Management of Patients with Burn Injury

Question 1

Risk Factors to patients with burn injuries

Answer 1

Pre-existing heart, lung, and kidney diseases
DM
Peripheral vascular diseases
Physical weaknesses like alcoholism, malnutrition
Concurrent fractures
Head injuries

Question 2

Goals of Burn Care

Answer 2

Lifesaving measures
Prevention of disability and disfigurement
Rehabilitation

Question 3

First degree burns AKA

Answer 3

superficial

Question 4

Second degree burns AKA

Answer 4

partial thickness

Question 5

Third degree burns AKA

Answer 5

full thickness

Question 6

Classification of burn that involves outermost layer of skin and stays intact. It is painful.

Answer 6

First degree

Question 7

Classification of burn that involves entire epidermis and varying portions of the dermis. Painful with blisters

Answer 7

2nd degree

Question 8

Classification of burn that involves destruction of epidermis, dermis, and underlying tissue Painless.

Answer 8

3rd degree

Question 9

Classification of burn that involves necrosis of tissue extending into deep tissue, muscle, or bone.

Answer 9

4th degree

Question 10

Types of burns

Answer 10

Thermal
Chemical
Electrical

Question 11

Thermal burns can be caused by

Answer 11

flame, flash, scald, or contact with hot objects

Question 12

What is the most common type of burn?

Answer 12

Thermal

Question 13

The severity of a thermal burn depends on what factors?

Answer 13

Temperature of the burning agent
Duration of contact time

Question 14

Chemical burns can result in injuries to?

Answer 14

skin, eyes, respiratory system, liver and kidneys

Question 15

What MUST be done with every patient who has an electrical burn?

Answer 15

Stabilize C spine

Question 16

Patients with an electrical burn are at risk for?

Answer 16

Dysrhythmias or MI
Myoglobinuria

Question 17

Why does myoglobinuria happen in patients with an electrical burn?

Answer 17

Injured muscle tissues release myoglobin which travels to the kidneys and blocks the renal tubules

Question 18

Electrical burns are known to cause what phenomena?

Answer 18

Iceberg effect

Question 19

Myoglobinuria can lead to?

Answer 19

Acute tubular necrosis
Acute kidney injury

Question 20

Factors to consider in determining burn depth

Answer 20

How the injury occurred
Causative agent
Temperature of causative agent
Duration of contact w causative agent
Thickness of skin at site of injury

Question 21

Clues of smoke inhalation injury to lower airway

Answer 21

Facial burns
Singed nasal hair
Hoarseness
Painful swallowing
Dark mucosal membranes
Carbonaceous sputum**
Enclosed space
Clothing burns around neck and chest

Question 22

What is the cardinal sign of a lower airway injury?

Answer 22

Carbonaceous sputum

Question 23

What is carbonaceous sputum?

Answer 23

Dark colored sputum

Question 24

3 Zones of Burn Injury

Answer 24

Zone of coagulation
Zone of stasis
Zone of hyperemia

Question 25

Which zone of burn injury has the most damage?

Answer 25

Coagulation

Question 26

Which zone of burn injury may be viable or turn necrotic within 24 hrs?

Answer 26

Stasis

Question 27

Which zone of burn injury has the least amount of damage?

Answer 27

Hyperemia

Question 28

Burns more than __% may produce a local and systemic response and are considered major burns

Answer 28

30%

Question 29

Major burn injuries cause fluid shifts and shocks that result in what?

Answer 29

Tissue hypoperfusion and organ hypofunction

Question 30

Effects of a Major Burn Injury

Answer 30

Fluid and electrolyte shifts CV effects Pulmonary injury Renal and GI alterations Immunologic alterations Effect on thermoregulation

Question 31

What type of pulmonary injuries may occur with a major burn?

Answer 31

Upper Lower CO2 poisoning Restrictive defects

Question 32

List the emergency response to an on-the-scene burn injury scenario

Answer 32

1. Prevent injury to self - safety check 2. Stop injury - extinguish flame, cool burn, irrigate chemical burn 3. ABCs 4. Start O2 and large bore IVs 5. Remove restrictive objects and cover wound 6. Do head-to-toe assessment and obtain med hx

Question 33

Phases of Burn Injury

Answer 33

Emergent or resuscitative phase Acute or intermediate phase Rehabilitation phase

Question 34

Describe the emergent phase of a burn injury

Answer 34

Generalized dehydration Reduced blood volume Decreased urine output Hyperkalemia Hyponatremia Metabolic acidosis

Question 35

When does the emergent phase of a burn injury begin and end?

Answer 35

At the time of injury to completion of fluid resuscitation

Question 36

When does the acute or intermediate phase of a burn injury begin and end?

Answer 36

From beginning of diuresis to wound closure

Question 37

When does the rehabilitation phase of a burn injury begin and end?

Answer 37

From wound closure to return to optimal physical and psychosocial adjustment

Question 38

Why is a foley catheter inserted during the emergent phase of a burn injury?

Answer 38

To carefully monitor I & O

Question 39

Nursing management of the patient during the emergent/resuscitative phase of a burn injury

Answer 39

Fluid resuscitation begins Foley cath is inserted NG tube inserted if burns exceed 20% ECG if electrical burn IV pain medications as appropriate Psychosocial needs and support ABCs VS and hemodynamic status Monitor for fluid volume deficit Assess extent of burnP

Question 40

Potential complications during emergent phase of burn injury

Answer 40

Acute Resp Failure Shock AKI Compartment syndrome Paralytic ileus Curlings ulcer

Question 41

When a burn injury occurs, immediate _______ in CO precedes loss of plasma volume

Answer 41

Decrease

Question 42

Vasoconstrictive compensatory means that the workload of the heart and O2 demand ________ but there is a _______ in CO

Answer 42

Increases Decreases

Question 43

Hypovolemia due to plasma loss results in?

Answer 43

Decreased perfusion and oxygen delivery

Question 44

Burn shock is a type of what kind of shock?

Answer 44

Hypovolemic shock

Question 45

Appropriate fluid resuscitation does what for our burn patients?

Answer 45

Maintains the blood pressure in the low to normal range and improves CO

Question 46

The greatest volume of fluid leak occurs when after a burn injury?

Answer 46

The first 24-36 hrs, peaking by 6-8 hrs

Question 47

If fluid resuscitation is too vigorous, the patient will show s/s of?

Answer 47

Heart failure or pulmonary edema

Question 48

Superficial burns cause edema how many hours after injury?

Answer 48

within 4 hrs

Question 49

Deeper burns can continue to form edema up to how many hours post injury?

Answer 49

18 hrs

Question 50

What electrolyte imbalance forms in burn patients due to massive cell destruction?

Answer 50

Potassium

Question 51

An incision through full-thickness eschar to relieve pressure

Answer 51

Escharotomy

Question 52

3 common GI alteration in burn patients

Answer 52

Paralytic ileus Curlings ulcer Translocation of bacteria

Question 53

Your burn patient has absence of intestinal peristalsis and decreased bowel sounds, what may they be developing?

Answer 53

Paralytic ileus

Question 54

Your burn patient has developed gastric bleeding and is regurgitating coffee ground material from the stomach, what do they have?

Answer 54

Curlings ulcer

Question 55

What is the ABA fluid resuscitation formula for adults with a chemical or thermal burn?

Answer 55

2 mL x kg (weight) x %TBSA One half of the fluid is given in the first 8 hrs from time of injury The rest is given in the next 16 hrs

Question 56

What is the ABA fluid resuscitation formula for adults with an electrical burn?

Answer 56

4 mL x kg (weight) x %TBSA One half of the fluid is given in the first 8 hrs from time of injury The rest is given in the next 16 hrs

Question 57

Adequacy of urine output for a thermal or chemical burn is

Answer 57

0.5-1 mL/kg/hr or 30-50 mL/hr

Question 58

Adequacy of urine output for an electrical burn is

Answer 58

75-100 mL/hr

Question 59

Nursing Interventions for Acute/Intermediate Burn Injury Phase

Answer 59

Continue to assess and maintain respiratory and circulatory support Fluid and electrolyte balances GI and renal function Infection prevention Burn wound care Pain management Early positioning and mobility

Question 60

Potential complications during the acute/intermediate phase of burn injury

Answer 60

Acute Resp Failure ARDS Heart failure Pulmonary edema Sepsis Delirium Visceral damage

Question 61

Describe the Acute/Intermediate Phase of a burn injury

Answer 61

Fluid reenters vascular spaces Increased urinary output Hyponatremia Hypokalemia (potential) Metabolic acidosis

Question 62

Goals of burn wound care

Answer 62

Infection prevention Promote tissue growth or successful skin grafting

Question 63

Types of burn pain

Answer 63

Background/resting Procedural Breakthrough

Question 64

Nonpharmacologic pain control for burns

Answer 64

Relaxation breathing Distraction - itching Guided imagery Music Hypnosis Therapeutic touch Humor