Chapter 54

Question 1

FIRST-DEGREE BURNS
-What kind of burn is this?
-Describe it
-What is a key assessment?
-Example?

Answer 1

-Superficial tissue burn
-Painful, but self-limiting
-Pain
-UV light exposure, brief exposure to hot liquids

Question 2

SECOND-DEGREE BURNS
-What kind of burns are there for this?

Answer 2

Superficial-Partial Thickness & Deep-Partial Thickness

Question 3

SECOND-DEGREE BURNS: Superficial
-Describe this
-What is destroyed?
-Example?

Answer 3

-EXTREMELY PAINFUL because tactile and nociceptors (pain sensors) remain intact
-epidermis
-brief exposure to flash, flame, or hot liquids

Question 4

SECOND-DEGREE BURNS: Deep
-What is destroyed?
-What will the patient feel?
-How is blanching
-Example

Answer 4

-Epidermis is destroyed, dermis damaged
-Diminished senstion in the deepest areas (burn) BUT the margins of the burn can still be painful bc pain & tactile sensors are intact
-It will be absent or prolonged
-Intense radiant energy, scalding liquids or hot semiliquids or solids, flame

Question 5

THIRD-DEGREE BURNS
-What kind of burn is this?
-What is destroyed?
-Describe what happens to the skin

Answer 5

-Full thickness burn
-Epidermis, dermis, & epidermal appendages
-Skin loses elasticity & massive edema accompanies the burn –> this results in a tounriquet-like effect bc the skin becomes tight (surgery may be needed to restore circulation)

Question 6

THIRD-DEGREE BURNS
-Describe pain
-Why?

Answer 6

-Painless to the touch
-All superficial nerve endings in the skin have been destroyed
-Pain MAY be felt in surrounding area

Question 7

THIRD-DEGREE BURNS
-What may this type of burn require?
-Where is this from?

Answer 7

-Skin grafting, using the patient’s own skin
-from a fatty area like the abdomen, thigh, or buttocks

Question 8

If you have a paitent with a 3rd degree burn who went to the OR for grafting, how many wounds will the nurse be caring for?

Answer 8

2 –> the area you grafted and the area where you got the skin from

Question 9

THIRD-DEGREE BURNS
-Example?

Answer 9

Prolonged contact with flame, hot objects, or chemicals

Question 10

FOURTH-DEGREE BURNS
-What kind of burn is this?

Answer 10

Full-thickness burn that extends BEYOND the dermis to involve muscle, bone, or both

Question 11

FOURTH-DEGREE BURNS
-What is this usually due to?

Answer 11

-A high-voltage electrical injury OR with prolonged exposure to intense heat (someone who is unconscious in a fire)

Question 12

FOURTH-DEGREE BURNS
-What may this require?

Answer 12

Skin graft, but you want to focus on cognition & airway first

Question 13

EXTENT OF INJURY: RULE OF NINES
-What does TBSA stand for?
-What is it?

Answer 13

-Total Body Surface Area
-Percentage of the body that is burned

Question 14

EXTENT OF INJURY: RULE OF NINES
-Head?

Answer 14

-4.5% anterior
-4.5% posterior

Question 15

EXTENT OF INJURY: RULE OF NINES
-Arms? (EACH INDIVIDUAL SIDE)

Answer 15

4.5% anterior & 4.5% posterior

Question 16

EXTENT OF INJURY: RULE OF NINES
-Torso?

Answer 16

-18% anterior
-18% posterior

Question 17

EXTENT OF INJURY: RULE OF NINES
-Perineum?

Answer 17

1% anterior

Question 18

EXTENT OF INJURY: RULE OF NINES
-Legs? (EACH INDIVIDUAL SIDE)

Answer 18

-9% anterior
-9% posterior

Question 19

MANAGEMENT
-What is the priority?

Answer 19

Elimination of the burn source

Question 20

MANAGEMENT
-What should the person do in a fire?

Answer 20

Stop, drop, & role

Question 21

MANAGEMENT
-What can you use if water if NOT accessible?

Answer 21

Blankets & coats

Question 22

MANAGEMENT
-what are scald injuries?
-What are they best treated with INITIALLY?
-Why?

Answer 22

-caused by hot liquids or steam
-cool water
-allows cooling of the scalding liquid as well as the underlying skin

Question 23

MANAGEMENT
-How do you assess?

Answer 23

ABCs, recognize inhalation injury (cough, stridor, hoarseness), heat-to-toe, TBSA

Question 24

MANAGEMENT
-How do you treat chemical injuries?

Answer 24

Remove any lingering contamination

Question 25

**NUTRITIONAL SUPPORT** -What is needed for wound healing?

Answer 25

-Protein & fluid restoration

Question 26

**NUTRITIONAL SUPPORT** -When should fluid restoration be done?

Answer 26

Within 24 hours for thermal injuries

Question 27

**NUTRITIONAL SUPPORT** -What formulas are used?

Answer 27

Parkland & Brook formula

Question 28

**NUTRITIONAL SUPPORT** -What does Parkland formula utilize as the resusciation fluid? -Why?

Answer 28

-Lactated Ringer solution -It closely matches the fluid being lost & minimizes profund electrolyte imbalance

Question 29

**NUTRITIONAL SUPPORT** -What is the issue with Parkland formula?

Answer 29

-There is a risk of over resuscitation, so the Brook formula is recommended bc it uses less fluid

Question 30

**WOUND HEALING** -What are the main concerns wih wound healing? (4)

Answer 30

1. **Infection** 2. Flexor contracture 3. Excessive scarring 4. Keloid formation

Question 31

**PHASES OF BURN** -What are the two phases of burn injury?

Answer 31

-Immediate -Delayed

Question 32

**PHASES OF BURN** -What is immediate?

Answer 32

Direct damage to skin cells from heat exposure

Question 33

**PHASES OF BURN** -What is delayed?

Answer 33

Progressive dermal ischemia

Question 34

**PHASES OF BURN** -What is the emergent phase?

Answer 34

time between end of burn shock & closure of wound to less than 20% TBSA

Question 35

**PHASES OF BURN** -What are the 3 components of emergent phase?

Answer 35

1. Wound management 2. Excision & grafting 3. Nutritional support

Question 36

**PHASES OF BURN** -When does the rehabilitation phase begin? -What is the patient able to assume?

Answer 36

-when the burn size is reduced to less than 20% TBSA -some self-care