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1

How are burns classified?

by degree

2

First Degree Burn =

Second Degree Burn =

Third Degree Burn =

1 = through epidermis/dermis

2 = through hair follicles, sweat glands, nerves, blood vessels

3 = through fat, muscle, to bone

3

Second Degree burns heals within ---- days

5-30

4

Second Degree burns cause skin to be ---

mottled (white to cherry red)

5

Third Degree burns case skin to be ---

white, leathery, charred

6

Results from direct contact w/ flames.

Third Degree Burn

7

Causes tissue coagulation with no pain.

Third Degree Burn

8

Which degree of burns has NO pain?

Third Degree (b/c nerve endings are destoyed)

9

Blisters are seen in which degree of burns?

second degree

10

Along w/ severity, burns are also classified by ---

thickness

extent/location

11

Types of Burns

- Thermal Burns (most in kids)
- Chemical Burns
- Electrical Burns
- Radiation Burns

12

Assessing Burn Injuries

1) % of BSA affected
2) depth of burn
3) location of burn injuries

13

What are local responses to burns?

- Edema
- Fluid Loss
- Circulatory Stasis
- Burn Wound

14

Systemic responses to burns?

- Circulatory (shock)
- Anemia
- Renal (decreased urine output to maintain fluid vol)
- Metabolism
- Growth Changes

15

Nursing Responsibilities in Emergent Phase of Burn

1) put out (stop drop and roll)
2) cover burn w/ sterile/clean cloth or gauze
3) transport child to medical care
4) NPO
5) Provide reassurance

16

To prevent hypovolemic shock in burns, what do we do?

maintain circulating fluid volume

2-4 mL/kg x TBSA

17

In --- ---, the wound remains exposed to air after cleaning.

Exposure Therapy

18

In --- ----, wound is resurfaced after cleaning.

Occlusive Dressing

19

Which rule is used to classify burn extent or location?

Rule of 9s

20

Why would you get anemia with a burn?

destruction of RBCs

21

A sign of facial burns is --- --- ---.

singed facial hairs

22

Type of Burn:

- Pink-Red color (no blisters)
- blanches w/ pressure
- heals within 5-10 days
- no scarring

First Degree (Superficial)

23

Type of Burn:

- Pink-Red color (w/ blisters)
- blanches w/ pressure
- heals within 14-21 days
- some scarring

Second Degree (Superficial Partial Thickness)

24

Type of Burn:

- Red to tan, black, brown, or white in color
- dry, leathery appearance
- no blanching
- heals within weeks to months
- grafting required

Third Degree (Full Thickness)

25

Type of Burn:

- color variable
- dull and dry
- charring
- possible visible ligaments/bones/tendons
- NO PAIN

Fourth Degree (Deep Full Thickness)

26

Why would the burn injury to an infant be deeper than a normal child?

their skin is thinner

27

Should we use ice on a burn wound?

NO

cool water only

28

Avoid using ---- or ---- on burns.

greasy lotions

butter

29

Which IV fluids are used during the early stage of burn recovery?

Isotonic Crystalloids (0.9% NS, Ringer's Lactate)

30

Maintain urine output of ---.

1-2 mL/Kg/hr if less than 30 kg

30 mL/hr if more than 30 kg

31

Topical Meds for Burns:

- silver sulfadiazine

- mafenide acetate

- bacitracin

32

A nurse is caring for a client who has a superficial partial thickness burn. Which of the following is an appropriate action for the nurse to take?

a) Administer an IV infusion of 0.9% sodium chloride
b) Apply cool, wet compress to affected area
c) Clean the affected area using a soft-bristle brush
d) Administer morphine sulfate

b) Apply cool, wet compress to affected area

33

A nurse is caring for a client who has major burns and suspected septic shock. Which of the following finding are consistent w/ septic shock? (select all that apply)

a) Increased Body Temp
b) Altered sensorium
c) Decreased capillary refill
d) Decreased urine output
e) Increased bowel sounds

a) Increased Body Temp

b) Altered sensorium

d) Decreased urine output

34

A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following is an appropriate nursing intervention to manage the client's pain?

a) Administer morphine sulfate IV via continuous infusion
b) Administer meperidine IM as needed
c) Administer acetaminphen PO every 4 hr
d) Administer hydrocodone PO every 6 hr

a) Administer morphine sulfate IV via continuous infusion

35

A nurse is caring for a client who has a skin graft. Which of the following clinical manifestations indicate infection. (select all that apply)

a) Green color to subcutaneous fat
b) Unstable body temp
c) Generation of granulation tissue
d) Subeschar hemorrhage
e) Change in skin color around infected area

a) Green color to subcutaneous fat

b) Unstable body temp

d) Subeschar hemorrhage

e) Change in skin color around infected area

36

A nurse is caring for a client who has a moderate burn. Which of the following is an appropriate action for the nurse to take?

a) Maintain immobilization of the affected area
b) Expose affected area to the air
c) Initiate a high-protein, high-calorie diet
d) Implement contact isolation

c) Initiate a high-protein, high-calorie diet

needed to meet increased metabolic demands and promote healing

37

A scald is an example of which type of burn?

Second Degree

38

Nursing Care re: Burns.

- Prevent heat loss
- Fluid balance and adequate hydration
- Prevent infection
- Pain management
- Promote nutrition (increase protein and calories)
- Dressings and ointments

39

Phase of Burn:

First 24-48 hrs

Acute Phase (Fluid Resuscitation Phase)

40

Phase of Burn:

Completion of adequate resuscitation through wound coverage

Management Phase

41

Phase of Burn:

Begins once the majority of the wounds have healed.

Rehabilitation Phase

42

Vaseline on burns?

NO, nothing w/ petroleum

COOL WATER!!!

43

Why cover the burn w/ gauze?

- to prevent contamination

- to alleviate pain by avoiding air contact

44

To maintain an adequatge area, the nurse can administer what?

anti-inflammatory agent such as DECADRON (dexamethasone)

45

Parkland Formula

The Parkland formula is a burn formula used to estimate the amount of replacement fluid required for the first 24 hours in a burn patient so as to ensure they remain hemodynamically stable.

2-4 mL/kg x TBSA

46

If necessary, which vaccine should be administered?

Tetanus

47

Methods of Wound Care:

Wound remains exposed to air after cleaning.

Exposure Therapy

48

Methods of Wound Care:

Wound is resurfaced after cleaning.

Occlusive Dressing

49

Methods of Wound Care:

Immediate debridement of necrotic eschar

Natural process of proteolytic degradation of tissues by body and bacterial enzymes

Primary Excision

50

The immediate postburn period is marked by dramatic alterations in ---

circulation (50% decrease circulation)

called burn shock,

51

Why are children younger than 2 at an increased risk for dehydration when burned?

lack of ability to concentrate urine due to immaturity of kidneys

52

Why are kidneys affected in burns?

Loss of fluid from the intravascular compartment causes renal vasocronstriction that in turn leads to reduced renal plasma flow and depressed GFR

53

Why GI problems in burns?

Loss of blood volume decreases Blood Flow to GI system by 1/3 even when cardiac output is maintained by fluid resuscitation

Ischemia results, causing painful ulcers, enterocolitis

54

How can we support the increased metabolism needs of burn victims?

increase protein and carbohydrates

55

Most reliable indicators for assessing how well fluid resuscitation has workd?

Cap refill

alterations in sensorium

urinary output

56

Grafts:

---- come from people (ex: cadavers or foreskin)


--- come from different species (pigskin, etc.)

Allografts (homografts)

Xenografts (heterografts)


NOTE: Transcyte --- come from bioengineered foreskin tissue (temporary)

57

Types of Temporary Grafts:

- Allografts (Homografts)

- Xenografts (Heterografts)

- Synthetic Skin Coverings

58

When do burn scars become HYPERtrophic?

when no pressure was put on the skin graft

59

Permanent Grafts

Autograft (from own body)

Isograft (from twin)

60

Common antibiotics for burn victims.

Tobramycin

Dicloxacillin

Methcillin

61

--- is the removal of dead tissue to speed up healing.

Debridement

62

Remember ---- before procedures.

Pain Control Meds

63

For 25% burns TBSA, give --- feedings.

enteral

2 grams protein/Kg

64

Vitamins --- and --- for increased growth of epithelial cells

Vitamin --- for wound healing

A and C

Zinc