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Burns
N123 Burn Lecture Study Material
| Question | Answer |
|---|---|
| How many burns occur yearly in the US and how many are treated? | 1 million and half. |
| What percentage of burn incidents result in hospitalization? | 5% |
| What is the vast majority of burns? | Minor, requiring little to no treatment |
| What is the most prevelant prevention mechanism in home burns? | Smoke alarms |
| What are the top 4 preventions that can decrease mortality rates? | Smoke detectors(not CO2), speed limit enforcement, self-extinguishing cigarettes, and MH intervention. |
| Name five preventions that can decrease impatient incidences? | smoke alarms, water heater limits, workplace/equipment safety, intelligent minimization, and public service projects |
| What three practices can reduce burn incidence? | Firedrill rehearsal, driving checkpoints, and two-second "step-back" |
| Do you heat or cool the site of burn initially? | cool burn to normal body temperature |
| You should leave burning material on? | False, remove it. |
| There is a a piece of new equipment in the boiler room at work that is making noises, what should you do? | Report it |
| Precautions should be taken when handling what? | Chemicals and O2 |
| Whate does R.A.C.E stand for? | Remove, alarm, confine, extinguish |
| Injury to ___ of the body caused by ___,____,____, or ____, defines burns. | heat, chemicals, electrical current, or radiation |
| What burn usually occurs when there is a forceable removal of the skin? | Degloving Injury |
| Frostbite is included in burns. | True |
| Name two diseases associated with burns. | Steven-Johnson and TENS |
| What are the three peaks of burn occurence? | Children 1-5yo, risk-taking males 18-35yo, and adults 60+ |
| What is the gender distribution? | 2:1, boys are more likely to be injured |
| What is the mortality rate for burns in the US? | 12000 |
| What age group has the highest mortality rate? | Elders |
| What is TBSA? | Total burn surface area |
| Why is TBSA estimated? | To determine where to treat, whether to treat, fluid resuscitation, NG usage, and LOS |
| Sunburn without blister is what burn degree? | First |
| What degree is deep dermal injury? | Third |
| Fourth degree burns are??? | treated as third degree burns |
| If you notice blisters, epidermal, and slight dermal injury what degree burn does your patient have? | second degree burns |
| First degree burns are used in TBSA calculation? | False. |
| An eight year old boy has a minor burn from the bathtub, what should be done? | wash and cover with bacitracin |
| A 15yo female burns both of her legs on her fathers motorcycle, what should be done? | cover with a clean cloth, elevate, and transport. |
| what is the chicken soup rule? | xeroform, ssd, and bacitracin |
| Skin functions to keep insides in, what is considered insides? | fluids, electrolytes, proteins, appearance, and heat |
| What does the skin keep outside? | Bacteria, yeasts, and fungi |
| When calculating the TBSA what is the head and neck worth? | 9 |
| When calculating the TBSA what is each leg worth? | 18 |
| When calculating the TBSA what is each arm worth? | 9 |
| When calculating the TBSA what is the genitelia worth? | 1 |
| What is the anterior trunk worth when calculating the TBSA | 18 |
| What is the posterior trunk worth when calculating the TBSA? | 18 |
| At what TBSA percentage would you treat a patient in the burn unit? | 10% or more; involvement of face, hands, feet; smoke inhalation; comorbidities affecting healing |
| When would you provide treatment in a local hospital? | Initial ER treatment and limited grafting |
| Where would you treat a burn victim with <10% TBSA? | At home with a responsible caregiver that can manage pain and if oral fluids are tolerated. |
| When deciding whether to treat a patient how would you calculate the mortality rate? | TBSA + age (comorbidities increase the sum) |
| When would you not seek cure and only provide comfort care? | When sum >120 with smoke inhalation present or comorbidity and for sums <120 with devastating smoke inhalation and cerebral hypoxia. |
| What are the 4 degrees of support? | comfort care, DNR, no compressions, and "everything but dialysis" |
| Burns of the face/neck and >40% TBSA requires what intervention? | Intubation |
| A patient has smoke inhalation,with risk for actual or potential respiratory distress what should you do? | Intubate |
| Do you intubate if a patient has actual respiratory distress without smoke inhalation? | yes |
| What are indicators that your patient has smoke inhalation? | blackened, burned nasal hair, soot in the mouth/nostrils, stridor, wheezing, or progressive hoarseness |
| When considering perfusion what should a patient receive? | Fluids |
| What is the formula for calculating resuscitation fluids? | body weight in kg x TBSA x 4ml per hour (Lactated Ringers). Half in the first 8hrs and the remainder in the next 16hrs |
| Why are lactated ringers used? | They are similar to plasma, which is leaked from the burns. |
| What is lost when burns leak plasma? | water, protein, and sodium |
| What kind of plasma protein is lost during a burn? | albumin |
| How do you titrate fluids? | Titrate to hourly UO of 0.5ml/kg/hr |
| When are foley's used? | When a patient has burns over 20% TBSA |
| What is used to judge the need of a foley? | Perfusion |
| What does impaired infusion imply? | nutrients and oxygen are being supplied and waste is being removed |
| Should you elevate extremeties or let them hang below heart level? | elevate |
| What are four things that will increase fluid needs? | smoke, ETOH, meth, and dryness |
| What occurs from insufficient perfusion? | injured cells in the zone of stasis can be killed |
| What can occur from overhydration? | distention of the sone of hyperemesis and increased pressure that kills injured cells in the zone of stasis |
| What are nursing priorities in the ER? | pain management by IV, tetanus shot, elevation, contact person, hx of condition and illnesses, and allergies |
| What should not be given in the ER? | antibiotics and wound care |
| What would you give for increased K? | Kayexelate |
| What is considered in the second 24hrs? | diuresis, colloids, decrease the fluids to burn maintenance, and monitor K/Na |
| before IVs what % of burns were lethal? for middle-aged adults? | >30%, 20% |
| What is a major issue with burn victims? | Dehydration |
| If emesis occurs what can be used for decompression? Why? | Salem Sump, to prevent airway hazards |
| What does a third degree burn look like? | "full"- white, cream, brown or black eschar, diminished surface sensation |
| What degree burn is pink to red, with some white or tan patches? | Second, deep partial |
| What degree is usually pale pink to pink with blisters? | second, partial |
| What two types of burn would you wait to graft? | Frostbite and electricity |
| Name two reasons for elevation. | tissue wellness and pain reduction |
| what are treatments in the burn unit? | body system support, dressing changes (bid), possible grafting, and physical/occupational therapy |
| what can excessive pain and anxiety meds cause? | respiratory depression |
| what effect can boluses have after initial resuscitation? | Pulmonary edema |
| emergent phase goals include... | fluid rate at maintenance, UO at 0.5ml/kg/hr, stable VS, Hgb WNL, Diuresis, Respiratory stable, and wound pattern initiated |
| Acute phase goals include... | wound closed/closing, pain controlled oral except with wound care, passive participation in therapy, nutrition goals met, and no mech. respiratory support. |
| What are the rehabilitation phase goals? | pt responsible for skin care, nutrition, ROM, formulates own plan for near/future, relative to relationships, work and avocations. |
| What is modern ongoing fluid management, or pseudoresuscitation? | complete resus, diuresis, early excision/grafting (fluid fluctuation), tranfuse for Hgb <7 in asymptomatic, older adults with comorbidities, and "out of the woods" (discharge meaning) |
| What is the acute and rehabilitation foci from admission? | Infection prevention, nutrition/digestion, unburned skin integrity, max range/function, MH/Teaching (pt and family) |
| What are some additional foci? | pain management, wound care, fluid/lytes, Pulmonary, collaboration (orders), no cross-contamination |
| Pulmonary issues are prevented using what? | IS |
| Name a Pulmonary curative. | Ventilator |
| what two drugs can cause memory loss? | ativan and versed |
| what medication can give a dreaming reality? | morphine |
| what might a patient experience when nerve endings begin to grow back? | pain and anxiety |
| What might cause a life change? | Functional grieving |
| Your pt has ICU psychosis, what is expected? | lack of sleep, noise, flashbacks, dreams |
| What are drugs might be used to manage pain? | Methedone,percocet, morphine, and fentanyl |
| Are PCA's used in the burn unit? | Sometimes |
| What is used for a pulmonary lavage? | saline pillows |
| what can be concluded if your pt has grey or sooty secretions? | inhalation |
| Where is the best place to measure the tube placement on a pt that has facial burns? | the teeth or gums. lips may be swollen from edema |
| ARDS. what should PEEP be placed at? | above 10 |
| What is associated with pulmonary edema? | cardiac problems and fluid overload |
| what should be considered when thinking about a possible compromised airway? | absolute tube integrity, ET tube secure and placement recorded, effect of diuresis on tube, IV fluid titration, and minimal pressure/oxygen |
| Compromised airway. What are you looking when a pt has no ET tube | monitor increased stridor,hoarseness; IS/TCDB/OOB ambulation; Oximetry+BS; mobilization of secretions (dry O2 in OR/ER) |
| Cardiovacular: what should nursing focus be during resus? | Dependable IV access, IV rate changes, not boluses, fluid titration q hr, urine fall before BP fall, edema not fluid overload, albumin (pressors), and feeding tube placement |
| CV: What should be the focus in critial state? | dependable IV access, Hypotension/tachycardia treated IV, albumin boluses, albumin drips, nutrional protein, symptomatic anemia before Hgb 7, micro-tube labs, and nutritional feeding at max |
| CV: post-critical focus? | mild hypotension/tachycardia, low diastolic pressures, micro-tube labs, iron replacement, protein/vit supp, IV access for HL only not fluids |
| GI>30%: what should be placed early, before edema? | feeding tube |
| GI>30%: what are salem sumps used for? | to check residuals |
| GI>30%:How often is TPN used? | rarely |
| GI>30%: Why are trickle feeds used? | bacteria stays in the gut |
| GI?30%: where is the feeding tube placed? | Postpyloric |
| GI>30%: what medications/treatments are used? | docusate, psyllium, bisacodyl, and disimpaction |
| GI<20%: What kind of diet and how often? | High protein, high calorie q 3-4hrs |
| what is the priority nutrient? | protein |
| what is important to keep the pts nutrition up? | patient by-in, nagging, threatening, reminding |
| write the formula for calories and protein | 25 kcal/kg + 40 kcal/TBSA, 20 calories as protein |
| How many calories per gram does protein have? | 4 |
| what is the glucose goal? | 80-120, up to 150 |
| what temp should pt be at? | 38.0 |
| what does dead tissue and lactic acid build up cause? | metabolic acidosis |
| what steroid is used for large burns? | oxandrolone |
| Why is hair removal performed in burned area? | Hair follicles trap bacteria |
| what does taking photographs provide? | provides a baseline; for legal and teaching as well |
| when would cultures be necessary subsequent to wound care? | for temps >38.5 |
| Outpt wound care is done by??? | daily washing with mild soap and warm water, apply cream/gauze, xeroform; net to hold |
| what is the goal when grafting? | grafts to stick, donors to heal and be re-harvested |
| Do you keep pt's room warm, hot, or cold? | warm |
| what are the two p's that should be checked? | perfusion and peripheral pulses |
| what is a cushion for many of the pt's? | denial |
| when is escharotomy performed? | no distal pulse, waning pulse in first 8-12hrs distal to burn |
| Should the extremity be elevate? | Yes |
| what is the gold standard med for burns? | morphine (also fentanyl/dilaudid |
| what med is contraindicated? | meperidine (demerol) |
| what kind of exam is considered a special consideration? | corneal |
| what kind of consent might family members give? | blanket |
| what promotes healing? | sleep, so prevent overvisiting |
| Name one special burn.what type of monitoring is done? | electrocution. EKG |
| how many wounds will the pt have if electrocuted? | at least two |
| How might a pt present to the ICU? | Thirrty, edematous, cold, dependent extremities, distraught, tired, denying family |
| What is done when a pt presents to the ER with no airway involvement? | stop burning, 2 large bore IVs/central line, sedation, intubation, tetanus, no antibiotics or dressings, put in foley for big burn. |
| What are admission priorities? | airway management,ventilation,perfusion, accurate TBSA, concomitant injuries, family (how long), and burn care |
| What are the priorities for grafting? | survival, function, and cosmesis |
| name two special problems. | dysfunctional family and intentional burns |
| What are attributes of a burn nurse? | critical thinking skills, physical strength, emotional balance, peer-interactive,funny, and the understanding that he/she makes a difference |
| Are burn pt's hypermetabolic or hypometabolic? | hypermetabolic |
| what parts of the body frequently require contracture releases? | eyes, neck, axillae, knees |
Created by:
queencamb
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