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Nursing 283 > Week 4 Burns > Flashcards

Week 4 Burns Flashcards

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1
Q

Problems resulting from burns

A

fluid and protein loss, changes in metabolic, endocrine, respiratory, cardiac, hematologic and immune function

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2
Q

Healing of burns to the epidermis

A

Can grow back
epidermal cells surrounding sweat and oil glands and hair follicles extend into dermal tissue and regrow to heal partial thickness wounds

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3
Q

Does the epidermis have blood vessels?

A

no

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4
Q

What is found in the dermis?

A

blood vessels, sensory nerves, hair follicles, lymph vessels, sebaceous glands, and sweat glands

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5
Q

Healing of burns to the dermis

A

if any more than the first 3rd is burned, the skin can no longer restore itself

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6
Q

Temperature skin can tolerate without injury

A

104

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7
Q

Temperatures above what cause rapid cell destruction

A

158

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8
Q

Superficial burn description

A

Pink to red, mild edema, painful, no blisters, no eschar, 3-6 day healing time, ex- sunburn

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9
Q

Superficial partial thickness burn description

A

pink to red color, mild to mod edema, painful, blisters present, no eschar, 2 week healing time, ex- scalds, flames

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10
Q

Deep partial thickness burn description

A

Red to white color, mod edema, painful, blisters unlikely, soft dry eschar, 2-6 week healing time, possible grafts, ex- flame, grease, and chemicals

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11
Q

Full thickness burn description

A

Black, brown, yellow, red or white color, severe edema, intermittent pain, no blisters, hard and inelastic eschar, weeks to months to heal, requires grafts, ex- flame, tar, grease, electricity

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12
Q

Deep full thickness burn description

A

Black color, no edema, no pain, no blisters, hard and inelastic eschar, weeks to months healing requiring grafts, ex- flame, electricity, grease, chemicals

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13
Q

Fluid shift occurring with burns

A

3rd spacing occurs in the first 12 hours until 24-36 hours

Imbalances in fluids, electrolytes and acid-base

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14
Q

Hemoconcentration in burns

A

elevated blood osmolarity, hematocrit, and hemoglobin from vascular dehydration and increases blood viscosity

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15
Q

Fluid remobilization

A

begins 24 hours after injury (when fluid shift stops) diuresis increases to remove excess fluid and edema subsides

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16
Q

Cardiac Changes Resulting from Burn Injury

A

Initially HR increases and CO decreases because of the initial fluid shifts and hypovolemia

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17
Q

Burns and GI changes

A

decreased motility and blood flow, peristalsis/paralytic ileus, ulcer development

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18
Q

Prevention of ulcer development after a burn

A

give H2 blockers or PPI’s early

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19
Q

Inflammatory compensation after a burn

A

can trigger healing
causes problems with fluid shift
helpful in the short term

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20
Q

Sympathetic nervous system response to burns

A

Stress response: increased thirst, HR and RR, catecholamine, aldosterone and metabolic rate, slowed GI motility, release of glycogen stores, fluid retention, vasoconstriction, decreased urine and hematocrit positive stools.

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21
Q

Factors that increase death from burns

A

age over 60
over 40% TBSA burned
inhalation injury

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22
Q

Factors that improve outcome from burns

A

vigorous fluids, early wound excision, improved critical care monitoring, early enteral nutrition, antibiotics, and the use of burn centers

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23
Q

Resuscitation/ emergent phase

A

occurs after injury until 24-48 hours

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24
Q

Priority care in the resuscitation/ emergent phase

A

Airway, circulation (fluid replacement), comfort with analgesics, prevent infection, maintain body temp and provide emotional support.

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25
General management for all burns
Assess airway, Administer O2, Cover with a blanket, Keep NPO, Elevate extremities, Obtain VS, IV access, and begin fluid replacement, Administer tetanus for prophylaxis, Perform a head-to-toe assessment.
26
Electrical Burns Management
Smother any flames, Initiate CPR, and Obtain an ECG
27
Signs of pulmonary injury
hoarseness, brassy cough, drool or difficulty swallowing, audible wheezes or stridor on exhalation
28
Cardiovascular assessment in burns
Monitor edema, measure central and peripheral pulses, BP, cap refill, and pulse ox
29
Rate of fluid resuscitation
whatever rate is needed to have urine output greater than 30-50 ml/hour
30
S/Sx of paralytic ileus
nausea, vomiting, and abdominal distention
31
Hemoglobin normal and what is expected after a burn
12-16g/dL (women) 14-18g/dL (men) Elevated as a result of fluid volume loss
32
Hematocrit normal and what is expected after a burn
37%-47% (women) 42%-52% (men) Elevated as a result of fluid volume loss
33
BUN normal and what is expected after a burn
10-20mg/dL Elevated as a result of fluid volume loss
34
Glucose normal and what is expected after a burn
70-105mg/dL Elevated as a result of the stress response and altered uptake across injured tissues
35
Na+ normal and what is expected after a burn
136-145mEq/L Decreased; sodium is trapped in edema fluid and lost through plasma leakage
36
K+ normal and what is expected after a burn
3.5-5.0mEq/L Elevated due to disruption of the sodium-potassium pump, tissue destruction, and RBC hemolysis
37
Cl- normal and what is expected after a burn
98-106mEq/L Elevated as a result of fluid volume loss and reabsorption of chloride in urine
38
PaO2 normal and what is expected after a burn
80-100mmHg Slightly decreased
39
PaCO2 normal and what is expected after a burn
35-45mmHg Slightly increased from respiratory injury
40
pH normal and what is expected after a burn
7.35-7.45 Low as a result of metabolic acidosis
41
Carboxyhemoglobin normal and what is expected after a burn
0%-10% Elevated as a result of inhalation of smoke and carbon monoxide
42
Total protein normal and what is expected after a burn
6.4-8.3g/dL Low; protein exudate is lost through the wound
43
Albumin normal and what is expected after a burn
3.5-5.0g/dL Low; protein is lost through the wound and through vascular membranes because of increased permeability
44
The priority problems in the resuscitation/ emergent phase for Pts with burns greater than 25% of the TBSA
``` Potential for inadequate oxygenation Hypovolemic shock Potential for organ ischemia Pain Potential for ARDS ```
45
When does upper airway edema become pronounced?
8-12 hours after fluid recuscitation | Vigorous suctioning is performed after chest physiotherapy and aerosol treatments
46
Ways to monitor for gas exchange
ABGs, assessing for cyanosis, disorientation, and increased HR
47
Priority intervention for b. Preventing Hypovolemic Shock and Inadequate Oxygenation
Rapid infusion of IV fluids (fluid resuscitation)
48
Best practices for fluid resuscitation
Administer one half of the total 24-hour prescribed volume within the first 8 hours post burn and the remaining volume over the next 16 hours, monitor VS, urine and fluid status hourly
49
Acute phase of burn injury time frame
36-48 hours until wounds are closed, begins when diuresis is noted
50
Leading cause of death during acute phase of resocery
infection
51
Priority problems for patients with burn injuries greater than 25% TBSA in the acute phase of recovery
``` Wound care management Potential for infection Excessive weight loss Reduced mobility Reduced self-image ```
52
Nursing interventions for maintaining patient mobility
neutral body position to prevent contractures, ROM 3x daily, ambulation, pressure dressings
53
Opioid administration during the resuscitation phase
IV only
54
Burn % of severe burns
over 20% TBSA
55
Poisonous bi-product of burning material
carbon monoxide
56
Healing time of superficial partial thickness burn
1-3 weeks
57
Chief characteristics of superficial partial thickness burn
blister formation | epidermis is gone and the upper third of the dermis is gone
58
Deep partial thickness burn and hypoxia
wound can progress to a full thickness
59
Deep partial thickness burn healing time
1-3 months
60
Zone of hyperemia
least damaged area of the burn, heals in 3-5 days
61
Zone of stasis
where tissue perfusion is compromised, vasoconstriction and thrombosis with lots of debris, can regenerate with tx
62
Zone of coagulation
permanent burn injury with cell death
63
Burn criteria for going to a burn center
Partial thickness burns >= 20% TBSA in patients 10 - 50 years old or >=10% TBSA in children < 10 or adults > 50 Full-thickness burns >= 5% TBSA in any age. Patients with partial or full-thickness burns of the hands, feet, face, eyes, ears, perineum, and/or major joints Electrical, chemical, inhalation, trauma, co-morbid illnesses
64
Body temperature after a burn injury
often develop a low grade fever, if the fever is high, an infection may be present (hypothalamus regulates temp and is not working well)
65
Immune response to burn
severe causes bone marrow suppression, shorter RBC lifespan, decreased/ ineffective WBC production
66
Rehabilitative phase of burn injury
begins after wound closure and can last a lifetime
67
Pulmonary fluid overload/ pulmonary edema
can occur even if no damage to lungs occurred due to histamine release and inflammatory response, can also be from over hydrating by IV
68
Vasoconstriction after a burn
occurs initially, body is trying to shunt blood from burned area and there is no blood there, may lead to vessel thrombosis (causing ischemia)
69
Vasodilation after a burn
occurs after vasoconstriction, leads to capillary leak/ 3rd spacing
70
How to manage hyperkalemia
give fluids so kidneys will get rid of it, kayexalate, or insulin + dextrose 50%
71
Common cause of death to burn patients in the emergent phase
shock, need to keep circulating blood volume up
72
During the initial stage of burns, where does the primary fluid imbalance/ shift occur?
from the plasma to the interstitial space
73
How do we know if fluid resuscitation is working?
Urine output is #1 | BP is #2
74
Myoglobin release
released from damaged muscle, it can circulate to the kidneys and clog them
75
Background burn pain
pain from the actual burn and damage to your body
76
Why does hyponatremia develop in burn patients?
Displacement of sodium in edema fluids and loss through denuded areas of skin
77
How often are wound dressings changed?
cleaned and dressed daily or more frequently depending on the amount of exudate or weeping or if they have an infection (with infection, it’s 2x a day)
78
Most common surgical management for burn injury
skin grafting
79
How to calculate how much fluid to give
wt in kg x TBSA % burned

Nursing 283 (10 decks)

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