Burns Crisis 2 BSN3

Topical Antibiotics (Bacitracin/Neosporin)1-3x/d and can bath in phisohex or antibiotic (Furacin)bath.

1st degree (superficial) burns treated with what?

Silvadene (silver sulfadiazine) cream. Applied using sterile technique after debriding or a dermabrasive bath.

2nd (Partial thickness) & 3rd degree (Full thickness) burns treated with what?

1. sedatives 2. anxiety

2nd degree burns, very painful! Narcotic or non-Narcotic Analgesics (Nubain, Morphine Sulfate, Demerol) should be used with combination _____1______ &/or anti-anxiety meds as ordered (Valium, Ativan) as _____2_____ is often a problem associated with anticipatory pain.

1. intubated 2. physical

3rd degree burns will be the least painful, patients may be _____1____ and sedated for rest and healing. Usually most psycho-effective due to _____2_____ impact of long term healing needs and social effects

C

Knowing the most common causes of household fires, which prevention strategy would the nurse focus on when teaching about fire safety? a. Set hot water temperature at 140° F. b. Use only hardwired smoke detectors. c. Encourage regular home fire exit drills. d. Never permit older adults to cook unattended.

1. 24-48 2. non-narcotics 3. Topical

Pain management for 1st degree burns is minor after first _____1_____ hours if area kept moist, may use oral _____2______, non-steroidal anti-inflammatory pain control agents & _____3____ anesthetics

1. Medications 2. Symptom 3. organ 4. moist 5. Tetanus 6. Crime

_______1________ have a limited role in the treatment of burns. ; _____2_____ management is key; Anticipate swelling and _____3______ damage; Anticipate fluid shifts & shock; Keep burns ______4______ and clean to aid healing; Keep bed/room as cool & clean as possible; Consider ____5____ shot; Was a ____6______ committed? If so, report

Burns

occurs when there is injury to the tissues of the body caused by heat, chemicals, electric current, or radiation. The resulting effects are influenced by temperature of the burning agent, duration of contact time, and type of tissue that is injured.

1

A burn client is receiving treatments of topical mafenide acetate to the site of injury. The nurse monitors the client, knowing that which finding indicates that a systemic effect has occurred? 1. Hyperventilation 2. Elevated blood pressure 3. Local rash at the burn site 4. Local pain at the burn site

4

A client arrives at the emergency department following a burn injury that occurred in the basement at home, and an inhalation injury is suspected. What would the nurse anticipate to be prescribed for the client? 1. 100% oxygen via an aerosol mask 2. Oxygen via nasal cannula at 6 L/minute 3. Oxygen via nasal cannula at 15 L/minute 4. 100% oxygen via a tight-fitting, nonrebreather face mask

2,3,5

A client is brought to the emergency department with partial-thickness burns to his face, neck, arms, and chest after trying to put out a car fire. The nurse should implement which nursing actions for this client? Select all that apply. 1. Restrict fluids. 2. Assess for airway patency. 3. Administer oxygen as prescribed. 4. Place a cooling blanket on the client. 5. Elevate extremities if no fractures are present. 6. Prepare to give oral pain medication as prescribed.

3

A client is undergoing fluid replacement after being burned on 20% of her body 12 hours ago. The nursing assessment reveals a blood pressure of 90/50 mm Hg, a pulse rate of 110 beats/minute, and a urine output of 20 mL over the past hour. The nurse reports the findings to the health care provider (HCP) and anticipates which prescription? 1. Transfusing 1 unit of packed red blood cells 2. Administering a diuretic to increase urine output 3. Increasing the amount of intravenous (IV) lactated Ringer's solution administered per hour 4. Changing the IV lactated Ringer's solution to one that contains 5% dextrose in water

A

A nurse in a provider's office is assessing a client who has a severe sunburn. Which of the following classifications should the nurse use to document this burn? A. Superficial thickness B. Superficial partial thickness C. Deep partial thickness D. Full thickness

A,C,D

A nurse is assessing a client who sustained deep partial‐thickness and full‐thickness burns over 40% of his body 24 hr ago. Which of the following are findings should the nurse expect? (Select all that apply.) A. Dyspnea B. Bradycardia C. Hyperkalemia D. Hyponatremia E. Decreased hematocrit

1

A nurse is caring for a client who has a major burn and is experiencing severe pain. Which of the following is an appropriate nursing intervention to manage this client's pain? 1. Give morphine sulfate IV continuous infusion 2. Give meperidine IM PRN 3. Give acetaminophen PO q4 hrs 4. Give hydrocodone PO q 6 hrs

3

A nurse is caring for a client who has a moderate burn. Which of the following is an appropriate action for the nurse to take? 1. Maintain immobilization of the affected area 2. expose affected area to the air 3. initiate a high protein, high calorie diet 4. implement contact isolation

1,2,4,5

A nurse is caring for a client who has a skin graft. Which is a clinical manifestations indicate infection? SELECT ALL 1. green color to sub q 2. unstable body temp 3. generation of granulation tissue 4. subechar hemorrhage 5, change in skin color around the affected area

1,2,4

A nurse is caring for a client who has major burns and suspected shock. Which of the following findings are consistent with septic shock? SELECT ALL 1. Increased body temp 2. Altered sensorium 3. Decreased cap refill 4. Decreased urine output 5. Increased bowel sounds

C

A nurse is caring for a client who has sustained burns over 35% of his total body surface area. Of this total, 20% are full‐thickness burns on the arms, face, neck, and shoulders. The client's voice has become hoarse. He has a brassy cough and is drooling. The nurse should identify these findings as indications that the client has which of the following? A. Pulmonary edema B. Bacterial pneumonia C. Inhalation injury D. Carbon monoxide poisoning

2

A nurse is caring for a pt. who has superficial partial thickness burn. Which of the following is an appropriate action for the nurse to take? 1. administer an IV infusion of 0.9% Sodium chloride 2. Apply cool, wet compresses to affected area 3. Clean the affected area using a soft bristle brush 4. administer morphine sulfate

A,C,E

A nurse is planning care for an adult client who sustained severe burn injuries. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) A. Limit visitors in the client's room. B. Encourage fresh vegetables in the diet. C. Increase protein intake. D. Instruct the client to consume 2,000 calories/day. E. Restrict fresh flowers in the room.

C

A nurse is preparing to administer fentanyl to a client who sustained deep partial‐thickness and full‐thickness burns over 60% of his body 24 hr ago. The nurse should plan to use which of the following routes to administer the medication? A. Subcutaneous B. Oral C. Intravenous D. Transdermal

B

A patient has 25% TBSA burn from a car fire. His wounds have been debrided and covered with a silver-impregnated dressing. The nurse's priority intervention for wound care would be to a. reapply a new dressing without disturbing the wound bed. b. observe the wound for signs of infection during dressing changes. c. apply cool compresses for pain relief in between dressing changes. d. wash the wound aggressively with soap and water three times a day.

D

A patient is admitted to the burn center with burns to his head, neck, and anterior and posterior chest after an explosion in his garage. On assessment, the nurse auscultates wheezes throughout the lung fields. On reassessment, the wheezes are gone and the breath sounds are greatly diminished. Which action is the most appropriate for the nurse to take next? a. Encourage the patient to cough and auscultate the lungs again. b. Obtain vital signs, oxygen saturation, and a STAT arterial blood gas. c. Document the findings and continue to monitor the patient's breathing. d. Anticipate the need for endotracheal intubation and notify the physician.

C

A patient is recovering from second- and third-degree burns over 30% of his body and the burn care team is planning for discharge. The first action the nurse should take when meeting with the patient would be to a. arrange a return-to-clinic appointment and prescription for pain medications. b. teach the patient and the caregiver proper wound care to be performed at home. c. review the patient's current health care status and readiness for discharge to home. d. give the patient written information and websites for information for burn survivors.

A

A therapeutic measure used to prevent hypertrophic scarring during the rehabilitation phase of burn recovery is a. applying pressure garments. b. repositioning the patient every 2 hours. c. performing active ROM at least every 4 hours. d. massaging the new tissue with water-based moisturizers.

3

An adult client was burned in an explosion. The burn initially affected the client's entire face (anterior half of the head) and the upper half of the anterior torso, and there were circumferential burns to the lower half of both arms. The client's clothes caught on fire, and the client ran, causing subsequent burn injuries to the posterior surface of the head and the upper half of the posterior torso. Using the rule of nines, what would be the extent of the burn injury? 1. 18% 2. 24% 3. 36% 4. 48%

Mafenide acetate (Sulfamylon)

Bacteriostatic for gram negative and gram-positive organisms; Used to reduce the bacteria present in avascular tissue (dead tissue); May be absorbed thru devascularized areas and may cause metabolic acidosis (hyperventilating=notify PCP & wash off); completely cover the burn

Silver sulfadiazine 1%(SSD) (Silvadene, Thermazene)

Broad spectrum coverage against gram-negative bacteria, gram-positive bacteria, AND YEAST!; Not used on children under 2 or pregnant women. ; Slow released=selectively toxic; Not a carbonic anhydrase inhibitor (no acidosis); Never use on the face can cause hearing loss/blindness; Do not use on healthy tissue

1. entry 2. exit

Electrical burns usually have an ____1_____ and _____2____ point

C

Fluid and electrolyte shifts that occur during the early emergent phase of a burn injury include a. adherence of albumin to vascular walls. b. movement of potassium into the vascular space. c. sequestering of sodium and water in interstitial fluid. d. hemolysis of red blood cells from large volumes of rapidly administered fluid

A,C,D

Pain management for the burn patient is most effective when (select all that apply) a. a pain rating tool is used to monitor the patient's level of pain. b. painful dressing changes are delayed until the patient's pain is completely relieved. c. the patient is informed about and has some control over the management of the pain. d. a multimodal approach is used (e.g., sustained-release and short-acting opioids, NSAIDs, adjuvant analgesics). e. nonpharmacologic therapies (e.g., music therapy, distraction) replace opioids in the rehabilitation phase of a burn injury.

1. bathing 2. secondary

Pre-medicate for pain prior to ____1_____ or therapy; Sulfa/metal allergies can result in _____2_____ burns

4

Silver sulfadiazine is prescribed for a client with a burn injury. Which laboratory finding requires the need for follow-up by the nurse? 1. Glucose level of 99 mg/dL (5.65 mmol/L) 2. Magnesium level of 1.5 mEq/L (0.75 mmol/L) 3. Platelet level of 300,000 mm3 (300 × 109/L) 4. White blood cell count of 3000 mm3 (3.0 × 109/L)

3

Silver sulfadiazine is prescribed for a client with a partial-thickness burn and the nurse provides teaching about the medication. Which statement made by the client indicates a need for further teaching about the treatments? 1. "The medication is an antibacterial." 2. "The medication will help heal the burn." 3. "The medication is likely to cause stinging every time it is applied." 4. "The medication should be applied directly to the wound."

A

The injury that is least likely to result in a full-thickness burn is a. sunburn. b. scald injury. c. chemical burn. d. electrical injury.

2

The nurse is administering fluids intravenously as prescribed to a client who sustained superficial partial-thickness burn injuries of the back and legs. In evaluating the adequacy of fluid resuscitation, the nurse understands that which assessment would provide the most reliable indicator for determining the adequacy? 1. Vital signs 2. Urine output 3. Mental status 4. Peripheral pulses

3

The nurse is caring for a client following an autograft and grafting to a burn wound on the right knee. What would the nurse anticipate to be prescribed for the client? 1. Out-of-bed activities 2. Bathroom privileges 3. Immobilization of the affected leg 4. Placing the affected leg in a dependent position

2

The nurse is caring for a client who suffered an inhalation injury from a wood stove. The carbon monoxide blood report reveals a level of 12%. Based on this level, the nurse would anticipate noting which sign in the client? 1. Coma 2. Flushing 3. Dizziness 4. Tachycardia

4

The nurse is caring for a client who sustained superficial partial-thickness burns on the anterior lower legs and anterior thorax. Which finding does the nurse expect to note during the resuscitation/emergent phase of the burn injury? 1. Decreased heart rate 2. Increased urinary output 3. Increased blood pressure 4. Elevated hematocrit levels

1

The nurse is preparing to care for a burn client scheduled for an escharotomy procedure being performed for a third-degree circumferential arm burn. The nurse understands that which finding is the anticipated therapeutic outcome of the escharotomy? 1. Return of distal pulses 2. Brisk bleeding from the site 3. Decreasing edema formation 4. Formation of granulation tissue

3

The nurse manager is observing a new nursing graduate caring for a burn client in protective isolation. The nurse manager intervenes if the new nursing graduate planned to implement which unsafe component of protective isolation technique? 1. Using sterile sheets and linens 2. Performing strict hand-washing technique 3. Wearing gloves and a gown only when giving direct care to the client 4. Wearing protective garb, including a mask, gloves, cap, shoe covers, gowns, and plastic apron

A

To maintain a positive nitrogen balance in a major burn, the patient must a. eat a high-protein, high-carbohydrate diet. b. increase normal caloric intake by about three times. c. eat at least 1500 calories/day in small, frequent meals. d. eat a gluten-free diet for the chemical effect on nitrogen balance.

Leukopenia & interstitial nephritis

What are some adverse effects of Silver sulfadiazine 1%(SSD) (Silvadene, Thermazene)?

-Topical solution, ointment, or cream -Broad spectrum antibacterial -Used when bacteria is resistant to other agents

What are some characteristics of Nitrofurazone 2% (Furasin)?

local pain, rash

What are some side effects of Mafenide acetate (Sulfamylon)?

Rash, contact dermatitis, pruritus, local edema

What are some side effects of Nitrofurazone 2% (Furasin)?

-Watch for 24-48 hours -Monitor vital organs -Maintain airway -Pain control -IV fluids -Topical treatments -Nutrition -Telemetry-transient A Fib

What are some things with caring for Electrocution?

-Plastic surgery-grafting -Stretching -Sun protection to prevent secondary burns and hyper-pigmentation of new skin (needs time to toughen up) -Missing hair -Altered sweat glands -Scar treatments (Mederma or Cica gel sheets) -Nutritional consult-Encourage high calorie/ high protein diet -Therapy physical, occupational, speech, social services -Psychiatric Support -Infection prevention (pneumonia shot, flu shot)

What might be included with Post Burn Treatments?

CBC, WBC's-if ^ then notify PCP

What should we monitor with Silver sulfadiazine 1%(SSD) (Silvadene, Thermazene)?

A,D,E

When assessing a patient with a partial-thickness burn, the nurse would expect to find (select all that apply) a. blisters. b. exposed fascia. c. exposed muscles. d. intact nerve endings. e. red, shiny, wet appearance.

1. Isotonic 2. second 3. Diuretics

With fluid management with burns, Rapid fluid replacement (999mls/hr) using _____1_____/volume restoring solutions (LR); 2-4 ml/kg (wt) x % burn=total volume replacement needed; Add Colloids with Dextrose during the ________2_______ 24 hours; Volume expanders (Hespan,or Albumin); Osmotic ______3_______ may be needed to restore/maintain urinary output and reduce organ swelling (Mannitol)