Burns

Question 1

What populations are at greater risk of death r/t burns?

Answer 1

children, elderly, and diabetics

Question 2

At what percent of total body area does survival become worse?

Answer 2

20 percent

Question 3

What age group has the best survival rate from burns?

Answer 3

15-45

Question 4

What are the four types of burns?

Answer 4

Thermal
Chemical
Radiation
Electrical

Question 5

Describe the difference between alkalitic and acidic burns

Answer 5

Akalitic; clumps the skin and erodes it away

Acidic; necrotic, stops on its own, eschar

Question 6

What is the damage from an electrical burn dependent on?

Answer 6

TYPE of current
PATHWAY of flow
tissue RESISTANCE
DURATION of contact

Question 7

Describe the difference between coming in contact with direct and alternating currents

Answer 7

DIRECT: are thrown away

ALTERNATING: cannot let go and keeps damaging

Question 8

What factors influence severity?

Answer 8

Depth of wound
Size of wound (rule of nines)
Age of pt
Past med hx
Location of burn injury
Associated trauma

Question 9

List the three ways that burns are classified

Answer 9

1) depth of the injury
2) extent of the body area
3) severity of the burn

Question 10

Describe the depth that burns can be (degree system)

Answer 10

1) superficial burns (first degree)
2) Deep Partial Thickness (2nd degree)
3) Full Thickness (3rd or 4th degree)

Question 11

Describe the characteristics of a superficial (1st degree) burn.

Answer 11

Epidermal tissue only affected

Erythema, blanching on pressure, mild swelling

no vesicles or blisters initially present

Not serious unless large area

Question 12

Describe the characteristics of a deep partial thickness (2nd degree) burn

Answer 12

epidermis and deep layer of dermis

fluid filled vesicles; red, shiny, wet, severe pain

Hospitilization required if over 25 percent involved

can scar significantly d/t extended healing time

can be red, whit, or brown

Question 13

Describe the characteristics of a full thickness (3rd/4th) degree burn

Answer 13

Destruction of all skin layers

immediate hospitalization

dry, waxy white, leathery, or hard skin. No pain

Question 14

Which chart for calculating TBSA is the most accurate for children and why?

Answer 14

Lund and Browder Chart

because it adjusts for age. it is good for children

Question 15

What type of burns are not involved in TBSA calculations?

Answer 15

superficial (1st degree) burns

Question 16

How is the severity of a burn classified? what are the three groups?

Answer 16

based on depth and TBSA

MINOR
MODERATE
MAJOR

Question 17

Describe the characteristics of a MINOR burn

Answer 17

1) <15 percent of TBSA
2) Full thickness <2 percent
3) no involvement of eyes, face, hands, feet, or perineum
4) no pre-existing medical conditions
5) adult under 50
6) no other injury associated with the burn

Question 18

Describe the characteristics of MODERATE burns

Answer 18

1) <25 percent TBSA
2) full thickness <10 percent
3) no involvement of eyes, face, hands, feet, perineum
4) no pre-existing medical conditions
5) adult under 50
6) no other injury associated with burn

Question 19

Describe the characteristics of a MAJOR burn

Answer 19

1) >25 percent TBSA
2) full thickness >10 percent
3) involvement of eyes, face, hands, feet, or perineum
4) Electric is automatically considered major
5) >50 years old
6) accompanied by other injuries or inhalation burns
7) has pre-existing medical conditions

Question 20

What is the systemic response to a burn?

Answer 20

inflammatory response; swelling, edema, increased cap permeability

Question 21

What is the cellular response to a burn?

Answer 21

neutrophils go to area

enzymes destroy damaged tissue causing hyperkalemia, increased permeability

Question 22

How much does the CO decrease in the first 30 minutes of a burn?

Answer 22

30 percent

Question 23

What happens to renal function in a burn?

Answer 23

decreased perfusion to kidneys causes pre renal failure

intra renal failure can occur from necrosis and ischemia

Question 24

What happens to GI function with a burn? What is a risk associated with this?

Answer 24

it is suppressed

Paralytic illeus

Question 25

What is the immune response to a burn?

Answer 25

macrophages go to area to eat dmgd tissue immunoglobulins are suppressed which increases risk of sepsis

Question 26

Why would you get a reduction of blood volume with a burn?

Answer 26

with the loss of plasma in fluid shift and decreased CO

Question 27

Why would you get decreased urinary output

Answer 27

2nd to fluid loss, decreased renal perfusion, and sodium and water retension

Question 28

Why would you get hyperkalemia with a burn?

Answer 28

as a result of the damaged cells releasing K+

Question 29

Why would you get metabolic acidosis with a burn

Answer 29

d/t the loss of bicarbonate along with Na+

Question 30

Why do you get a Na+ deficit with a burn?

Answer 30

large amounts of this are trapped in the edema fluid and by shifts into cells

Question 31

What is hemoconcentration and why does it occur in burns?

Answer 31

it is when there is a loss of plasma causing RBC to be more concentrated d/t a loss of plasma proteins and decreased ability to hold onto the fluid

Question 32

What is the best fluid of choice for crystalloid replacement in burns and why?

Answer 32

Warmed RL because it helps to counteract metabolic acidosis

Question 33

Describe the two formulas used to calculate the total amount of fluid that should be resuscitated in burns.

Answer 33

Consensus Formula 2ml x percent TBSA x wt Parkland Formula 4ml x percent TBSA x wt

Question 34

When using the Parkland Formula, describe the ratios and times that this amount should be given over

Answer 34

based on time of burn 1/2 within the first 8 hrs 1/4 within next 8 1/4 within next 8

Question 35

What are the three stages of burn care?

Answer 35

EMERGENT ACUTE REHABILITATION

Question 36

Describe the EMERGENT phase of burn care

Answer 36

from onset to completion of fluid resuscitation ABCs of trauma care GOALS: secure airway, support circulation, comfort, prevent infection through wound care, maintain body temp, provide emotional support Gain knowledge of circumstances of burn obtain pre burn wt (if not available use dry wt) Know health hx because latent conditions can flare up d/t stress

Question 37

Describe the ACUTE phase of burn care

Answer 37

from start of diuresis to near completion of wound closure efforts are pain relief to manage wound adequate nutrition; prefer NG than parenteral if possible d/t lots of fluids maintain fluid, electrolyte, acid base balance monitor for complications provide emotional support planning for rehab and discharge wound management

Question 38

Describe the REHABILITATION phase of burn care

Answer 38

often a long process not only encompassing physical injuries but also psychosocial care of individual and family reconstructive surgery may be necessary to address functional and cosmetic problems

Question 39

What are the four goals of wound management

Answer 39

1) Contain bacterial growth 2) Provide comfort 3) Facilitate the healing process 4) Promote restoration and function

Question 40

Why should you not use ice at home to manage? what is an appropriate solution?

Answer 40

It vasoconstricts and causes tissue shock luke warm water is better