Burns

Front 1

Pathophysiology of Burns:

~Why does plasma seep out into the tissue?

Back 1

Increased capillary permeability (leaking) which can make vascular volume decrease which can lead to shock

Front 2

Pathophysiology of Burns:

~When does the majority of the plasma seeping out occur?

Back 2

Within the 1st 24 hours

Front 3

Pathophysiology of Burns:

~Why does the pulse increase?

Back 3

This pt is most likely in Fluid Volume Defecit and this causes the HR to increase

Front 4

Pathophysiology of Burns:

~Why does Cardiac Output (CO) decrease?

Back 4

Less fluid/volume to pump out

Front 5

Pathophysiology of Burns:

~Why does urine output decrease?

Back 5

Kidneys either trying to hold onto fluid or they aren't being perfused

Front 6

Pathophysiology of Burns:

~Why is epinephrine secreted?

Back 6

Makes you vasoconstrict and shunts blood to the vital organs

Front 7

Pathophysiology of Burns:

~Why are ADH and Aldosterone secreted?

Back 7

to rebuild blood volume on the vascular space

ADH retains water and Aldosterone retains: Sodium and water both will help fluid volume to increase

Front 8

Carbon Monoxide Poisoning

Back 8

Most common airway injury, the carbon monoxide reaches the hemoglobin first which doesn't allow the o2 to bind to the hemoglobin the pt becomes hypoxic place them on 100% o2

This patient will show 100% o2 sat so a different test needs to be done to determine the poisoning called Carboxyhemoglobin test, the pt may look okay but they still need the o2

Front 9

Classification of Burns:

~Rule of 9's

Back 9

Head and Neck: 9%

Trunk: Front 18% and Back 18%

Arms: 9% Each

Legs: 18% Each

Genital: 1%

Front 10

Treatment for Burns:

~Fluid Replacement

Back 10

*Helps to increase the vascular volume

*It is important to know when the burn occurred b/c fluid therapy for the 1st 24hr is based on the time of injury, not when treatment was started

Common Rule: Calculate how much fluid is needed for the 1st 24hr and give 1/2 of the fluid in the 1st 8hrs

Front 11

What would you choose to help you determine if a pt fluid volume is adequate?

Back 11

For Burn pt only you use their urine output over daily weights

Front 12

Treatment: Emergency Management

~A pt was wrapped in a blanket to stop the burning process, since the flames are gone does that mean the burning process has stopped?

Back 12

NO

Front 13

How can someone stop the burning process?

Back 13

Blanket or cool water (not ice water because it would cause to much vasoconstriction)

Front 14

How do you know if there is an airway injury?

Back 14

*singed facial/nasal hair

*dark sputum

*if inhaled lots of smoke the will have soot on their face

Front 15

Prophylactic Treatment

Back 15

Dr will most likely have pt intubated because airway may swell

Front 16

Medication Management:

~Albumin

Back 16

*If given it is given after the 1st 24hrs

*It helps hold onto fluid in the vascular space

*It helps:

kidney perfusion to increase
BP to increase
Cardiac Output to increase

*it will help to correct the FVD

*since the albumin is helping the pt hold onto fluid this is going to cause an increase workload on the heart, if pt is given too much and retains too much fluid it can -->FVE -->decrease Cardiac Output because heart is failing--> wet/crackles lung sounds

Front 17

Medication Management:

~Pain Management (IV or IM meds?)

Back 17

IV pain meds over IM because they act fast

Front 18

Complications

*Circulatory System (4 major circulatory checks you do )

Back 18

1. Skin Color
2. Skin Temp
3. Capillary refill
4. *Priority Is....Check for a Pulse

Front 19

Complications

*circulatory System (a pt has a circumferential burn on their arm...what does this mean and what should you be checking?)

Back 19

Means= the burn goes all the way around and cuts off circulation

check for circulation

Front 20

Complications

*Circulatory System (If a pt's vascular checks in his arm are bad the doctor may do what procedure to relieve pressure?)

Back 20

Escharotomy

Front 21

What will an escharotomy do for pt?

Back 21

will relieve the pressure and restore the circulation through the eschar

Front 22

What will a fasciotomy do for this pt?

Back 22

will relieve the pressure and restore the circulation but the cut is much deeper into the tissue, cut goes through the eschar and the fascia

Front 23

Complications:

*Renal System (A foley catheter was inserted so you can measure urine output. How often will this need to be monitored?)

Back 23

Hourly

Front 24

Complications:

*Renal System (Is it possible that when you insert the foley catheter that no urine will return? Why?)

Back 24

Yes because the kidneys are attempting to conserve the fluid or they are not being perfused adequately.

Front 25

Complications: of a Burn Patient

*Renal System (What would you do if the urine was brown or red?)

Back 25

this is normal after a major burn, still be worried about it, when cells are broken they release heme, this is what makes the urine this color. But the #1 concern is the broken down cells can clog up the kidneys and now the pt may go into renal failure

Front 26

Complications:

*Renal System (What meds might be ordered to flush out the kidneys?)

Back 26

Lasix (this will help to increase kidney perfusion and try to save the kidneys) & Dobutamine (will help to increase cardiac output (CO) and anytime there is an increase in CO, it helps the kidneys to perfuse more)

Front 27

Complications:

*Renal System (If there is no urine output or if it is less than 20ml/hr, you would start to worry about?)

Back 27

Renal Failure

Front 28

Complications:

*Renal System (After 48hrs, the pt will begin to diurese. Why?)

Back 28

Because fluid is going back into the vascular space and now we have to worry about Fluid Volume Excess

Front 29

Complications:

*Renal System (After 48hrs what happens to the urine output?)

Back 29

it will increase if the kidneys are working

Front 30

Electrolyte Imbalances:

Potassium (K+) likes to live inside outside of the cells?

Back 30

Inside

Front 31

With a burn pt what happens to cells?

Back 31

they rupture, breakdown

Front 32

So, what happens to the # of k+ in the serum (vascular space)?

Back 32

they increase

Front 33

What is the electrolyte imbalance we are worried about? and what are the s/s and tx for this electrolyte imbalance?

Back 33

hyperkalemia

s/s:
begins with muscle twitching-->weakness -->flaccid paralysis
life threatening arrythmias (takes priority)

tx:
~Dialysis-kidneys aren't working ~Calcium Gluconate (decreases arrhythmias)
~Glucose & Insulin (Insulin carries glucose and K+ into the cell) ~Anytime you give IV Insulin watch for hypoglycemia and hypokalemia
~Sodium Polystyrene Sulfonate (Kaexalate)- given for hyperkalemia it exchanges the Na for K+ in the GI tract

Front 34

GI System:

Why do you think Carbonate/Magnesium Carbonate (Mylanta), Pantoprazole (Protonix), and Famotidine (Pepcid) are ordered?

Back 34

because stress ulcers can occur

Front 35

GI System:

Why do you think the doctor wants the pt to be NPO and have an NG tube hooked to suction?

Back 35

paralytic ileus- ileus not working, GI tract shuts down, no bowel sounds

Front 36

GI System:

If pt has no bowel sounds what will happen to the abd girth?

Back 36

increases

Front 37

GI System:

Do you think the pt will need more or less calories?

Back 37

More in their diet b/c they needs lots of protein and vitamin C to promote healing

Front 38

GI System:

The NG tube will be removed when you hear what?

Back 38

Bowel Sounds

Front 39

GI System:

When you start GI feedings, what could you measure to ensure that the supplement was moving through the GI tract OK?

Back 39

Gastric residuals

Front 40

GI System:

What are some lab work you can check to ensure proper nutrition and a positive nitrogen balance?

Back 40

Total protein or Albumin

Front 41

Integumentary System:

*Contractures (Since the pt has partial thickness and full thickness burns, is it possible they could have problems with contractures?)

Back 41

yes and if they have burns on their hands the Dr may order splints to prevent contractures

Front 42

Classifications of Burns:

~Superficial Thickness

~Partial Thickness

~Full-Thickness

Back 42

~Superficial Thickness: formally called 1st Degree burn, damage only to epidermis

~Partial Thickness: formerly called 2nd degree burn, damage to entire epidermis and varying depths of the dermis

~Full-Thickness: formerly called 3rd degree burn, damage to the entire dermis and sometimes fat

Front 43

Integumentary System:

Since they have burns on their hands, what are some specific measures that may be taken?

Back 43

splints to prevent contractures, wrap the fingers individually, separated b/c they may grow back together

Front 44

Integumentary System:

How do you position the pt neck?

Back 44

hyper extended (no pillows)

Front 45

Integumentary System:

*Infections
~With a perineal burn, the #1 complication is?
~What is eschar?
~Does it have to be removed?
~If it's not removed can new tissue regenerate?
~What likes to grow in eschar?

Back 45

~Infection
~dead tissue
~yes
~no
~bacteria

Front 46

Treatment:

What type of isolation will you use with the pt?

Back 46

Reverse/ protective isolation

Front 47

Treatment:

What will Sutilanis (Travase) or Collagenase (Santyl) do?

Back 47

~enzymatic drug-->eats dead tissue (use very carefully)

don't use:

on face
if pregnant
over large nerves
if area opened to a body cavity

Front 48

Treatment:

Hydrotherapy

Back 48

also used to get rid of dead tissue
(whirlpool) medicate pt prior to b/c this is painful

Front 49

Treatment:

~mycin drugs

Back 49

when giving these drugs watch the pt BUN and Cr if they increase or if the pt complains of hearing loss this can mean a toxicity (irreversible hearing loss) and/or nephrotoxicity

Front 50

Chemical/Electrical Burns:

*What do you do with a chemical burn?

Back 50

flush with water but if it's a powder chemical, 1st brush off the powder chemical

Front 51

Chemical/Electrical Burns:

*Electrical Burns--> 2 wounds, what are they?

Back 51

1. entrance and 2. exit

also has internal damage where the electricity traveled

Front 52

Chemical/Electrical Burns:

*Electrical Injury? what do you do?

Back 52

1st thing put pt on a heart monitor for 24hrs

Front 53

Chemical/Electrical Burns:

*what arrhythmia is this pt at high risk for?

Back 53

ventricular fibrillation (V-Fib)- need to know fast so we can defibrillate the pt

Front 54

Chemical/Electrical Burns:

*With electrical burns _____ can build up and cause ______ damage.

Back 54

toxins

kidney

Front 55

Chemical/Electrical Burns:

*complications of electrical wounds

Back 55

cataracts, gait problems -this pt may never walk again, just about any type of neuro deficit