns
A
Elevate extremities above heart level to decrease edema
25
Phases of burn management
“EAR”: Emergent, Acute, Rehabilitative
26
The onset of injury to the restoration of capillary permeability (24-48 hrs after burn)
Emergent phase
27
Pathophysiology of emergent phase of burns
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)
28
Vital signs associated with emergent phase of burns
Increased HR, decreased BP, CO, and UO (similar to hypovolemic shock)
29
Labs associated with emergent phase of burns
Elevated potassium, hematocrit (hemoconcentration), and BUN/creatinine, decreased WBCs and sodium
30
Nursing interventions during emergent phase of burns
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
31
Stabilization of capillary permeability to wound closure (48-72 hours after burn and until wounds have healed)
Acute phase
32
Pathophysiology of acute phase of burn
Capillary permeability restored, diuresis (increased UOP), excess fluid shifts from interstitial space back to intravascular space
33
Acute phase of burns goals
Prevent infection (antibiotics), proper nutrition (increased calories, protein, vit C for healing), pain relief, wound care (premedicate, debridement or grafting)
34
Renal nursing considerations during acute phase of burn
Diuresis is happening —> Foley catheter to monitor UOP
35
GI nursing considerations during acute phase of burn
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
36
Burn is healed and patient is functioning mentally and physically (could be weeks - years)
Rehabilitative phase
37
Goals of rehabilitative phase of burn
Psychosocial, ADLs, PT, OT, cosmetic corrections
38
Formula used to calculate the total volume of fluids (mL) that a patient needs 24 hours after experiencing a 2nd or 3rd degree burn
Parkland formula
39
Parkland formula
4 mL x TBSA (%) x body weight (kg) = total mL of fluid needed
40
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
8; 16
41
What kind of burns carry a risk for inhalation injury?
Chemical, thermal, and electrical (electrical can also lead to cardiac arrest)
42
Burn severity depends on several factors including
Depth (partial/full thickness/degree), TBSA %, age, medical hx, location
43
Populations at risk for burn complications
Elderly, children, HF, DM
44
Top layer of skin that protects us from environment and prevents infection
Epidermis
45
Layer of skin that contains blood vessels, nerve endings, sweat/oil glands, and cells that create new skin
Dermis
46
Patients who have endured burns that damage the dermis may be unable to
Make new skin cells (skin grafts may be needed to promote healing)
47
Layer of skin composed of subcutaneous tissue containing fatty tissue, veins, arteries, and nerves
Hypodermis
48
Function of hypodermis
Insulation, regulation of body temperature
49
Patients with full-thickness burns, which cause damage all the way through the hypodermis, will have problems with
Regulating body temperature (keep room between 85-100 degrees for these patients!)
50
Interventions for first degree burns
Cool compress (cool saline soak), analgesics
51
Types of 2nd degree partial thickness burns
Superficial partial thickness, deep partial thickness
52
Complications of 2nd degree burns
Infection, scarring, contractures
53
Permanent tightening of the muscles, tendons, skin, and surrounding tissues causing joints to shorten and stiffen
Contractures
54
Interventions for 2nd degree burns
Cool compress, elevation, professional care
55
Complications of third degree burns
High risk for infection, shock, respiratory distress, organ failure, extensive scarring, contractures, functional impairment
56
Interventions for 3rd degree burns
Fluid resuscitation (LR or NS 0.9%), wound care, early intubation recommended in patients showing signs of upper airway injury
57
Oral pain medications should be administered at least ___ min before dressing changes or ___ min if given IV
30; 15
58
Degree of deep full thickness burn
4th degree
59
Characteristics of 4th degree burn
Affects all layers of skin and extends into muscle, bone, ligaments; loss of sensation, appears black and charred w/ eschar
60
4th degree burn intervention
Skin grafting
61
Interventions for partial thickness burns
Fluid resuscitation, cover wounds w/ antibiotic ointment (non-adherent dressings), cleanse other areas w/ mild soap and gently scrubbing to reduce infection risk
62
Treatment of choice for partial thickness burns
Hydrocolloid dressings (moisture promotes healing)
63
Characteristics of superficial partial thickness burns
Red, painful, may blister, heals within a few weeks with minimal scarring
64
Characteristics of deep partial thickness burns
Red, mottled appearance with blistering, painful, may require more time to heal and scarring can be significant
65
Skin grafts must be
Sterile
66
Third degree burn priority
Assessment of fluid level and swelling
67
Mechanical ventilator settings for patients with severe burns and respiratory failure
Slightly higher respiratory rates (16-20 breaths/min) and smaller tidal volumes (7-8 mL/kg); high-frequency flow interruption ventilation
68
_________ ventilator may be preferred after smoke injury
Oscillating
69
Patients with elevated COhb levels and a pH <7.4 should be treated with
Hyperbaric oxygenation
70
Emergent phase of burn risks
Hypovolemic shock, respiratory distress, compartment syndrome
71
S/S of hypovolemic shock
Weak, thready pulses, decreased CO and BP, increased HR
72
Acid-base imbalance associated with acute phase of burn
Potential for metabolic acidosis d/t accumulation of lactic acid and metabolic byproducts
73
Why is increased caloric intake very important for burn patients?
Burns cause the body to adopt a hypermetabolic state to maintain body heat as a result of burn injury and tissue damage
74
Diet during acute phase of burns
High protein and fats (central line lipids may be used to supplement metabolic demands)
75
Caloric intake formula for adults
(25 x body weight [kg]) + (40 x TBSA%)
76
Caloric intake formula for children
(60 x body weight [kg]) + (35 x TBSA%)
77
S/S of paralytic ileus
Decreased bowel sounds, lime green vomit
78
Paralytic ileus interventions
NPO, NGT, TPN once bowel sounds return, high calorie/protein/carb for healing
79
Holes in the GI tract that develop after a person experiences great physical stress
Curlings ulcer
80
S/S of curlings ulcer
Gnawing pain, N/V, blood
81
Curlings ulcer interventions
May require NGT, colostomy
82
Burns <20% TBSA treatment
Combination of oral and IV fluids
83
Burns >20% TBSA treatment
IV fluid resuscitation (using parkland formula) due to GI ileus
84
Moderate burn victims should have at least ___ large-bore IV line through _________ skin
1; unburned
85
Severe burn victims should have at least ___ IV lines and venous catheters may be placed through _____ skin or via _________
2; burned; venous cutdown
86
When considerable fluid resuscitation or cardiopulmonary disease is present, use a
Central venous line
87
In patients with massive burns, respiratory injury, elderly patients with severe burns, or cardiac disease, monitor fluid volume with a
Pulmonary artery catheter (swan-ganz)
88
Albumin administration during acute phase of burn
5% albumin at 0.5 mL/kg/% TBSA
89
Medication used to restore renal and splanchnic blood flow
Low-dose dopamine
90
In patients with major burn injuries requiring fluid resuscitation, insert _____ for initial evacuation of fluid and air from the stomach and feeding access
NGT
91
Adequate resuscitation is evidenced by
Normal sensorium, stable vital signs, normal UOP
92
UOP indication adequate resuscitation in children younger than 2 years
1 mL/lb/hr
93
UOP indicative of adequate resuscitation in older children
0.5/lb/hr
94
UOP indicative of adequate resuscitation in adults
>/= 30-40 mL/hr
95
Referring to the parkland formula, the first 8 hours is
From the time of the burn injury
96
Method that uses the patient’s palm to measure body surface area burned
Palmer method (palm of patient is about 1% of the BSA)
97
Rule of nines entire head and neck percentage
9% (anterior and posterior each 4.5%)
98
Rule of nines entire arm percentage
9% (anterior and posterior each 4.5%)
99
Rule of nines entire leg percentage
18% (anterior and posterior each 9%)
100
Rule of nines anterior trunk percentage
18%
101
Rule of nines posterior trunk percentage
18%
102
Rule of nines genitalia percentage
1%
103
Layers involved with first degree frostbite
Epidermis
104
Layer involved with second degree frostbite
Epidermis and dermis
105
Layers involved with third degree frostbite
Hypodermis
106
Layers involved with fourth degree frostbite
Skin, muscles, tendons, and bones
107
S/S of first degree frostbite
Erythema and edema
108
S/S of second degree frostbite
Hard edema and clear blisters
109
S/S of third degree frostbite
Hemorrhagic bullae, pale grey extremity
110
S/S of fourth degree frostbite
Insensate, black/grey
111
Rewarming effects of first degree frostbite
Minimal pain with rewarming
112
Rewarming effects of second degree frostbite
Mild to moderate pain with rewarming
113
Rewarming effects of third degree frostbite
Severe pain with rewarming
114
Rewarming effects of fourth degree frostbite
Painless during rewarming
115
Guidelines for rewarming frostbite
Gentle, gradual rewarming using body heat or the warmth of another person’s body
116
Burn treatment
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
Burn treatments to avoid
Ice, creams, antibiotic ointments to open skin. Do not remove anything adhering to skin
118
Assessment of fluid resuscitation in emergent phase (first 24 hrs)
Urine output >30, SBP > 90, HR < 120
119
Only IV pain meds during _________ phase of burn
Emergent
120
inhalation injury treatment
100% O2 with NRB mask until COHgb falls below 15%
121
Calculation used to calculate the total body surface area percentage of the body that is burned
Rule of nines 
122
Interventions for acute phase of burn
Antibiotics, increase calorie intake, pain management, intubation, if respiratory complications 
123
Topical antibiotics for burn injuries
Silver sulfadiazine and mafenide acetate (mafenide acetate penetrates eschar)
