BURNS 🔥

Question 1

In the rule of 9s, what body percentage is each arm?

Answer 1

9%

Question 2

In the rule of 9’s what body percentage is the whole head AND neck?

Answer 2

9%

Question 3

In the rule of 9’s the entire trunk of the body is 36%. So what percentage would that make the front (chest + abdomen) and the back?

Answer 3

the front (chest + abdomen) is 18% and your entire back (including butt) is 18%

can be further split into 9%

Question 4

In the rule of 9’s what body percentage is an entire leg?

Answer 4

18%

Each legs is 18%
**the front of each leg is 9% and the back of each leg is 9%)

Question 5

if you are outside a medical facility what are the 2 treatment priorities until medical help is had?

Answer 5

cool the burns, warm the person
-cool for at least 20 minutes w/ water
cover with lose clean dressings

Question 6

What are the 4 DONT’S of treating a burn outside the hospital? (until they can receive medical attention)

Answer 6

-no toothpaste or butter on the burn (will trap heat and keep burning)

-don’t pop or burst blisters

-don’t rip off clothing/ anything stuck to the burn

-don’t apply ice to the burn

Question 7

In the emergent phase of a burn, what 5 things are we assessing? (if this is outside the hospital?

Answer 7

• ABC’s
  -vital signs
  -hemodynamic status
  -monitor for hypovolemia
  -assess extent of burn

Question 8

What type/ amount of oxygen should a burn patient receive ASAP?

Answer 8

100% humidified oxygen

Question 9

During the emergent or resuscitative phase of a burn, what are our priorities?

Answer 9

-prevent respiratory distress
-first aid
-prevent shock
-detection + treatment of other injuries

Question 10

Describe the emergent/ resuscitative phase of a burn.

Answer 10

this is the onset of the injury until fluid resuscitation is complete

Question 11

Describe the acute/ intermediate phase of a burn?

Answer 11

when diuresis starts to near completion of wound healing

Question 12

What are the priorities during the acute/ intermediate phase of a burn?

Answer 12

-wound assessment + care
-wound closure
-prevent + treat complications (infection)
-nutritional support
-fluid/ electrolyte imbalance
-GI and renal function
-respiratory/ circulatory function
-pain management
-early positioning + mobility

Question 13

describe the rehabilitation phase of a burn?

Answer 13

this starts with major wound closure to the return of the patients optimal functioning

Question 14

What are the priorities during the rehabilitation phase of a burn?

Answer 14

-prevention of scars and contractures
-PT and OT
-cosmetic procedures
-counseling

Question 15

True or False?
medication, specifically pain meds, can ONLY be given via IV on a burn patient.

Answer 15

true

Question 16

If a patients burns exceed 20%-25% they should have an __________ placed to suction to avoid aspiration and to help w/ fluid and nutritional needs.

Answer 16

NG tube

Question 17

During the emergent/ resuscitative phase of a burn, why is a foley catheter placed?

Answer 17

to closely monitor/ COCA urine output

Question 18

What are the 5 factors used to determine the depth of the burn?

Answer 18

How
Causative agent
Temperature of agent
Duration of contact with agent
Thickness of the burn

Question 19

An example of a ____ burn is touching a hot object like an iron or stove.

Answer 19

dry

Question 20

A _______ burn is from hot liquid or steam.

Answer 20

scald

Question 21

A _____ burn is caused by rough services like carpet or road rash.

Answer 21

friction

Question 22

A _______ is from radiation like an x-ray or prolonged UV rays.

Answer 22

sunburn

Question 23

It is important to know and take note of the entry (burn) point and the exit (burn) point with an _______ burn.

Answer 23

electrical

Question 24

sulfuric battery acid, bleach + ammonia are examples of agents that can cause a _______ burn.

Answer 24

chemical

Question 25

A thermal burn is from an external heat source, raising the temperature of the skin and tissue, causing cell death and charring. What are the 3 types of burns that fall into this category?

Answer 25

-dry -scald -friction

Question 26

What are 4 essential bits of information that need to be collected about a burn patient to guide their care?

Answer 26

-list of medications -last tetanus immunization -current body temperature -pre burn body weight

Question 27

The inflammatory response can exacerbate a burn injury because?

Answer 27

-a prolonged inflammatory response can cause prolonged swelling + redness -a systemic response can affect the entire body -excessive inflammation can lead to scar tissue and fibrosis, which will restrict movement, possible disfigurement -chronic inflammation can delay the healing process

Question 28

According to Prep U, _________ is the analgesic of choice for burn pain.

Answer 28

Morphine Sulfate **Fentanyl is better for procedural pain due to the rapid onset and short duration**

Question 29

why should burn depth be reassessed after 72 hours?

Answer 29

the early burn appearance may change

Question 30

if a burn patient already has a patent airway, what is the FIRST PRIORITY?

Answer 30

fluid resuscitation

Question 31

What are the typical fluid and electrolyte shifts that occur in the acute phase of a burn, that as a nurse you need to monitor for?

Answer 31

-hemodilution (decreased hematocrit) -increased urinary output -metabolic acidosis -hyponatremia -hypokalemia

Question 32

The nurse provides care for a client with a full-thickness, circumferential burn of the left lower leg. During the nurse’s initial shift assessment, the client is resting and the physical assessment of the left lower extremity is unremarkable. One hour later, the nurse notes the pulses of the left lower leg cannot be obtained by a Doppler ultrasound device, and the capillary refill of the left great toe is greater than 2 seconds. What is the nurse’s best response based on the clinical findings?

Answer 32

contact the provider and prepare for an escharotomy

Question 33

what kind of precautions and PPE should be used with all burn patients?

Answer 33

universal precautions -gloves -gown -goggles + face shield (non porous materials)

Question 34

First degree burn is damage to the __________ layer of the skin, sunburn.

Answer 34

outermost

Question 35

A second degree burn is the entire epidermis and varies with the dermis. These are very painful with _______.

Answer 35

blisters

Question 36

Third degree burns are full thickness, destruction to the epidermis, dermis and _________ __________ - with these burns patient have a lack of sensation.

Answer 36

underlying tissue

Question 37

4th degree burns go all the way down to the deep tissue, muscle or_______. There is deep tissue necrosis.

Answer 37

bone

Question 38

a TBSA of over 30% could be _____.

Answer 38

fatal

Question 39

_______ sign is a staph. infection where the superficial layers of the skin rub off with slight pressure, from a burn or an autoimmune disease (pemphigus)

Answer 39

Nikolsky's

Question 40

Pemphigus vulgaris is a rare group of autoimmune diseases that causes blisters on the ______ + ________ _________. Affecting the mouth, nose, throat, eyes + genitals.

Answer 40

skin + mucous membranes

Question 41

A ________ Nikolsky's sign is when the top layer of skin doesn't shear off when rubbed.

Answer 41

negative

Question 42

A _______ Nikolsky's sign is when the top layer of skin does peel off when rubbed, leaving it pink, moist + tender.

Answer 42

positive

Question 43

Which treatment of burns involves using jets in water to clean the wounds and burned skin?

Answer 43

hydrotherapy

Question 44

What does hydrotherapy help to reduce in healing burn wounds?

Answer 44

-redness -pain -scarring -permanent discoloration

Question 45

how soon after the burn trauma can a patient start hydrotherapy?

Answer 45

-after the initial shock -after they're stabilized

Question 46

What will sodium and potassium levels look like in the acute/ intermediate phase due to fluid re-entering the vascular space with fluid resuscitation?

Answer 46

(potential) hyponatremia and hypokalemia

Question 47

What is causing metabolic acidosis with a burn injury?

Answer 47

decreased blood flow and oxygen delivery, and fluid and electrolyte loss

Question 48

How often should a patient's response to fluid resuscitation therapy be re-evaluated? -vitals -urine output

Answer 48

every hour

Question 49

Background or resting pain, is pain the patient feels at rest, due to the _____/______ ______.

Answer 49

burn/ thermal injury

Question 50

Procedural pain is intense episodes of pain felt during 1. 2. 3. 4. **PRE-MEDICATE**

Answer 50

wound debridement dressing changes baths physical therapy

Question 51

breakthrough pain is __________, it is felt in between times of medication administration

Answer 51

intermittent

Question 52

What pain meds are used depending on mild, moderate and severe pain(emergent + acute phases)?

Answer 52

mild - acetaminophen + naproxen moderate - opioids severe - fentanyl, lidocaine, ketamine, versed

Question 53

Benzodiazepines: valium, Xanax, Ativan, Klonopin These drugs are used for sedation and hypnosis to help with 1. 2. 3.

Answer 53

anxiety muscle spasms reduce seizures **you need sleep to heal**

Question 54

TPN/ PPN support may be needed because these patients will extensive nutritional needs to heal. **high carbohydrates** What puts there body into a hypermetabolic state?

Answer 54

STRESS **they may also need insulin** high cortisol = high BG

Question 55

Why are J tubes preferred to maintain nutritional status?

Answer 55

they have a lower aspiration risk

Question 56

TRUE OR FALSE? fluid resuscitation is only for 3rd and 4th degree burns. (maybe sometimes 2nd degree)

Answer 56

true