Ms2 - Exam 3 - Burns

Front 1

What happens with carbon monoxide poisoning? What is the hallmark symptom?

Back 1

CO replaces O2 on hemoglobin causing carboxyhemoglobinemia.

Death at CO levels >20%

Cherry red lips

Front 2

What are the symptoms of an inhalation injury above the glottis?

Back 2

Facial burns, singed nasal hair, hoarseness, painful swallowing, darkened oral and nasal membranes, carbonaceous sputum, history of being burned in an enclosed space, clothing burns around the chest and neck.

Can cause mechanical obstruction. This is a medical emergency!!

Front 3

What are the symptoms of inhalation injury below the glottis?

Back 3

Pulmonary edema or ARDS that appears 12-24 hours after the burn.

Usually this is chemically produced.

Front 4

What is the iceberg effect?

Back 4

Most of the damage from an electrical injury is below the skin.

Front 5

What sort of injury do you assume all electrical injury pts have?

Back 5

Broken bones from muscle contractions or a fall.

Immobilize cervical spine during transport.

Front 6

What complications are there from electrical burns?

Back 6

Dysrhythmias, cardiac arrest, metabolic acidosis, myoblobinuria which leads to acute tubular necrosis.

Delayed dysrhythmia or arrest may occur without warning in the first 24 hours.

Front 7

What are the criteria for burn center referral?

Back 7

1. Partial thickness burns >10% of TBSA.
2. Burns that involve the face, hands, feet, genitalia, perineum, or major joints.
3. Third-degree burns in any age-group.
4 Electrical burns, including lightning injury.
5. Chemical burns.
6. Inhalation injury.
7, Burn injury in pts with preexisting medical disorders that could complicate management/prolong recovery (heart or kidney disease)
8. Any pt with burns and trauma (fractures). Stabilize in trauma center then transfer to burn center.
9. Burn injury to pts who will require special social, emotional, or long-term rehabilitative intervention.

Front 8

What is a first degree burn?

Back 8

Partial-thickness.

Erythema, blanching on pressure.

Sunburn, quick heat flash

Front 9

What is a 2nd degree burn?

Back 9

Partial-thickness

Has blisters and severe pain

Flame flash, scald, contact burns, chemical, tar, electric current.

Front 10

What is a 3rd and 4th degree burn?

Back 10

Full thickness burn.

dry, waxy white, leathery, or hard skin; visible thrombosed vessels; insensitivity to pain b/c of nerve desctruction

flame, scald, chemical, tar, electric current

Surgival intervention required.

Front 11

When calculating TBSA burned, what do you not include?

Back 11

First degree burns like a sunburn.

Front 12

What complication do burns to the face and neck have?

Back 12

Affects respiratory function

Front 13

What complication does a burn to the hands, feet, joints, or eyes have?

Back 13

Makes self-care difficult

Front 14

What complication do burns to the ears and nose have?

Back 14

Infection due to poor blood supply to the cartilage.

Front 15

How do you treat small thermal burns <10% TBSA?

>10% TBSA?

Back 15

Cover with a clean, cool, tap water-dampened towel

ABC's, gently remove burned clothing, leave adhered clothing

Front 16

How long do you cool a large burn?

Back 16

No longer than 10 min to prevent hypothermia

Never cover a burn with ice as this causes vasoconstriction and reduces blood flow to the burn.

Front 17

What is the first aid for chemical burns?

Back 17

Flush with copious amounts of water and remove clothing containing the chemical.

Brush dry chemical from skin before irrigation.

Flush from inner to outer corner of eye with water unless lactated Ringer's is available.

Front 18

What do you do for pts that you suspect CO intoxication?

Back 18

100% humidified O2

Front 19

What is the emergency management for thermal burns?

Back 19

ABC's
Stabilize cervical spine.
Assess inhalation injury.
O2
Remove clothes
Cover burned areas with dry dressings or clean sheet.
Establish IV access with 2 large-bore cathters if burn >15% TBSA
Insert cathetar
Elevate burned limbs
Administer IV analgesia

Front 20

What is the emergent phase of burn injury?

Back 20

Time of burn - 72 hours post burn

Worry: hypovolemic shock/edema

3rd spacing - blisters, edema in nonburned areas

Water, Na, and protein move in to interstitial spaces

Complications: hypovolemic shock, dysrhythmias, airway injury

Front 21

What are the 3 biggest worries with burn injuries?

Back 21

Pneumonia from inhalation injury as it is the leading cause of death.

Thromboembolism

Acute tubular necrosis (adequate fluid replacement can counteract this)

Front 22

What antitoxin do we give burn pts?

Back 22

Tetanus

Front 23

What is the Parkland Formula?

Back 23

Lactated Ringers:

4ml x body weight in kg x %TBSA burned

Give 1/2 in first 8 hour, 1/4 in next 8, 1/4 in last 8 hour

Front 24

How do we assess the adequacy of fluid resuscitation?

Back 24

Urine output!!

1ml/kg/hr or 75-100ml/hr for pt with hemoglobinuria/myoclobinuria

MAP >65mmHg

Peripheral measurement is invalid due to vasoconstriction and edema.

Front 25

How do you do wound care for a burn pt?

Back 25

Shower once daily with a dressing change in the am, dressing change in pt room in the pm.

Front 26

What sort of PPE do you need when burns are exposed?

Back 26

Disposable hats, masks, gowns, gloves

Sterile gloves when applying ointments and dressings

Front 27

Temp of a burn pts room should be...

Back 27

>85 degrees b/c of loss of heat regulation

Front 28

How do you position a pt with burns to their ears?

Back 28

No pillows!! Use a rolled towel under the shoulders to hyperextend the neck.

Front 29

How often do burn pts get perineal care?

Back 29

1-2 times/day

Front 30

When is PT started on a burn pt?

Back 30

Immediately, sometimes during showering/dressing changes. Early ROM to facilitate mobilization of fluid and prevent contractures.

Front 31

What kind of pain meds do burn pts get early?

Back 31

IV b/c GI function is slowed

Front 32

What immunization do burn pts get and why?

Back 32

Tetanus b/c of the likelihood of anaerobic burn wound contamination

Front 33

What kind of meds do burn pts get?

Back 33

Analgesia (morpine, fentanyl, NSAIDS, methadone, neurontin)

Sedation/hypnosis (Haldol, Ativan, Versed, Ambien)

Antidepressants (Zoloft, Celexa)

Anticoagulants to prevent DVT

Nutritional support (vit A, C, E, Zn, Fe and oxandrolone (Oxandrin) to promote weight gain and preservation of lean body mass)

GI support like ranitidine (Zantac) and esomeprazole (Nexium) to prevent Curling's ulcer and nystatin to prevent thrush

Front 34

What allergy do we ALWAYS check for in burn pts??

Back 34

Sulfas b/c many burn creams contain sulfas.

Front 35

What sort of nutritional therapy do burn pts get?

Back 35

Early enteral feeding to preserve GI function

Front 36

What is the acute phase of burn injury?

Back 36

The 2nd phase where there is mobilization of extracellular fluid and diuresis. May take weeks-months.

Worry about Na and K balance!!!
Worry about delirium at night especially with the elderly!!
Worry about hyperglycemia due to stress response!!

Front 37

What interventions do you do during the 2nd phase of burn injury (acute phase)?

Back 37

Encourage stretching and movement of burned body parts.

Feed pt as soon as possible to prevent Curling's ulcer.

Front 38

What is Curling's ulcer?

Back 38

gastroduodenal ulcer caused by stress response resulting in decreased mucus production and increased gastric acid secretion.

Feed pt ASAP!!!!

Front 39

What are the function of blebs in burn care nursing?

Back 39

With facial grafts, the unmeshed sheet graft is left open so bleb form between the graft and the recipient be so that the graft does not permanently attach to the wound bed. Evacuate blebs by aspirating with a TB syringe.

Front 40

What do you have to do with full-thickness burns before they heal?

Back 40

Excision and grafting

Front 41

What is a CEA?

Back 41

Cultured epithelial autograft - graft grown from biopsy specimens obtained from the pts own unburned skin

Be careful to prevent shearing injury and infection

Front 42

What is Integra?

AlloDerm?

Back 42

Acellular dermis and silicone

skin harvested from cadavers that is decellularized to render it immunogenic

Front 43

When is the best time for exercise?

Back 43

During and after wound cleansing when the skin is softer and bulky dressings are removed.

Front 44

How do you prevent contractures when there are neck burns?

Back 44

Have pt sleep without pillows or with the head hanging slightly over the top of the mattress to encourage hyperextension.

Front 45

What do you do before you start feeding a pt after extubation?

Back 45

Swallowing assessment!!

Front 46

What is the rehabilitative phase of burn injury?

Back 46

The 3rd and last phase when the burn wounds have healed and the pt is able pt is able to resume ADL's.

Interventions include:

Pressure garments to minimize scarring (don't wear over unhealed wounds, take off only during short periods while bathing)

Use H2O based moisturizers and Benedryl for itching.

Keep burns away from sunlight for 3 months to prevent hyperpigmentation.

Front 47

What is the most common complication during the rehabilitative (3rd phase) of recovery?

Back 47

Contracture

Avoid flexed position during healing. Use positioning, splinting, and exercise.

Front 48

What is a common emotional response in the rehabilitative phase?

Back 48

Regression which can be healthy.