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74 Cards in this Set

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What is the main concern for burns especially the 1st 24 hours?
1st: fluid/electrolytes, 2nd infection prevention
Body surface area is a formula that involves what 3 factors?
Age, weight and height
Extent and depth, effect on physiologic functioning, and degree and mechanism of healing are determined by what 3 factors?
Time exposed, area exposed, temperature
Burns affecting the epidermis heal by ______, whereas burns involving deeper dermal and subcutaneous tissues heal by _____ ______ ________
regeneration vs scar tissue replacement
First-degree involve what layer(s)? 1) epidermis 2) epidermis and some dermis 3) epidermis and entire dermis 4) epidermis, dermis and subcutaneous
1-epi
Second-degree superficial partial thickness involve what layer(s)? 1) epidermis 2) epidermis and some dermis 3) epidermis and entire dermis 4) epidermis, dermis and subcutaneous
2 epi and some dermis
2nd degree deep partial thickness involve what layers? 1) epidermis 2) epidermis and some dermis 3) epidermis and entire dermis 4) epidermis, dermis and subcutaneous
3 epi and entire dermis
Third-degree involve what layer(s) 1) epidermis 2) epidermis and some dermis 3) epidermis and entire dermis 4) epidermis, dermis and subcutaneous
epi, dermis, and subcutaneous
Which burn causes the most pain?
2nd partial thickness (??superfical or deep?)
Which burn doesn’t hurt?
Full-thickness or 3rd
Burns that should go to burn unit:
Partial thickness greater than 10% of total body, Face, hands, feet, genitalia, perineum or major joints, 3rd degree, Burns in pts that require special interventions, Electrical, chemical or inhalation burns, Burn w/ any preexisting med disorder that could complicate management, Burns and concomitant trauma ie fractures, Children if no qualified personal
Magnitude of body response proportional to extent of injury, usually reaching plateau when approximately __% of body is burned
60%
Hemodynamic instability begins within what time frame?--with injury to capillaries in the burned area and persists for approximately how long after burn injury? A-w/in 24 hrs/days b- w/in minutes/24 hrs c-w/in 1hr/48hrs d-none of the above.
w/in min/24 hrs
loss of capillary seal is what?
Fluid loss from vascular, interstitial and cellular componenets.
Burn Shock – significant decrease in ______ output and systemic peripheral vascular ______, and impaired _______ of organs
cardiac output, vascular resistance, perfusion
Why are burn patients disposed to blood clotting?
↑ blood viscosity
Burns wider than ____ [in or cm??] usually require skin grafts as the regenerative layer (dermal) have been destroyed
1.5 in
Burn shock is ______ involving cardiovascular and cellular components. A-hypervolemic b-hypometabolic c-hypovolemic d-none of the above.
Burn complicatins: Respiratory system dysfunction-Damages mucous membranes leading to _______and ______. Signs and symptoms may be delayed for___ to ___ hours
bronchospasms and edema. 24-48hrs.
Burn complications: [Hypermetabolic or hypometabolic??] response in metabolic and nutritional requirements, [Increase or decrease???] in O2 consumption, glucose use, and protein and fat wasting, Peaks in _ to__days – enteral and parenteral hyperalimentation may be used to treat.
Hypermetobolic, increase, 7-10 days.
Complications of Burns: Dysfunction of other organ systems such as Renal insufficiency due to? A- hypervolemia b-hypovolemia c-hypernatremia d-hypokalemia
b-hypovolemia
Burn complications: renal system- May have initial _____ followed by diuresis (generally after the first 24 hours) A-anuria b-enuresis c-polyuria d-dysuria
a-anuria
Burn complications: GI tract Decreased _______ – often compounded by immobility and narcotics – observe carefully for what and what? A-peristalsis b-motility c-dysphagia d-anorexia
a-peristalsis, observe for vomiting and fecal impaction
Burn complications GI tract- May develop _______ syndrome (peptic ulcer of the duodenum) due to stress & ischemia – H2 antagonists or proton pump inhibitors
Curling’s syndrome
Sepsis may occur from burn or from what other 2illness?
pneumonia, or UTI
Tx of Burns Remove causative agent ––what type of water/ don’t use what?
flowing water or immersion, don’t use ice
Tx of Burns Emergent treatment to stabilize if severe – IV fluid resuscitation ( ___% TBSA in child – ____% TBSA in adult) Crystalloids or colloids used
10% child, 15% adult
Circumferential burns (arms, legs, torso) – if severe can act as _______ and cause major tissue damage to muscles, tendons, and vasculature – can form from _______or formation of leathery_______
tournaquite, edema, eschar
What is the leading cause of morbidity for burns?
Systemic infection
Evaporative Water Loss (EWL) Changes dramatically with burns as skin loss increases and loss from lungs due to what? A-hyperventilation and hypometabolism b-hyperventilation and hypermetabolism
b-hyperventilation and hypermetabolism
Formula for Basal, evaporative and total maintence fluids.
Burns-grafts: person’s own body 1) Synthetic grafts 2) 3) Heterograft 4) Autograft 5) Homograft
autograft
Burns-grafts: skin obtained from another person, alive or dead 1) Synthetic grafts 2) 3) Heterograft 4) Autograft 5) Homograft
homograft
Burns-grafts: skin obtained from another species, such as the pig 1) Synthetic grafts 2) 3) Heterograft 4) Autograft 5) Homograft
heterograft
Burns-grafts: two layers, silicone and fibers, skin attaches to fibers enabling dermal growth 1) Synthetic grafts 2) 3) Heterograft 4) Autograft 5) Homograft
synthetic
Skin Cancer [Increase or decrease????] in incidence during the last several decades. Why?
Increase, lifestyle, environ
Skin cancer -Increases on average are __% per year
Most prevalent form of cancer
skin
Nearly all persons over age___ will have @ least 1 skin cancer
65
Cumulative sun exposure increases risk of ? Where as intermittent severe sun exposure with blistering increases risk of?
Basal, squamous. Intermittent. Or lots at young age: melanoma
Most important risk factor for melanoma is what???
Amount of exp as young child
Which melanoma account for 70% has Raised edges; grow horizontally and vertically and will Ulcerate and bleed 1) Superficial Spreading 2) Nodular 3) lentigo maligna 4) acral lentiginous
1-superficial spreading
Which melonoma is Dome-shaped, blue-black and account for 15%–30%? 1) Superficial Spreading 2)Nodular 3) lentigo maligna 4) acral lentiginous
2-nodular
Which melonoma account for 4%–10% and are Slow growing, flat? 1) Superficial Spreading 2) Nodular 3) lentigo maligna 4) acral lentiginous
3-lentigo maligna
Which melonoma account for 2%–4% and On palms, soles, nail beds, mucous membranes 1) Superficial Spreading 2) Nodular 3) lentigo maligna 4) acral lentiginous
4-acral lentiginous
Squamous cell carcinoma-Where is the tumor? A-outer epidermis b- deeper
a- outer epi
Is squamous cell carcinoma metastasis more or less common than w/ basal?
More common
What is the treatment for squamous?
Surgical/chemo/rad.
When Does the person need to monitored for rest of life with squamous, or basal?
Squamous
Which type of skin cancer? Melanoma, basal or squamous? Most common skin cancer accounting for 75% of all nonmelanoma skin cancers
basal
Which type of skin cancer? Melanoma, basal or squamous Incidence twice as high among men as women and greatest in 55 to 75 year old age group
basal
Which type of skin cancer? Melanoma, basal or squamous Usually nonmetastasizing tumor that can extend wide and deep if not treated
basal
Which burn- Involve only epidermis only. A-1st b-2nd –partial c-2nd full d-3rd
a-1st
Red or pink, dry and painful . A-1st b-2nd –partial c-2nd full d-3rd
a-1st
skin can maintain its softness & elasticity. A-1st b-2nd –partial c-2nd full d-3rd
c-2nd full
if Blisters only after 24 hrs. . A-1st b-2nd –partial c-2nd full d-3rd
a-1st
Important to maintain intact blisters (act as bandage) and may promote wound healing, . A-1st b-2nd –partial c-2nd full d-3rd
b-2nd partial
Require supportive medical care to prevent further tissue damage, provide hydration, and ensure granular bed can support re-epithelialization . A-1st b-2nd –partial c-2nd full d-3rd
c-2nd full
Heal in approximately 1 to 2 weeks . A-1st b-2nd –partial c-2nd full d-3rd
b-2nd partial
Hair follicles and sweat glands remain intact. A-1st b-2nd –partial c-2nd full d-3rd
c-2nd full
Also painful as pain sensors intact but diminished. A-1st b-2nd –partial c-2nd full d-3rd
c-2nd full
Vary in color from waxy white or yellow to tan, brown, deep red, or black – hard, dry, and leathery . A-1st b-2nd –partial c-2nd full d-3rd
d-3rd
Extensive loss of skin tissue predisposes to attack by _______, causes massive loss of __________body fluids, interferes with _______-________ regulation, and imposes excessive demands on the ________ and reparative processes of the body
microorganisms, body- temperature, metabolic
Appeal mottled pink, red, or waxy white areas with blisters & edema,
2nd full
Heal in approximately 1 month
2nd full
No pain because nerve sensors have been destroyed
3rd
may be loss of some sensation with formation of scar tissue
2nd full
Extend into subcutaneous tissue and may involve muscle and bone, Underlying vascular involved,
3rd
Edema is extensive in burn area and surrounding tissue,
3rd
Most painful, moist, red, and blistered – sensitive to temperature changes, air exposure and touch
2nd partial
heals in 3-10 days
1st
abcde rule for skin cancer
a-asymmetrical
b-borders-irregular
c-color -what colors?
d-diameter >.6 cm
e-evolving
rule of nines
head front 4.5, head back: 4.5
trunk front: 18, trunk back 18
1 arm front: 4.5 1 arm back: 4.5
genitals 1
1 leg front: 9 1 leg back: 9
rule of nines
head front, head back
trunck front, trunk back
1 arm front, 1 arm back
genitals
1 leg front, 1 leg back
head front 4.5, head back: 4.5
trunk front: 18, trunk back 18
1 arm front: 4.5 1 arm back: 4.5
genitals 1
1 leg front: 9 1 leg back: 9