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Level 3 > Complex Exam 4 - tissue integrity > Flashcards

Complex Exam 4 - tissue integrity Flashcards

1
Q

When does the emergent/resuscitative phase begin and end?

A
  • begins with injury
  • lasts 24-48 hours
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2
Q

What are the priorities during the emergent/resuscitative phase?

A
  • airway
  • circulation
  • perfusion (fluid replacement)
  • pain
  • infection (wound care)
  • body temperature
  • emotional support
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3
Q

When does the acute phase begin and end?

A
  • begins at 36-48 hours
  • ends with closure of the wound
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4
Q

What are the priorities during the acute phase?

A
  • cardio
  • respiratory
  • GI
  • infection (wound care)
  • pain
  • psychosocial
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5
Q

When does the rehabilitative phase begin and end?

A
  • begins when most of the burn area has healed
  • ends when the client achieves the highest level of functioning possible (can take years)
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6
Q

What are the priorities for the rehabilitative phase?

A
  • psychosocial
  • scars, contractures
  • resumption of activities
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7
Q

What can cause dry heat injuries?

A
  • open flames
  • explosions
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8
Q

What can cause moist heat injuries?

A

hot liquid or steam

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9
Q

When are scalding injuries more common?

A
  • older adults
  • young children
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10
Q

What can cause contact burns?

A

hot metal/tar/grease

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11
Q

What can cause chemical burns?

A

caustic agents
- cleaning: drain/oven cleaner, bleach
- industrial: soda sulfuric acid

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12
Q

What can electrical burns cause?

A
  • loss of organ function
  • tissue destruction
  • possible amputation
  • cardiac/respiratory arrest
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13
Q

What can cause thermal burns?

A

ignition of clothes from heat/flames produced by electrical sparks

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14
Q

What causes flash (arc) burns?

A

electrical currents traveling through the air

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15
Q

What causes conductive electrical injuries?

A

touching electrical wiring/equipment

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16
Q

What causes radiation burns?

A
  • cancer treatment
  • sunburn
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17
Q

What should be removed from the body after a burn occurs?

A

clothing/jewelry that might conduct heat

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18
Q

What can be used on burns to help with the pain? What should not be used?

A
  • YES: cool water soak, cool water
  • NO: ice
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19
Q

How can contamination and hypothermia be prevented?

A

covering the burn wit a clean cloth

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20
Q

How should burns be cleaned?

A

with mild soap and tepid water (no friction)

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21
Q

What type of ointment should be used?

A

antimicrobial

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22
Q

What type of dressing should be used to cover the burn if clothing is irritating?

A

non-adherent hydrocolloid dressing

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23
Q

What immunization might be needed after being burned?

A

tetanus

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24
Q

What happens during the initial/resuscitation phase?

A
  • increased HR, BP, BG
  • decreased GI motility
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25
Q

What cardio should be monitored with moderate/major burns?

A
  • edema
  • pulses
  • cap refill
  • pulse ox/O2 sat
  • BP
  • EKG
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26
Q

What respiratory should be monitored with moderate/major burns?

A
  • RR, depth
  • upper airway edema
  • crowing, stridor, dyspnea
  • trach
  • chest tube
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27
Q

When might upper airway edema occur?

A

8-12 hours after starting fluid resuscitation

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28
Q

When would intubation be needed?

A

crowing, stridor, and dyspnea

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29
Q

When would ventilation be needed?

A

inhalation injury

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30
Q

What should be done every hour?

A
  • incentive spirometer
  • suctioning
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31
Q

What should be done for airway injury?

A
  • supplemental O2
  • coughing
  • deep breathing
  • elevate HOB
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32
Q

What should be done for F&E imbalances (hypovolemic shock)?

A
  • daily weight
  • I&O’s
  • labs
  • IV replacement
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33
Q

What should be assessed when monitoring for a wound infection?

A
  • discoloration
  • edema
  • odor
  • drainage
  • fluctuating temp and HR
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34
Q

What should be done for a suspected wound infection?

A
  • culture
  • antibiotics
  • labs
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35
Q

What is needed for dressing changes?

A

surgical asepsis

36
Q

What can scar tissue cause?

A

limited movement, contractures

37
Q

What should be done at least 3 times/day for mobility?

A

active or passive ROM

38
Q

What position is encouraged?

A

neutral with limited flexion

39
Q

What should be encouraged for mobility?

A
  • splints
  • ambulation
  • compression dressings for up to 24 months
40
Q

What is done if there is a loss of circulation?

A

fasciotomy

41
Q

What can rhabdomyolysis lead to?

A

kidney failure

42
Q

What does compartment syndrome put the patient at risk for?

A

infection

43
Q

How many calories should someone consume after burns?

A

5000/day

44
Q

What happens to caloric needs 4-12 days after the burn?

A

they double or triple

45
Q

Why should protein be increased?

A
  • prevents tissue breakdown
  • promotes healing
46
Q

Why should calories be increased?

A
  • increased metabolic demands
  • prevents hypoglycemia
47
Q

Why would enteral therapy or TPN be needed?

A
  • decreased GI motility
  • increased caloric needs
48
Q

What does a superficial thickness (1st degree) burn involve?

A

epidermis

49
Q

What does a superficial thickness (1st degree) burn look like?

A
  • pink to red
  • NO blisters
  • mild edema
  • NO eschar
50
Q

What burn is painful/tender and sensitive to heat?

A

superficial thickness (1st degree)

51
Q

How long does it take for superficial thickness (1st degree) burns to heal?

A

3-6 days

52
Q

Do superficial thickness (1st degree) burns have scarring?

A

NO

53
Q

What is an example of a superficial thickness (1st degree) burn?

A

sunburn

54
Q

What does a superficial partial thickness (2nd degree) burn involve?

A

the entire epidermis and some parts of the dermis

55
Q

What does a superficial partial thickness (2nd degree) burn look like?

A
  • pink to red
  • blisters
  • mild to moderate edema
  • no eschar
56
Q

How long does a superficial partial thickness (2nd degree) burn take to heal?

A

3 weeks

57
Q

Does a superficial partial thickness (2nd degree) burn have scarring?

A

NO

58
Q

What is an example of a superficial partial thickness (2nd degree) burn?

A

brief contact with a hot object

59
Q

What does a deep partial thickness (2nd degree) burn involve?

A

the entire epidermis and deep into the dermis

60
Q

What does a deep partial thickness (2nd degree) burn look like?

A
  • red to white
  • NO blisters
  • moderate edema
  • eschar soft and dry
61
Q

What type of burn is painful and sensitive to touch?

A

deep partial thickness (2nd degree) burn

62
Q

How long does it take a deep partial thickness (2nd degree) burn to heal?

A

2-6 weeks

63
Q

Does scarring and grafting occur with a deep partial thickness (2nd degree) burn?

A

yes

64
Q

What is an example of a deep partial thickness (2nd degree) burn?

A
  • flames and scalds
  • grease/tar/chemical burns
65
Q

What does a full thickness (3nd degree) burn involve?

A
  • the entire epidermis
  • can extend into the SQ tissue
  • nerve damage
66
Q

What does a full thickness (3nd degree) burn look like?

A
  • red, black, brown, yellow, or white
  • NO blisters
  • severe edema
  • eschar hard and inelastic
67
Q

Does a full thickness (3nd degree) burn have sensation?

A

it is minimal or absent

68
Q

How long does it take a full thickness (3rd degree) burn to heal?

A

weeks to months

69
Q

Do scarring and grafting occur with a full thickness (3nd degree) burn?

A

yes

70
Q

What are examples of a full thickness (3nd degree) burn?

A
  • scalds
  • grease, tar, chemical, electrical burns
71
Q

What does a deep full thickness (4th degree) burn involve?

A
  • all layers of the skin
  • muscles/tendons/bones
72
Q

What does a deep full thickness (4nd degree) burn look like?

A
  • black
  • NO blisters
  • NO edema
  • eschar hard and inelastic
73
Q

How long does it take a deep full thickness (4nd degree) burn to heal?

A

weeks to months

74
Q

Do scarring and grafting occur with a deep full thickness (4nd degree) burn?

A

yes

75
Q

What is an example of a deep full thickness (4nd degree) burn?

A
  • electrical burns
  • flames
76
Q

What happens to facial hair (nose, eyebrows, eyelashes) with inhalation damage?

A

singed

77
Q

What happens to the sputum with inhalation damage?

A

sooty

78
Q

What type of cough signifies impending loss of airway?

A

brassy

79
Q

Where is edema present with carbon monoxide inhalation?

A

upper airway

80
Q

Where is sloughing present with carbon monoxide inhalation?

A

respiratory tract mucosa

81
Q

What percent is the head with the RON?

A

4.5% on each side

82
Q

What percent is the chest with the RON?

A

18% on each side

83
Q

What percent is each arm with the RON?

A

4.5% on each side

84
Q

What percent is each leg with the RON?

A

9% on each side

85
Q

What percent is the pelvic area with the RON?

A

1%

86
Q

How is the amount of fluid needed after a burn calculated?

A

Parkland formula
4 mL x weight (kg) x TBSA % = total mL in 24 hours

87
Q

How should fluid resuscitation be administered?

A
  • the first half over 8 hrs
  • the second half over the next 16 hours

Level 3 (29 decks)

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