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Burns Flashcards

1
Q

What are the 2 most common burns?

A

Flame and scald

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2
Q

How are burns classified?

A

By the depth of the injury and the extent of the TBSA that is burned

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3
Q

What factors are considered when determining the depth of a burn?

A
  • how injury occurred
  • causative agent
  • temperature of burning agent
  • duration of contact
  • thickness of skin in burned area
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4
Q

How are burns described?

A
  • superficial
  • superficial-partial thickness
  • deep-partial thickness
  • full thickness
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5
Q

Superficial burns only damage what?

A

the epidermis

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6
Q

Superficial Burns

A
  • red and dry
  • slight swelling
  • NO blister
  • painful like sunburn
  • no scarring
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7
Q

How long does it typically take superficial burns to heal?

A

7 days with usually no scarring

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8
Q

Superficial Partial-Thickness burns affect how much of the skin?

A

the epidermis is destroyed and small portion of underlying dermis

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9
Q

Superficial Partial-Thickness burns

A
  • blistered
  • exposed dermis is red and moist
  • hair follicles are intact
  • no scarring
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10
Q

How long does it take Superficial Partial-Thickness burns to heal?

A

14-21 days

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11
Q

Deep Partial-Thickness burn affects how much?

A

Extends into the reticular layer of the dermis and is hard to distinguish from full-thickness

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12
Q

Deep Partial-Thickness Burn

A
  • red or white
  • mottled
  • moist or fairly dry
  • severe pain
  • permanent scarring
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13
Q

How long does it take Deep Partial-Thickness burns to heal?

A

3-8 weeks

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14
Q

How much will a Full-Thickness burn affect?

A

involves total destruction of dermis and continues into the subcutaneous fat
Can also involve muscle and bone

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15
Q

How do Full-Thickness burns heal?

A

By contraction or epithelial migration

Will require surgery

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16
Q

Full-Thickness Burns

A
  • charred/leathery skin
  • hair follicles/sweat glands are destroyed
  • no longer experiences pain
  • significant scarring
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17
Q

A deep partial-thickness burn can convert to a full-thickness burn in how long?

A

24 hours

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18
Q

How can the nurse prevent a deep-partial thickness burn from converting to full-thickness burn?

A

Immediate assessment and management

-application of cool tap water for a minimum of 5 minutes

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19
Q

Why should the use of ice water be avoided for large burn injuries?

A

It can result in hypothermia and increased mortality

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20
Q

Why is tap water good for burn injuries?

A
  • reduction of pain

- reduction of tissue necrosis and need for skin grafting

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21
Q

What are the 3 distinct zones seen as a Bulls Eye pattern in burns?

A
  • zone of coagulation (center)
  • zone of stasis
  • zone of hyperemia
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22
Q

When is fluid volume loss at its greatest?

A

first 6-8 hours

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23
Q

When does capillary integrity return towards normal?

A

36-48 hours after the burn

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24
Q

What are the special care areas that are automatically considered major burns?

A

eyes, ears, face, hands, feet, perineum, joints

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25
Burns of 60% TBSA can cause what?
- depressed myocardial contractility - hemoconcentration - massive edema formation - hypovolemic shock
26
What is the onset of Burn Shock?
Fluid loss continues and vascular volume decreases, the CO and BP drop
27
Burn Shock is characterized by what?
- capillary leak - third spacing - severe hypovolemia - decreased CO
28
What is the preferred IV fluid for burn resuscitation?
Lactated Ringer's b/c sodium and potassium concentration are similar to normal intravascular levels
29
Lactate Ringers solution can also be converted to Bicarbonate by the liver to correct what seen w/ Burn Shock?
Metabolic ACIDOSIS
30
If Fluid Resuscitation is delayed, large burn wound victims are at risk for what?
Abdominal Compartment Syndrome
31
Abdominal Compartment Syndrome
fluid shifts into the abdominal cavity causing increased abdominal distention that interferes w/ pulmonary ventilation
32
The volume loss into the peritoneal space w/ Abdominal Compartment Syndrome results in what?
- decreasing CO - hypotension - decreasing urine output
33
Escharotomy
surgical incision into the eschar to relieve the constricting effect of the burned tissue
34
Severe lactic acidosis is associated w/ what?
high early mortality
35
Consequences of inhalation injury
- upper airway edema - bronchospasm - small airway occlusion - increased dead space - tracheobronchitis - pneumonia
36
What are the 2 categories of pulmonary injuries?
upper airway injury | inhalation injury below glottis
37
Upper airway injury result from what?
direct heat and edema
38
S/S of Upper Airway injury
- mechanical obstruction - bronchospasms - edema
39
Treatment for Upper Airway injury
Short course of endotracheal intubation
40
Inhalation injury below the glottis results from what?
inhaling noxious gases or steam
41
S/S of Inhalation Injury
- hypersecretion - severe mucosal edema - possible bronchospasm - atelectasis - expectoration of carbon particles
42
What is the most common cause of inhalation injury?
Carbon Monoxide
43
What is Standard care for Carbon Monoxide poisoning?
100% oxygen for 6 hours until HbCO level is below 10% and patient is asymptomatic
44
Any patient w/ possible inhalation injury must be observed for how long?
24 hours
45
S/S of Possible Pulmonary Damage
- burns of face/neck - singed nasal hair - hoarseness, voice change, dry cough, stridor - sooty or bloody sputum - labored breathing or tachypnea - erythema and blistering of oral/pharyngeal mucosa
46
What are the 2 potential GI complications that may occur w/ burns?
paralytic ileus and curling ulcer
47
What are the 3 phases of burn care?
- emergent/resuscitative - acute intermediate - rehabilitation
48
What steps are important to remember?
``` CABD circulation airway breathing disability ```
49
Nursing Management for Circulation
- monitor Apical pulse/BP frequently - tachycardia/slight hypotension are expected - urinary catheter is placed - strict I/O's - daily weights - large bore IV - maybe endotracheal intubation
50
Immediate interventions for establishing airway are?
100% humidified oxygen
51
What can occur because of high-voltage electrical injuries?
- spinal cord injury | - cardiac arrhythmias
52
How long should a person have cardiac monitoring after an electrical injury?
24 hours after cessation of arrhythmia
53
What may indicate cerebral hypoxia?
- restlessness - confusion - difficulty answering questions - decreasing LOC
54
If the burn exceeds 20% TBSA what type of tube should be inserted?
NG tube to low suction to decompress abdomen and prevent vomiting
55
Why must a BP cuff be removed between readings?
It may act as a tourniquet as the extremity swells
56
What color urine indicated muscle damage?
burgundy colored/pigmented
57
When does the Acute/Intermediate phase of burn care begin?
48-72 hours after burn injury
58
What is the most frequent clinically related complication that occurs in patients w/ fire/flame injuries?
Pneumonia
59
What are the 2 goals of Debridement?
- to remove tissue contaminated by bacteria and foreign bodies - to remove devitalized tissue or burn eschar in prep for grafting/healing
60
Why are autografts the ideal covering for burn wounds?
They are the patient's own skin and will not be rejected
61
Purposes of wound covering are?
- decrease risk of infection - prevent further loss of protein, fluid, and electrolytes - minimize heat loss
62
Homograft
donor skin from a cadaver
63
What are commonly used after grafting to immobilize the graft?
Occlusive dressing
64
What type of dressing may be used to protect grafts?
Synthetic dressing
65
Hyperalgesia
enhanced intensity of pain
66
4 Types of Pain w/ Burn patients
- rest pain/constant background/dull pain - breakthrough pain/intermittent;short duration;rapid onset - procedural - psychogenic pain;anticipatory pain
67
Rest pain is best handled by what type of medication?
Regularly scheduled long-acting opioids
68
Procedural pain requires what?
premedication w/ analgesic meds before painful procedures
69
What is the analgesic of choice for Burn Pain?
Morphine sulfate
70
Other Medications for Burns
- ketamine - fentanyl - PCA pump - oxycodone
71
What type of diet will burn patients be on?
High protein and calorie rich diet
72
Promoting Mobility in burn patients
- deep breathing - turning - proper positioning - low air loss/rotation beds - elastic pressure bandages for lower extremities

Critical Care Nursing (14 decks)

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