Mca Iii Final: Burns

Front 1

what is the primary reason for death in burn pts?

Back 1

infection

Front 2

describe the type of room burn pts would be in?

Back 2

isolated rooms with hypoallergenic sheets. 80 degrees or higher (b/c they are predisposed to hypothermia)

Front 3

what must you consider in thermal burns

Back 3

if burned in the thoracic area always worry about the respiratory system. if heat has been inhaled, it can cause internal damage -> swelling of the glottis & trachea. may have to intibate b/c of the edema.

Front 4

what must you do in chemical burns

Back 4

wash the skin and flush the eyes

Front 5

what can electrical burns cause?

Back 5

dysrhythmias

Front 6

what are the most common types of burns

Back 6

thermal

Front 7

who are more at risk for thermal burns

Back 7

elderly and children

Front 8

what can occur in conjunction w/inhalation injury

Back 8

- swelling of the glottis causing airway obstruction, may need to intubate.
- increases the risk of injury

Front 9

heat intensity and duration

Back 9

< 111 = no burn injury
> 140 = full-thickness burn w/in 3-5 seconds

Front 10

superficial burns

Back 10

- 1st degree burn
- dermis, outside layer, no blistering

Front 11

partial thickness burn

Back 11

- second degree burn
- blistering

- superficial partial thickness -> epidermis & some dermis
- deep partial thickness -> epidermis and most of dermis

Front 12

full-thickness burn (explain depth of burn)

Back 12

- third degree burn
- epidermis, dermis, and SQ tissue

Front 13

describe full-thickness burns

Back 13

1. formation of eschar
2. nerve damage or destruction -> painless burn
3. require skin grafting

Front 14

describe eschar

Back 14

thick, leathery, nonelastic, coagulated layer of necrotic tissue

Front 15

what can happen with the formation of eschar

Back 15

compartment syndrome. if edema forms w/eschar and there is no room for the tissue to escape.

Front 16

escharotomy

Back 16

need to slice through the tissue to allow edema to occur. if not performed, compartment syndrome will occur along w/nerve & circulatory loss

Front 17

physiological response

Back 17

...

Front 18

hemodynamic response (5)

Back 18

1. tachycardic
2. decreased preload
3. decreased PAWP (decreased PAP unless there is damage to the lungs)
4. decreased CO (impaired tissue perfusion)
5. increased SVR

Front 19

pulmonary response (3)

Back 19

1. edema
2. vasoconstriction
3. hypertension

Front 20

renal response (4)

Back 20

1. hypertension b/c of hypovolemia
2. oliguria (decreased urine)
3. trigger renin-angiotensin-aldosterone system
4. acute renal failure

Front 21

GI response (4)

Back 21

1. vasoconstriction
2. ischemia of stomach and bowel
3. increased risk of curling's ulcer
4. decreased motility and peristalsis

Front 22

what is the best way to give pain meds

Back 22

IV not PO b/c of the decreased motility and peristalsis

Front 23

metabolic response (5)

Back 23

hypermtabolic rates:
1. produces catabolic effect
2. skeletal muscle breakdown
3. increased glucose utilization
4. decrease protein synthesis
5. depletion of glycogen stores -> muscle wasting and weight loss

Front 24

resuscitative or emergent phase of burn care

Back 24

1. emergency phase
2. occurs @ time of injury until 48 hours post when fluid shifts stabilize
3. focus on ABC's

Front 25

specific ABC's to focus on

Back 25

1. airway edema (ETT)
2. eschar may restrict breathing
3. monitor breath sounds, O2, and ABG's

Front 26

if there wheezing turns to absent breath sounds

Back 26

there is a problem with the airway

Front 27

ABG ...

Back 27

metabolic acidosis

Front 28

fluid resuscitation burn phase

Back 28

1. parkland formula
2. LR -> buffers meatbolic acidosis
3. colloids -> for osmotic pull b/c of fluid shifts into the inerstitial areas leading to peripheral edema

Front 29

peripheral circulation burn phase

Back 29

1. monitor peripheral pulses (compartment syndrome)
2. elevate extremities (after ABC's) to reduce edema

Front 30

acute phase for burn care

Back 30

occurs after fluid resuscitation
1. diuresis
2. occurs after 48-72 hours until wound closure
3. focus on wound healing, prevention of infection, phychosoical for pt. & family

Front 31

rehabilitative phase of burn care

Back 31

restore pts functional ability

Front 32

nursing management (8)

Back 32

1. *continually assess ABC's
2. tetanus toxoid immunization (emergent/acute phase)
3. monitor body temp
4. monitor electrolytes
5. serum lactate levels and ABG's
6. pain control
7. infection control
8. wound care

Front 33

how can you monitor body temp (5)

Back 33

1. increase room temp
2. keep door closed
3. clean dry covers/blankets
4. fluid/blood warmers
5. radiant heat lamps

Front 34

how do you monitor electrolytes

Back 34

1. monitor NA and K in initial burn phase
2. hyperglycemia
3. increased BUN

Front 35

if Na is low

Back 35

use 3% Na

Front 36

if K is low

Back 36

kexolate but can not give IV

Front 37

if increased glucose

Back 37

insulin drip

Front 38

what can occur if the kidneys can't filter

Back 38

acute tubular necrosis at the intrarenal level

Front 39

what to remember when monitoring pain (5)

Back 39

1. opiates
2. IV route most effective
3. prior to dressing changes
4. PCA
5. continually assess pain & medicate PRN

Front 40

what to remember with infection control?

Back 40

- high risk
- gown, glove, mask
- doors closed
- strict hand washing
- nutrition
- monitor sepsis
- antibacterials, antibiotics, antimicrobials
- aseptic technique for dressing changes

Front 41

what to remember with wound care

Back 41

- hydrotherapy to soften skin and debridement
- topical agents -> silver nitrate used to caudarize and mycostatin for infection

Front 42

skin grafting

Back 42

1. surgical debridement
2. allgrafts (cadaver skin)
3. xenograft (animal skin)
4. autograft

Front 43

3 types of autograft

Back 43

1. pts skin from another site
2. split thickness skin graft (epidermis & some dermis)
3. full thickness skin graft (down to SQ)