Burns

Question 1

Major burns

Answer 1

25 percent or more of TBSA/adult

10 percent or more of TBSA/children

Question 2

Response of the body

Answer 2

Systemic

Question 3

Burn affects

Answer 3

All systems of the body

Question 4

FIRST STEP

Answer 4

airway patency

Question 5

SECOND STEP

Answer 5

oxygen

Question 6

THIRD STEP

Answer 6

vitals

Question 7

FOURTH STEP

Answer 7

IV line and fluid replacement

Question 8

FIFTH STEP

Answer 8

elevate extremities

Question 9

SIXTH STEP

Answer 9

keep warm and put on NPO

Question 10

Superficial-thickness burn (first degree) 6

Answer 10

• only epidermis
• dry/pink to red
• no blistering
• blanching is present
• pain eased by cooling
• healing in 3-6 days

Question 11

Superficial partial-thickness burns (second degree) 4

Answer 11

• into dermis
• moist red blanching blistering edematous
• sensitive to cold air
• 10-21 days

Question 12

Deep partial-thickness burns (second degree)

Answer 12

• deeper into dermis
• No blistering
• Red and dry with moderate edema
• May need grafting
• Scar formation and perhaps contractures
• soft and dry eschar
• 3 to 6 weeks

Question 13

Full thickness (third-degree)

Answer 13

• into the fatty layer of the skin
• dry hard leathery eschar
• severe edema
• reduced or absent sensation
• removal of eschar and grafting is necessary
• weeks to months

Question 14

deep-full thickness burns

Answer 14

• muscle tendon and bone are damaged
• black and no sensation whatsoever
• severe edema
• grafts are required

Question 15

Major priorities

Answer 15

prevention of infection and wound closure

Question 16

Thinner skin, sensory impairment, decreased mobility

Answer 16

increased depth of injury, and increased risk of burn injury

Question 17

slower healing time

Answer 17

greater infection and loss of function risk

Question 18

reduced inflammatory and immune responses

Answer 18

increased risk for infection/sepsis, no fever

Question 19

pre-existing conditions

Answer 19

can interfere with wound healing

Question 20

circumferential burns of extremities

Answer 20

compartment syndrome

Question 21

circumferential thorax burns

Answer 21

inadequate chest wall expansion and pulmonary insufficiency

Question 22

Mortality rate

Answer 22

higher younger than four and birth to one, older than 65 years

Question 23

Assessment findings in inhalation injury

Answer 23

• facial burns
• singed hair, eyebrows, and eyelashes
• black carbon particles in the nose, mouth, and sputum
• edema of the nasal septum
• drooling
• difficulty swallowing
• tachy
• agitation and anxiety
• wheezing, dyspnea
• edema in the oropharynx and nasopharynx

Question 24

For inhalation injuries

Answer 24

IMMEDIATELY PLACE UPRIGHT

Question 25

Vasoactive substances

Answer 25

cause an increase in capillary permeability

Question 26

Extensive burns

Answer 26

generalized body edema, decrease in circulating blood volume

Question 27

Fluid losses result in...

Answer 27

a decrease in organ perfusion

Question 28

Heart rate, blood pressure, and cardiac output...

Answer 28

increases, decreases, and decreases.

Question 29

Hyponatremia and hyperkalemia...

Answer 29

occur.

Question 30

Hematocrit levels...

Answer 30

increase.

Question 31

The kidneys start with...

Answer 31

oliguria

Question 32

Gastrointestinal tract...

Answer 32

intestinal ileus and gastrointestinal dysfunction

Question 33

Pulmonary hypertension

Answer 33

decrease in lung compliance and oxygen

Question 34

Primary goals in resuscitation/emergent phase

Answer 34

maintain airway, administer IV fluids, preserve organs Conserve body heat and get an IV going.

Question 35

Major burns

Answer 35

Administer 100 percent oxygen with a nonrebreather mask until the carboxyhemoglobin level is below 15%. Maintain urine output. NPO status (until bowel sounds are heard) NG tube Administer tetanus.

Question 36

Minor burns

Answer 36

Active range of motion exercises and wound care treatments

Question 37

Resuscitative Phase

Answer 37

Begins with fluid initiation. Ends with capillary integrity mainly intact and large fluid shifts decreasing. Prevent shock!! Fluids are calculated from time of injury. Elevate head of bed to 30 degrees. Initiate ECG monitoring. Monitor daily weights (expect a weight gain of 15 to 20 pounds in the first 72 hours). Prevent stress ulcers. Watch for occult blood. Urine output needs to be between 30 to 50. Elevate burns of the extremites above the heart. No diuretics. Keep room warm. Keep sterile sheets off of client's skin Watch myoglobin and hemoglobin levels. No pain meds via oral route. Don't do subq or IM injections. Diet high in protein, carbs, fats, vitamins (more than 5000 calories). Daily weights.

Question 38

Acute phase

Answer 38

Restorative therapy until wound closure. The client is stable, capillary permeability is restored, diuresis. 48-72 hours. Infection control, pain management, physical therapy, nutritional support.

Question 39

Escharotomy

Answer 39

no anesthesia pack it with fine mesh guaze

Question 40

Fasciotomy

Answer 40

general anesthesia

Question 41

Hydrotherapy

Answer 41

30 minutes or less Premedicate!! Not used for unstable clients or those with new skin grafts. Maintain body temp!!

Question 42

Autografting

Answer 42

Immobilization of graft site and elevation Monitor for infection suspicions. Protect from sunlight. Donor site needs to be kept clean, dry, and free from infection. Apply lotions.

Question 43

Rehabilitative phase

Answer 43

Increase strength and function...provide emotional support...minimize deformities...promote wound healing.

Question 44

Fentanyl

Answer 44

can prevent oversedation

Question 45

Longer procedures

Answer 45

use morphine