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Flashcards in T2-Burns PPT Deck (84):
1

What is an example of a first degree burn? Scarring?

Sunburn; heals without scarring

2

What degree burn is superficial?

First

3

What degree burn is superficial partial thickness or deep partial thickness?

Second

4

Second degree (partial or deep partial)
1. Affects?
2. Caused by?
3. Pain type?
4. Appearance?
5. Blistering?
6. Healing time?

1. Affect epidermis, dermis, hair follicles, nerves, and sweat glands

2. Caused by contact with hot liquids, flames, or chemicals

3. Severe pain on surface; loss of sensation if deeper

4. Moist, mottled skin--white to cherry red

5. Yes, blisters

6. Heals within 5-30 days

5

What degree is a full thickness burn?

3rd

6

Full thickness burns
1. Affects?
2. Results from?
3. Appearance?
4. Destroys?
5. Causes?

1. Affects epidermis, dermis, hair follicles, sweat glands, nervers, blood vessels, fat, muscle, and bone

2. Results from direct contact with flames

3. White, leathery, charred skin

4. Destroys hair follicles, blood vessels, and nerve endings

5. Causes tissue coagulation, with no pain; heals slowly, with scarring

7

Example of superficial burn?

Sunburn

8

Example of partial thickness burn?

Scalds

9

Example of full thickness burn?

Flame

10

What is nursing care we can provide to patients with burns? (6)

-Prevent heat loss
-Prevent infection
-Pain management
-Promote nutrition
-Dressings and ointments
-Fluid balance and adequate hydration

11

What are 4 types of burns?

Thermal
Chemical
Electrical
Radiation

12

Example of thermal burn?

Flames, scalds, boiling water, ramen noodles

13

Example of chemical burn?

Ingestion

14

Example of electrical burn?

Kid sticks something in electrical outlet and gets shocked; kid chews on electrical wire and gets shocked

15

Examples of radiation burns?

Radioactive--chemo

16

Cigarette lighter burn, scalded milk, dipped in hot water scalds, burn from grates, are all examples of ____ burns

Child abuse

17

Who asses what % of the body the burn is?

Doctor

18

How do doctors assess burn injuries?

-% of BSA affected
-depth of injury
-location of burn injury

19

What are 5 systemic responses to burn injuries?

-Circulatory
-Anemia
-Renal
-Metabolism
-Growth changes

20

What are 4 complications of burn injuries?

-Pulmonary
-Wound sepsis
-Curlings ulcer
-CNS

21

What is a sign of facial burns?

Singed nasal hairs
Wheezing
Hoarsness
Wet crackles
Nasal secretions

22

What are signs of curlings ulcers?

Abdominal pain
Bleeding
Coffee ground emesis
Abdominal distention

23

What are the 3 phases for the management of burns?

1. Acute
2. Management
3. Rehabilitative phase

24

The acute phase is the first ____ hours.

24-48 hours

25

Emergent phase

Acute

26

Fluid resuscitative phase

Acute

27

Completion of adequate resuscitation through wound coverage (taking care of the wound still)

Management phase

28

Begins once the majority of the wounds have healed. What is predominant focus?

Rehab phase;
rehab

29

During the acute stage of management, there is an emergent phase. What happens here?

STOP THE BURNING PROCESS (smother the fires; stop, drop, and roll!)

30

In the emergent phase, if the fire or burn is off contact, what do we do to stop the burning process?

-Cover burning area
-Rinse chemical burns with cool running water
-Slow immersion in cool water to relieve pain, slow process of heat damage and edema formation

31

Is it ok to put vaseline or petroleum on a burn?

No, don't do this

32

Why do we cover the burn and what do we cover it with?

Cover with sterile or clean cloth/gauze to prevent contamination and alleviate pain by avoiding air contact

33

Acute: Emergent phase

____ temporarily for extensive burns

NPO

34

Acute: Emergent phase

Why do we provide reassurance?

1. Reduce anxiety
2. Conserve energy

35

Management phase:

Where are minor burns taken care of? Major burns?

Minor: outpatient wound care (teach parents about wound care & follow up care)

Major: hospitalization

36

What is the first priority for a burn patient?

Establish and maintain an adequate airway!!

37

If we are going to have to be giving oxygen, why is it important we can get an endotracheal tube in quickly? What do we monitor?

Get the endotracheal tube in BEFORE THE AIRWAY SWELLS (especially for facial or inhalation types of injuries)

Monitor blood gases

38

What is the second priority concern a nurse has for a burn patient?

Maintain circulating fluid volume to prevent hypovolemic shock

39

Maintaining circulating fluid volume: what is the goal of urine output for children under 30 kgs? What about for all other patients?

Under 30 kg: 1 mL/kg/hr

Other patients: 0.5 mL/kg/hr

40

What is the third priority nursing concern for a burn patient? Why?

Care of the wound

- prevent infection
- facilitate wound healing
- restore max. function as possible
- Give tetanus if indicated

41

What are 3 types of methods of burn wound care?

1. Exposure therapy
2. Occlusive dressing
3. Primary excision

42

Burn wound care type?

Wound remains exposed to air after cleaning

Exposure

43

Burn wound care type?

Wound is resurfaced after cleaning

Occlusive

44

Burn wound care type?

Immediate debridement of necrotic eschar; natural process of proteolytic degradation of tissues by body and bacterial enzymes

Primary excision

45

How is primary excision burn wound care enhanced?

Dressing changes and gentle cleansing

46

What are the types of closure and resurfacing techniques?

Temporary grafts
Permanent grafts

47

What are the 3 types of temporary grafts?

Allograft (homograft)
Xenograft (heterograft)
Synthetic skin covering

48

What type of temporary graft:

Genetically different members of the same species (cadavers)

Allograft

49

With allografts, there must be no signs of rejections up to ___ days.

14

50

What type of temporary graft: skin substitute, bioengineered from newborn foreskin tissue

Transcyte (a type of allograft)

51

What type of temporary graft:

Members of different species (pigskin)

Xenograft

52

How often are xenografts changed?

1-3 days

53

These are all examples of what?

-Elastic films
-Hydroactive and colloidal materials
-Nylon fabric
-Beta glucagons
-Biobranes
-Jobst or pressure garmets

Temprary grafts--synthetic skin coverings

54

Why are permanent grafts used?

To achieve maximum functioning and for cosmetic appearance

55

What are the 2 types of permanent grafts?

Autografts
Isografts

56

Type of permanent graft: From undamaged parts of patients own body. Examples?

Autograft

Ex: Mesh, sheet, ACE wrap

57

What type of permanent graft: histocompatible tissues from identical twins

Isograft

58

What would we rather use on burns: temporary or permanent grafts?

Permanent

59

Blood flow can become constricted due to edema and results in tissue hypoxia, so docs can do an incision into the constricting tissue to restore peripheral circulation. What is this procedure called?

Escharotomy or fasciotomy

60

What are some common topical preparations for burns?

Silver Nitrate
Sulfamylon
Silvadene
Garamycin
Betadine

61

What is the leading cause of death in burn patients?

Infection (after the resuscitative phase)

62

What are some main portals of entry for infections? (5)

Wound
Resp. tract
GI tract
GU tract
IV sites

63

What are some common organisms that get into the wound and cause infections?

-Staph
-Pseudomonas

64

Wound care: Management phase

Removal of dead tissue to speed healing

Debridement

65

-How is debriedment enhanced?
-What can PT do to help?
-What do topical enzymes do?
-How is this done--like by who?

-Enhanced by dressing change and gentle cleansing

-PT does hydrotherapy

-Topical enzymes destroy dead tissue

-Removed with scalpel by physician

66

What should we do FIRST before starting debridement?

GIVE PAIN CONTROL MEDS BEFORE PROCEDURES!!!

67

Pain control is an important goal during the management of burn care. Why

-Promote rest and sleep
-Decrease anxiety and fear
-Increase compliance and cooperation
-Prevent burn injury induced hypermetabolism

68

Management of care: pain control

This drug of choice is used because of its predictable analgesic effect, safety profile, and ease of reversibility with Naloxon

Morphine sulfate via PCA pump

69

Management of care: Pain control

What is a short acting opioid?

Fentanyl

70

Management of care: pain control

Rapid onset and quick return to baseline. What drug?

Propofol

71

Management of care: Pain control

Used to increase threshold for pain

Nitous oxide

72

Management of care: pain control

Combo drug used for procedural pain

Demerol-thorazine phenergan

73

Management of care: Nutrition

Increase stress= ____

Increase metabolism

74

Management of care: Nutrition

Increase stress= increase metabolism, which causes increase in _____ leading to increase in ____ therefore an increase in ____ & ___ are needed to prevent further protein breakdown!

^ stress= ^metabolsism, which causes ^ in NUTRITIONAL NEEDS, leading to ^ in CATABOLISM, therefore an ^ in CALORIES AND PROTEINS are needed to prevent further protein breakdown

75

Management of care: Nutrition

How much protein needed?

2 g/kg

76

Management of care: Nutrition

When do you get an enteral feeding?

Enteral feedings for 25% burns TBSA!!!

77

Enteral feedings are preferred over _____ because of greater benefits, such as blood flow to GI tract and preserves GI function

PREFERRED OVER HYPERALIMENTATION

78

Management of care: Nutrition Review

What kind of diet do burn patients need?

A diet high in calories and high in protein!!

79

Management of care: Nutrition review

What is preferred: enteral feeding or hyperalimentation

ENTERAL FEEDING

80

Management of care: Nutrition

What is Vit. A and C needed for?

Increased growth of epithelial cells

81

Management of care: Nutrition

What is zinc used for?

Wound healing

82

Another goal during the management phase is prevention of other complications. What are examples of other complications?

Keloids
Contractures
Developmental delays
Ulcers

83

Management phase: Support the family unit

What does this mean?

Family is going through disruptions in routines, and possibly putting extra demands on its members

Parents may be having feelings of guilt if neglect is an issue

84

120 degrees it would take 5 minutes of contact/exposure to get the same burn that you would get in 1 SECOND if it was set at 155. What is the thermostat needed to be set on?!

120 F is the magic number

*MAKE SURE you check this, especially if you've recently moved into a new home!!

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