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35 Cards in this Set
- Front
- Back
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- delayed until airway, circulation and fluid replacement have been established - infection serious threat - MOIST WOUND HEALING - most common OPEN wound - no dressing , PPE, sterile gloves CLOSED wound - sterile gauze, PPE, sterile gloves - Room WARM |
Wound Care |
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- homograft or allograft (same species) Temporary coverage 3 days -2 weeks |
Cadaveric skin |
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pt. own skin and cell cultures permanent takes 18-25 days |
Cultured Epithelial Autograft (CEA)
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Heterograft of xenograft different species temporary 3 days to 2 weeks |
Porcine skin |
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pts own skin permanent |
autograft |
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for dressing changes and debridement |
Drug therapy |
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Tetanus (if >10 years) IM ok IV antibiotics - NOT typically used (because eschar has very little blood supply so abx are NOT delivered to the wound |
Drug Therapy |
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Aquacel, Articoat, Silverlon, Silvadean
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Check for allergy to Sulpha |
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Leading cause of death - IV abx are initiated - Fungal infections develop (because intense abx kills off natural flora) |
Sepsis |
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- fluid replacement takes priority over nutritional needs - early and aggressive nutritional support WITHIN HOURS of burn injury - dec. mortality and and complications - optimized wound healing - minimizes negative effects (no intibation and <20% TBSA - pt can eat enough on their own) (intubated and >20% burns - pt. will need tube feedings) |
Nutritional therapy - EMERGENT phase |
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- resting metabolic expenditure may be increased by 50-100% ABOVE NORMAL - core temp is elevated - caloric needs about 5000 kcal/day - early, continuous enteral feeding - supplemental vitamins/iron may be given |
Nutritional therapy - EMERGENT phase |
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- begins when pt. diuresis (dumping urine) - pt. will be less edematous - healing begins - phagocytosis occurs - necrotic tissue begins to slough - keep wound FREE OF DRYNESS (desiccation = dehydration of skin) |
ACUTE phase |
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- develop eschar (dead skin) - heals in apx. 21 days (3 weeks) |
Partial thickness burns - ACUTE phase
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- requires surgical debridement + skin graft |
Full Thickness burns - Acute phase |
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cause by GI symptoms (NG tube), diarrhea from tube feeds, constipation from opioids - dilutional (drink other fluids than H20) |
Hyponatremia |
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- caused by hypertonic solutions - tube feedings |
Hypernatremia |
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- large amounts of K+ released into cells
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Hyperkalemia
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- prolonged IV therapy, K+ loss through burn |
Hypokalemia |
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- electrolyte imbalance - stress - cerebral edema - medication |
Neurologic complications from burns |
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- scar tissue formation - ROM limited (pt. prefers flexed position for comfort) - CONTRACTURES - splint |
Musculoskeletal complications from burns |
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- paralytic ileus (sepsis) - diarrhea (tube feeds) - Constipation (opiates) - Curling's Ulcer (stress ulcer) - give PPI/H2B |
GI complications from burns |
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- increase in insulin productions ( however it becomes insensitive leading to elevated glucose) - IV insulin needed |
Endocrine complications from burns |
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- promote wound healing - necrotic tissue begins to slough - granulation tissue forms - cleanse wounds with soap/water or NS - partial thickness burns heal from edges (outside to inside) - full thickness burns - must be covered by skin grafts |
Burn Wound Care - ACUTE phase |
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full thickness burns require surgical excision
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Burn site debridement |
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- requires moist healing (Op-site, tegaderm) - petroleum gauze |
Graft site |
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- autograft - CEA - artificial skin |
Early excision and grafting |
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- where the skin comes from - requires moist healing (Opsite) - decrease pain at site - prevent infections - average healing time 10-14 days |
DONOR site (care) |
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- IV morphine - hydromorphone - Dilauded - MS contin - time released morphine NON-pharmacologic - guided imagery, games nystatin (mycostatin) - anti-fungal |
Pain management - acute phase |
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- ROM - Neck burns (no pillows) - custom splints (to extend extremeties) |
Physical & occupations tx - ACUTE phase |
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- ideally weight loss <10% of preburn body wt. - high protein, high carb foods - diet supplements - weigh patients regularly |
Nutritional tx - acute phase |
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- physical debilitation renders pt. LESS able to recover - alcoholism - drug abuse - malnutrition - concurrent fractures, head injuries, or other trauma also lead to a poor prognosis |
Healing in ACUTE phase
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- burns are covered with skin or healed - pt. is able to resume a level of self-care activity - can take weeks to months - skin never completely regains color - scarring (pressure garments help to decrease scarring) |
Rehabilitation phase |
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- elastic dressings (help to reduce scaring - protect healing burns from direct sunlight for 3 months (sun burn injury) - prevent contractures - WATER based moisturizers for itching - emotions, self-esteem, counseling - pt. may experience guilt over accident |
Rehabilitation phase |
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- teach pt. & family how to care for wounds (active learning) - pain mgmt. - cosmetic surgery is often required for major burns - EXERCISE cannot be overemphasized - address spiritual & cultural needs - maintain high calorie/protein diet - OT/PT - gets pt. back to functional level |
Rehabilitation phase |
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