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Pediatric- Burns

Pediatric burns, stages, and treatments

What are the 5 types of burns? Chemical, electrical, thermal, inhalation, radiation
What is the treatment for chemicals in the eyes? Flush for 20-30 minutes
What is the treatment for chemicals on the skin? Remove clothing and rinse skin for 20-30 minutes
Kidney failure from an electrical burn is related to... Muscle destruction and myoglobinuria
What must be done before treating a patient with an electrical burn? Make sure the power is turned off and patient is disconnected from the power source
Clinical manifestations of an electrical burn include... Entrance and exit site, tetany, convulsions, arrhythmias, seizures, cardiopulmonary arrest
What can cause a thermal burn? Exposure to flames, scalds, hot objects, sun, cold
Clinical manifestations of a 1st degree burn include... redness, pain, skin blanches and refills
Clinical manifestations of a 2nd degree burn include... redness, pain, moist/blisters, skin blanches and refills, minimal edema and scarring
Clinical manifestations of a 3rd degree burn include... Painless, hair follicle/sweat gland destruction, skin will not blanch, eschar formation
What are two ways to determine the extent of burn? Rule of Nines and Lund-Browder Chart
Describe the Rule of Nines. Head 9%, Arms 9% each, Legs 18% each, back/buttocks 18%, chest/abdomen 18%, genitalia 1%
Describe initial treatment of a burn patient. 1. Assess airway2. Determine cause of burn/ call 9-113. Determine where incident occurred4. Obtain medical history5. Apply cool, wet, clean compresses
What is the treatment for carbon monoxide poisoning? 30 minutes of high flow 100% oxygen or hyperbaric chamber
Which fluids are utilized for fluid replacement in a burn patient? Lactated Ringer's or Isotonic solution with electrolytes (NS 0.9%)
Parkland fluid replacement formula Weight (kg) x % burn (in a whole number) x 4mL = replacement amount for 1st 24 hours. * 1st 8hrs: 1/2 of calculated fluid * 2nd 8hrs: 1/4 of calculated fluid * 3rd 8hrs: 1/4 of calculated fluid
What is the best way to monitor circulatory status? urinary output
What is the pediatric minimum output? 1-2 mL/kg/hr
What are the 3 phases of burns? 1. Hypovolemic burn shock2. Diuretic/ Septic Shock3. Recovery/ Rehabilitation
How long does the hypovolemic stage last? 48 hours from the time of injury
What are the major electrolyte changes that occur during the hypovolemic stage? Decreased sodium and protein Increased potassium
Renal failure and lactic acid formation result in... Metabolic acidosis
Clinical manifestations of hypovolemic burn shock include... cool/clammy skin, weak/thready pulses, increase heart/respiratory rate, decreased BP/output/LOC, tetany, leg cramps, convulsion, intestinal colic/diarrhea, cardiac arrest
Nursing interventions for hypovolemic burn shock include... airway, fluid replacement, circulatory status, VS, weight, IV MSO4, NPO status, tetanus toxoid/TIGH
What is the time frame for the diuretic/septic shock stage? 48 hours to 5 days
What is the pathophysiology of the diuretic stage? Capillaries seal off, no longer loosing fluid to 3rd spacing. Fluid shifts from interstitial back into intravascular
Clinical manifestations of the diuretic stage include... increased BP and output, pulmonary edema, water intoxication
What are the major electrolyte changes that occur in the diuretic stage? Initial increase in sodium then it decreases, decrease potassium
What is expected from a CBC during the diuretic stage? decreased RBCs, H&H
Name 3 complications of burns. 1. Eschar formation2. Compartment syndrome3. Curling's ulcer
How do you prevent a Curling's ulcer? Test gastric pH, administer H2 blockers, return of bowel sounds before beginning PO intake
What is the time frame for the recovery/rehabilitation stage? From day 5 on...
NANDA for the recovery stage is Altered nutrition: less than body requirements R/T... hypermetabolic burn wound state
If a burn patient has no bowel sounds, what type of nutrition would they receive? TPN with lipids
NANDA for the recovery stage is Impaired physical mobility R/T... burns involving joints, splint immobilization, and pain
What are the 4 goals of burn care? 1. Speed wound debridement2. Protect granulation tissue and grafts3. Conserve heat and fluids4. Provide comfort and support
Burn care includes... 1. culture wound if infection suspected2. Debride3. photograph burns and progression of healing
Name the 2 types of burn care. 1. open2. closed
What are 3 advantages to open burn care? 1. Allows for frequent inspection without dressing change2. Decreases moist medium = less bacterial growth3. Increased ROM
What are 4 disadvantages to open burn care? 1. Increased risk for contamination2. Risk for hypothermia3. Children can pick at injuries4. Can't play outside of reverse isolation room
What are 5 advantages to closed burn care? 1. Protects from contamination2. Can play in a playroom3. Decreases contractures by allowing functional positioning of affected parts4. Protects from injury5. Helps with debridement
What are 3 disadvantages to closed burn care? 1. Can't view the burn site easily2. Dressing changes can be very painful3. Warm, moist environment for bacterial growth
What is silvadene? Burn dressing medication. Good for gram +/-, candida. Must be soaked off before next application. Allows for re-epitheliation
What are 3 disadvantages to silvadene? 1. Skin around burn appears grayish/infected2. May cause rash3. Needs repeated applications
What is silver nitrate? Burn dressing med. Gauze is impregnanted with medication and must remain wet. Decreases edema. Bacteriostatic.
What are 3 disadvantages to silver nitrate? 1. Stains2. Disrupts electrolytes: pulls sodium3. May cause rash, itching on good skin
What is sulfamylon? Broad spectrum antibiotic. Diffuses through eschar rapidly. Used with open burn care. Thick application.
What are 4 disadvantages to sulfamylon? 1. Burns for 5-10 minutes2. Rash if allergic to Sulfa3. causes metabolic acidosis4. Eschar separates slowly, delaying graft
What is travase (Accuzyme)? Broad spectrum, proteolytic enzyme. Dissolves eschar and necrotic tissue.
What are 3 disadvantages to travase (Accuzyme)? 1. Painful to good tissue2. Applied 1/4" beyond the burn and covered with wet dressing3. Can cause a rash
What is bacitracin? Petroleum based antimicrobial works well against gram+ organisms. Provides barrier protection to the wound. Can be used with open burn care.
What are 2 disadvantages to bacitracin? 1. Only mild antimicrobial activity2. Poor penetration of eschar
What determines if a graft will take? 1. eschar formation (will delay)2. good granulation tissue base3. infection (will delay)
When is a graft procedure done? 5-20 days from initial injury
What are 5 rationales for a graft? 1. Less scarring2. increases strength and movement3. closes an open wound decreasing infection and pain4. decrease fluid/heat losses5. restores function and appearance
Name and define the 5 types of grafts. 1. Autograft- made from own skin; permanent2. Heterograft- pig, animal skin3. Homograft- cadaver, skin bank4. Isograft- from victim's twin5. Synthetic (Biobrane)- manmade, clear, plastic sheath. Semi-permeable and hypoallergenic
What is a Jobst garment? Like a giant TED hose that prevents or minimizes disorganized scarring. Worn for 2 years post-burn
What changes occur with grafted skin? less perspiration, less sebum, sparse hair growth
Created by: NurseTasha