Term
| What are the the two most common burn etiologies? |
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Definition
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Term
| Who is most likely to die from a burn? Why? |
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Definition
Morbidity and mortality rates associated with burns are greater in the elderly
Live alone, have reduced mobility, changes in vision, and decreased sensation in their hands and feets. |
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Term
| How are burns classified and staged? |
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Definition
| Depth and Body surface injured |
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Term
| What are the types of burns based on depth? |
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Definition
o Superficial – 1st
o Superficial partial-thickness injuries – 2nd
o Deep partial-thickness injuries – 2nd
o Full-thickness injuries – 3rd |
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Term
| What is considered when assessing depth? |
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Definition
• How the injury occurred
• Causative agent
• Temperature of the burning agent
• Duration of contact with the agent
• Thickness of the skin in area burned |
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Term
| What is a superficial burn? |
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Definition
1st degree - Damages only the epidermis.
Pink, red, and dry with no blistering |
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Term
| What is a superficial partial-thickness burn? |
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Definition
2nd degree - Damages the epidermis and a small portion of the underlying dermis.
Very painful, pink, moist, hair follicles are intact, and often presents as blisters.
Heals within 5-10 days without scarring |
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Term
| What is a deep partial thickness burn? |
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Definition
2nd degree - extends into the reticular tissue (dense connective tissue that gives skin strength and elasticity, and houses the sweat glands, lymph vessels, and hair follicles) of the dermis and is hard to distinguish from a full thickness burn.
Red or white, mottled, and can be moist or fairly dry. Can take up to 14 days to heal with variable scarring. |
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Term
| What is a full thickness burn? |
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Definition
3rd/4th degree burn - involves total destruction of the dermis and extends into the subcutaneous fat. It can also involve muscle and bone.
Heals by contraction and requires skin grafting.
Wound color ranges from mottled white to red, brown or black. Wound appears leathery, hair follicles and sweat glands are destroyed. |
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Term
| How is extent of body surface injury figured? |
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Definition
RULE OF 9's!
Head = 9
Arm (x2) = 9
Front of torso = 18
Back of torso = 18
Leg (x2) = 18
Genitals = 1 |
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Term
| What is considered a minor burn injury? |
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Definition
-2nd degree burn <15% in adults and <10% in children
-3rd degree burn <2% not involving special care areas
-EXCLUDES: all its w/ electrical injury, inhalation injury, or concurrent trauma. |
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Term
| What is considered a moderate, uncomplicated burn injury? |
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Definition
-2nd degree burns of 15-25% TBSA in adults and 10-20% in children
-Third degree burns in <10% TBSA not involving special care areas
-EXCLUDING: Same as minor |
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Term
| What is considered a major burn injury? |
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Definition
-2nd degree burns >25% TBSA adults and >20% in children
-All third degree burns in 10%
-All burns involving eyes, ears, face, hands, feet, crotch and joints, inhalation burns, electrical, concurrent trauma |
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Term
| What does BURNS stand for? |
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Definition
B - breathing/body image
U - urine output
R - rule of 9/resuscitation of fluids
N - nutrition
S - Shock/silvadene |
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Term
| What do you do with a burned airway? |
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Definition
| o Burn with airway – intubate, cool humidified air |
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Term
| Why would urine output be interrupted with burns? |
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Definition
| Rhabdo (release of protein through muscle damage and fucks up kidneys) |
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Term
| What diet should burn victims follow? |
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Definition
| High vitamin C and protein |
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Term
| Who cannot take Silvadene? |
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Definition
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Term
| What labs are affected by a burn? |
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Definition
-Hyperkalemic
-Hyponatremic
-High protein due to tissue damage
-I&O
-F/E |
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Term
| What does hyponatremia and hyperkalemia cause? |
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Definition
| o Confusion, EKG differences – elevated T wave |
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Term
| What is done for fluid, sodium and protein loss? |
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Definition
| o Fluid loss causes decrease in vascular volume; cardiac output (CO) and blood pressure (BP) falls |
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Term
| What fluid is administered to a burn patient? |
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Definition
| o Lactated Ringer’s (LR) is administered |
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Term
| What is third space shift? |
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Definition
| leaky capillaries due to dropped oncotic pressure from the loss of protein. Causes Hypovolemia. Happens a lot in the stomach. Can cause ARDS corrected with PEEP. |
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Term
| How is fluid replacement calculated for burns? |
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Definition
| Parkland formula ->4 X kg X % burned |
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Term
| How fast is fluid delivered for burn victims? |
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Definition
| • The first half of the total amount is given within 8 hours from the burn incident, and the remaining over next 16 hours. *Only second- and third-degree burns |
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Term
| What is important to look for with fluid resuscitation? |
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Definition
| • Fluid Overload – neck vein distention, high BP, bounding pulse rate, urine output increased, crackles in the lungs etc. |
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Term
| What are the effects of burns on the pulmonary system? |
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Definition
• Upper airway injury
• Inhalation injury |
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Term
| What usually causes damage with an inhalation injury? |
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Definition
| o Usually related to carbon monoxide |
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Term
| What are the inhalation burn patients at risk for? |
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Definition
| • The patient is at risk of acute respiratory failure and acute respiratory distress syndrome (ARDS) – capillary leak -> PEEP |
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Term
| What are the systemic effects of burns? |
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Definition
• Renal function may be altered as a result of decreased blood volume
• Impairment to the immune system diminishes resistance to infection
• Loss of skin also results in an inability to regulate body temperature
• Gastrointestinal complications include paralytic ileus and Curling’s ulcer |
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Term
| What are the first priorities IMMEDIATELY after a burn? |
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Definition
airway, breathing, and circulation
o Always stabilize C-spine if you don’t know the method of injury |
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Term
| What follows the priorities in immediate care? |
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Definition
• Neurological status must also be rapidly assessed
• Health history should be determined if possible
• Analgesia is also a priority
• Transfer to a regional burn center should be facilitated
• Fluid and electrolyte imbalances and the potential for shock must be addressed
• Vigilant, comprehensive nursing care is required |
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Term
| When does the acute phase begin? |
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Definition
| 48 to 72 hours after the burn injury |
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Term
| What do the priorities include for acute care of the burn patient? |
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Definition
o Assessment and maintenance of respiratory and circulatory status
o Fluid and electrolyte balance
o Gastrointestinal function |
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Term
| What else is important in the acute phase? |
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Definition
• Infection prevention:
o Vigilant application of standard precautions is important |
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Term
| What kind of debridement is done for burns? |
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Definition
| • Wouldn’t want to use chemicals because it is technically burning the skin |
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Term
| What are the choices of wound care products? |
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Definition
• Aloe
• Silvadene cream
Moisten the dressing with sterile water or it’ll burn the skin
• Bactrim
o Topical antibiotics |
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Term
| What is the standard of pain management in burns? |
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Definition
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Term
| What else is addressed in the acute phase? |
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Definition
• Nutritional support:
o Metabolic abnormalities must be addressed with adequate nutrition
• Complications of immobility must be avoided
• Emotional support must be provided |
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Term
| What happens in the rehabilitation phase? |
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Definition
• Rehabilitation often extends for years
• Reconstructive surgery to improve body appearance and function is often needed
• Elastic pressure garments are used to prevent hypertrophic scarring
• Multidisciplinary continuing care must be organized |
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Term
• A patient has sought care in the emergency department for a scald that has resulted in a superficial partial-thickness burn. This burn has damaged the patient’s:
o Epidermis
o Epidermis, dermis, and part of the subcutaneous tissue
o Epidermis and part of the dermis
o Complete epidermis, dermis, and subcutaneous tissue |
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Definition
| Epidermis and part of the dermis |
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Term
• Is the following statement true or false?
o The respiratory complications of burn injuries are most readily apparent in the 2 to 4 hours following the injury |
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Definition
• ANSWER: False
• Rationale: Pulmonary abnormalities are not always immediately apparent. More than half of all patients with burn injuries with pulmonary involvement do not initially demonstrate pulmonary signs and symptoms. Any patient with possible inhalation injury must be observed for at least 24 hours for respiratory complications. |
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Term
• When providing care for a burn patient’s skin graft site, the nurse should:
o Ensure that the site is completely free of moisture at all times
o Ensure that the graft is not moved or disturbed
o Maintain consistent, high pressure on the graft
o Apply a hypertonic solution two to three times daily |
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Definition
• ANSWER: B. Ensure that the graft is not moved or disturbed
• Rationale: The patient with a skin graft is positioned and turned carefully to avoid disturbing the graft or putting pressure on the graft site. It is not necessary to keep the site completely dry, but hypertonic solutions are not applied. |
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Term
• Is the following statement true or false?
o Rehabilitation for a patient with a burn injury should begin as soon as possible after the injury occurs. |
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Definition
• ANSWER: True
• Rationale: Rehabilitation is a long and continuously changing process that begins immediately after the burn has occurred |
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Term
• What would be the highest priority for a client 72 hours after having 2nd degree burns to 20% of his body in the lower abdominal area and both legs?
o Airway
o Body Image
o Fluid & Electrolytes
o Pain |
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Definition
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Term
• The nurse is caring for a patient prescribed Silvadene for burn therapy. Which patient allergy indicate the nurse should question the order? Allergy to:
o A.) Shellfish
o B.) Latex
o C.) Sulfa Drugs
o D.) Lactose |
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Definition
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Term
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Definition
| Resuscitation fluids and how the patient is responding. |
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Term
| How do we know if the shock treatment is enough? |
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Definition
| Urine output of 30-50mL/hr . If it exceeds this, it can be turned down. |
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Term
| What can cause infection in a burn patient> |
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Definition
| Their own intestines and the environment they're in. |
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Term
| What is used to treat infection in a burn patient? |
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Definition
-Antimicrobial topical ointment
-Aseptic techniques
-Antibiotics are sometimes used |
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Term
| What are some of the antimicrobial topical ointments used? |
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Definition
-Silver sulfadiazine -> watch for leukopenia
-Mafenide acetate -> Monitor ABG for acidosis
-Silver nitrate -> Monitor Na and K levels, stains sheets
-Acticoat -> Do not use oil based products, can be left in place for 3-5 days |
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Term
| What is used to moisten acticoat dressings? |
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Definition
STERILE WATER!
NEVER SALINE! |
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Term
| What does CO2 poising cause? |
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Definition
Tissue hypoxia -> carboxyhemoglobin which competes with oxygen for binding sites.
Treated with early intubation/mechanical ventilation of 100% oxygen. |
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Term
| When do pulmonary abnormalities surface? |
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Definition
| Not always immediate - need to observe for at least 24 hours. |
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Term
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Definition
Use cool water briefly, to cool the wound and halt the burning process. Limits tissue edema,
DO NOT USE ICE, NEVER WRAP PERSON IN ICE, OR LEAVE ANYTHING COLD ON THEM FOR AN EXTENDED PERIOD OF TIME. |
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Term
| What is the treatment of choice for electrical burns? |
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Definition
| Mafenide Acetate because it can penetrate thick eschar. |
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