class 14 burn's

Question 1

role of epidermis

Answer 1

barrier

Question 2

role of dermis

Answer 2

dense connective tissue

Question 3

role of subcutaneous tissue

Answer 3

regulation of body temp

Question 4

what are the functions of the skin

Answer 4

-protection against infection
-prevention of fluid loss
-temperature maintenance
-sensory organ(touch, heat, cold, pain)
-can be eliminated partially or totally depending on burn

Question 5

infants and burns

Answer 5

-thinner, more permeable skin, less subcut fat
-greater potential for fluid loss, less effective temperature regulation
-can be damaged at a lower temp/less duration than adults
-larger body surface area= greater loss of fluid, have to have inc calories & protein

Question 6

older adults and burns

Answer 6

-skin becomes thin with a decrease in strength, moisture, and elasticity
-decrease in lean muscle mass and subcut fat, diminished sensation of pain
-slower wound healing

Question 7

moralitiy with thermal injuries

Answer 7

-fire/smoke inhalation= most common
-death rates 11x higher in low/middle income countries
-infants, elderlt at greatest risk

Question 8

morbiditiy with thermal injuries

Answer 8

-most pediatric burns are d/t scalds
-most are in the home

Question 9

nursing care for burns patients

Answer 9

-knowledgable about physiology changes
-good wound care
-good assessment skills

Question 10

what is a thermal burn

Answer 10

-majority
-exposure/contact to something hot (fire, steam, stove etc)

Question 11

what is an electrical burn

Answer 11

-very common in children/teen(risk behaviour)
-occurs when in contact with electricity (socket, lighting, live wire)

Question 12

what is a chemical burn

Answer 12

-burns that occur when in contact with a harsh substance such as acid
-can have mucus membrane bruns from drinking
-i.e bleach, drain cleaner, paint thinner

Question 13

what are radiation burns

Answer 13

damage to the tissue as a result from radiation

Question 14

treatment of burn

Answer 14

-determined by percentage of burn and depth
-is on face/nares, airway is priority

Question 15

what is the rule of nines

Answer 15

each part of the body represents 9% (chest, each leg, abdomen, both arms)
-used for ages 10+ (in kids head is 18%)
-compartment syndrome can occur is the circumference of the body part is burned

Question 16

what is a superficial injury

Answer 16

-1st degree
-epidermis only, appearance of skin is red, blanches easily, painful
i.e.sunburn
-place in cold water & take tylenol

Question 17

what is a partial thickness injury

Answer 17

epidermis and part of dermis
-burns look wet, moist, blistered, red, painful
-pending on how much of the dermis is involved can be broken down further to deep partial thickness

Question 18

what is a deep partial thickness injury

Answer 18

involves more of the dermal
-skin appears mottled, pink, red, even waxy white areas, edema, and blisters

Question 19

what is a full thickness injury (3rd degree)

Answer 19

-subdermal involves entire epidermis, dermis, and its structure (some muscle, nerve endings, sweat glands, hair follicles destroyed)
-skin looks tough, leathery, black, dry
-does not blanch, is painless to touch
-grafting is required

Question 20

what is a full thickness injury (4th degree)

Answer 20

-all skin and nerve endings destroyed and includes muscle and bone
-blood vessels and bone may be visible
necrosis occurs, amputation common, grafting is required

Question 21

what percent is considered a minor burn

Answer 21

<10% TBSA in adults or <5% in young or old
<2% full-thickness burn

Question 22

what percentage is considered a moderate burn

Answer 22

10-20% in TBSA
-5-10% TBSA kids or old
2-5% full thickness burn

Question 23

what percentage is considered a major burn

Answer 23

> 20% TBSA in adult
10% TBSA young or old
5% full-thickness burn

Question 24

what is an inhalation injury

Answer 24

-burns in the airways
-look for signs of thermal injury to upper airway
-crackles in lungs/wheezing

Question 25

local physiologic responses to burn

Answer 25

-tissue damage, erythema, edema, infection (bacteria colonizes on burn) -burns that do not exceed over 10% do not have a local response

Question 26

systemic physiologic response to burn

Answer 26

-capillary permeability -hypovolemia -anemia -decreased blood flow to GI tract -increased metabolism

Question 27

post burn physiologic response to burn

Answer 27

temp will be 38 (less indicated sepsis) -if fluid resus doesn't work->albumin and fresh frozen plasma -shunt of blood to brain/heart/kidneys -decreased BF to GI can lead to inc risk for aspiration (NG on low continuous)

Question 28

management of minor burns

Answer 28

-cool -cleanse -manage blisters (do not pop unless chemical) -apply topical medication + dressing -analgesia for comfort -possible tetanus shot

Question 29

management of major burns

Answer 29

-airway, 100% o2 (ET if airway burn) -v/s, nv assess -IV (large bore) -NGT, foley -IV pain management -EKG, cardiac monitor for electrical burns -baseline labs -tetanus -room temp 28-32 to prevent hypothermia

Question 30

fluid resus in burns

Answer 30

-gauged by physiologic response -determined by output, BP, AR, COC, cap refill -IV fluids given if >10% burned (RL)

Question 31

nutriton and burns

Answer 31

first 2-3 days: hypometabolic phase 5-9 days: hypermetabolic -erosion of lean body mass, muscle weakness, immunosuppression, poor wound healing -high protein, high calorie -vitamins A, C, Zinc -supplement feedings in burns 25% or greater

Question 32

wound care for burns

Answer 32

-primary excision -debridement - hydrotherapy -topical antimicrobials & dressings -biological skin coverings -permanent skin covering

Question 33

rehab phase of burns

Answer 33

cont'd pain & puritis management -scare management -minimize functional loss/prevent contractures -ongoing psychosocial support