Burns

Question 1

What are the four types of burns

Answer 1

Thermal Burns
Flash, flame, contact, scalding burns
Can include radiation buns

Chemical Burns
Acids, alkalis, organic compounds

Electrical Burns
Intense heat generated by electrical current

Inhalation Injury
Chemicals, hot air, or other substances can damage the airway

Question 2

What is the difference between partial and full thickness burns?

Answer 2

Partial thickness (anything above subcutaneous tissue)
1st degree involves epidermis
2nd degree involves epidermis and dermis

Full thickness (subcutaneous tissue down to bone)
3rd degree involves epidermis and dermis down to subcutaneous fat, muscle and possibly bone

Question 3

Using the rule of nines, what parts of the body are considered 4.5%

Answer 3

front/back of head
front/back of entire arms

Question 4

Using the rule of nines, what parts of the body are considered 9%

Answer 4

front/back of chest (upper back)
front/back of abdomen (lower back)
front/back of legs

Question 5

Using the rule of nines, what part of the body is considered 1%

Answer 5

genitals

Question 6

What is the Emergent phase:

Answer 6

first 72 hours after the burn has occurred

Question 7

What is the Acute phase:

Answer 7

Starts after 72 hours and ends when partial-thickness wounds are healed or full thickness are grafted-lasts weeks to months

Question 8

What is the Rehabilitation phase:

Answer 8

wounds have nearly healed and they are able to participate in self-care

Question 9

What are the two major parts of injury in the emergent phase of a burn

Answer 9

Burn injury causes damage to tissue, then inflammatory response (increased capillary permeability) causes more issues such as:

fluid out of the intravascular space and into the interstitial spaces (third spacing)
Shift of electrolytes and possible necrosis of tissue
The immune system is also compromised because the skin is removed and the inflammatory process reduces the availability of the innate and specific immune systems

At risk of hypovolemic shock

Question 10

Expected labs for burn victims

Answer 10

Hypoalbuminemia
Hyponatremic
Hyperkalemic
Increased BUN, creatinine
Low GFR
ABGs (effects of respiratory injury)

Question 11

Manifestations of the emergent phase of a burn

Answer 11

altered mental status possible
high level of pain for superficial burns no pain for deep burns
tachycardia, hypotension, dysrhythmias
hoarseness, difficulty swallowing, hypoactive/absent bowel sounds
oliguria

Question 12

Manifestations of a First degree Thermal Burn

Answer 12

-blanching with pressure, tenderness, pain, redness

Question 13

Manifestations of a Second degree Thermal Burn

Answer 13

-blanching with pressure, pain, blisters, change in skin color

Question 14

Manifestations of a Third degree Thermal Burn

Answer 14

-absence of pain, eschar, impaired sensation, no blanching

Question 15

Manifestations of a First degree Electrical Burn

Answer 15

Cardiovascular disruptions-dysrhythmias, cardiac arrest

Question 16

Manifestations of a Second degree Electrical Burn

Answer 16

May look superficial, but will have internal injuries that are more severe

Question 17

Manifestations of a Third degree Electrical Burn

Answer 17

Possible fractures or dislocations from muscle contraction

Question 18

What is the first intervention for a chemical burn

Answer 18

remove the source of the the chemical burn

Question 19

What are the secondary effects of major burns you should monitor for?

Answer 19

acute kidney injury

Question 20

What is a TBSA calculation

Answer 20

Total Body Surface Area (Rule of Nines)

Question 21

What are some medications you treat for the secondary effects of major burns

Answer 21

Analgesics
Sedatives
VTE prophylaxis
Tetanus immunization
Antibiotics/antimicrobials

Fluid therapy (use Parkland Formula)
Isotonic fluids-most commonly LR
Possible albumin administration

Question 22

What is the Parkland Formula

Answer 22

Determine fluid resuscitation for burn victims over the first 24 hours by:

multiplying 4ml times the percentage of body surface area times the patient’s weight in kg

multiply by .5 and give first half the first 8 hours and the second half the next 16 hours

If pt produces less than 30ml of urine/hr with current level of fluid therapy, tell doc. SHOULD have large diuresis as fluid shifts back into interstitial space

Question 23

Circumferential burns (compartment syndrome) often require what intervention?

Answer 23

Escharotomy or fasciotomy (allows swelling to occur without compromising circulation)

Question 24

What are the two types of wound care?

Answer 24

Open method: creams and salves with no dressing (around face and head)
Closed method: Burns have dressings

Question 25

T/F: You should always use sterile technique and provide pain medication when performing wound care on burn victims

Answer 25

True.

Question 26

What are the nursing priorities in order when a burn victim is in the emergent phase?

Answer 26

Monitor and manage airway Provide oxygen support as needed Establish IV access Replace fluid therapy and monitor for effectiveness/over replacement Strict I&O monitoring Monitor for infection Perform wound care Monitor and prevent pressure injuries Monitor and report abnormal lab values Coordinate with PT/OT

Question 27

Describe the nutritional needs of a burn victim

Answer 27

hypermetabolic state, high calories diet

Question 28

Describe the sx of the acute phase of burn victim

Answer 28

Hyperglycemia r/t increased stress hormones can impede healing process Increased urine output increased pain level

Question 29

What are some lab manifestations of the acute phase of burn victims

Answer 29

Monitor for hemodilution May change from hyponatremic to hypernatremia and hyperkalemic to hypokalemic. Must monitor chem panel Elevated WBC and ESR/CRP Hyperglycemia ABGs

Question 30

Describe the changes in pharmacology for the acute phase of a burn

Answer 30

Starting to wean off of narcotics (pain meds) and sedation if possible Try switching to PO fluid/electrolyte replacement VTE prophylaxis Antibiotics/antimicrobials Continue monitoring glucose, may use insulin to control

Question 31

What type of wound care would a nurse perform during the acute phase

Answer 31

Manual debridement or with enzymes Excision (escharectomy) (prep for graft) Skin Grafting

Question 32

How do you prep a burn patient for OT/PT

Answer 32

Remove dressings to increase possible ROM Will possibly have splints etc. to prevent contractures

Question 33

What is a Allograft

Answer 33

Try Cadaveric skin to see if pt will accept transplant at all TEST TO DO AUTOGRAFT, NOT PERMANENET

Question 34

What is a Autograft

Answer 34

Skin taken from patient if there is enough Skin grafts are typically meshed which allows the graft to cover a larger area

Question 35

What do you do if there is not enough skin available to make a graft

Answer 35

Possible cultured epithelial autograft (CEA). Dermal Substitute Different types that may be permanent or used as a bridge for a severely burned patient waiting on CEA

Question 36

T/F: The burn site is often more painful than the donor site

Answer 36

False: Donor site if often more painful than burn site

Question 37

What are the common complications found in burn patients?

Answer 37

Paralytic ileus Contractures Constipation Curling’s ulcer (Burns cause a reduction in plasma volume, which can lead to ischemia and cell death in the stomach lining) Hyperglycemia

Question 38

Itching, pain, skin flaking are manifestations of what phase of burn healing

Answer 38

Rehabilitation Phase