T2 - Burn Injuries Lecture (Josh) Flashcards
1
Q
How are burns classified?
A
by degree
2
Q
First Degree Burn =
Second Degree Burn =
Third Degree Burn =
A
1 = through epidermis/dermis
2 = through hair follicles, sweat glands, nerves, blood vessels
3 = through fat, muscle, to bone
3
Q
Second Degree burns heals within —- days
A
5-30
4
Q
Second Degree burns cause skin to be —
A
mottled (white to cherry red)
5
Q
Third Degree burns case skin to be —
A
white, leathery, charred
6
Q
Results from direct contact w/ flames.
A
Third Degree Burn
7
Q
Causes tissue coagulation with no pain.
A
Third Degree Burn
8
Q
Which degree of burns has NO pain?
A
Third Degree (b/c nerve endings are destoyed)
9
Q
Blisters are seen in which degree of burns?
A
second degree
10
Q
Along w/ severity, burns are also classified by —
A
thickness
extent/location
11
Q
Types of Burns
A
- Thermal Burns (most in kids)
- Chemical Burns
- Electrical Burns
- Radiation Burns
12
Q
Assessing Burn Injuries
A
1) % of BSA affected
2) depth of burn
3) location of burn injuries
13
Q
What are local responses to burns?
A
- Edema
- Fluid Loss
- Circulatory Stasis
- Burn Wound
14
Q
Systemic responses to burns?
A
- Circulatory (shock)
- Anemia
- Renal (decreased urine output to maintain fluid vol)
- Metabolism
- Growth Changes
15
Q
Nursing Responsibilities in Emergent Phase of Burn
A
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
Q
To prevent hypovolemic shock in burns, what do we do?
A
maintain circulating fluid volume
2-4 mL/kg x TBSA
17
Q
In — —, the wound remains exposed to air after cleaning.
A
Exposure Therapy
18
Q
In — —-, wound is resurfaced after cleaning.
A
Occlusive Dressing
19
Q
Which rule is used to classify burn extent or location?
A
Rule of 9s
20
Q
Why would you get anemia with a burn?
A
destruction of RBCs
21
Q
A sign of facial burns is — — —.
A
singed facial hairs
22
Q
Type of Burn:
- Pink-Red color (no blisters)
- blanches w/ pressure
- heals within 5-10 days
- no scarring
A
First Degree (Superficial)
23
Q
Type of Burn:
- Pink-Red color (w/ blisters)
- blanches w/ pressure
- heals within 14-21 days
- some scarring
A
Second Degree (Superficial Partial Thickness)
24
Q
Type of Burn:
- Red to tan, black, brown, or white in color
- dry, leathery appearance
- no blanching
- heals within weeks to months
- grafting required
A
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
