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Thermal burns
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Adult Health part 3
Burns, Integumentary, Pre-op, Intra-op, Post-op
| Question | Answer |
|---|---|
| Burn (definition) | Occurs when there is injury to the tissues of the body caused by heat, chemicals, electric current, or radiation |
| Thermal burns | caused by flamed, flash, scald, or contact with hot objects (most common type) |
| Chemical burns | result from tissue injury and destruction from acids, alkalis, and organic compounds |
| Smoke and Inhalation Injury | result from inhalation of hot air or noxious chemicals and can cause damage to the tissues of the respiratory tract |
| Electrical burns | A result of intense heat generated from an electric current. Direct damage to nerves and vessels, causing tissue anoxia and death. |
| Cold Thermal Injury (frostbite) | results in the formation of ice crystals in the tissues and cells |
| How is severity of a burn determined? | depth of the burn extent of the burn location of the burn Pt risk factors |
| Partial-thickness skin destruction includes | First degree and second degree burns |
| First-Degree | superficial epidermal damage with hyperemia |
| Second-Degree | epidermis and dermis involved to varying depth: mild to moderate edema and blisters |
| Full-Thickness skin destruction includes | Third and Fourth degree burns |
| Third and Fourth-Degree | all skin elements and local nerve endings destroyed. Necrosis present. Surgical intervention required for healing |
| The severity of the burn injury is related to the __________ of the burn wound. | Location |
| Lund-Browder chart | considered more accurate because the pt's age, in proportion to relative body-area size, is taken into account |
| Rule of Nines | considered adequate for initial assessment of an adult burn patient. |
| Cardiovascular complications of burn injury | Dysrhythmias and hypovolemic shock Ischemia, paresthesias, necrosis, gangrene Increase in blood viscosity Microcirculation is impaired |
| Respiratory complications of burn injury | upper airway burns cause edema formation and obstruction of the airway inhalation injury |
| Urinary complications of burn injury | Acute Tubular Necrosis blood flow to kidneys decreased, causing renal ischemia |
| Early endotracheal intubation in the burn pt | elimates the necessity for emergency tracheostomy after respiratory problems have become apparent |
| Fluid therapy for the burn pt | establish IV access that can accommodate large volumes of fluid. |
| Debridement | necrotic skin is removed |
| Open method of wound care | pt's burn is covered with a topical antimicrobial and has no dressing over the wound |
| Multiple dressing change method of wound care | sterile gauze dressing are saturated with or laid over a topical antimicrobial |
| Drug therapy for burn pts | analgesics and sedatives tetanus immunization antimicrobial agents |
| _________ takes PRIORITY over nutritional needs | Fluid replacement |
| What nutritional needs do burn pts have? | high calorie, high protein, supplemental vitamins, iron supplements |
| Emergent phase | the period of time required to resolve the immediate, life-threatening problems resulting from the burn injury |
| Acute phase | begins with mobilization of ECF and subsequent diuresis. Ends when the burned area is completely covered by skin grafts or when the wounds are healed. |
| From the onset of the burn event until the pt is stabilized, nursing and collaborative management predominately consists of airway management, fluid therapy, and wound care. | true |
| Skin health promotion includes | avoiding environmental hazards, adequate rest/exercise, proper hygiene/nutrition, use of self-examination techniques |
| Environmental hazard: sun exposure | premature aging, precancerous and cancerous lesions. Tanning is skin's response to injury. Some medications enhance the sun's effect |
| Environmental hazard: radiation | excessive radiation can cause edema, erythema, and hypo/hyperpigmentation |
| Adequate rest | sleep is restorative. NREM: body tissue restoration and repair and renewal of epithelial cells occurs |
| Exercise | increases circulation and dilates blood vessels. |
| _______ and __________ protect from bacterial overgrowth | Perspiration, skin acidity |
| Most soaps _________ skin surface | neutralize |
| Nutrition | well-balanced diet can produce healthy skin, hair, and nails. Important for skin support: vit A, B, C, K, protein, unsaturated fatty acids |
| Macule | flat, nonpalpable change in skin color, smaller than 1 cm |
| papule | Palpable, circumscribed, solid elevation in skin, smaller than 1 cm |
| Wheal | irregularly shaped, elevated area or superficial localized edema, varies in size |
| Vesicle | circumscribed elevation of skin filled with serous fluid, smaller than 1 cm |
| Pustule | Circumscribed elevation of skin similar to vesicle but filled with pus; varies in size |
| 5 characteristics of malignant skin lesions | A = asymmetry B = Border irregularity C = Color variation D = Diameter > 6 mm E = elevation |
| Malignant melanoma | a tumor occuring in melanocytes. Can spread to any organ. Most deadly skin disease. |
| Normal bacteria on the skin | staph aureus and strep b |
| Predisposing factors for infections | moisture, obesity, skin disease, systemic corticosteroids, antibiotics, chronic diseases |
| Bacterial infections of the skin | Impetigo, Furuncle, Folliculitis, Carbuncle |
| Cellulitis is characterized by | erythema, tenderness, edema |
| Viral infections of the skin | Herpes simplex (types 1/2), Herpes Zoster (shingles), Warts/plantar warts |
| Silver is | a natural antibiotic |
| Fungal infections of the skin | Candidiasis, tinea Corporis (ringworm), tinea curis (jock itch), tinea pedis (athlete's foot), tinea unguium (nails) |
| Scabies | mites under the skin |
| symptoms of scabies | severe itching at night usually not on face, on hands, wrists, genitals, axillary folds |
| treatment of scabies | launder all clothes, antibiotics if 2ndary infection, anti-itch creams |
| Begbugs | were nearly eradicated in the US 50 years ago, resistant strains of "super" bedbugs are infesting mattresses at an alarming rate. |
| Urticaria | erythema and edema from histamine response. Treat by removing the source, implementing antihistamine therapy, systemic corticosteroids, and applying cool compresses |
| Rashes from drug reactions can occur _______ days after medication. | 1-14 days |
| Lesions from contact dermatitis can appear ______ after contact with allergen | 2-7 days |
| benign conditions of the skin | acne, nevi, psoiasis, seborrheic keratoses, acrochordons, lipoma, vitiligo, lentigo |
| What are the uses of wet dressings? | to remove scales and crusts off lesions |
| What are the different types of baths? | saline, water, sodium bicarb, oatmeal |
| Surgery (definition) | the art and science of treating disease, injuries, and deformities by operation and instrumentation |
| Surgery involves... | the pt, surgeon, anesthesia care provider, and nurse |
| Purposes of surgery | Diagnosis, cure, palliation, prevention, exploration, and cosmetic improvement |
| Diagnosis: | determination of the presence and/or extent of pathology |
| Cure: | elimination or repair of pathology |
| Palliation: | alleviation of symptoms without cure |
| Prevention: | examples include removal of a mole before it becomes malignant or removal of the colon in a pt with familial polyposis to prevent cancer |
| Exploration: | surgical examination to determine the nature or extent of a disease |
| Cosmetic Improvement | examples include repairing a burn scar or changing breast shape |
| Elective surgery | carefully planned surgery |
| Emergency surgery | unexpected, urgent intervention |
| Inpatient surgery | pt is admitted to the hospital on the day of surgery. Usually pts who are in the hospital before surgery due to medical conditions |
| Ambulatory surgery is also called what? | same-day or outpatient surgery |
| What are the benefits of ambulatory surgery? | more convenient, involves fewer laboratory tests, fewer pre/post op meds, less psychological stress, less susceptibility to hospital-acquired infections, do not require an overnight hospital stay |
| Who prefers ambulatory surgery? | Physicians, third party payers, and pts |
| What kind of anesthetic is used in ambulatory surgery? | general, regional, or local anesthetic |
| What is the nurse's role in surgery? | prepare pt for surgery, care for pt during surgery, facilitate pt recovery following surgery |
| What are the primary purposes of the pt interview? | to obtain health information, to determine pt's expectation about surgery/anesthesia, to provide and clarify information about the surgical experience, to assess pt's emotional state/ readiness for surgery |
| Goal of assessment of the preop pt | to gather data in order to identify risk factors and plan care to ensure pt safety throughout the surgical experience |
| The most common psychologic factors in surgery are | anxiety, fear, and hope |
| Anxiety | Comes from facing the unknown |
| Anxiety | extremely high levels diminish cognition, decision making, and coping abilities |
| Anxiety | can arise from lack of knowledge, fear of the potential outcome, or unrealistic expectations of surgery |
| Anxiety | can arise when surgical interventions are in conflict with the pt's religious and cultural beliefs |
| Most prevalent fear | potential for death or permanent disability resulting from surgery |
| Hope | May be the pt's strongest method of coping |
| Why should a medication history be taken? | drugs and herbal products may interact with anesthetics |
| Why should a medication hx be taken? | Recreational drug use may affect the type and amount of anesthesia required. |
| Allergies | the pt with a hx of any allergic responsiveness is at a greater risk of developing hypersensitivity reactions to drugs administered during anesthesia. |
| What type of allergy should the nurse screen for? | Latex allergies |
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