Burns

Front 1

When a patient suffers a burn, how long is the projected time spent in rehab with relevance to his hospital stay?

Back 1

7 Times longer than the hospital stay.

Front 2

Which layer of the skin is composed of the blood vessels, sweat and sebaceous glands, hair follicles, nerves and sensory receptors for pain, touch and temperature.

Back 2

The dermis

Front 3

What is the appearance of a superficial partial thickness burn (first degree burn), and what are 2 examples?

Back 3

I superficial partial thickness burn appears red and moist and results in local pain. Examples are Sun and Steam burns.

Front 4

What is the appearance of a superficial dermal partial thickness burn (2nd degree)?

Back 4

A partial thickness burn involves the upper 1/3 or the dermis and appears light to bright red mottled appearance; it can be wet, weeping, and may contain bullae (blisters with serous fluid).

Front 5

What causes superficial dermal partial thickness burns (2nd degree), and what are the interventions?

Back 5

Partial thickness burns are caused by flames, hot liquid, and diluted chemicals. The intervention is to prevent air from getting to them, because they are sensitive to air.

Front 6

What are the 2 types of Partial Thickness burns (2nd degree burns)?

Back 6

Superficial dermal burns, and Deep-dermal burns

Front 7

In caring for a Deep-dermal Partial Thickness burn, what must a nurse assess first?

Back 7

Assess respiratory status; has the respiratory tract been injured?

Front 8

What intervention may be necessary in a patient with a Deep-dermal partial thickness burn?

Back 8

They may need to be put on a ventilator, even if conscious, during edema (fluid shift).

Front 9

In a full thickness burn (3rd degree), what layers are involved, and what are the symptoms?

Back 9

A full thickness burn involves all layers of skin and SQ tissue. It is painless because it burns through the nerves.

Front 10

What does a full thickness burn (3rd degree) look like?

Back 10

It can be pale white or charred, red or brown and leathery.

Front 11

What layers are involved in a 4th degree burn?

Back 11

All the layers of the skin as well as muscle and bone.

Front 12

Using the "Rule of Nines", Estimate the % of burn for the following scenario: The anterior of the head and trunk, the anterior of the right arm and right leg have been burnt.

Back 12

36%

Front 13

Use the "Rule of Nines" for the following burn scenario: The posterior of the trunk, anterior and posterior of the legs, and the perineal are have been burnt.

Back 13

55%

Front 14

Use the "Rule of Nines" to estimate the % burnt in the following scenario: The anterior and posterior of the trunk, the face, the anterior of the arms, and the perineal area have been burnt.

Back 14

50.5%

Front 15

What is the priority intervention when caring for a patient with a burn?

Back 15

STOP THE BURNING!

Front 16

How do you treat a thermal burn?

Back 16

Apply cool water within 10 minutes from injury.

Front 17

How do you treat a chemical burn?

Back 17

Rinse with clear, cool water for 15-20 minutes.

Front 18

How do you treat an electrical burn?

Back 18

Separate victim from source of electricity and turn it off.

Front 19

What characteristics of a burn patient would make you suspect damage to the respiratory tract?

Back 19

Singed eyebrows, facial burns, nasal hair, and carbon deposits in the oropharynx or sputum.

Front 20

If damage to the respiratory tract is suspected, what intervention is imperative?

Back 20

Immediate intubation and respiratory support is necessary before tracheal edema occurs and occludes the airway.

Front 21

What are the 3 steps, in order, for immediate first aid for burns?

Back 21

Stop the burning; Assess airway, breathing, circulation; Conserve body heat and minimize wound contamination.

Front 22

What are the signs and symptoms of CO poisoning?

Back 22

Headache, dizziness, N/V, dyspnea and confusion.

Front 23

What is the intervention for a patient who has impaired gas exchange 2ndary to smoke inhalation?

Back 23

Give HIGH FLOW O2 @ 100% by mask or ET/T tube (Rids the body of CO in 60-80 minutes)

Front 24

Ineffective breathing pattern r/t full thickness circumferential burns of the chest causes what symptoms, and what intervention is necessary?

Back 24

Restlessness and agitation occur; Escharotomies immediately are necessary.

Front 25

What are the preferred escharotomy sites?

Back 25

The joints

Front 26

A major problem with burns is fluid volume deficit that can lead to hypovolemic shock. What is the protocol for administering Lactated Ringers to replace fluids?

Back 26

Give LR @ 2-4 ml/kg/%BSA; Also, give 1/2 of the dose in the first 8 hours and the remainder of the dose over the final 16 hours.

Front 27

What desired outcome for the values of CVP and PCWP following fluid recucitation?

Back 27

CVP <12 and PCWP <18

Front 28

What are the normal values for Na+ and K+?

Back 28

Na+ 135-145 K+ 3.5-5

Front 29

In burns, what is the range amount for fluid loss that is typically seen?

Back 29

90-350 cc/hr

Front 30

What type of isolation will a burn patient be placed and why?

Back 30

Reverse isolation; They are extremely vulnerable to infection.

Front 31

What 2 interventions will be necessary when considering that burn patients may have altered renal tissue perfusion?

Back 31

Rapid fluid replacement; Administer Mannitol because other diuretics will deplete the already compromised intravascular volume; Assess BUN and Creatinine!

Front 32

Altered peripheral tissue perfusion r/t third spacing that causes decreased blood flow to the extremities requires an hourly assessment. What does this assessment consist of?

Back 32

Assess every hour for the 6 P's:
Pulselessness, Pallor, Pain, Paresthesia, Paralysis, Poikilothermia (when a limb changes its temperature to the temperature of the environment)

Front 33

Fluid loss from burns can lead to what electrolyte problem and what GI problem?

Back 33

Hypovolemia leads to hypokalemia that can cause a paralytic illeus.

Front 34

In burns, if a stress ulcer occurs r/t decreased perfusion to the GI tract, what medication will the patient be given?

Back 34

Protonix; You can also maintain gastric pH with antacids, Tagamet, or Zantac

Front 35

When administering pain medications for burn patients, what class of medications and what route are recommended and why?

Back 35

Narcotics IV because IM injections may not get absorbed.

Front 36

What nutritional interventions are necessary for burn victims to heal the quickest and why?

Back 36

Give high calorie and high protein diets due to the patient being in a hypermetabolic state secondary to the burn.