burns

Question 1

what cause burns

Answer 1

Thermal, chemical, electrical, and radioactive agents

Question 2

results in

Answer 2

cellular destruction of the skin layers, and underlying tissue.
- destruction of body tissue, a burn injury results in the loss of temperature regulation, sweat and sebaceous gland function, and sensory function.
- Metabolism increases to maintain body heat as a result of burn injury and tissue damage.

Question 3

dry heat injuries

Answer 3

result from open flames and explosions

Question 4

moist heat injuries

Answer 4

injuries result from contact with hot liquid or steam.

Question 5

contact burns

Answer 5

occur when hot metal, tar, or grease contacts the skin.

Question 6

chemical burns

Answer 6

result from exposure to a caustic agent

Question 7

cleaning agents

Answer 7

in the home (drain cleaner, oven cleaner, bleach) and agents in the industrial setting (caustic soda, sulfuric acid) can cause chemical burns.

Question 8

thermal burns

Answer 8

result when clothes ignite from heat or flames that electrical sparks produce.

Question 9

flash (arc burns)

Answer 9

result from contact with electrical current that travels through the air from one conductor to another.

Question 10

conductive electric injury

Answer 10

results when a person touches electrical wiring or equipment.

Question 11

radiation

Answer 11

burns most often result from therapeutic treatment for cancer or from sunburn.

Question 12

severity of burn based off of

Answer 12

• Depth/Degree of burn.
• Percent of body surface areas involved. (TBSA)
• Location of the burn on the body.
• Association with other injuries.
• Patient’s age.
• Causative agent.
• Respiratory involvement and overall health of the patient. MOST IMPORTANT

Question 13

1st and 3rd degress

Answer 13

1st: sunburns
3rd: into tissue

Question 14

rules of nines

Answer 14

Quick method to approximate the extent of burns by dividing the body into multiples of nine. The sum equals the TBSA.

Question 15

emergent (resuscitative)

Answer 15

Begins with the injury and continues for 24 to 48 hr.
- Priorities include securing the airway, supporting circulation and organ perfusion by fluid replacement, managing pain, preventing infection through wound care, maintaining body temperature, and providing emotional support.

Question 16

acute

Answer 16

• Begins 36 to 48 hr after injury when the fluid shift resolves.
• Ends with closure of the wound.
  Priorities include assessment and maintenance of the cardiovascular, respiratory, and gastrointestinal systems (including nutrition); wound care; pain control; and psychosocial interventions.

Question 17

rehabilative

Answer 17

• Begins when most of the burn area has healed.
• Ends when the client achieves the highest level of functioning possible.
• Priorities include psychosocial support; prevention of scars and contractures; and resumption of activities, including work, family, and social roles.
• This phase can last for years.

Question 18

older adults

Answer 18

• Higher risk for damage to subcutaneous tissue, muscle, connective tissue, and bone because of thinner skin
• Higher risk for complications from burns because of chronic illnesses (e.g., diabetes mellitus, cardiovascular disease)

Question 19

Inhalation Injury: Clinical Findings

Answer 19

• Singed nasal hair, eyebrows, and eyelashes;
• Sooty sputum; hoarseness; wheezing; edema of the nasal septum; and smoky smelling breath.
• Indications of the impending loss of the airway include hoarseness, brassy cough, drooling or difficulty swallowing, and audible wheezing, crowing, and stridor

Question 20

Carbon monoxide inhalation

Answer 20

(from burns in an enclosed area) findings include headache, weakness, dizziness, confusion, erythema (pink or cherry red skin) and upper airway edema, followed by sloughing of the respiratory tract mucosa

Question 21

what can result from inhalation injury

Answer 21

Hypovolemia and shock can result from fluid shifts
Additional findings include hypotension, tachycardia, and decreased cardiac output.

Question 22

Resuscitation phase on inhalation injury lab values:
glucose
bun
hct and hgb
sodium
potassium

Answer 22

Initial fluid shift (occurs in the first 12 hr and continues for 24 to 36 hr)
●Glucose: elevated due to stress
●BUN: elevated due to fluid loss
- Hct and Hgb: elevated (hemoconcentration) due to the loss of fluid volume and the fluid shift into the interstitial space (third spacing)

Electrolytes
- Sodium: decreased due to third spacing (hyponatremia)
- Potassium: increased due to cell destruction (hyperkalemia)

Question 23

inhalation injury fluid remobilization labs:
hgb hct
sodium
potassium
wbc
blod glucose
abgs
total protein and albumin

Answer 23

(starts at about 24 hr; diuretic stage begins at 48 to 72 hr after injury)

• Hgb and Hct: decreased (hemodilution) due to the fluid shift from the interstitial space back into vascular fluid
• Sodium: remains decreased due to renal and wound loss
• Potassium: decreased due to renal loss and movement back into cells (hypokalemia)
• WBC count: initial increase then decrease with left shift
• Blood glucose: elevated due to the stress response
• ABGs: slight hypoxemia and metabolic acidosis
• Total protein and albumin: low due to fluid loss

Question 24

% of head

Answer 24

9

Question 25

% of arms

Answer 25

4.5 front 4.5 back = 9% for each arm

Question 26

% of legs

Answer 26

18

Question 27

% of chest

Answer 27

18

Question 28

% of back

Answer 28

18

Question 29

% of perineum

Answer 29

1

Question 30

minor burns nursing care

Answer 30

Stop the burning process. - Remove clothing or jewelry that might conduct heat. - Apply cool water soaks or run cool water over injury; do not use ice. - Flush chemical burns with a large volume of water. - Provide analgesics. - Cleanse with mild soap and tepid water: 2 parts cold water, 1 part boiling water - Use antimicrobial ointment. - Educate the family to avoid using greasy lotions or butter on the burn. - Teach the family to observe for evidence of infection. - Determine the need for a tetanus immunization

Question 31

s/s of moderate and major burns

Answer 31

During the initial (resuscitation) phase (from the time of injury to 12 to 48 hr later) following a major burn: - Sympathetic nervous system manifestations - Tachycardia - Increased respiratory rate - Decreased gastrointestinal motility - Increased blood glucose

Question 32

nursing actions for moderate and major burn fluid replacement

Answer 32

To maintain cardiac output!!! - Hypovolemic shock is a common cause of death in the resuscitation phase. - Initiate IV access, a central venous catheter, or intraosseous catheter. - Third spacing (capillary leak syndrome) is a continuous leak of plasma from the vascular space into the interstitial space, which results in electrolyte imbalance and hypotension. - Rapid fluid replacement during the emergent phase maintains tissue perfusion and prevents hypovolemic (burn) shock. - Administer half of the total 24-hr IV fluid volume within the first 8 hr and the remaining volume over the next 16 hr. - Infuse isotonic crystalloid solutions, such as 0.9% sodium chloride or lactated Ringer’s. - Infuse colloid solutions, such as albumin or synthetic plasma expanders, after the first 24 hr of burn recovery. - Assess for fluid overload: edema, engorged neck veins, rapid and thready pulse, lung crackles, wheezes. - Weigh the client daily. - Maintain urine output of 30 mL/hr (0.5 mL/kg/hr). - Prepare to administer blood products. Monitor for manifestations of shock

Question 33

hypothermia

Answer 33

- With skin injury, the body loses heat. - Use warm, inspired air, a warm room, warming blankets, and warmers for infusing fluids.

Question 33

hyperthermia

Answer 33

Low-grade temperature develops as a compensatory mechanism.

Question 34

pain management

Answer 34

- Avoid routes other than IV due to decreased absorption from other routes. - Use IV morphine, hydromorphone, and fentanyl or anesthetics, such as ketamine, and nitrous oxide. - Monitor for respiratory depression - The use of patient-controlled analgesia (PCA) is appropriate for some clients. - Administer pain medication prior to dressing changes and procedures. - Use nonpharmacologic methods for pain control, such as guided imagery, music therapy, and therapeutic touch, to enhance the effects of analgesic medications and manage pain more effectively.

Question 35

infection prevention

Answer 35

- Maintain a protective environment. - Restrict plants and flowers due to the risk of contact with Pseudomonas - Restrict consumption of fresh fruits and vegetables. Limit visitors. - Monitor for manifestations of infection and report them to the provider. - Administer tetanus toxoid. - Administer antibiotics to treat infection. Monitor peak and trough levels. - Use strict asepsis with wound care.

Question 36

nutritional support

Answer 36

- Large burns require 5,000 calories/day for healing. - Caloric needs double or triple 4 to 12 days after the burn. - Increase caloric intake to meet increased metabolic demands and prevent hypoglycemia. - Increase protein intake to prevent tissue breakdown and promote healing. - Decreased gastrointestinal motility and increased caloric needs require enteral therapy or total parenteral nutrition.

Question 37

Silver nitrate 0.5%

Answer 37

Apply with a gauze dressing. Reduces fluid evaporation Inexpensive

Question 38

disadvantage for silver nitrate

Answer 38

Does not penetrate eschar Stains clothing and linen Depletes sodium and potassium

Question 39

silver sulfadiazine 1%

Answer 39

- Apply a thin layer with a clean glove. - Usually pain-free - Effective against gram-negative bacteria, gram-positive bacteria, and yeast

Question 40

disadvantage for silver sulfadiazine

Answer 40

- Can cause transient neutropenia - Sulfa allergy is a contraindication - Penetrates eschar minimally - Can cause a gray or blue-green discoloration - Decreases granulocyte formation

Question 41

wound care

Answer 41

Nonsurgical management, such as hyperbaric oxygen therapy - Pre-medicate the client with an analgesic. - Remove all previous dressings. - Assess for odors, drainage, and discharge. - Assess for sloughing, eschar, bleeding, and new skin-cell regeneration.