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Burns
pn 141 test 3 book burke: pg 1114
| Question | Answer |
|---|---|
| where is the most common site for fire related burns | the home |
| what factors are associated with burn related deaths | age (kids <4 or adults >65), careless smoking, alcohol or drug intoxication, phys. or mental disability |
| what is a burn | an injury in which a transfer of energy from a heat source to the human body results in tissue loss, damage, or irreversable destruction |
| what are the types | thermal, chemical, electrical, or radiation |
| thermal burns: what is the cause of it | from exposure to dry heat, moist heat |
| what is the most common type of burns | thermal |
| thermal burns: examples | flames, steam or hot liquids |
| thermal burns: who gets this type often | young children and older adults |
| chemical burns: what is the cause of it | by direct skin contact with either acid or alkaline agent |
| electrical burns: what is the cause of it | electricity follows the path of least resistence which in the human body tends to lie along the muscles, BVs, nerves, bones |
| electrical burns: the severity of them depends on what | the type and duration or current and the amount of voltage |
| electrical burns: necrosis of tissue results from what | impaired blood flow secondary to blood coagulation at the site of electrical injury |
| radiation burns: what is the cause of it | sunburn or radiation tx for cancer |
| radiation burns: what does it mean that these burns tend to be superficial | that they only involve the outer layer of the epidermis |
| after a burn tissue damage is determined by what | primarily by the extent of the burn (the percentage of body area involved)and the depth of the burn (affected layers of tissue) |
| what is the extent of the burn | (the percentage of body area involved) |
| what is the depth of the burn | (affected layers of tissue) |
| extent and depth of the burn is used to classify burns how | minor, moderate, or major |
| superficial burn: aka | 1st degree burn |
| superficial burn: what skin layers are lost | the epidermis |
| superficial burn: what will the skin look like over the brun | red, may have local edema |
| superficial burn: is there skin function | yes, present |
| superficial burn: s/s of it | pain, localized edema |
| superficial burn: tx | regular cleaning, topical agents of choice, mild analgesics |
| superficial burn: is there scarring | none, just the outer layer peels |
| superficial burn: how long does it take to heal | 3-6 days |
| paritial thickness burn: aka | 2nd degree |
| paritial thickness burn: what skin layers are lost | epidermis and dermis |
| paritial thickness burn: what will the skin look like over the brun | fluid filled blisters, bright and pink, may appear waxy white with deep partial thickness burns |
| paritial thickness burn: is there skin function | no, absent |
| paritial thickness burn: s/s of it | severe pain, edema, weeping of fluid |
| paritial thickness burn: is there a pain sensation | yes |
| superficial burn: is there a pain sensation | yes |
| paritial thickness burn: tx | regular cleaning, topical agent of choice, may require skin grafting |
| paritial thickness burn: how long does it take to heal | 14-21 days |
| full thickness burn: aka | 3rd degree |
| full thickness burn: what skin layers are lost | epidermis, dermis and underlying tissue |
| full thickness burn: what will the skin look like over the brun | waxy white, dry leathery, charred |
| full thickness burn: is there skin function | absent |
| full thickness burn: is there pain sensation | no |
| full thickness burn: s/s | little pain, edema |
| full thickness burn: tx | regular cleaning, topical agent of choice, skin sunstitutes, excision of eschar, skin grafting |
| full thickness burn: is there scarring | yes in grafting areas |
| full thickness burn: how long long does it take to heal | it requires skin grafting to heals |
| partial thickness burn: is there scarring | may occur in deep burns |
| superficial burn: what is the cause | sunburn, ultraviolet light, minor flash injury from sudden ignition or explosion, or mild radiation burn associated with cancer tx |
| superficial burn: does the skin remain intact | yes |
| superficial burn: systemic s/s | chills, HA, NV, |
| superficial burn: if older adults get them and they are extensive, what may be required | IV fluids |
| partial thickness burn: what is it subdivided into | superficial or deep |
| partial thickness burn: what is a superficial one | it involves the top 1/3 dermis and the entire epidermis |
| partial thickness burn:superficial- causes | a brief exposure to flash flame or dilute chemical agent or contact with a hot surface |
| partial thickness burn:superficial- does it blanche | yes |
| partial thickness burn:superficial- what is common | pigment changes |
| partial thickness burn: deep- what is it | it involves the entire dermis plus hair follicles, but sebaceous glands and sweat glands remain intact |
| partial thickness burn: deep- causes | hot liquids or solids, flash flame, direct flame, intense radient energy, chemical agent |
| partial thickness burn: deep- are the blisters easy to rupture | yes |
| partial thickness burn: deep- is it more or less painful then a superifical partial brun | less |
| partial thickness burn: deep- complications | contractures, hypertrophic scarring and functional impairement |
| full thickness burn: where can it extend to besides all the layers of the skin | the subq fat, connective tissue, muscle, and bone |
| full thickness burn: cause | prolonged contact with flames, steam chemicals or hign voltage electric currents |
| full thickness burn: does it blanch | no |
| estimating the extent of the burn: what is the "rule of nines" | a rapid method to estimate the extent of partial and full thickness burns |
| estimating the extent of the burn: "rule of nines"- where is it used | prehospital and emergency |
| estimating the extent of the burn: "rule of nines"- how does this work | the head, extremities, trunk and perineum is estimated in percentages |
| effects on the CV system: what happens to cell wall integrity at the injury site and in the capillary bed | there is loss of cell wall integrity |
| effects on the CV system: the loss of cell wall integrity causes what to shift; and where | massive amounts of fluid shift from inttracellular space into the interstitial space |
| effects on the CV system: what happens to the capillary walls | they become more permeable |
| effects on the CV system: the capillary walls being more permeable causes what | fluid leaks from the capillaries at the burn site and throughout the body |
| effects on the CV system: the leakage of fluid from the capillaries decreases what | intravascular fluid volume |
| effects on the CV system: what happens to the pt when there is inadequate fluids in the intracellular and extracellular space | the pt becomes hypovolemic |
| effects on the CV system: what lytes and minerals escape along with the fluid | plasma proteins and sodium |
| effects on the CV system: when plasma proteins and sodium escape this further increases what | edema |
| effects on the CV system: why does BP fall | b/c CO decreases |
| effects on the CV system: what is the net effect on the CV system | hypovolemic shock, with a burn it is burn shock |
| effects on the CV system: why does vasocontriction occur | the vascular systems attempt to compensate for fluid loss |
| effects on the CV system: why does platelet aggregation and WBC accumulation occur | as a result in ischemia and eventual thrombosis in the deeper tissue below the burn |
| effects on the CV system: what happens to the RBCs | the hemolize |
| effects on the CV system: why do the RBCs hemolyze | b/c of direct damage from the brun |
| effects on the CV system: since plasma fluid is lost rather than the RBCs, what develops | hemoconcentration |
| effects on the CV system: what is hemoconcentration | seeen as an elevated hematacrit |
| effects on the CV system: what type of WBCs accumulate at the burn site; what level will be elavated in a differential | neutriphils; leukocyte count |
| effects on the CV system: the leakage of fluid in the interstitial spaces comprimises what body system; this results in what | the lymphatic system; intravascular hypovolemia and edema at the burn site |
| effects on the CV system: what does edema do to circulation; this does what to the underlying tissues | it impairs it; necrosis in the underlying tissues |
| effects on the CV system: why do potassium ions leave the cells; what does the lack of potassium do and why | due to burn injury and RBC hemolysis; dysrhythmias- b/c not enough potassium to maintain normal cardiac rhythm |
| effects on the CV system: pt is at increased risk to develop ________ ht rhythms | abnormal (dysrhythmias) |
| effects on the CV system: when does burn shock reverse | when fluid is reabsorbed from the interstitium into the intravscular space |
| effects on the CV system: s/s of burn shock reversing | BP increases and UO improves, cO improves |
| effects on the CV system: how long does diuresis last post burn | several days -2 weeks |
| effects on the immune system: the capillary leakage does what to the immune system | it impairs the acctive components of both the cell mediated and humoral immune system |
| effects on the immune system: what serum levels are diminished | all immunoglobulins |
| effects on the immune system: how long are serum protein levels low | until wound closes |
| effects on the immune system: these changes in the immune system create a state of what; this increases pt risk for what | acquired immuneodeficiency; infection |
| effects on the immune system: how long is pt at increased risk for infection | 4 weeks post burn |
| effects on the immune system: complications of infection | death |
| effects on the integumentary system: why is it good that the microcirculation of the skin remains intact | it cools and protects the deeper portions of the skin and cools the outer surface once the heat source is removed |
| effects on the integumentary system: what happens if microcirculation is lost | the burning process continues even after the heat source is removed |
| effects on the integumentary system: the thickness of ____________ varies from one area of the body to another | the dermis and epidermis |
| effects on the respiratory system: what is inhalation injury | a complication that may range from mild respiratory inflam. to massive pulmonary failure |
| effects on the respiratory system: exposure to toxic chemicals can cause what | asphaxia, smoke, and heat initiates that initiates the pathophys process of inhalation injury |
| effects on the respiratory system: what produces carbon diaxide | incomplete burning of materials |
| effects on the respiratory system: charecteristics of carbon diaxide | colorless, tasteless odorless gas |
| effects on the respiratory system: what does carbon dioxide do to oxygen and hemoglobin; this casues what | it displaces oxygen and binds with hemoglobin; carbonoxyhemoglobinemia |
| effects on the respiratory system: without oxygen what happens to the tissue and eventually to whole self | tissue hypoxia and death |
| effects on the respiratory system: s/s of carbon monoxide poisoning | mild visual impairements and HA to coma and death |
| effects on the respiratory system: when does smoke inhalation and posioning occur | results when toxic gases and soot are deposited on the pulmonary mucosa |
| effects on the respiratory system: where does inflammation occur | at localized sites w/in the airways |
| effects on the respiratory system: what happens to the cells and bronchial cilia; this causes increased risk for what | thecells are destroyed, and the cilia are inactivated; bronchial congestion and infection |
| effects on the respiratory system: why does interstitial pulmonary edema develop | secondary to the movement of fluid from the pulmonary BVs into the interstitial compartment of the lung tissue |
| effects on the respiratory system: smoke inhalation damages the alveoli which inactivates what | surfactant |
| effects on the respiratory system: without surfacant what happens to the alveoli ; this leads to what | they collapse; atelectasis |
| effects on the respiratory system: sloughing of damaged and dead lung tissues produces what | debris that may lead to complete airway obstruction |
| effects on the respiratory system: upper airway thermal injuries result in what | inhalation of heated air |
| effects on the respiratory system: upper airway thermal injuries- s/s | presence of soot, charring, edema, blisters and ulcerations along the mucosal lining of the oropharynx and larynx |
| effects on the respiratory system: when does the edema in the airways peek | in 24-58 hours of injury |
| effects on the respiratory system: thermal injury below the ______- is rarely seen; why | vocal cords; the laryngeal reflexes protect the lower airways |
| effects on the respiratory system: cause of thermal injury below the vocal cords | inhalation of steam or explosive gases or aspiration of hot liquidds |
| effects on the GI system: what is curling's ulcer | ab acute ulceration of the stomach or duodenum that may form following a burn injury |
| effects on the GI system: s/s of a gastric ulcer formation | abnormal pain, acidic gastric PH levels, hematemesis, occult blood in stool |
| effects on the GI system: s/s of paralytic ileus | lack of gastric motility, gastric distention, N/V, and hematemisis |
| effects on the GU system: the massive fluid loss early in the injury result in what | dehydration, hemoconcentration and decreased urinary output |
| effects on the GU system: what may indicate hemoglobinuria | dark brown concentrated urine |
| effects on the GU system: cause of hemoglobinuria | the release of large amounts of dead and damaged erythrocytes after a major burns |
| effects on the GU system: what can the pigments do to the renal tubules | they can occlude them and cause renal failure (especially when shock , dehydration, acidosis |
| effects of metabolism: what are the two distinct metabolic phases that occur in a burn | the ebb phase and the flow phase |
| effects of metabolism: what is the ebb phase, when does it occur | lasting the first 3 days of the injury, manifested by decreased oxygen consumtion, fluid imbalance, shock and inadequate circulating volume, this protected the body from the initial impact of the injury |
| effects of metabolism: what is the flow phase, when does it occur | it occurs when adequate burn resuscitation has been accomplished. there is increased cellular activity, and protein catabolism, lipolysis and gluconeogenesis |
| effects of metabolism: flow phase- what happens to BMR | it reaches twice the normal rate |
| effects of metabolism: flow phase- what happens to Heat and body wt | they drop dramatically |
| effects of metabolism: flow phase- how long does hypermetabolism occur | persists until afte wound closure and may reappear if complications occur |
| diagnostic tests- why is a UA done | to eval the renal perfusion and nutritional status, nitrogen loss is measured in a 24 hour UA |
| loss of plasma protein and dehydration lead to what | protein uria and elevated urine specific gravity |
| diagnostic tests- why is a CBC done | it is checked regularily, |
| why is hematocrit elevated | hemoconcentration and fluid shift from the intravascular compartment during emergent phase |
| why is hemoglobin decreased | secondary to hemolysis |
| why are WBCs elevated | in the presence of an infection |
| why are sodium levels decreased | secondary to massive fluid shifts into the interstitium |
| what are potassium levels initially; what are they after burn shock resolves (why) | high; low as fluid shifts back to the intercellular and intravascular compartments |
| diagnostic tests- why is a chest xray done | may show atelectasis, pulmonary edema, acute respiratory disease |
| what are the three stages that tx is divided into | emergent/resuscitation stage, acute stage, rehab stage |
| emergent stage: what is it | the stage lasts from the onset of injury through successful fluid resuscitation, the burn is assessed, inital tx |
| acute stage: what is it | begins with the start of diuresis and ends with closure of the burn wound, grafting hydrotherapy is done, antimicrobials are given |
| rehab stage: what is it | it begins w/ wound closure and ends when the client returns to the highest level of health, can take years, prevent contractures,scars, pt resumption of work, soc roles |
| meds: for pain | iv narcotics |
| meds: what is used to eliminate infection on the wound | a topical antimicrobial |
| fluid resuscitation: why is it done | to conteract the effects of burn shock |
| fluid resuscitation: what is done | these guidlines are used to replace the extensive fluid and electrolyte losses assoc. with the burn |
| fluid resuscitation: it is necessary in all wounds with >_________% of the TBSA | 20% |
| fluid resuscitation: what is used | colloids, crystalloids, blood, blood products |
| nutrition: what is the issue with oral intake | it can seldom meet the requirements needed to reverse excessive protein loss |
| nutrition: what is the daily calorie need | 4-6,000 day |
| nutrition: why are enternal feedings placed | to offset hypermetabolism, improve nitrogen balance and decreased length of hospital stay |
| nutrition: enternal feedings are contraindicated in who | curlings ulcer, bowel obstruction, feeding intolerance, pancreatitis, septic ileus |
| wound management: why must they be cleaned and debrided | to promote healing and prevent prolonged inflammation |
| wound management: what is debridement | the process of removing dead tissue from the wound |
| wound management: what is administered med wise b4 tx | narcotics |
| wound management:what is mechanical depbridement | it is performed during hydrotherapy, loose necrotic tissue is gently washed with a washcloth or gauze pad to remove dead skin and eschar, blistered skin is grasped with gauze and removed |
| wound management: what is eschar | a hard crust that forms over a burn wound |
| wound management: how hard should the wounds be rubbed | hard enough to remove debris yet not cause bleeding |
| wound management:what are hydrotherapy measures | showering, using a spray table, immersion in a bath tub |
| wound management: what is enzymatic debridement | it involves the use of a topical agent to dissolve and remove necrotic tissue, following therapy and enzyme is applied in a thin layer to wound and covered with a wet dressing |
| surgery: surgical debridement- what is it | the process of excising the tissue from the burn wound to the level of viable tissue |
| surgery: esscharotomy- what is it | performed by the md with a scalpal, a sterile surgical incision is made longitudinally along the extremity or trunk to prevent constriction, impaired ciculation and gangrene |
| surgery: autografting- what is it | is used to effect permanent skin coverage of the wound, healthy skin is removed from the healthy area of the body and applied to the burn |
| surgery:cultured epithelial autografting- what is it | skin cells are removed from unburned sites on the clients body and and placed in a culture for growth, enough skin can be grown in 3 wks to cover a whole body |
| biologic/ biosynthetic dressings: what are they | any temporary material that rapidly adheres to the wound bed, promotes healing and prepares the burn wound for autograft |
| when is a scar formed | when the burn extends into the dermis and it is repaired through scar formation |
| scars: what is a hypertrophic scar | an overgrowth of dermal tissue that remains with in the boundaries of the wound |
| scars: what is a keloid | a scar the extends beyond the boundaries of the original wound |
| scars: who is at a greater risk for forming scars | ppl with dark skin |
| scars: what causes a contracture of the wound | as the wound heals the burn scar shrinks and becomes fixed and inelastic, results in permenant shortening of connective tissue |
| scars: contractures do what to body movement | they limit it |
| who is at risk | children, elderly, smoking, drugs, ETOH, mental disabilities |
| what factors influence recovery | how much, depth, location, mechanism |
| what are the functions of the skin | protect from infection, prevention of loss of body fluids, thermoregulation (hot&cold), production of vit D, excretion (sweat and oils), determination of idendity, sensation of reception |
| what are the types of burns | chemical, thermal, electrical, radiation, inhalation |
| what does the severity of burns depend on | duration of contact, temperature of agent, amount of tissue exposed, ability of agent to dissipate energy |
| what type of burn causes 90% of the majority of burns | thermal burns |
| what type of burn must be completely removed or neutralized or damage will continue | chemical burns |
| types of chemicals that burn | alkaline, acid and organic |
| with an electrical injury what are the two types of wounds you are looking for | and enterence and exit wound |
| electrical injuries: electricity follows the path of ______ resistence | least |
| electrical injuries: what has the greatest resistence in the body | bone |
| electrical injuries: heat is absorbed by what | the muscle around the bones |
| electrical injuries: where is there damage | the entire pathway betweem the exit and enterence wounds there could be damaage |
| superficial burn: is there scarring | no |
| partial thickness burn:deep- protein loss will look like what | yellow ( it indicates the pt is losing important stuff |
| eschar: what does it look like | tree bark |
| eschar: why does it need to be removed | it is dead, and unless it is removed it does not allow the new skin to regrow |
| why is the pt given a tetanus shot | b/c they have an open wound, preventative |
| why are lactated ringers used | they are the most replicable to our plasma |
| why are fluids given immediately | to prevent hypovolemia |
| why is NG tube placed | to decrease gastric acid due to stress response |
| what is the body's response to a burn | fight or flight |
| what is a curling's ulcer | it is no different than a peptic ulcer |
| why is pt at a high risk for renal failure | b/c lots of fluid shifts are going on |
| where does fluid shift | from the vascular bed to the interstitual bed |
| immunity: what remains low; what does this cause | serum inuoglbins andn serum proteins remain; a state of acquired immunodeficiency |
| how long is pt at risk from infection | 4 weeks post burn |
| ebb phase: what is this phase all about | ABCs |
| flow phase: what is this phase all about | body is trying to repair itself BMR increases |
| what is protein catabolism | breakdown of proteins |
| what is lipolysis | breakdown of fats |
| what is gluconeogenesis | body is trying to make suger |
| rule of nines: what is the head worth | 9 |
| rule of nines: what is the front of chest worth | 18 |
| rule of nines: what is one arm worth | 9 |
| rule of nines: what is the genitals worth | 1 |
| rule of nines: what is one leg worth | 9 |
| open wound care: what are the antibiotic creams used | sulfamylon (antibx), silvadene (antibx), |
| closed wound care: what is done | a topical cream plus dressing: they rapidly adheres to the wound bed, promotes healing or prepares the wound for permanent autografting |
| closed wound care: examples of the dressing | biobrane, dermagraft, integra, alladerm, transcyte, acticoat |
| med: silvadene ointment: what is it | a wide spectrum antibiotic, painless, leave wounds exposed or wrapped |
| what is acticoat | a silver coated wound dressing it has a, antimicrobial agent (bcroad spectrum >150), cost effective |
| what is a heterograft/xenograft: | a graft that is temporary and from a pig (not used often now) |
| how is an autograft secured q | with staples, site is immobilized for 72 hours, meshed vs sheet graft |
| autograft: why should the site be immobilized for 72 hours | movement breaks the graft apart and it does not adhere |
| autograft: doner site- how long does it take to heal | 8-14 days |
| autograft: doner site- what is used for the dressing | a biosynthetic dressing to stop bleeding, a fine mesh dressing |
| pressure garment: how long is it worn, what does it do | 23 hours a day/2 years; lessons scarring |
| silverdene- what is it | a topical sulfonamide prep |
| silverdene- what is the most adverse reaction seen with a topical agent | burning sensation seen with the topical application |
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