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Integumentary > Lesson 4: Burns > Flashcards

Lesson 4: Burns Flashcards

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1
Q

Etiology of Burn Injuries

A

Thermal
Chemical
Electrical

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2
Q

What do thermal burns result from?

A

Result from direct/indirect contact with flame, hot liquid, or steam

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3
Q

Severity of thermal burns influenced by:

A

Contact time
Temperature
Type of insult

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4
Q

Chemical Burn Injuries

A

Acids, bases, industrial accidents, assaults

More likely to cause full-thickness damage

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5
Q

Severity of Chemical burns influenced by:

A

Alkaline burns are more severe than acidic
Contact time (burning continues until removed/diluted, therefore thoroughly irrigate
for 20–30 min)
Chemical concentration
Amount of chemical

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6
Q

Electrical Burn Injuries

A

Low- and high-voltage currents
Entrance wound – depressed or charred
Exit wound – larger, explosive
Skin may not be severely damaged despite deep tissue injury due to differences in resistance

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7
Q

Concomitant injuries with electrical burns:

A

Fractures, muscle necrosis, neurological injuries

Cardiac, pulmonary, other organ failure

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8
Q

Severity of electrical burns influenced by:

A

High-voltage current causes more damage
AC burn injuries are more severe
Contact time

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9
Q

How long do chemical burns take to develop?

A

24–72 hours

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10
Q

Superficial Burns

A

First-degree burns”/Integumentary Pattern B
Dry, bright red, or pink skin that blanches upon pressure
No dermal vessel damage
Epidermis damaged

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11
Q

Types of superficial burns:

A

Sunburn, minor flash burn

Erythema, significant pain, lack of blisters, sunburn

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12
Q

Superficial Partial-Thickness Burns

A

Superficial second-degree burns”/Integumentary Pattern C
Painful, moist, weeping, blistered skin with local erythema and edema
Blanches to pressure with immediate capillary refill
Epidermis and part of dermis damaged

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13
Q

Examples of Superficial Partial-Thickness Burns

A

Brief contact burns, flash burns, brief contact with dilute chemicals

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14
Q

Deep Partial-Thickness Burns

A

Deep second-degree burns”/Integumentary Pattern C
Mottled areas of red with white eschar, blistering possible, may have areas of insensitivity/reduced sensation
Blanches to pressure with slow capillary refill
Scarring, pigment changes, contractures possible

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15
Q

Examples of Deep Partial-Thickness Burns

A

Severe sunburn, scald, flash burn, brief contact with dilute chemicals

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16
Q

Time to heal for Deep Partial-Thickness Burns:

A

May take 3 or more weeks to heal

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17
Q

Time to heal for Superficial Partial-Thickness Burns

A

Heal within 10–14 days with minimal or no scarring

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18
Q

Time to heal for Superficial Burns

A

Resolves within 3–5 days without scarring

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19
Q

Full-Thickness Burns

A

Third-degree burns”/Integumentary Pattern D
Initially look red then become mottled white/black, dry, leathery eschar, very painful
Burned areas insensate to light touch
Scarring and contractures likely
Most require surgical debridement and grafting

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20
Q

Examples of Full-Thickness Burns

A

Prolonged contact with flame, immersion scald injury

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21
Q

What layers affected with full-thickness burn:

A

Epidermis, Dermis, and complete destruction to subcutaneous fat

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22
Q

Subdermal Burns

A

“Fourth-degree burns”/Integumentary Pattern E
Charred, mummified appearance
Exposed deep tissues
Burned areas insensate to light touch
May have permanent nerve damage
Require surgery (fasciotomy, escharotomy, grafting) and possible amputation

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23
Q

Examples of subdermal burn:

A

Electrical burn, strong chemical burn

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24
Q

Rule of Nines:

A

Divides the integument into areas roughly equivalent to 9% of TBSA

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25
9% of TBSA:
Head, front and back of each UE, front of each LE, back of each LE
26
Perineum is:
1% of TBSA
27
Lund-Browder Classification
Takes into account variation of body proportion from child to adult Appropriate for children under age 16 Preferred by pediatric burn units
28
Palmar Method
Uses the area of palmar surface of the hand to determine burn size Highly unreliable, inaccurate
29
What is burn severity determined by:
Burn size Burn depth Age (child vs. adult)
30
Minor burn:
generally treat as out-patient
31
Moderate burn:
generally treat as in-patient
32
Major burn:
generally treat in specialized burn unit
33
Pathophysiology of Burn Injuries
Zone of coagulation Zone of stasis Zone of hyperemia
34
Zone of coagulation
Central portion, irreparable damage | Characterized by coagulation, ischemia, necrosis
35
Zone of stasis
Area of cellular injury and compromised perfusion | Conversion: widening and deepening of necrosis
36
Zone of hyperemia
Outer edges, minimal cellular injury
37
Be aware of
Bandages that are too tight Undue pressure from splints Improper patient positioning
38
Burn shock
massive fluid shift causing hypovolemia and edema Results in decreased blood volume Tissue necrosis, organ failure, and death are possible
39
Who is at high risk for burn shock?
Patients with >15% TBSA burns at high risk for burn shock
40
Cardiovascular system:
Fluid resuscitation is of primary importance Blood pressure generally decreases as a result of hypovolemia Resting heart rate 100–120 bpm for adults Monitor peripheral pulses Must monitor and manage edema
41
Pulmonary System
Suspect lung involvement if singed facial hair, carbonaceous sputum, closed space injury, burns to face/neck/torso Monitor for signs of breathing difficulties Monitor oxygen saturation Encourage aggressive pulmonary hygiene
42
Metabolism
``` Basal metabolic rate doubles or triples Increase in core temperature Sustained hyperglycemia Increased fat catabolism Decrease in body mass ```
43
When does metabolism peak after a burn injury?
7–17 days post major burn injury
44
What percentage of burn patient death are due to infection?
75%
45
Why is sepsis and infection common?
Endogenous and exogenous bacteria Decreased tissue perfusion reduces immune system effectiveness Neutrophils less effective Eschar, blister fluid, residual topical agents excellent medium for bacterial growth Open wound for extensive periods of time
46
Clinical should be aware of what consequences to immune system?
Aggressive debridement and rapid skin coverage necessary to reduce risk of infection Follow infection-control guidelines Prophylactic topical antimicrobials
47
Complications to other systems possible
Multi-organ system dysfunction CNS dysfunction Acute kidney failure GI dysfunction/peristalsis/ileus/ulcers
48
Psychological Dysfunction
Posttraumatic stress disorder Anxiety/depression/disturbed sleep Extremely common
49
Coordination, Communication, and Documentation
Reinforce goals set by other disciplines Participate in patient rounds Patient education Give patients control over their rehabilitation
50
Patient/Client-Related Instruction
Instruct patients in ways to control pain Tell patients what to expect prior to procedures Instruct how to care for wounds including positioning techniques Educate patients on the importance of skin care/scar management
51
Precautions
``` Screen for domestic violence Anticipate/prevent complications when possible Contractures Infections Deconditioning Pulmonary dysfunction Pressure ulcers Ensure adequate pain control ```
52
Keys to Local Wound Care:
Debridement Infection Control Dressings Scar Management
53
Debridement
Debride Foreign debris, residual topical agents, exudate, hair, necrotic tissue Remove blisters (open and closed) Consider enzymatic debridement if appropriate
54
Infection Control:
Use sterile technique for large TBSA burns Topical antimicrobials are standard Signs of infection
55
Topical antimicrobials are standard
Silver sulfadiazine Mafenide acetate Bacitracin
56
Signs of infection
Increasing erythema/pain, foul odor, purulence | Increase in necrosis, fever, increased tachycardia
57
Dressings
Topical antimicrobial covered with nonadherent impregnated gauze, bulky gauze dressing Limit bulk to allow/encourage movement, splint use Short-stretch compression wrap to decrease edema and scarring
58
Scar Management
Moisturize Protect from friction and shear Scar mobilization Compression – mandatory if wound takes 3+ weeks to close Consider silicone gel sheets/pads, ultrasound, paraffin Darker-skinned individuals > incidence of hypertrophic scarring and keloids
59
Vancouver Scar Scale
``` Rates 4 scar qualities Vascularity Pliability Pigmentation Height Scores range from 0–14, lower scores indicate less severe scar tissue ```
60
Procedural Interventions
Range of motion Mobility training – assistive device as needed Breathing exercise Aerobic exercise – target HR 50–70% of maximum predicted HR
61
Physical Agents and Modalities
``` Whirlpool Remove necrotic tissue/topical agents, soften eschar Easier ROM Pulsed lavage with suction – smaller wounds Ultrasound Paraffin ```
62
Medical Interventions
Pharmacological management Ensure adequate control of pain and anxiety Time procedures with medications
63
Surgical Interventions
Debridement | Early debridement often performed on patients with medium and large full-thickness burns
64
Graft failure may be due to:
Infection Eschar Insufficient immobilization Fluid collection under graft
65
Skin substitutes
Bilayered dressings with epidermal and dermal analog Used on donor sites and wounds Examples: AlloDerm, Biobrane, Integra
66
Cultured epithelial autografts
Cultures patients’ own cells | Grown in lab and stapled/sutured in place
67
Intervention Goals
Superficial wounds heal spontaneously within the first 2 weeks with pain management and topical dressings to prevent infection Deeper wounds take longer than 2 weeks to heal and may require surgical intervention. Need to prevent infection- topical antibiotic creams, Vaseline gauze to prevent trauma to tissue After initial injury, cooling of burn site important
68
Escharotomy
Incision through eschar and subcutaneous tissue to release tissue constricting circulation
69
Fasciotomy
Incision through fascia to release pressure/improve distal circulation

Integumentary (18 decks)

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