Regulation of body temperature - F/E balance - protect - sensory - Vit D - regenerates itself

shows extent and % of burns - add posterior + anterior - NO 1st degree burns - must say CHEST & ABDOMEN for full 18%

Burns Flashcards by Amanda silva

Roles of Skin

Regulation of body temperature

F/E balance
protect
sensory
Vit D
regenerates itself

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Physiology of burns:

1) release of catecholamines

increases BP/HR
vasoconstriction
disrupted BF

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Physiology of Burns:

2) increased capillary permeability

Edema EVERYWHERE (lungs)
3rd spacing–> hypovolemia
fluid shifts
HR fast but low C.O

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what does third spacing and hypovolemia change in electrolytes

Na & K changes

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Physiology of burns:

3) decreased perfusion to GI system

paralytic ileus
abd distention
stress ulcer

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Physiology of burns:

4) Inflammatory response- destroyed skin

immunosuppressed
risk for infection
lose ability to sweat

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Physiology of burns:

5) Increased metabolic demands

massive catabolism and increase need for calories
incr. body temp
incr. O2 demand

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Physiology of Burns:

6) RBCs hemolyzing causing hemoconcentration

high Hct
high hgb
incr. blood viscosity
- thick blood= incr. risk DVT, acute kidney injury

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What type of diet for burn victims?

High calorie and high PRO diet

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SUPERFICIAL (1st deg.) burns

only damages the outermost layer of the skin (epidermis)

RED, BLISTER, PAINFUL
heals in a few days

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PARTIAL THICKNESS (2nd deg) burns

Destroys epidermis into the dermis

RED, SWOLLEN, SKINY, EDEMA, BLISTER, VERY PAINFUL
heals in 2 weeks to 21 days
d/t hot fluids

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FULL THICKNESS (3rd deg) burns

-ALL layers of the skin
-NO PAIN!!
TOUGH, LEATHERY, MANY COLORS, DRY
** CANNOT grow new skin

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Treatment for superficial and partial thickness burns

stop the burning process
keep moist
NO ALOVERA with alcohol
use triple antibiotic cream
clean 2 x /day with non-adhesive dressing

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Treatment for 3rd degree burns

Surgical excision

- SKIN GRAFT

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How long should surgeries be for burn patients

short b/c don’t want to put too much more stress on the patients body

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Rule of 9’s

shows extent and % of burns

add posterior + anterior
NO 1st degree burns
must say CHEST & ABDOMEN for full 18%

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what day after admission is skin graft done?

day 1 or 2

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Complications of skin grafts

1- bleeding
2- donated skin will create a new open wound
3- Grafts are very fragile

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What temp should a skin graft room be?

85 F

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When to assess if skin graft worked

after first dressing change

-48 hr is first change?

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What burns are considered SERIOUS

face
eyes
hands
feet
perineum
CIRCUMFERENTIAL

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Why are hand and feet burns serious?

so many joints, can cause contractures

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Why is there decr. circulation to 3rd degree burns

d/t swelling and leathery skin

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Risk factors for burn complications

old/young
CV
Respiratory/renal dz
Alcoholism
malnutrition

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What are the two highest complications of burns?

HYPOVOLEMIC SHOCK -most common cause of death | INFECTION

Types of burns: | 1) Thermal

most common - flame - flash - scald - contact with hot objects

Types of burns" | 2) Chemical

- acid - alkalis - organic compounds - * most common to the hands

Chemical burns - which substance is most dangerous and why - how do you treat it

alkali because you don't feel burning sensation - RINSE WITH WATER * NO NEUTRALIZING until cause of burn identified

Chemical burns | -what is there a high risk for

* risk of inhalation injury! check airways for damage or swelling!

Types of burns: | 3) Electrical

- there will be an entry and exit wound * ** check heart * high voltage can fracture bones - common in children

Types of Burns: | 4) Radiation

uncommon

Burn Care Goals

- prevent infection - fluid balance - thermoregulation - pain control - skin integrity - nutrition: start early - emotional support

Primary Survey | 1) AIRWAY

constantly reassess - give 100 % O2 - Protect airway: INTUBATE

why do you give abdomen and up burn patients 100% O2

to help with carbon monoxide build up

S/S of inhalation injury

- happened in an enclosed space - fumes - smoke - stridor - hoarse or raspy voice - carbonaceous sputum - singed nasal hairs - swelling : INTUBATE * MAJOR CAUSE OF MORTALITY

how do you give 100% oxygen

non-rebreathing mask

S/S carbon monoxide poisoning

cherry, red skin N.V headache

what type of burns cause ventilation problems

circumferential burns

How to treat circumferential burns

ESCHAROTOMY

what is an Escharotomy

- done at bedside or OR - made thru elastic eschar - returns BF to body part

Is escharotomy painful?

No! b/c full thickness wounds cut thru nerves

What meds to give during escharotomy?

BENZOS to help their anxiety

Circulation: | do burns bleed

Evaluation of circulation: | 5 P's

``` BP Pulses Pallor Temp ect ```

where to insert large bore IVs

NOT under burns

what fluids to use to replace fluids in burns

LACTADE RINGERS

Parkland Formula: | what does it determine?

how much fluid the patient needs

Parkland Formula:

1/2 the first 8 hrs 1/2 over remainder 16 hrs ** time starts at the time of injury

DISABILITY: | how should patient be acting with burns

should be A/O, if not assess for other problems

Disabilty: | -reasons why pt not A/O

- CO poisoning - Substance abuse - hypoxia - pre-exist prob (seizure)

Disability: | -logrolling

to assess for burns on the back | assess for gross deformities d/t burns

EXPOSURE/ENVIRONMENT: | -interventions

e-remove all clothing, jewelry, metal, shoes - keep warm: cover with blankets - irrigate with cool water

What do you NEVER use to cool burns

ICE b/c it vasoconstricts

SECONDARY SURVEY | -complete hx and physical

to see if the injury matches the story

Secondary survey: | -EKGs

- assess baseline | - MONITOR when it is an electrical burn

Secondary survey: | -TBSA

calculate to give fluids | -reassess ABGS

Secondary Survey: | -Medications: analgesics and sedatives

IV ONLY! (NO IM OR PO) - b.c third spacing - b.c decr. absorption and paralytic ileus

what is the only IM medication you can give to burn pt

TETANUS!

what topical meds are best for burns

Antimicrobials, silver sulfadazine | *caution if sulfa allergy

What do other meds for burns

-stress ulcer and clot prevention meds

What do nurses wear when doing dressing changes

wear all PPE and sterile gloves

Recovery: | -Full thickness wounds

-excision and wound coverage -skin graft multiple OR visits

Recovery: | -partial thickness wounds

daily wound care with anti-anxiety meds and pain meds

Rule of thumb for ICU LOS

1% TBSA= 1 day in ICU

Rehab phase | -minimize

- skin and joint contractures - scarring - Body image disturbance - PTSD

autograft

-permanent coverage | sheets or meshed

homograft/allograft

temporary wound coverage - allows for vascularization - better control of bacteria