burns + transplant

Question 1

what are the types of burns?

Answer 1

• thermal
• chemical
• smoke inhalation injury
• electrical
• cold thermal

Question 2

what are the common causes of thermal burns?

Answer 2

• flame
• flash
• scald
• contact with hot objects

Question 3

thermal burns are the most common type of burn injury

Answer 3

true

Question 4

what are the factors that affect the severity of burn injury?

Answer 4

• temperature of burning agent
• duration of contact

Question 5

partial thickness burn

Answer 5

Question 6

full thickness burn

Answer 6

Question 7

what are the common causes of chemical burns?

Answer 7

contact with
* acids
* alkalis
* organic compounds

Question 8

why are alkali burns more difficult to manage?

Answer 8

leads to protein hydrolysis & melting

Question 9

where are alkalis most commonly found?

Answer 9

• cement
• oven cleaners
• drain cleaners
• heavy metal cleaners

Question 10

which organic compounds can be found in alkalis?

Answer 10

• phenols
• petroleum products

Question 11

a patient arrives in the ED following an accidental fall in wet cement at a construction site, what type of burn injury does the nurse expect to be sustained?

Answer 11

chemical burn

Question 12

what are the causes of smoke inhalation injury?

Answer 12

inhaling
* hot air
* noxious chemicals

Question 13

what types of complications following a smoke inhalation injury can rapidly develop?

Answer 13

• airway compromise
• pulmonary edema

Question 14

what are the types of smoke inhalation injuries?

(3)

Answer 14

• upper airway
• lower airway
• metabolic asphyxiation

Question 15

how does metabolic asphyxiation occur?

Answer 15

CO & hydrogen cyanide are inhaled

Question 16

metabolic asphyxiation can lead to what complications?

Answer 16

• hypoxia
• elevated carboxyhemoglobin levels

Question 17

carboxyhemoglobin levels of greater than 20% leads to imminent death

Answer 17

true

Question 18

definition

upper airway injury

Answer 18

injury to mouth, oropharynx, & larynx

Question 19

a physical assessment of a patient in the ED reveals their oral mucosa is red, blistered, & edematous, what type of injury did they sustain?

Answer 19

upper airway injury from smoke inhalation

Question 20

why is the nurse’s priority in caring for a patient with an upper airway injury from smoke inhalation to ensure patent airway?

Answer 20

eschar & edema from the injury will quickly obstruct the airway and compromise breathing

Question 21

definition

lower aiway injury

Answer 21

injury to
* trachea
* bronchioles
* alveoli

Question 22

how long does it typically take for pulmonary edema to manifest following a lower airway injury?

Answer 22

12-48 hours

Question 23

pulmonary edema from lower airway injury first manifests as

Answer 23

ARDS

Question 24

definition

electrical burns

Answer 24

injury from intense heat generated from an electric current

Question 25

***electrical burns*** will result in damage to *nerves & vessels*

Answer 25

true

Question 26

what are the *categories* that are included in the **depth of burn**?

Answer 26

* partial thickness *(superficial & deep)* * full-thickness

Question 27

what are factors that determine the *severity of injury*?

Answer 27

* depth * extent *(TBSA)* * location * **age***(young & elderly pt's most likely critical)* * pre-burn medical Hx

Question 28

# characteristics **superficial** partial-thickness burn

Answer 28

* epidermis * ***first-degree***

Question 29

# characteristics **deep** partial-thickness

Answer 29

* dermis * ***second degree***

Question 30

# characteristics **full**-thickness burn

Answer 30

* involves skin elements, nerve endings, fat, muscle, bone * ***third/ fourth degree***

Question 31

how is **TBSA** determined?

Answer 31

rule of nines

Question 32

Rule of Nines

Answer 32

* **18%** (torso) * **9%** (lower extermities) * **4.5%** (upper extremities, head) * **1%** (genitals)

Question 33

burns to the **ears, nose, & genitals** pose a *higher risk* for infection

Answer 33

true

Question 34

what are the phases of *burn management*?

Answer 34

* emergent * acute * rehabilitative

Question 35

# definition **emergent** phase of burn management

Answer 35

time required to resolve immediate problems resulting from injury

Question 36

how long does the **emergent** phase of burn management take?

Answer 36

72 hours

Question 37

what are the main concerns during the **emergent** phase (1) of burn management?

Answer 37

* hypovolemic shock * edema * paralytic ileus

Question 38

what are the resuscitative measures taken during the **emergent** phase of burn management?

Answer 38

* fluid mobilization *(counter hypovolemic shock)* * diuresis

Question 39

what are the common clinical manifestations of ***burns***?

Answer 39

* hypovolemic **shock** * **paralytic ileus** *(no bowel sounds)* * pain * blisters * AMS * **shivering**

Question 40

what is the nursing management for **partial**-thickness burn during the *acute phase*?

Answer 40

* escharotomy * facilitate skin re-epithelization

Question 41

what is the medical management for **full**-thickness burn during the *acute phase (2)*?

Answer 41

* skin **grafting** * surgical **debridement**

Question 42

what are the nursing actions for ***airway management*** regarding burns?

Answer 42

* **high fowlers** * **CPT** * **bronchodilation** * **escharotomies** of the chest * humidified 100% O2 * fiberoptic bronchoscopy * **intubation**

Question 43

what are the nursing actions for ***fluid therapy***?

Answer 43

* use **Parkland Burn formula** * initiate *central lines **or** 2 **large bore** IV lines*

Question 44

when is it appropriate to initiate **2 large bore IV lines**?

Answer 44

fo TBSA of ***greater than 15%***

Question 45

when is a **central line** appropriate?

Answer 45

for burns ***greater than 20%*** of TBSA

Question 46

what are the purposes of starting **arterial lines** in burn patients?

Answer 46

* invasive BP monitoring * drawing frequent ABGs

Question 47

what is the purpose of the **Parkland Burn formula**?

Answer 47

to calculate the amount of IV fluids needed for the first 24 hours after a burn injury of ***greater than 20%*** ONLY

Question 48

Parkland Burn formula

Answer 48

(4mL) x (weight) x (% TBSA) = volume of fluids w/in 24 hours

Question 49

what are the guidelines for appropriately following the **Parkland burn formula** in administering the correct amount of fluids?

Answer 49

* **first 8 hrs**: 1/2 * **second 8 hrs**: 1/4 * **third 8 hrs**: 1/4 | FIRST 8 IS CRUCIAL!!

Question 50

patients who suffered from burns are allowed to take showers **once daily**

Answer 50

true

Question 51

how often do **dressing changes** occur for patients who suffered from burns?

Answer 51

***twice a day*** in the morning and night

Question 52

for how long are **antimicrobial dressings** left in place?

Answer 52

3-14 days

Question 53

nurses need to don PPE when caring for patients with **open burn wounds**

Answer 53

true

Question 54

nurses must use **strerile gloves** when applying *antimicrobial ointment* & *sterile dressings* on a burn patient

Answer 54

true

Question 55

why can **hyperkalemia** occur in a burn patient?

Answer 55

large amounts of potassium are released into the bloodstream by damaged cells from burns

Question 56

what happens during the **acute phase** of burn management?

Answer 56

mobilization of extracellular fluid & subsequent diuresis

Question 57

when does the **rehabilitative phase** in burn management begin?

Answer 57

* partial thickness wounds have healed * full thickness burns are covered by skin grafts

Question 58

what are the signs of **organ rejection**?

Answer 58

* flu-like symptoms * fatigue * fever * organ specific symptoms

Question 58

what indicates successful **fluid resus** during the *emergent phase* of burn management?

Answer 58

diuresis

Question 59

what are the types of **organ rejection**?

Answer 59

* hyperacute rejection * acute rejection * chronic rejection

Question 60

# characteristics hyperacute rejection

Answer 60

* within 24 hours of transplant * must remove organ

Question 61

# characteristics acute rejection

Answer 61

* within 6 months of transplant * must increase immunosuppressants

Question 62

why is there a need to *increase* **immunosuppressants** in organ rejection?

Answer 62

prevent further rejection & save the organ

Question 63

# characteristics chronic rejection

Answer 63

within months or years; typically irreversible