Nur144 Exam 2: Burns B

Front 1

Burns
V. Treatment
A. ------------- process--mostly prehospital

Back 1

Burns
V. Treatment
A. Stop burning process--mostly prehospital

Front 2

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of ---------- and jewelry (especially w/ --------- burns)

Back 2

Burns
V. Treatment
A. Stop burning process--mostly prehospital
1. Removal of clothing and jewelry (especially w/ chemical burns)
2. Cut around areas where clothing is stuck to skin

Front 3

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is -------- to skin

Back 3

Burns
V. Treatment
A. Stop burning process--mostly prehospital
2. Cut around areas where clothing is stuck to skin

Front 4

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush -------------- off skin followed by lavage w/ water for at least -------min (for chemical)

Back 4

Burns
V. Treatment
A. Stop burning process--mostly prehospital
3. Brush solid particles off skin followed by lavage w/ water for at least 20min (for chemical)

Front 5

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and ---------- dressing or clean sheet to prevent -------- loss (for thermal)

Back 5

Burns
V. Treatment
A. Stop burning process--mostly prehospital
4. Cover and dry dressing or clean sheet to prevent heat loss (for thermal)

Front 6

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep ---------- patent

Back 6

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
1. A--keep airway patent

Front 7

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess ------- and -------

Back 7

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
2. B--assess RR and O2Sat

Front 8

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess --------- and look for ------------ burns

Back 8

Burns
V. Treatment
B. Assess ABCs--burns to airway can cause swelling that blocks flow of air into lungs
3. C--assess pulses and look for circumferential burns

Front 9

Burns
V. Treatment
C. Assess for __________--circumstances of injury

Back 9

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury

Front 10

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. -------------- burns--concurrent w/ spinal injuries due to falls

Back 10

Burns
V. Treatment
C. Assess for other injuries--circumstances of injury
1. High voltage burns--concurrent w/ spinal injuries due to falls

Front 11

Burns
VI. Phases
A. --------------- Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Back 11

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)

Front 12

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. ------------------- formation and continues until mobilization and diuresis begins

Back 12

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
1. Initial fluid loss and edema formation and continues until mobilization and diuresis begins

Front 13

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >____%)

Back 13

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)

Front 14

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. ---------- and ------------ shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Back 14

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 15

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (------------- greatest risk)--leads to formation of edema (as early as -------min and can last 7-10days)

Back 15

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)

Front 16

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑---------- shift (↑----------- volume loss insensible skin loss)

Back 16

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
i. Larger burns ↑fluid shift (↑intravascular volume loss insensible skin loss)

Front 17

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. ____________--Na moves into the interstitial spaces

Back 17

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
ii. Hyponatremia--Na moves into the interstitial spaces

Front 18

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. ----------------: released from injured cells and hemolysed RBCs vasculature

Back 18

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iii. Hyperkalemia-released from injured cells and hemolysed RBCs vasculature

Front 19

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. ---------------- (↑Hct)--blood is more viscous

Back 19

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
iv. Hemoconcentration (↑Hct)--blood is more viscous

Front 20

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. -------------- (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Back 20

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 21

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓-------------)--↑permeability fluid from ------------- to interstitial space ↓---------- vascular pressure 2nd and 3rd spacing

Back 21

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
v. Hypotproteinemia (↓albumin)--↑permeability fluid from intravascular to interstitial space ↓colloidal vascular pressure 2nd and 3rd spacing

Front 22

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored ------------ (still creates problems)

Back 22

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
a. Fluid and electrolyte shifts (hypovolemia greatest risk)--leads to formation of edema (as early as 20min and can last 7-10days)
vi. At end of stage--restored capillary permeability (still creates problems)

Front 23

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to -------------

Back 23

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Proteins can’t return to vascular space

Front 24

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• ----------- can move back into vascular space

Back 24

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Fluids can move back into vascular space

Front 25

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓------- (as --------- moves back into cell and pt. diureses hypokalemia)

Back 25

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)

Front 26

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to ---------

Back 26

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
• Assess for ↓K (as K moves back into cell and pt. diureses hypokalemia)
b. Immunologic--widespread impairment causing susceptibility to infection

Front 27

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release------------ ---------------- markers ↑permeability (severe w/ >---------%)

Back 27

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
i. ↑Release cytokines inflammatory markers ↑permeability (severe w/ >30%)

Front 28

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. ------------ suppression and ↓circulating WBCs

Back 28

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
b. Immunologic--widespread impairment causing susceptibility to infection
ii. Bone marrow suppression and ↓circulating WBCs

Front 29

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑-------------- ↑SVR ↓---------

Back 29

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO

Front 30

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor --------------- depression (↓contractility)

Back 30

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
i. Release of tumor necrosis factor myocardial depression (↓contractility)

Front 31

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓-----------

Back 31

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
c. Cardiovascular--volume depletion ↑cardiac workload ↑SVR ↓CO
ii. ↓BP ↓organ perfusion

Front 32

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--_____________; ARDS (__________ is a risk factor)

Back 32

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
d. Respiratory--brochoconstriction; ARDS (trauma is a risk factor)

Front 33

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑-------x need ↑------------ (aggressive w/ caloric intake)

Back 33

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
2. Changes--systemic response (w/ burns >30%)
e. Metabolic--basic metabolic rate ↑3x need ↑nutrition (aggressive w/ caloric intake)

Front 34

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. -------------- shock--↓BP, ↑HR

Back 34

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
a. Hypovolemic shock--↓BP, ↑HR

Front 35

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. ____________--fluid overload need fluids b/c all fluid is not where it needs to be

Back 35

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
b. Edematous--fluid overload need fluids b/c all fluid is not where it needs to be

Front 36

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--__________ and ___________ burns

Back 36

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
c. Pain--superficial and partial thickness burns

Front 37

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to -----------) ↑---------- requirements

Back 37

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
d. Shivering--heat loss (can lead to hypothermia) ↑energy requirements

Front 38

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. ______________-- massive trauma response and occurs from K shifts (must assess gut)

Back 38

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
3. Clinical Manifestations
e. Adynamic ilius-- massive trauma response and occurs from K shifts (must assess gut)

Front 39

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i._____________--electrolyte shifts (especially electrical burns through heart)

Back 39

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
i. Dysrhythmias--electrolyte shifts (especially electrical burns through heart)

Front 40

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. ______________ shock--can become irreversible shock end organ failure

Back 40

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
ii. Hypovolemic shock--can become irreversible shock end organ failure

Front 41

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired --------------- circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Back 41

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 42

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need --------------- or --------------)

Back 42

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
a. Cardiovascular
iii. Impaired peripheral circulation--especially w/ circumferential burns (compartment syndrome need escoratomy-burns or fashiotomy-nonburns)

Front 43

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur ---------- days after initial injury)--inflammatory ------------ release

Back 43

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release

Front 44

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--___________ airway

Back 44

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
b. Respiratory (can occur 2 days after initial injury)--inflammatory marker release
i. Upper respiratory tract injury--swelling/blocking airway

Front 45

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--___________ and ↓______ diffusion

Back 45

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Pneumonia risk
ii. Inhalation injury--interstitial edema and ↓gas diffusion

Front 46

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑--------------- permeability, ↑------------, ↑PVR, and ↑-------------- constriction

Back 46

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
• Inflammatory marker release ↑capillary permeability, ↑SVR, ↑PVR, and ↑peripheral constriction

Front 47

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute -------------- Necrosis (most common complication in this phase)

Back 47

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)

Front 48

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from --------------- shock

Back 48

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
i. Can result from hypovolemic shock

Front 49

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑------------- and ------------- release block renal tubules

Back 49

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
ii. Electrical burns ↑Myoglobin and hemoglobin release block renal tubules

Front 50

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--__________ and diuretics, flush ___________ out

Back 50

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
4. Complications
c. Urinary--Acute Tubular Necrosis (most common complication in this phase)
iii. Treatment--fluids and diuretics flush myoglobin out

Front 51

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ---------- and ------------

Back 51

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
i. Assessment of ventilation and oxygenation

Front 52

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early ------------ and ventilatory management within 1-______hrs (ABGs)

Back 52

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
ii. Early intubation and ventilatory management within 1-2hrs (ABGs)

Front 53

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. B__________

Back 53

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iii. Bronchoscopy

Front 54

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified ----------% O2, ↑-----------, CDB, chest PT, -------------

Back 54

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
iv. Inhalation injury: humidified 100% O2, ↑Fowlers, CDB, chest PT, suction

Front 55

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2

Back 55

###
Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
a. Airway Management
v. CO poisoning: ------------% O2 100% O2

Front 56

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 ------------- IVs and maybe central line

Back 56

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
i. Establish IV access--2 large bore IVs and maybe central line

Front 57

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >------------% TBSA

Back 57

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
ii. Consider therapy for burns >15% TBSA

Front 58

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st -----------hrs colloids generally not given (leak out w/ ↑------------- cost more)

Back 58

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
b. Fluid therapy
iii. 1st 12hrs colloids generally not given (leak out w/ ↑permeability cost more)

Front 59

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give ---------- instead

Back 59

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• Usually give LR instead

Front 60

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. --------------- Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Back 60

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 61

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: ---------mL/kg/%TBSA = total ---------- replacement in 24hrs

Back 61

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
iv. Parkland Burn Formula: 4mL/kg/%TBSA = total fluid replacement in 24hrs

Front 62

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first -----------hrs from time of burn

Back 62

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given in first 8hrs from time of burn

Front 63

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next -----------hrs

Back 63

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• ½ given over next 16hrs

Front 64

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to ------------ therapy

Back 64

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
v. Monitory response to fluid therapy

Front 65

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be ______-50mL/hr (if electrical _____-100mL/hr)

Back 65

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• Urine output should be 30-50mL/hr (if electrical 75-100mL/hr)

Front 66

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >____
• HR <_____

Back 66

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
• b. Fluid therapy
• BP >90
• HR <120

Front 67

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after --------- and IV ------- replacement (low priority) PAINFUL

Back 67

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL

Front 68

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove -------- ------------skin (should not see blood)

Back 68

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
i. Cleaning and debridement--remove escar necrotic skin (should not see blood)

Front 69

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in ------------/NA water bath or showered no longer than ______-30min/day to flush off loose necrotic skin

Back 69

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
ii. Hydrotherapy--immersed in isotonic/NA water bath or showered no longer than 20-30min/day to flush off loose necrotic skin

Front 70

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause --------------- (not sterile water)

Back 70

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Can cause cross contamination (not sterile water)

Front 71

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• May cause too much ------------ shift (pulls Na out)
• For chemical burns flush w/ water no hotter than -----------°

Back 71

###
• May cause too much electrolyte shift (pulls Na out)
• For chemical burns flush w/ water no hotter than 104°

Front 72

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and ------------ wound w/ thin layer of topical -----------

Back 72

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iii. Open Method--exposing and covering wound w/ thin layer of topical antibiotic

Front 73

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q-----------hrs (acticote can stay ---------- days)

Back 73

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
iv. Closed Method--multiple dressing changes q8hrs (acticote can stay 3 days)

Front 74

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of ____________--primary goal (some__________ from pts own flora)

Back 74

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
v. Prevention of infection--primary goal (some infections from pts own flora)

Front 75

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned,-------------, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages ------------ sterile gloves, but put on ---------- sterile gloves

Back 75

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Always gowned, gloved, and masked (strict visitor handwashing/gowning)
• Remove dirty bandages w/out sterile gloves, but put on w/ sterile gloves

Front 76

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean ------------ infected wounds first (clean to dirty)
• Antibiotics (------------, NaNO3, ---------------)--topical penetrates; can develop resistance (requires changing antibiotics)

Back 76

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
• Clean less infected wounds first (clean to dirty)
• Antibiotics (Silvidine, NaNO3, Sulfamyoline)--topical penetrates; can develop resistance (requires changing antibiotics)

Front 77

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV -------------- before dressing changes (oral meds difficult w/ slow gut)

Back 77

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vi. Adequate pain control--IV morphine before dressing changes (oral meds difficult w/ slow gut)

Front 78

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >-------------° and wound changes under ------------

Back 78

Burns
VI. Phases
A. Emergent Phase--period of time required to resolve immediate problems (usually 24-48hrs)
5. Nursing Management
c. Wound Care--done after ABCs and IV fluid replacement (low priority) PAINFUL
vii. Avoid hypothermia--room >85° and wound changes under heat lamp

Front 79

Burns
VI. Phases
B. Acute Phase--occurs until wound is ------------ or completely covered by ------------- (weeks to months)

Back 79

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)

Front 80

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular ------------ mobilization into ---------------- space pt diureses begins

Back 80

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins

Front 81

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. ---------------- (necrotic tissue) separates and begins to slough off formation of -------------- tissue (for partial thickness buns)

Back 81

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
a. Escar (necrotic tissue) separates and begins to slough off formation of granulation tissue (for partial thickness buns)

Front 82

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by ----------
c. Return of ----------- sounds

Back 82

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
1. Pathophysiology--extracellular fluid mobilization into intravascular space pt diureses begins
b. Full thickness burns must be covered by skin grafts
c. Return of bowel sounds

Front 83

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know -------- and -------- values)

Back 83

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)

Front 84

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess-------------, ---------- suctioning, diarrhea, excess ----------- replacement, excess dieresis

Back 84

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
i. Hyponatremia--excess hydrotherapy, NG suctioning, diarrhea, excess fluid replacement, excess dieresis

Front 85

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, ------------ (think O2, --------, or ↑---------)

Back 85

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Muscle cramps, fatigue, weakness, HA, confusion (think O2, Na, or ↑HR)

Front 86

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much--------------- solution or not enough ----------- (dehydrated)

Back 86

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
ii. Hypernatremia--too much hypertonic solution or not enough fluid (dehydrated)

Front 87

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried --------------, -------------, seizures

Back 87

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
• Thirsty, dried furrowed tongue, confusion, seizures

Front 88

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue -------------- (electrical burns ATN -------------- can’t filter out K)
• Dysrhythmias, muscle weakness

Back 88

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 89

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out ----------)
• ------------, muscle weakness

Back 89

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iii. Hyperkalemia--Tissue destruction (electrical burns ATN kidney damage can’t filter out K)
• Dysrhythmias, muscle weakness

Front 90

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, -------------, ------------ suction, wound -----------
• Dysrhythmias

Back 90

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
a. Alterations in Electrolytes--potential for all sorts of shifting (know K and Na values)
iv. Hypokalemia--excess hydrotherapy, vomiting, GI suction, wound drainage
• Dysrhythmias

Front 91

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) -------------- (leading death cause in hospitalized burn pts)

Back 91

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)

Front 92

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >---------% full thickness burns, children, ------------, preexisting disease

Back 92

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
i. Risk factors: >30% full thickness burns, children, elderly, preexisting disease

Front 93

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑---------, ↑HR, ↑---------, ↓BP, ↓--------- output, mild confusion, ---------, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 93

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 94

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑----------, ↑RR, ↓BP, ↓urine output, ----------- confusion, chills, ↓-------------, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (-----------)

Back 94

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 95

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-_________ (pt becomes immunosuppressed) can spread to blood (sepsis)

Back 95

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
ii. ↑temp, ↑HR, ↑RR, ↓BP, ↓urine output, mild confusion, chills, ↓appetite, WBCs 10-20,000 (pt becomes immunosuppressed) can spread to blood (sepsis)

Front 96

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to ----------- degree

Back 96

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iii. Burn can worsen--2nd degree can convert to 3rd degree

Front 97

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove -------------- tissue early and wound ------------ as soon as possible

Back 97

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible

Front 98

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly ------------- (can create resistance)
• ------------ everything if sepsis is suspected

Back 98

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
b. Infections--often gram (-) pseudomonas (leading death cause in hospitalized burn pts)
iv. Treatment--remove necrotic tissue early and wound closure as soon as possible
• IV antibiotics not given unless pt is truly septic (can create resistance)
• Culture everything if sepsis is suspected

Front 99

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ---------------- if no underlying cause of confusion (---------------’s Syndrome)

Back 99

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
c. Neurologic--extreme disorientation
i. ICU psychosis if no underlying cause of confusion (Sundowner’s Syndrome)

Front 100

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of --------------- (frequent ----------, make pt/family aware)

Back 100

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
d. Musculoskeletal--prevention of contractions (frequent ROB, make pt/family aware)

Front 101

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. G__________
i. IV antibiotics and -------------- can cause diarrhea

Back 101

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
i. IV antibiotics and tube feedings can cause diarrhea

Front 102

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much ----------- + ------------ ↓motility constipation

Back 102

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
ii. Too much narcotics + bed rest ↓motility constipation

Front 103

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for _________--↓blood flow to ________ track (_________’s ulcer-burn specific)

Back 103

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
iii. High risk for ulcers--↓blood flow to GI track (Curling’s ulcer-burn specific)

Front 104

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ ___________, -__________-blocker (Zantac, etc.)

Back 104

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
e. Gastrointestinal
• Tx w/ antacid, H2-blocker (Zantac, etc.)

Front 105

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. ___________--risk for ↑blood sugar (check frequently-often need ________ coverage)

Back 105

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
2. Complications
f. Endocrine--risk for ↑blood sugar (check frequently-often need insulin coverage)

Front 106

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents ------------- -------------- protects ------------- tissue until autogafting is possible (will be rejected due to diff DNA)

Back 106

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)

Front 107

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until ----------------- established (48hrs) and up to several weeks

Back 107

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
• Used until revascularization established (48hrs) and up to several weeks

Front 108

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (--------------)--skin from --------- (skin bank-fresh or frozen)

Back 108

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
i. Homografts (Allografts)--skin from humans (skin bank-fresh or frozen)

Front 109

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (-----------)--from ------------- (mostly pigs)

Back 109

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
a. Biological Dressings--temp wound closure prevents infection fluid loss protects granulation tissue until autogafting is possible (will be rejected due to diff DNA)
ii. Heterografts (xenografts)--from animals (mostly pigs)

Front 110

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (------------)--dermalayer becomes permanent part of ------------ (absorbed) and top later removed in ~______weeks when autograft is placed (less costly)

Back 110

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
b. Synthetic Dressings (Integra)--dermalayer becomes permanent part of wound (absorbed) and top later removed in ~2weeks when autograft is placed (less costly)

Front 111

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ ------------ (donor site take _______-15days to heal)

Back 111

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)

Front 112

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured ---------------- autografts--pt w/out enough own skin (>----------% body need)

Back 112

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
i. Donor sites
ii. Cultured epithelial autografts--pt w/out enough own skin (>50% body need)

Front 113

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ ------------- growth factor
• Takes _________-4 weeks for skin to grow (use __________ graft during this time)

Back 113

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
3. Skin Grafting
c. Autograft--unburned skin removed w/ dermatome (donor site take 10-15days to heal)
• Remove skin sample and culture in medium w/ epidermal growth factor
• Takes 3-4 weeks for skin to grow (use temporary graft during this time)

Front 114

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and ----------- to prevent bacterial growth
ii. Minimize further destruction of ----------- skin
iii. Promote wound ----------------/successful skin grafting

Back 114

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
a. Wound Management/Care
i. Cleanse and debride to prevent bacterial growth
ii. Minimize further destruction of viable skin
iii. Promote wound reepithelialization/successful skin grafting

Front 115

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. ----------------- methods esp. useful in burn (distractions, visualization, etc.)

Back 115

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
b. Pain management--PCA (document effectiveness and assess for changes)
i. Nonpharmacologic methods esp. useful in burn (distractions, visualization, etc.)

Front 116

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents ------------- (get pt family involved)

Back 116

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
c. PT and OT--prevents contractures (get pt family involved)

Front 117

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic ---------------- state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in -----------hrs)

Back 117

Burns
VI. Phases
B. Acute Phase--occurs until wound is healed or completely covered by skin grafts (weeks to months)
4. Nursing Management
d. Nutritional therapy--hypermetabolic hypercatabolic state worsens w/ anxiety/pain
i. Need nutrition consultation (need food w/in 72hrs)

Front 118

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑------------ deposit
a. Apply pressure garments (-----------hr/day for 1-2yrs until complete healing) to scar and ---------------- to prevent collagen deposit and keep scar fat

Back 118

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
a. Apply pressure garments (23hr/day for 1-2yrs until complete healing) to scar and massage to prevent collagen deposit and keep scar fat

Front 119

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for ----------yr (to prevent ---------------)

Back 119

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
1. Scar control--prevent hypertrophic scaring due to ↑collagen deposit
b. Keep out of sun for 1yr (to prevent hyperpigmentation)

Front 120

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent ___________--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Back 120

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 121

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons--------------- and CT replaced by ------------ limits mobility

Back 121

Burns
VI. Phases
C. Rehabilitation Phase--wounds are healed/grafts are in place
2. Prevent contractures--need PT, splinting, exercise/positioning
a. Occur due to tendons shortening and CT replaced by scar tissue limits mobility

Front 122

Burns
VII. Psychosocial Care--very important
A. Physical and ------------- scars (array of emotions)
B. Team effort--support from nurses, -------------, PT, OT, ------------ workers

Back 122

Burns
VII. Psychosocial Care--very important
A. Physical and emotional scars (array of emotions)
B. Team effort--support from nurses, physicians, PT, OT, social workers

Front 123

Burns
VII. Psychosocial Care--very important
C. Family and patient ------------ groups
D. Psychiatric treatment--__________

Back 123

Burns
VII. Psychosocial Care--very important
C. Family and patient support groups
D. Psychiatric treatment--depression

Front 124

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to --------------- secondary to burn
1. Goal--pt sets realistic goals regarding ------------ lifestyle
2. Goal--acceptance of ----------- body image

Back 124

Burns
VII. Psychosocial Care--very important
E. Nursing diagnosis--disturbed body image related to disfigurement secondary to burn
1. Goal--pt sets realistic goals regarding future lifestyle
2. Goal--acceptance of altered body image