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Burns

N123 Burn Lecture Study Material

QuestionAnswer
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