Critical Care Nursing > Burns > Flashcards

Burns Flashcards

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1
Q

GI Complications of Burns

A

Paralytic Ileus
Constipation
Diarrhea
Curling Ulcer

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2
Q

Endocrine Complications of Burns

A

increased insulin production
insulin insensitivity
hyperglycemia

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3
Q

Musculoskeletal Complications of Burns

A

Contractures

decreased ROM

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4
Q

Collaborative Management for Burns

A 
Pain Management
Wound Care
Excision and Grafting
Fluids
Nutrition
Physical Therapy
Occupational Therapy
Psychosocial
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5
Q

Nursing Diagnosis for Burns

A 
Acute Pain
Fluid and Electrolyte imbalance
Nutrition less than Body requirements
Immobility rt contractures
Risk for Skin Breakdown
Risk for infection
Disturbed Body image
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6
Q

Three phases and times of Burn management

A

Emergent/resuscitative (72 hours)
Acute/healing
Rehab/ restorative

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7
Q

Emergent phase for burn interventions 1st 72 hours

A

Airway

Fluids

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8
Q

main concerns during the emergent phase for burns (2)

A

hypovolemic shock

edema

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9
Q

emergent phase of burns (increased or decreased)

  • vascular volume
  • hct
  • serum k
  • serum na
  • serum protein
A 
vascular volume-decreased
hct-increased
serum protein -decreased
serum K- increased
serum na- decreased
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10
Q

expected findings in the emergent phase (6)

A 
shock
painful/painless
blisters
paralytic ileus
shivering
ALOC
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11
Q

complication in the emergent phase
Cardiovascular (5)
Respiratory (4)
Renal (2)

A

cardiovascular-

  • decreased peripheral circulation
  • paresthesias
  • dysrhythmias
  • hypovolemic shock
  • tissue ischemia and necrosis

respiratory-

  • upper airway burns leading airway obstruction dt edema
  • lower airway
  • pneumonia
  • pulmonary edema

renal-

  • decreased perfusion leading to renal ischemia
  • ATN rt myoglobinuria 2ndry to hgb destruction
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12
Q

Emergent phase in burn injuries

  • airway management (6)
  • fluids (2 types)
  • iv lines (3)
  • wound care (3)
  • facial care method of wound care
  • eye care (3)
  • ear care (2)
  • hand/arms (3)
  • pericare
  • lab tests
  • meds (5)
  • nutrition (1)
A

airway management

  • immediate intubation if face and neck injuries and resp distress
  • 02,
  • humidified air if no intubation,
  • escharotomies
  • fiberoptic bronchoscopy (if smoke inhahation)
  • bronchodilators for brochospasm

Fluids
-types- lactated ringers, albumin

IV Lines (3)

  • 2 large bore if 15% TBSA
  • Picc line if 30% of TBSA
  • Arterial line for frequent ABGs and BP

wound care - daily shower, morning and evening dressing change

facial care- open method

eye care- frightening pt cannot open eyes dt edema, artificial tears, antbx ointment

ear care- no pillows, pressure free

hand/arms positioning- 1. overextension and 2. elevation preferred, 3 early rom

perineal care

routine lab tests- CBC,

meds- analgesics, tetanus, antibx, systemic meds if invasive wound sepsis, VTE prophylaxis

-nutrition (high carbohydrate, high protein)

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13
Q

emergent phase fluid resuscitation (2)

- name of fluid replacement formula

A
  • 2 large bore ivs if 15% of TBSA burn

- Parkland fluid replacement formula

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14
Q

Parkland fluid replacement calculations for emergent phase fluid resuscitation

A

50% of (4ml x TBSA x wt (kg))
ex: 4ml x 5 x 50=1000/2= 500ml for 1st 8 hours
Another 50% (500ml) given over 16 hours

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15
Q

restorative phase interventions 6-12 months (8) which includes meds (3)

A

-PT
-OT
-Pain
-wound care
-nutritionn
-reconstructive surgery
-Psychosocial/psychiatric support
-meds
antihistamine for itching
antidepressants if needed
water based creams

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16
Q

dressing change methods in emergent phase

  • open include
  • close include
A

open-topical antibiotic, no dressing

close- topical antibiotics, sterile dressing changed every 12-24 hours

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17
Q

Interventions in Emergent phase in burn injuries (10)

A
  • airway management (6)
  • fluids (2 types)
  • iv lines (3)
  • wound care (3)
  • facial care method of wound care
  • eye care (3)
  • ear care (2)
  • hand/arms (3)
  • pericare
  • lab tests
  • meds (5)
  • nutrition (1)
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18
Q

Acute phase starts and ends with (2) then 9 interventions in between

A

begin with diuresis and ends with evidence of wound healing

  1. fluids
  2. wound care
  3. excision and grafting
  4. pain/anxiety
  5. PT/OT
  6. nutrition
  7. RT
  8. psychosocial
  9. meds
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19
Q

time of administration and rationale for colloids in burn pts

A

after the 12-24 hours postburn when capillary permeability returns to near normal and plasma can remain in vascular space and expand the circulating volume

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20
Q

assessment of adequate fluid resuscitation in burns

A

urine output of 75-100 ml/hr in electrical burns
MAP >65 and SBP >90 and HR less than 120 measured by arterial line for accuracy dt inaccurate manual BP rt vasoconstriction and edema

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21
Q

sources of wound infection (3)

A

Pt’s own flora, respiratory tract, GI and skin

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22
Q

protective equip when changing open wounds (4)

A

hats, masks, gown, glove

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23
Q

meds for burns

  • analgesics (7)
  • tetanus
  • bronchodilators
  • sedatives/hypnotics
  • antidepressants
  • anticoagulants
  • nutritional supplements
  • gi support
A
  • analgesics- morphine, dilaudid, hydromorphone, fentanyl, oxycodone and acetaminophen (percocet), nsaids ketoralac, adjuvants gabapentin
  • tetanus-
  • bronchodilators
  • sedatives/hypnotics- lorazepam for anxiety, midazolam for sedation, zolpidem for sleep
  • antidepressants- sertaline( prozac), citalopram( celexa)
  • anticoagulants -enoxaparin( lovenox), heparin for DVT prophylaxis
  • nutritional supplements- vit A, C, E, multi for healing; zinc iron for red cellformation and cell integrity, oxandrolone for weight gain and lean muscle mass
  • gi support- ppi and h2 blocker for stomach acid and prevent curling’s ulcer; nystatin for candida overgrowth
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24
Q

causes of hyponatremia in burns

A
  • gi suctioning
  • diarrhea
  • vomiting
  • third spacing
  • fluids/ water intake
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25
annother name for dilutional hyponatremia and intervention
water intoxication- drink juice instead of water
26
when do you see hypernatremia in burns? causes of hypernatremia
after successful fluid resuscitation. causes are too much salt intake like in hypertonic fluids, dietary sodium, bicarbonate intake, too little water intake as in NPO, meds and conditions that cause salt retention such as glucocorticoids, cushings, kidney failure, aldosteronism failure to produce
27
this type of crystalloid can cause hypernatremia
hypertonic solution
28
these disease or conditions can cause hypernatremia
cushings- excess corticosteroids causes sodium to be retained kidney failure- causes decrease excretion of sodium aldosteronism causes sodium and water retention
29
types of burns (5)
``` thermal electric cold thermal smoke inhalation chemical ```
30
these (2) affect treatment plan
type of burn and severity of burn
31
thermal burns examples(3)
steam, hot liquids, flames
32
electrical burns can cause these system problems (5)
respiratory, cardiac, skeletal(amputation, loss of organ function, tissue destruction
33
chemical burns when in contact with three main compounds
acid alkali organic
34
thermal burns can be caused by (4)
flame flash scald contact
35
severity of thermal burns depend on (2)
temperature and duration of contact
36
interventions for chemical burns
1 remove chemical from skin
37
continued tissue destruction xhours after removal of chemical
72 hours
38
causes of inhalation injuries (2)
inhalation of hot air | inhalation of noxious chemicals
39
this is a major predictor of mortality in burn victim
smoke inhalation injury
40
3 types of smoke inhalation injuries
metabolic asphyxiation upper airway injury lower airway injury
41
metabolic axphyxiating is due to what and treatment
Carbon monoxide poisoning, 100% humidified o2
42
manifestations of metabolic asphyxiation (3)
1 hypoxia 2. carboxyhemoglobinemia
43
upper airway injury manifestations (8)
``` blisters edema hoarseness difficulty swallowing stridor copious secretions retractions total airway obstruction ```
44
lower airway injuries manifestations (9)
``` facial burns singed facial hair singed nasal hairs dyspnea wheezing carbonaceous sputum hoarseness ARDS ALOC ```
45
damage (2) dt electrical burns can lead to (2)?
nerves and vessels lead to tissue anoxia and death
46
severity of electrical burn depend on (5)
``` voltage tissue resistance current pathways surface area duration of exposure ```
47
burning inside the skin without evidence of burn on the skin surface
iceberg effect
48
effecct of electrical burn on bones
fractures
49
risks for (4) in electrical burns
dysrhythmias myoglobinuria metabolic acidosis cardiac arrest
50
thermal flash injury can be this type of burn
electrical
51
severity of injury depends on (4)
depth 1st thru 4th degrees (superficial, superficial partial thickness, deep partial thickness, full thickness) extent %TBSA location face, neck,chest pt risk factors
52
burns to the face, neck and chest lead to complications in
respiratory obstruction
53
burns to the hands, feet, joints and eys will lead to complicatios in
self care
54
burns to ears, nose, buttocks, perineum may lead to
infection
55
circumferential burn leads to (1) due to (1)
distal circulation problems dt compartment syndrome
56
concurrent conditions that make for poor prognosis and recovery time
cardiac, respiratory, renal, debilited, | Conditions: DM, PVD, head trauma, factures, head injuries
57
interventions for small thermal burns and large thermal burns
cover with cool damp towel for small burns | large burns- ABC, remove clothing,wrap in clean dry sheet or blanket do not immerse in cool water or icepace
58
inhalation injuries
treat quckly with 100% humidified 02if CO poisoning
59
chemical injuries (2)
1 brush solid particles off | 2use water lavage
60
``` manifestations in the initial burn vascular volume serum na serum k serum protein ```
vascular volume decreased serum na decreased serum k increased serum protein decreased
61
redness, blanch on pressure, no blisters, mild pain
superficial or 1st degree
62
ex of superficial or 1st deg burn (2)
sunburn, heat flash
63
2 major classifications of burns
partial thickness and full thickness
64
2 types of partial thickness burns
superficial, deep
65
vesicles, red, shiny, wet, severe pain, mild to moderate edema
deep partial thickness
66
ex of deep partial thickness burns (7)
``` flame flash scald contact burns chemical tar eletric current ```
67
deep partial thickness burn or this degree burn
2nd
68
dry, waxy white, leathery, hard; no pain, involves muscles, bone, tendons
full thickness 3 and 4th degree burns
69
when does the emergent phase end
with fluid remobiliz`ation and diuresis
70
avoid grapefruit juice when taking these meds (17) | 9 categories and 17 drugs
Statins (cholesterol-lowering drugs): lovastatin (Mevacor), atorvastatin (Lipitor), simvastatin (Zocor, Vytorin) Antihistamines: ebastine Calcium channel blockers (blood pressure drugs): nitrendipine, felodipine (Plendil), nifedipine (Adalat, Procardia) Psychiatric drugs: buspirone (BuSpar), triazolam (Halcion), carbamazepine (Tegretol), diazepam (Valium), midazolam (Versed), sertraline (Zoloft) Immunosuppressants: cyclosporine (Neoral), tacrolimus (Prograf) Pain medications: methadone Impotence drug (erectile dysfunction): sildenafil (Viagra) HIV medication: saquinavir (Invirase) Antiarrhythmics: amiodarone (Cordarone)
71
problem and pt teaching re cyclosporine (4)
nephrotoxic- mon bun and creatinine avoid grapefruit juice- can decrease levels of cyclosporine htn- monitor bp infection- avoid crowds
72
interventions for smoke inhalation (7)
``` humidified 02 high fowlers cough and deep breath every hour reposition q1-2 hr suction and physiotherapy ventilator/intubation for severe resp distress (sob and horseness) bronchodilators ```
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