Pediatric burns, stages, and treatments
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| What are the 5 types of burns? | Chemical, electrical, thermal, inhalation, radiation
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| What is the treatment for chemicals in the eyes? | Flush for 20-30 minutes
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| What is the treatment for chemicals on the skin? | Remove clothing and rinse skin for 20-30 minutes
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| Kidney failure from an electrical burn is related to... | Muscle destruction and myoglobinuria
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| 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
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| Clinical manifestations of an electrical burn include... | Entrance and exit site, tetany, convulsions, arrhythmias, seizures, cardiopulmonary arrest
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| What can cause a thermal burn? | Exposure to flames, scalds, hot objects, sun, cold
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| Clinical manifestations of a 1st degree burn include... | redness, pain, skin blanches and refills
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| Clinical manifestations of a 2nd degree burn include... | redness, pain, moist/blisters, skin blanches and refills, minimal edema and scarring
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| Clinical manifestations of a 3rd degree burn include... | Painless, hair follicle/sweat gland destruction, skin will not blanch, eschar formation
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| What are two ways to determine the extent of burn? | Rule of Nines and Lund-Browder Chart
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| Describe the Rule of Nines. | Head 9%, Arms 9% each, Legs 18% each, back/buttocks 18%, chest/abdomen 18%, genitalia 1%
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| 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
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| What is the treatment for carbon monoxide poisoning? | 30 minutes of high flow 100% oxygen or hyperbaric chamber
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| Which fluids are utilized for fluid replacement in a burn patient? | Lactated Ringer's or Isotonic solution with electrolytes (NS 0.9%)
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| 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
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| What is the best way to monitor circulatory status? | urinary output
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| What is the pediatric minimum output? | 1-2 mL/kg/hr
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| What are the 3 phases of burns? | 1. Hypovolemic burn shock2. Diuretic/ Septic Shock3. Recovery/ Rehabilitation
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| How long does the hypovolemic stage last? | 48 hours from the time of injury
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| What are the major electrolyte changes that occur during the hypovolemic stage? | Decreased sodium and protein
Increased potassium
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| Renal failure and lactic acid formation result in... | Metabolic acidosis
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| 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
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| Nursing interventions for hypovolemic burn shock include... | airway, fluid replacement, circulatory status, VS, weight, IV MSO4, NPO status, tetanus toxoid/TIGH
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| What is the time frame for the diuretic/septic shock stage? | 48 hours to 5 days
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| 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
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| Clinical manifestations of the diuretic stage include... | increased BP and output, pulmonary edema, water intoxication
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| What are the major electrolyte changes that occur in the diuretic stage? | Initial increase in sodium then it decreases, decrease potassium
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| What is expected from a CBC during the diuretic stage? | decreased RBCs, H&H
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| Name 3 complications of burns. | 1. Eschar formation2. Compartment syndrome3. Curling's ulcer
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| How do you prevent a Curling's ulcer? | Test gastric pH, administer H2 blockers, return of bowel sounds before beginning PO intake
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| What is the time frame for the recovery/rehabilitation stage? | From day 5 on...
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| NANDA for the recovery stage is Altered nutrition: less than body requirements R/T... | hypermetabolic burn wound state
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| If a burn patient has no bowel sounds, what type of nutrition would they receive? | TPN with lipids
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| NANDA for the recovery stage is Impaired physical mobility R/T... | burns involving joints, splint immobilization, and pain
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| 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
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| Burn care includes... | 1. culture wound if infection suspected2. Debride3. photograph burns and progression of healing
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| Name the 2 types of burn care. | 1. open2. closed
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| What are 3 advantages to open burn care? | 1. Allows for frequent inspection without dressing change2. Decreases moist medium = less bacterial growth3. Increased ROM
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| 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
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| 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
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| 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
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| What is silvadene? | Burn dressing medication. Good for gram +/-, candida. Must be soaked off before next application. Allows for re-epitheliation
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| What are 3 disadvantages to silvadene? | 1. Skin around burn appears grayish/infected2. May cause rash3. Needs repeated applications
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| What is silver nitrate? | Burn dressing med. Gauze is impregnanted with medication and must remain wet. Decreases edema. Bacteriostatic.
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| What are 3 disadvantages to silver nitrate? | 1. Stains2. Disrupts electrolytes: pulls sodium3. May cause rash, itching on good skin
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| What is sulfamylon? | Broad spectrum antibiotic. Diffuses through eschar rapidly. Used with open burn care. Thick application.
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| 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
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| What is travase (Accuzyme)? | Broad spectrum, proteolytic enzyme. Dissolves eschar and necrotic tissue.
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| 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
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| What is bacitracin? | Petroleum based antimicrobial works well against gram+ organisms. Provides barrier protection to the wound. Can be used with open burn care.
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| What are 2 disadvantages to bacitracin? | 1. Only mild antimicrobial activity2. Poor penetration of eschar
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| What determines if a graft will take? | 1. eschar formation (will delay)2. good granulation tissue base3. infection (will delay)
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| When is a graft procedure done? | 5-20 days from initial injury
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| 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
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| 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
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| What is a Jobst garment? | Like a giant TED hose that prevents or minimizes disorganized scarring. Worn for 2 years post-burn
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| What changes occur with grafted skin? | less perspiration, less sebum, sparse hair growth
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