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NSG 430 - Critical Care > T14: Burns & Skin Infections > Flashcards

T14: Burns & Skin Infections Flashcards

(85 cards)

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1
Q

burns

A

an injury to the tissues of the body caused by heat, chemicals, electrical current or radiation

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2
Q

When you break skin barrier it is a

A

MASSIVE RISK FOR INFECTION

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3
Q

Decreased circulating intravascular blood volume leads to

A

fluid loss can cause decrease in organ perfusion : HR increases, CO and BP decrease

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4
Q

why do we need fluids in burn patients

A

the fluid is extravascular but the blood in the vessel is THICK so we are worried about a DVT!!!

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5
Q

thermal burns

A

caused by flame, flash, scald or contact with hot objects; this would even be considered as a sunburn

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6
Q

chemical burns

A

Result of contact with acids, alkalis, and organic compounds
Alkali burns are hard to manage because they cause protein hydrolysis and liquefaction

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7
Q

immediate care of chemical burns

A

o Chemical should be quickly removed from the skin (lavage with water *think about eye wash stations)
o Clothing containing chemical should be removed
o Tissue destruction may continue up to 72 hours after chemical injury

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8
Q

smoke inhalation injury

A

injury occurs with inhaling of products of combustion during fire

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9
Q

clinical manifestations smoke inhalation injury

A

facial burns, SINGED NASAL HAIRS, swelling of oropharynx and nasopharynx, stridor, wheezing, dyspnea, hoarse voice, sooty (carbonaceous) sputum and cough

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10
Q

electrical burns can cause

A

“Iceberg effect;” muscle spasms strong enough to FRACTURE BONES

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11
Q

with electrical burns patients are at risk for

A

o Dysrhythmias or cardiac arrest –>VF, cardiac standstill (place on a monitor)
o Seizures (place on seizure precautions)
o Muscle movement is affected (heart, intercostals, diaphragm, walking)
o Severe metabolic acidosis
o Myoglobin and hemoglobin from damaged RBCs travel to kidneys
- Acute tubular necrosis (ATN)
- Eventual acute kidney injury

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12
Q

superficial partial thickness burn

A

Involves the epidermis

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13
Q

deep partial thickness burn

A

involves the dermis

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14
Q

full thickness burn

A

involves all skin elements, nerve endings, fat, muscle, bone

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15
Q

rule of nines

A

a method used in calculating body surface area affected by burns

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16
Q

Face, neck, chest burns risk for

A

respiratory obstruction

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17
Q

Hands, feet, joints, eyes burn risk for

A

self-care deficit and mobility

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18
Q

Ears, nose, buttocks, perineum burn risk for

A

infection

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19
Q

Circumferential burns of extremities can cause

A

circulation problems distal to burn

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20
Q

compartment syndrome check

A

6 Ps

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21
Q

6 P’s

A

Pain
Pulse
Pallor
Paresthesia
Paralysis
Pressure

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22
Q

pre hospital care for burns

A
  • Remove person from source of burn and stop burning process
  • Rescuer must be protected from becoming part of incident
  • ASSESS ABCs
  • Cover burns with sterile or clean clothes and remove constricting jewelry and clothing
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23
Q

at the hospital care for burns

A

o O2 100%
o IV access to non-burned skin or central line
o Fluids for hypovolemia
o Insert foley to manage fluid resuscitation of 30-50mL/hr
o NPO
o NG tube to remove gastric secretions and prevent aspiration
o TETANUS

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24
Q

interventions for electrical burns

A
  • Removal of current source must be done by trained personnel with special equipment to
    prevent injury to rescuer
  • Assess and tx pt after removal from source of current
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25
intervention for chemical burns
o Brush solid particles off skin o Use water lavage o Tissue destruction may continue for up to 72 hours after
26
small thermal burn interventions
o Cover with clean, cool, tap water—dampened towel
27
large thermal burn interventions
o Circulation (check for presence of pulse), airway (patency), breathing o Cool burns for no more than 10 minutes (in order to prevent hypothermia) o Do not immerse in cool water or pack with ice-hypothermia o No ice-vasoconstriction o Remove burned clothing o WRAP IN CLEAN, DRY SHEET OR BLANKET § DRY OTHERWISE WET WILL DRY AND PULL OF SKIN
28
how to wrap burns
o WRAP IN CLEAN, DRY SHEET OR BLANKET - DRY OTHERWISE WET WILL DRY AND PULL OF SKIN
29
inhalation injury intervention
o Watch for signs of respiratory distress o Treat quickly and efficiently o 100% humidified oxygen via non-rebreather if CO poisoning is suspected
30
emergent stage begins
at time of the injury
31
emergent stage ends
when fluid mobilization and diuresis begin
32
clinical manifestations of emergent stage
- Shock from HYPOVOLEMIA - Blisters - Paralytic ileus - Shivering - Altered mental status
33
goal of emergent stage
maintain patent airway, administer IV fluids to prevent hypovolemic shock and preserve vital organ functioning
34
Normal insensible fluid loss
30-50 mL/hr
35
severely burned patient fluid loss
200 to 400 mL/hr
36
As RBCs are destroyed more K+ gets in blood so
WATCH K+ AND NA+ LEVELS
37
burn shock
a type of hypovolemic shock; if not corrected, can result in DEATH
38
IMMUME SYSTEM IS CHALLENGED WHEN BURN OCCURS because
the skin barrier is destroyed, bone marrow is depressed, circulating level of immune globulin are decreased, WBC develop defects
39
burns and CV system
Dysrhythmias and hypovolemic shock, increased blood viscosity (sludging)
40
escharotomy
§ (a scalpel or electrocautery incision through the full-thickness eschar) is frequently done after transfer to a burn center to RESTORE CIRCULATION TO COMPROMISED EXTREMITIES.
41
burns and respiratory system
Edema formation, mechanical airway obstruction and asphyxia, pneumonia, pulmonary edema
42
burns and urinary system
- ↓ Blood flow to kidneys causes renal ischemia - Acute tubular necrosis (ATN) due to myoglobin from muscle damage ->myoglobinuria and hemoglobinuria-PINK urine that is not formed RBCs · Would need to be on CRRT
43
fluid therapy
- TWO LARGE BORE IV LINES FOR >15 % - >30% CENTRAL LINE - 0.9 NS -LR and albumin -DAILY WEIGHTS TO DETERMINE ADEQUATE FLUID REPLACEMENT
44
Wound care should be delayed until
patent airway, adequate circulation, and adequate fluid replacement have been achieved
45
Hydrotherapy (burns)
cleansing can be done on a shower cart in a shower or on a bed · Once daily shower, dressing change in morning and evening, preemedicated before procedure
46
debridement
loose necrotic skin is removed
47
open method
burn is covered with topical antibiotic with NO dressing over wound
48
open method of wound care
· STERILE gauze dressing are laid over topical antibiotic · APPLICATION OF SILVER SULFADIAZINE TO MOISTENED GAUZE
49
autografting
surgical removal of a thin layer of clients own skin which is then applied to the excised burn wound
50
Other Care measures for burns
Ears should be kept free of pressure · No use of pillows Hands and arms should be extended and elevated on pillows or foam wedges Perineum must be kept as clean and dry as possible · Indwelling catheter · Perineal care Routine laboratory tests Early ROM exercises · Early PT to prevent complications and facilitate fluid mobilization and healing
51
pain management drugs
analgesics, sedatives, morphine, ect
52
Antimicrobial drugs
silver sulfadiazine, mafenide acetate
53
Tetanus immunization or ImmuneGlobulin
o routinely given to all burn patients
54
nutrition therapy for burns
High protein, carb, fat and vitamins; lots of calories (5000+)
55
acute phase for burns begins with
- mobilization of extracellular fluid and subsequent diuresis weeks to months HEMODYNAMICALLY STABLE - DIURESIS from fluid mobilization OCCURS, and patient is less edematous - Bowel sounds return - Healing begins as WBCs surround burn wound and phagocytosis occurs
56
acute phase for burns ends with
- Partial thickness wounds are healed and/or - Full thickness burns are covered by skin grafts - Necrotic tissue begins to slough
57
GI complications for burns
-Paralytic ileus: things like fluid status and stool softeners - CURLING'S ULCER: PPI and H2 BLOCKERS, prevention is helped if patient feeding occurs as soon as possible after the burn injury
58
dermatome
Donor skin is taken from the patient for grafting by means of a DERMATOME, which removes a thin (14/1000 to 16/1000 inch) split-thickness layer of skin from an unburned site.
59
dermatome intervention
Nurse has to take care of donor and graft site MUST STAY MOIST AND STERILE
60
hyperbaric oxygen therapy
flood that part of body with O2 to promote healing
61
How to put on compression sleeve
roll down then roll up the extremity
62
rehabilitative stage of burns begins when
- Wounds have healed - Patient is engaging in some level of self-care
63
rehab stage ends
o Rehab goes on FOREVER -Consider emotional and psychological needs as well
64
parkland formula for burns
- TBSA x 4mL x wt (kg) = 24 hour volume o Then divide in half - 1st ½ over 8 hours divided by 8 2nd ½ over 24 hours divided by 16
65
Staphylococcus aureus
o Impetigo, folliculitis, cellulitis, and furuncles o MRSA-verify by culture
66
Group A β-hemolytic streptococci
o Impetigo, erysipelas, cellulitis, and lymphangitis
67
Erysipelas-red demarcated (RED HOT AND CAN BECOME SYSTEMIC) clinical manifestations
Fever, HA, INCREASED WBC, toxic
68
Erysipelas treatment
- Possible Bacteremia - Antibiotics-PCN based
69
Cellulitis clinical manifestations
Fever, chills, malaise
70
Cellulitis Treatment
- Moist heat, immobilization, elevation - IV antibiotics -Vancomycin, linezolid-Zyvox, daptomycin-Cubicin
71
Impetigo intervention
o SOAP/WATER TO LOOSEN CRUSTS THEN PAT DRY THEN PUT OINTMENT mupirocin topical
72
medications for herpes simplex
ACYCLOVIR, valacyclovir
73
herpes zoster clinical manifestations
o Unilaterally clusters skin vesicles along the peripheral sensory nerves, burning and pain
74
herpes zoster interventions
o Isolate client, prevent rubbing and scratching, light weight clothing o Medications-Same but sooner to prevent neuralgia o Neuralgia-gabapentin, pregabalin o VACCINE-ZOSTAVAX FOR >50 YO
75
Candida
white cheese like discharge (thrush/ yeast infection) o MOUTH IN BETWEEN FINGERS, ALL OVER BODY, IT ITCHES LIKE CRAZY
76
interventions for candida
CAN GIVE ANTIHISTAMINE LIKE BENYDRYL o Keep skin folds clean and dry, frequent mouth care
77
Tinea clincial manifesations
scaly surfaces, nail beds
78
Tinea interventions
o Keep areas dry o Medications-topical or systemic Azoles, fluconazole, ketoconazole>>Watch liver enzymes
79
management for skin infections
Þ Wet compresses-quality or sterile water o Warm/tepid or cool for antinflammatory Þ Baths Þ Topical medications o Gels, lotions, creams, ointments o Occlusion with plastic wrap increases absorption and blood levels-caution Þ Control of pruritus o Break the itch/scratch cycle: KNUCKLE SCRATCH o Cool environment o Hydration, wet compresses, moisturizers o Topical drugs Þ Prevention of spread o Careful hand washing and the safe disposal of soiled dressings Þ Prevention of secondary infections-scratching
80
Steven Johnson Syndrome (SJS)
COMMON SEVERE DRUG REACTION/CHANGE IN MEDICATION
81
If untreated SJS
TEN (toxic epidermal necrolysis- tissue is actually dying)
82
clincial manifestations of SJS
o Fever, flulike, erythema and blisters 24-96 hours o Eye, mucus membranes, GI tract, urogentital o Immunosuppression and opportunistic infections - Sepsis and PNA common - NO CORTICOSTEROIDS - Immuneglobulin may help o Prevent progression to deeper tissues
83
interventions for SJS
o STOP SUSPECTED AGENT IMMEDIATELY o Silver based and biologic dressings o ICU care - Fluid resuscitation - Enteral or parenteral nutrition
84
Necrotizing Fasciitis
a severe infection caused by Group A strep bacteria inflammation of fascia producing death of the tissue
85
Clincial Manifestations of Necrotizing Fasciitis
o Localized, painful, edema, induration, crepitus, EXTREME PAIN

NSG 430 - Critical Care (42 decks)

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