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Burns Flashcards

(54 cards)

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1
Q

Why does plasma seep out into the tissue

A

Increased capillary permeability

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2
Q

When does capillary permeability happen

A

first 24 hours

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3
Q

capillary permeability leads to

A

fluid volume deficit, shock, increased heart rate

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4
Q

why does cardiac output decrease in burns

A

less volume in vascular space

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5
Q

why does urine output decrease

A

kidneys holding on to fluid OR inadequate renal perfusion (only takes 20 minutes for acute tubular necrosis)

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6
Q

why is Epinephrine secreted

A

vasoconstriction to increase BP and shunt blood to vital organs

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7
Q

what other hormones are secreted

A

ADH (retain water) & Aldosterone (retain sodium and water)

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8
Q

what is the most common airway injury

A

Carbon monoxide

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9
Q

what are the S/S & Tx of carbon monoxide poisoning

A

S/S: cherry red color
Tx: 100% oxygen

burns that occur in close space increase the amount of CO that was inhaled

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10
Q

when you see a client with burns to face, chest, neck, facial hair, think what first

A

prophylactically intubation

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11
Q

Rule of 9s

A 
burned area: 
head/neck -9%
arm (each) -9%
leg (each) -18%
trunk (back) -18%
trunk (front) -18%
genital -9%
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12
Q

clients with burns over 20/30% of body

A

fluid replacement is the most important aspect of treatment.

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13
Q

when should fluid replacement therapy occur

A

first 24 hours after the time of injury

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14
Q

what is the parkland formula

A

(4ml of LR) X (body weight in kg) X (% of TBSA burned) = total fluid requirement for first 24 hours after burn

hrs 1-8: 1/2 the total volume
hrs 8-16: 1/4 the total volume
hrs 16-24: 1/4 the total volume

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15
Q

restlessness could indicate what

A

pain, hypoxia, inadequate fluid replacement

hypoxia takes prescience
in priority Qs refer to Maslow’s hierarchy

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16
Q

how do you determine client’s fluid volume is adequate

A

in Burns use Urine Output to determine fluid volume. In first 24 hours we are loading them with fluids because their vesicles are leaking (due to shock), so weight is not accurate.

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17
Q

what is normal urine output

A

0.5 ml/kg/hr -adults
1 ml/kg/hr -children

for adults minimum is 30-50 ml/hr

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18
Q

Emergency Management of burns

A

treat burn site with cool (not cold) water to stop burning process that still may be occurring.

wrap client in blanket to prevent heat loss and protect against germs

remove jewelry due to swelling of skin after burn and possibility that jewelry is still hot after burn

remove non-adhearent clothing to prevent swelling and cover burn site with clean dry cloth

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19
Q

signs of airway injury

A

singed facial hair, burnt hair, burnt nasal hair soot on face, coughing up black soot and sputum, blisters on lips/tongue/gums/oral pharyngeal mucosa

respiratory acidosis is possible due to shallow respirations

upper body burn is more dangerous due to airway restriction

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20
Q

medication management

A

Albumin increases vascular volume (Na & H2O)

hold fluid in vascular space, increase vascular volume, increase kidney perfusion, increase BP, increase cardiac output, corrects fluid volume deficit.

watch out for putting increased work load on heart and possibility of fluid volume excess

if fluid volume excess occurs, then CO will drop, lung sounds will be wet. Must take CVP measurements every hour to ensure client is not going into overload

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21
Q

Pain management

A

IV because it is fast acting and IMs won’t work due to poor muscle perfusion.

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22
Q

Immunizations

Study These Flashcards
A

Booster shot (toxoid) is ACTIVE IMMUNITY -body must take ACTIVE role in making anti-bioties to agonist. Takes 2-4 weeks

IMMUNE GLOBULIN is IMMEDIATE protection, because the anti-bodies are supplied immediately to body in Immune Globulin. Lasts 3 Mo

23
Q

circumferential burn

Study These Flashcards
A

burn is all the way around (arm, leg)

NURSING PRIORITY: check pulses

24
Q

Circulatory Check:

Study These Flashcards
A

Pulse
Skin Color
Temperature
Capillary Refill

25
Escharotomy
circulation is restored & pressure is relieved by cutting through eschar (dead tissue)
26
Fasciotomy
relieves pressure & restores circulation by cutting deeper into tissue, through eschar and fascia
27
if you insert a foley and no urine is produced what is the cause?
Kidneys are either preserving the fluid they have left OR they aren't being perfused adequately. output should be checked every hour
28
what do you do if Urine is red or brown?
Call doctor. This is likely to happen, however it is still a concern. Red -hemoglobin from RBC destruction Brown -myoglbin from muscle tissue destruction could clog kidneys and lead to renal failure Manitol (osmotic diuretic) might be ordered to flush out kidneys. one time EXCEPTION TO RULE: normally wont want to decrease the CO of a burn client, but to save kidney fxn diuretic is used Manitol crystalized in solution if cold. Before administration observe for clarity, do not refrigerate, and use inline filter.
29
if Urine Output is less than 30 ml/hr what do we worry about?
Kidney Failure
30
Why will client begin to diurese after 48 hours
fluid is returning to vascular space. Now we worry about fluid volume excess. UO should increase (depending on kidney fxn)
31
burn clients are at risk for what electrolyte imbalance
hyperkalemia. Most of our potassium is found inside the cell, with a burn the cells lyse and K+ ions are in the vascular space.
32
are antacids ordered for burn clients
to prevent curlings ulcer (stress ulcer in stomach with burn client). Mylanta, Protonix, or Pepcid are ordered.
33
Antacids:
Amphogel, milk of magnesium
34
H2 Antagonist:
Zantac, Pepcid, Axid
35
Proton Pump Inhibitor:
Protonix, Nexium
36
why is client NPO and on NG tube suction?
likelihood of developing a paralytic illius, blood is shunted to vital organs away from intestines. abdominal girth will increase paralytic illus is caused by 1) low vascular volume (blood shunting) 2) normal stress response 3) Hyperkalemia (muscle weakness of intestines prevents movement -not as common)
37
nutrition
hypermetabolic state requires more calories, PROTEIN & VITAMIN C NG tube feedings must pull back for a residual volume, hold feedings if over 50 ml & give residual back to patient (if you don't, if could mean fluid, lyte, acid/base imbalance). NG tube is removed after osculating bowel sounds
38
labs to ensure proper nutrition and positive nitrogen balance
PRE-ALBUMIN (quicker & more sensitive), total protein, & albumin.
39
contractures
skin is being pulled and off sets muscle development if client has partial and full-thickness burns (especially 3rd degree).
40
classification of burns:
superficial thickness: formally called first degree burn; damage only to epidermis partial thickness: formally called second degree burn; damage to entire epidermis and varying depths of the dermis full-thickness: formally called third degree; damage to entire dermis, and sometimes fat.
41
special measures
separately wrap each finger use hand/finger splint to prevent contractures hyper extend neck as it's healing to prevent contractures, don't use pillow, promote chin to chest
42
perineal burn #1 complication
infection
43
eschar
dead tissue. It must be removed to promote new tissue growth and prevent bacterial growth
44
type of isolation
protective (reverse) isolation, protect them from us
45
travase or collagenase
enzymatic drugs to eat dead tissue 1) dont use on face (scarring) 2) dont use if pregnant 3) dont use over large nerve 4) dont use if area is opened to a body cavity
46
Hydrotherapy
used to debriefed. watch for cross contamination. medicate prior to Tx
47
Common drug used with burns
Silvadene - soothing, apply directly, if rubs off apply more, can lower the WBC, can cause rash Sulfamylon -can cause acid base problems, stings, if it rubs off apply more Silver nitrate -keep these dressings wet; can cause electrolytes problems Betadine -stings, stains, allergies, acid-base problems drugs should be alternated to prevent bacterial resistance or tolerance
48
why do we avoid broad spectrum antibiotics
to prevent super or secondary infections broad spectrum may be used until the wound cultures come back collect cultures BEFORE starting antibiotics
49
Mycin drugs
worry when BUN or creatinine increases or andy change is hearing can cause OTOTOXICITY & NEPHROTOXICITY stop if any hearing changes occur. If BUN or creatinine increase, assume it is nephrotoxic
50
grafts
site can be harvested every 13 to 14 days if well nourished graft site is open wound, so cover until bleeding stops if new skin graft is blue or cool then there is poor circulation might need to use Q tip and do a spiral pattern to remove air & fluid under graft or else it will not adhere
51
chemical burn
flush with water for 15 to 20 minutes (if chemical is powder then brush powder off first).
52
electrical burn
there are 2 wounds; entrance and exit (exit will be much bigger)
53
electrical injury precaution
heart monitor for 24 hours watch for V fib watch Kidney Damage with myoglobin & hemoglobin buildup in rentals place client in C collar because they may have fallen or contracted their muscles forcefully
54
why do amputations happen with electrical burns
electricity kills vascularity cataracts, gait problems, and any neurological deficit (vessels and nerves get messed up)

NCLEX (6 decks)

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