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50 Cards in this Set
- Front
- Back
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What is a skin burn and how are they caused?
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A burn occurs when there is injury to the tissues of the body caused by heat, chemicals, electric current, or radiation. The resulting effects are influenced by the temperatue of the burning agent, duration of contact time, and type of tissue that is injured.
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What are thermal burns?
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These are burns that can be caused by flame, flash, scald, or contact with hot objects, and are the most common type of burns.
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What is a chemical burn?
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A chemical burn result from tissue injury and destruction from acids, alkalis, and organic compounds. Acids are found in many household cleaners and include hydrochloric, oxalic, and hydrofluoric acid.
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Which chemical burns are more difficult to manage when providing initial treatment?
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Alkali burns can be more difficult to manage than acid burns since alkaline substances are not neutralized by tissue fluids as readily as acid substances.
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What happens when alkalis adhere to skin tissue?
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Protein hydrolysis and liquefaction.
* The damage continues even when the alkali is neutralized. Alkalis are found in oven and drain cleaners, fertilizers, and heavy industrial cleansers. Organic compounds, including phenols and petroleum products, produce contact burns and systemic toxicity. Phenols are found in chemical disinfectants, while petroleum products include creosote and gasoline. |
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How does Carbon dioxide poisoning occur during a smoke inhalation injury?
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CO is inhaled and displaces O2 on the hemoglobin molecule, causing the following:
1. Hypoxia 2. Carboxyhemoglobinemia 3. Ultimately, death when CO levels are high. |
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What treatment would you provide as the nurse to the patient with elevated carboxyhemoglobin levels?
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Quickly treat the patient with 100% humidified O2 and the carboxyhemoglobin level should be measured.
An indicator that the victim has carbon monoxide poisoning is the "cherry red" color of his or her skin. |
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What do I do as the nurse if I see someone waste a caustic chemical on their skin. What first aid measures should I take to limit damage?
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1. Brush off dry chemical!
2. Flush the skin with copious amounts of water to irrigate the skin. (This technique is effective when used anywhere from 20 minutes to 2 hours post exposure). 3. Unfortunately, tissue distruction may continue for up to 72 hours after a chemical injury. |
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How can you differentiate whether or not if a person has substained an inhalation injury above or below the glottis? What important facts could you learn from the two injuries?
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Inhalation burns above the glottis are often thermally produced from inhaling hot air, steam, or smoke.
Below the glottis are more likely the result of a ingested chemical. |
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What are some clues that would lead a person to suspect that the patient has an inhalation injury of the upper glottis?
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- Facial Burns
- Singed nasal hairs - Hoarseness - Painful Swallowing - Darkened oral & nasal mucosa - Carbonaceous sputum - Being caught in a enclosed burning area - Clothing burns around the chest and neck. |
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How long does it take on average for the appearance of clinical manifestations of a burn below the glottis?
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Pulmonary edema may not appear until 12 to 24 hours after the burn and then they manifest as acute respiratory distress syndrome (ARDS).
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What is the pathophysiology of an electrical burn?
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The person is burned by an electrical current. Direct damage to nerves and vessels causing tissue anoxia & death can occur.
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What factors predict the amount of damage a person receives from an electrical burn?
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1. The amount of voltage
2. Tissue resistance 3. current pathways 4. surface area in contact with the current 5. The length of time that the current flow was substained. |
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What causes metabolic acidosis in the patient with an electrical burn?
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Severe metabolic acidosis develops within minutes after injury, even in the absence of cardiac arrest because of extensive damage to tissue and cell rupture.
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How is metabolic acidosis corrected after an electrical burn?
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Sodium bicarbonate is administered in an amount sufficient to maintain the serum pH at near normal levels.
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Explain how an electrical burn, full thickness burns, and crushing injuries could lead to acute renal failure?
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Due to excessive damage to muscle tissue and the rupture of RBC's, myoglobin and hemoglobin is released into the body's circulation. These substances are then transfered to the kidneys where they block the tubules due to their large size. This causes acute tubular necrosis and eventual acute renal failure if not appropriately treated.
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How is acute tubular necrosis prevented in a victim that has had a burn injury?
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Fluid resuscitation with Lactated Ringer's solution at a rate sufficient to maintain urinary output at 75ml to 100ml/hr. Therapy sould continue until lab values show that hemoglobin and myoglobin has been flushed from the circulatory system.
In addition an osmotic diuretic such as mannitol should be given to increase urinary output and sodium bicarbonate can be given to reduce urine acidity. |
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What functions are altered when damage occurs to the epidermis?
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- retention of fluid and electrolytes
- body temperature regulation - entrance of harmful environmental agents into the body. |
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What functions are altered when damage occurs to the dermis?
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damage can occur to blood vessels, connective tissue, hair folicles, nerve endings, sweat glands, and sebaceous glands.
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What functions are altered when damage occurs to the subcutaneous tissue?
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the body looses heat, because our subcutaneous tissue is our insulation for the body. Muscles, tendons, and bones, and internal organs are exposed to microorganisms in the environment.
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What is the most used diagram to determine the total body surface area affected or the extent of a burn wound?
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The Sage Burn Diagram is a newer, computerized burn estimation tool.
Two others is the rule of 9's and the Lund-Browder Chart. |
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Explain what is a partial thickness superficial burn. What is the clinical appearance, cause, and structures involved?
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This burn was once know as a first degree burn. The Appearace is that of erythema, blanching on pressure, pain and mild swelling, no vesicles or blisters (although after 24 hours skin may blister and peel).
Causes are usually superficial sunburn or quick heat flash. Superficial epidermal damage with hyperemia. Tactile and pain sensation is intact. |
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Explain what is a partial thickness deep burn. What is the clinical appearance, cause, and structures involved?
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This burn was once know as a second degree burn. The appearance is that of fluid-filled vesicles that are red, shiny, wet (if vesicles have ruptured); severe pain caused by nerve injury; mild to moderate edema.
Causes of these type of burns are flame, flash, scald, contact burns, chemical burns, and tar. The epidermis and dermis involved to varying dept. Skin elements, from which epithelial regeneration occurs, remain viable. |
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Explain what is a full thickness burn. What is the clinical appearance, cause, and structures involved?
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The full thickness burn was once known as a third and fourth degree burn. The appearance of the wound is dry, waxy white, leathery, or hard; visible thrombosed vessels are present; insensitivity to pain occurs because of nerve destruction; possible involment of muscles, tendons, and bones occur.
Causes include flames, scalds, chemical burns, tar, or electric current. All skin elements and local nerve endings are destroyed. Coagulation necrosis is present. Surgical intervention is required for healing. |
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How much total body surface area needs to be damaged in a burn in order to be classified as a massive burn?
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15% = Massive burn
25% = Death (Usually) |
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Why are burns to the ears and nose of great concern?
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Burns to the ears and nose are suceptible to infection because of poor blood supply to the cartilage.
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What is the concern with patients that experience circumferential burns to the extremeties?
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Circumferential burns to the extremities can cause circulatory compromise distal to the burn with subsequent neurologic impairment of the affected extremity. Patients may also develop compartment syndrome from direct heat damage to the muscles or preburn vascular problems.
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What is the emergent phase of burn management?
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The emergent phase is the period of time required to resolve the immediate, life-threatening problems resulting from the burn injury. This phase may last from the time of the burn to 3 or more days, but it usually lasts 24 to 48 hours. The primary concern is the onset of hypovolemic shock and edema formation. The phase ends when fluid mobilization and diuresis begin.
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Why does hypovolemic shock occurs after a burn?
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It is caused by a massive shift of fluids out of the blood vessels as a result of increased capillary permeability and can begin as early as 20 minutes postburn.
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Explain the shift of fluids out of the vascular space into other spaces after a burn.
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As capillary walls become more permeable, water, sodium, and later plasma proteins (especially albumin) move into interstitial spaces and other surrounding tissue. The colloidal osmotic pressure decreases with progressive loss of protein from the vascular space.
* This results in more fluid shifting out of the vascular space into the interstitial spaces. (Fluid accumulation in the interstitium is termed second spacing.) Fluid also moves to areas that normally have minimal to no fluid, a phenomenon termed third spacing. Examples of third spacing in burn injury are exudate and blister formation, as well as edema in nonburned areas. |
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What is a Heterograft or Xenograft?
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Porcine skin that provides temporary coverage anywhere from 3 days to 2 weeks.
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What is a Homograft or allograft?
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A graft that comes from the same species and is usually cadaveric skin. Provides temporary coverage anywhere from 3 days to 2 weeks.
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What is an Autograft?
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A graft from another site on the patient's own body. The graft is permanent.
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What is BioBrane?
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Porcine collagen bonded to silicone membrane that is temporary for 10 to 21 days.
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What is TransCyte?
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Human, dermal fibroblast-derived matrix with growth factors. Temporary for 10 to 21 days.
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What is Integra?
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Bovine collagen and glycosaminoglycan bonded to silicone membrane. This is permanent.
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What is Alloderm?
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Acellular dernal matrix derived from donated human skin. The results are permanent.
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At what temperature should the room of the burn victim be kept in order to maintain a optimum body temperature?
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approximately 85F [29.4C].
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What intervention should be done by the nurse in order to prevent dryness of the eyes in a patient with facial burns?
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Instillation of methylcellulose drops or artificial tears into the eyes provides comfort for the patient.
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What intervention can be carried out for the hands and feet of a burn victim in order to keep them functional?
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Hands and arms should be extended and elevated on pillows or in slings to minimize edema. Splints may need to be applied to burned hands and feet to maintain them in functional positions.
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What is the number one pain medication of choice when treating burn victims?
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I.V. Morphine
Other medications that can be used is I.V. Fentanyl, Hydromorphone, and Methadone. |
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Because of the likelihood of anaerobic burn wound contamination, what vaccination should be given to all burn victims?
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Tetanus toxoid.
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What are the names of a few common topical antimicrobial agents used to treat burn victims?
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Some topical burn agents penetrate the eschar, thereby inhibiting bacterial invasion of the wound. *Silver sulfadiazine (Silvadene, Flamazine) and mafenide acetate (Sulfamylon) are commonly used.
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Why is the use of systemic antibiotic avoided in burn victims?
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Systemic antibiotics are not usually used in controlling burn wound flora because there is little or no blood supply to the burn eschar, and consequently, there is little delivery of the antibiotic to the wound.
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What is the leading cause of death in patients with major burns?
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Sepsis.
** In the case of a diagnosis of sepsis, although systemic antibiotics are avoided, they will be initiated in an attempt to destroy the invading microorganisms. |
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How long can silver-impregnated dressings (Acticoat, Silverlon, and Aquacel Ag) be left in place on burn victims?
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Up to 3 days and in some cases longer.
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What therapy is initiated to treat fungal infections in the burn victim's mucus membranes (mouth & genitalia)?
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The offending organism is usuallly Candida albicans. Oral infection is treated with nystatin (Mycostatin) mouthwash. When a normal diet is resumed, yougurt or Lactobacillus (Lactinex) may be given by mouth to reintroduce the normal intestinal flora that has been destroyed by antibiotic therapy.
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When does the acute phase occur with burn victims?
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The acute phase begins with the mobilization of extracellular fluid and subsequent diuresis.
This phase is concluded when the burned area is completely covered by skin grafts or when the wounds are healed. This may take weeks or many months. |
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What must occur if bowel sounds are absent in the burn victim?
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An NG tube must be put in place.
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Why does hyponatremia occur in burn victims?
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It may occur due to lengthy hydrotherapy (bath water pulls sodium from open burn areas), excessive GI suctioning, diarrhea, and excessive water intake. Manifestation include weakness, dizziness, muscle cramps, fatigue, headache, tachycardia, and confusion.
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