burns (complex exam three)

what is an important consideration when dealing with a patient with face or neck or circumferential burns to the chest or back?

they can interfere with breathing

what is an important consideration for burns on the hands, feet, joints, and eyes?

they can make self-care difficult

that is an important consideration when the patient has circumferential burns to the extremities?

they can effect circulation distally and possible nerve damage

what greatly decreases a patient prognosis following a burn?

a pre-existing heart, lung, or kidney disease

what classification of burn has erythema, blanching, and no blisters?

superficial (first degree)

what classification of burn has fluid filled vesicles, is shiny and wet, and has severe pain?

deep (second degree)

what classification of burn is dry waxy white, leathery, and has no pain due to nerve damage?

full thickness (third)

what is the classification of a burn that involves the full thickness of skin and underlying structures?

fourth degree

what is the term for the substance the occurs on burns following the rupture of vesicles that retreats to the side of the burn?

slough

what is an important consideration following muscle damage from a burn?

there will be an increased level of myoglobin; kidneys will need to expel this so worry about injury

what does partial thickness burns on more than 10% of the body indicate?

transport to a burn center

what does burns that involving the face, hands, feet, genitalia, perineum, and major joints indicate?

transfer to a burn center

what do third degree burns of any type indicate?

transfer to a burn center

a patient with electrical burns should be -

transferred to a burn center

a patient with chemical burns should be -

transferred to a burn center

what are the two ways to estimate the amount of skin affected by burns?

rule of nines, Lund-Browder chart

which way to estimate the amount of surface area affected by a burn is more accurate?

Lund-Browder - considers patient’s age and proportion to relative body area size

in what regions do you have an increased risk for infection following a burn?

nose, ears, buttocks, perineum

what is a priority intervention following a chemical burn?

removing all clothing that contains the chemical (burning process will continue as long as it is in contact with the skin)

what is the first 24 to 28 hour following a burn called?

emergent phase

what is the greatest initial threat following a burn?

hypovolemic shock

edema, decreased blood pressure, and increased pulse are all manifestations of what?

hypovolemic shock

what electrolyte shifts occur during the emergent phase?

potassium leaves the cell and sodium enters the cell

what accumulates at the sight of the burn during the emergent phase?

neutrophils and monocytes

how does a burn effect the immune system in the emergent phase?

bone marrow depression, defects in function of WBCs, inflammatory cascade triggered

this is given to burn patients by going into the intravascular space and taking fluid with it when it is excreted?

albumin

what happens to the hematocrit during the emergent stage of a burn?

it increases

what is a common vascular complication during the emergent phase of a burn?

increased peripheral resistance

what is a common gastrointestinal issue in the emergent phase of a burn?

ileus (inability to stand fluid intake)

individuals who are older, obese, have lower extremity burns/trauma, or have prolonged immobility are at an increased risk for what?

VTE

what can occur if you provide fluid resuscitation too fast?

heart failure

what do you check to confirm an inhalation injury?

carboxyhemoglobin

how quickly in intubation needed for an individual with face or neck burns?

1-2 hours

how is CO poisoning treated?

100% oxygen with humidification

what procedure is done by cutting through layers of burnt skin to decrease pressure and increase blood flow?

escharotomy

a patient comes in with burns on more than 15% of their body surface - what is a priority?

placing 2 large bore IVs (fluid therapy)

what fluid are normally given to burn patients?

crystalloids (dextrose, lactated ringers) and colloids (albumin, dextran)

how long should you wait before giving a burn patient colloids? why?

12-24 hours; capillary permeability returns to normal/near normal

what is the expected urinary output for a burn patient?

30-50 cc/hr

what is the expected urinary output in an individual with electrical burns?

75-100 cc/hr

why is it better to give topical antibiotics rather than systemic?

circulation to burns is poor

when does the emergent phase end?

after the first 72 hours

this phase is characterized by eschar separation and epithelialization of burns?

acute phase

the patient’s burns have nearly healed and they partake in some part of their self care - what phase have then entered?

rehabilitation

what is a common Musculo-skeletal complication of burns?

contracture