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43 Cards in this Set

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  • Back
What type of burn is associated with a risk for cardiac arrhythmias or arrest?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
d. electrical
What type of burn occurs as a result of hot cooking oil?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
a. thermal
What type of burn is associated with tissue adherence with protein hydrolysis?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
b. chemical
What type of burn causes coagulation necrosis?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
d. electrical
What type of burn can be caused by an explosive flare?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
a. thermal
What type of burn may cause carbon monoxide poisoning?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
c. smoke and inhalation
What kind of burn is indicated by facial burns and hoarseness?

a. thermal
b. chemical
c. smoke and inhalation
d. electrical
c. smoke and inhalation
True or False?

Inhalation injury below the glottis may occur with _EXPOSURE TO TOXIC FUMES_.
True
True or False?

_ACID SUBSTANCES_ that cause chemical burns continue to cause tissue damage even after neutralized.
False

ALKALINE SUBSTANCES that cause chemical burns continue to cause tissue damage even after neutralized.
True or False?

Lavage with large amounts of water is important to stop the burning process in _SCALD_ injuries.
False

Lavage with large amounts of water is important to stop the burning process in _CHEMICAL_ injuries.
True or False?

The visible skin injury seen with _AN ELECTRICAL BURN_ often does not represent the full extent of tissue damage.
True
True or False

Metabolic acidosis occurs immediately following an _ACID CHEMICAL BURN_.
False

Metabolic acidosis occurs immediately following an ELECTRICAL BURN.
What is the burn classification for a 25yo with a 5% full-thickness burn of the left hand?

a. minor
b. moderate uncomplicated
c. major
c. major
What is the burn classification for a 45yo with smoke inhalation and superficial partial-thickness injury of the face?

a. minor
b. moderate uncomplicated
c. major
c. major
What is the burn classification for a 58yo with 20% deep partial-thickness burns of the legs?

a. minor
b. moderate uncomplicated
c. major
b. moderate uncomplicated
What is the burn classification for a 32yo who has been struck by lightening?

a. minor
b. moderate uncomplicated
c. major
c. major
What is the burn classification for a 19yo with a superficial partial-thickness sunburn of the legs, arms, and back?

a. minor
b. moderate uncomplicated
c. major
a. minor
When assessing a patient's full-thickness burn injury during the emergent phase, the nurse would expect to find:

a. leathery, dry, hard skin
b. red, fluid-filled vesicles
c. massive edema at the injury site
d. serous exudate on a shiny, dark-brown wound
a. Dry, waxy white, leathery, or hard skin is characteristic of full-thickness burns in the emergent phase. Deep partial-thickness burns in the emergent phase are red, shiny, and have blisters. Edema may not be as extensive in full-thickness burns because of thrombosed vessels.
The initial intervention in the emergency management of a burn of any type is to:

a. establish and maintain an airway
b. assess for other associated injuries
c. establish an IV line with a large-gauge needle
d. remove the patient from the burn source and stop the burning process
d. The first intervention is to remove the source and stop the burning process. Airway maintenance would be second, then establishing IV access, followed by assessing for other injuries.
What are the criteria for the emergent phase of burn injury? What is the approximate time frame for it?
Criteria: fluid loss and formation of edema

Time frame: usually 24-48 hours but may be up to 5 days
What are the criteria for the acute phase of burn injury? What is the approximate time frame for it?
Criteria: mobilization of fluid and diuresis

Time frame: weeks to months
What are the criteria for the rehabilitation phase of burn injury? What is the approximate time frame for it?
Criteria: burned area covered and wounds healed

Time frame: weeks to months
The initial cause of hypovolemia during the emergent phase of burn injury is:

a. increased capillary permeability
b. loss of sodium to the interstitium
c. decreased vascular oncotic pressure
d. fluid loss from denuded skin surfaces
a. Although all the selections add to the hypovolemia that occurs in the emergent burn phase, the initial and most pronounced effect is caused by fluid shifts out of the blood vessels as a result of increased capillary permeability.
The response of the immune system to a burn injury includes:

a. decreased activity of neutrophils
b. an increase in T-helper lymphocytes
c. increased production of interleukin-1 and interleukin-2
d. becoming overwhelmed by microorganisms entering denuded tissue
a. Burn injury causes widespread impairment of the immune system, with depression of neutrophil activity, decreased T-helper cells and decreased levels of interleukins.
One clinical manifestation that the nurse would expect to find during the emergent phase in a patient with a full-thickness burn over the lower half o the body is:

a. fever
b. severe fever
c. intense first
d. unconsciousness
c. Because of the hypovolemia and relative fluid loss, intense thirst is a common finding in the intially burned patient. Severe pain is not common in full-thickness burns, nor is unconsciousness unless there are other factors present. Fever is a sign of infection in later burn phases.
A patient has a 20% TBSA deep partial-thickness and full-thickness burn to the right anterior chest and entire right arm. It is most important that the nurse assess the patient for:

a. presence of pain
b. swelling of the arm
c. formation of eschar
d. presence of pulses in the arms
d. In circumferential burns, circulation to the extremities can be severely impaired, and pulses should be monitored closely for signs of obstruction by edema. Swelling of the arms would be expected, but it becomes dangerous when it occludes vessels. Pain and eschar are also expected.
Nasotracheal or endotracheal intubation is instituted in burn patients who have:

a. electrical burns causing cardiac arrhythmias
b. thermal burn injuries to the face, neck, or airway
c. symptoms of hypoxia secondary to carbon monoxide poisoning
d. respiratory distress to inelastic eschar formation around the chest
b. Patients with major injuries involving burns to the face and neck require intubation within 1 to 2 hours after burn injury to prevent the necessity for emergency tracheostomy, which is done if symptoms of upper respiratory obstruction occur. Carbon monoxide poisoning is treated with 100% oxygen, and eschar constriction of the chest is treated with an escharotomy.
The physician orders IV mannitol (Osmitrol) and sodium bicarbonate to be given in addition to replacement fluids to a patient in the emergent phase of burn injury. The nurse understands that the rationale fo rtheses drugs is to help prevent:

a. pulmonary edema
b. metabolic acidosis
c. hypovolemic shock
d. acute tubular necrosis
d. Acute tubular necrosis occurs when kidney tubules are mechanically blocked by myoglobin (from muscle cell breakdown) and hemoglobin (from RBC breakdown). Fluid intake at a rate to maintain urinary output at 75 to 100 ml/hr, osmotic diuretics such as mannitol, and sodium bicarbonate to alkalinize the urine help flush the myoglobin and hemoglobin from the circulatory system through the kidneys.
A patient's deep partial-thickness burns are treated with the open method. The nurse plans to:

a. ensure that sterile water is used in the debridement tank
b. apply topical silver sulfadiazine (Silvadene) with clean gloves
c. use clean gloves to remove the dressings and wash the wounds
d. wear a cap, mask, gown, and gloves when caring for the patient
d. When the patient's wounds are exposed with open method, the staff must wear hats, masks, gowns, and gloves. Sterile water is not necessary in the debridement tank, and topical antiinfective agents should be applied with sterile gloves. Open method of treatment does not use dressings.
A patient with deep partial-thickness burns over 45% of his trunk an dlegs is going for debridement in a hydrotherapy tank 48 hours postburn. The drug of choice to control the patient's pain during this activity is:

a. IV morphine
b. midazolam (Versed)
c. IM meperidine (Demerol)
d. long-acting oral morphine
a. Morphine is the drug of choice for pain control, and during the emergent phase, it should be administered IV because GI function is impaired and IM injections will not be absorbed adequately.
The nurse assesses absent bowel sounds and abdominal distention in a patient 12 hours postburn. The nurse notifies the physician and prepares to:

a. withhold all oral intake except water
b. insert a nasogastric tube for decompression
c. administer a histamine-2 blocking agent such as cimetidine (Tagamet)
d. administer nutritional supplements through a feeding tube placed in the duodenum
b. The patient with large burns often develops paralytic ileus within a few hours, and a nasogastric tube is inserted and connected to low, intermittent suction. After GI function returns, feeding tubes may be used for nutritional supplementation and H2 blockers may be used to prevent Curling's ulcers. Free water is not given to drink because of the potential for water intoxication.
The nurse positions the patient with ear, face, and neck burns:

a. prone
b. on the side
c. without pillows
d. with extra padding around the head
c. Patients with ear burns are not allowed to use pillows, because of the danger of the burned ear sticking to the pillowcase, and patients with neck burns are not alllowed to use pillows, because contractures of the neck can occur.
Three factors that increase nutritional needs during the emergent and acute phases of burn injury are

1. _____ _____ resulting from increased plasma catacholamines and substrate mobilization

2. massive _____ resulting from protein breakdown and increased gluconeogenesis

3. _____ and _____ for tissue repair
1. HYPERMETABOLIC STATE resulting from increased plasma catacholamines and substrate mobilization

2. MASSIVE CATABOLISM resulting from protein breakdown and increased gluconeogenesis

3. CALORIES and PROTEIN for tissue repair
At the end of the emergent phase and the initial acute phase of burn injury, a patient has a serum sodium of 152 mEq/L and a serum potassium of 2.8 mEq/L. The nurse recognizes that these imbalances could occur as a result of:

a. free oral water intake
b. prolonged hydrotherapy
c. mobilization of fluid and electrolytes at the acute phase
d. excessive fluid replacement with dextrose in water without potassium supplementation
c. At the end of the emergent phase, fluid mobilization moves potassium back into the cells and sodium returns to the vascular space, causing a hypokalemia and a hypernatremia. As diuresis in the acute phase continues, sodium will be lost in the urine and potassium will continue to be low unless replaced. Excessive fluid replacement with 5% dextrose in water without potassium supplementation can cause a hyponatremia with a hypokalemia. Prolonged hydrotherapy and free oral water intake can cause a decrease in both sodium and potassium.
A burn patient has a nursing diagnosis of impaired physical mobility related to a limited range of motion secondary to pain. An appropriate nursing intervention for this patient is to:

a. have the patient perform ROM exercises when pain is not present
b. teach the patient the importance of exercise to prevent contractures
c. provide analgesic medications before physical activity and exercise
d. arrange for the physical therapist to encourage exercise during hydrotherapy
c. The limited range of motion in this situation is related to the patient's inability or reluctance to exercise the joints because of pain, and the appropriate intervention is to help control the pain so that exercises can be performed. The patient is probably never without some pain, and although exercises and enlisting the help of the physical therapist are important, neither of these interventions addresses the cause.
The nurse suspects the possibility of sepsis in the burn patient based on changes in:

a. vital signs
b. urinary output
c. gastrointestinal function
d. burn wound appearance
a. Early signs of sepsis include an elevated temperature and increased pulse and respiratory rate accompanied by decreased BP and, later, decreased urine output and perhaps paralytic ileus. A burn wound may become locally infected without causing sepsis.
Identify one major complication of burns, believed to be stress related, that may occur in the neurologic system during the acute burn phase.
Dementia
Identify one major complication of burns, believed to be stress related, that may occur in the GI system during the acute burn phase.
Curling's ulcer
Identify one major complication of burns, believed to be stress related, that may occur in the endocrine system during the acute burn phase.
Stress diabetes
A permanent skin graft that may be available for the patient with large body surface area burns who has limited skin for donor harvesting is _____ _____ _____.

HINT: c__ e__ a__
cultured epithelial autograft
Early excision and grafing of burn wounds involves excising _____ down to clean viable tissue and applying _____-_____ _____.

HINT: e__
s__-t__ g__
eschar

split-thickness grafts
To help a burn patient who has developed an increasing dread of painful dressing changes, it would be most appropriate to ask the physician to prescribe:

a. midazolam (Versed) to be used with morphine before dressing changes
b. morphine in a dosage range so that more may be given before dressing changes
c. buprenorphine (Buprenex) to be administered with morphine before dressing changes
d. PCA so that the patient may have control over analgesic administration
a. Midazolam is useful when patients' anticipation of the pain experience increases their pain because it causes a short-term memory loss, and if given before a dressing change, the patient will not recall the event. A dosage range of morhpine is useful, as is PCA, but seldom will these doses effectively relieve the discomfort of dressing changes. Buprenorphine has an analgesic action but is a narcotic antagonist and so cannot be used with other narcotics.
During the rehabilitation phase of wound injury, the contour of scarring can be controlled with:

a. pressure garments
b. avoidance of sunlight
c. splinting joints in extension
d. application of emollient lotions
a. Pressure garments help keep scars flat and prevent elevation and enlargement above the original burn injury area. Lotions and splinting are used to prevent contractures. Avoidance of sun is necessary for 1 year to prevent hyper-pigmentation and sunburn injury to healed burn areas.