BURNS U
Silver Sulfadiazine
-The wound moisture activates the silver and releases it into the wound. -An advantage of silver dressings is that the dressing does not need to be changed daily because of the sustained release of silver. - Silver dressings should be used judiciously and limited to 4 to 6 weeks despite the current absence of negative systemic or local consequences. -it is effective against many gram + and Gram - bacteria associated with burn wound infection
Why does the pigskin dissolve in 5-7 days?
a lack on blood supply
The nurse and a new graduate nurse are caring for a patient with extensive burns. They are discussing skin grafts. Which statement indicates the new graduate understood the information?
autographs with provide permanent coverage and be the least expensive
Which zones are usually ore affected by a burn injury usually?
central zone(irreversible skin death) or the zone of coagulation
Using the "rule of nines," calculate the percent of injury in an adult who was injured as follows: the patient sustained partial and full-thickness burns to half of his left arm, his entire left leg, and his perineum.
4.5(half is left arm)+ 18(entire left leg)+ 1%(pireneum)= 23.5%
A patient is brought to the emergency department after a house fire. He fell asleep with a lit cigarette, and the couch ignited. What is the nurse's first priority?
asses airway and provide 100% oxygen
A patient is admitted to the burn unit with extensive burns after a house fire. The patient's vital signs and physical exam include a heart rate of 140 beats/min, a urine output of 25 mL/h, and clear lung sounds. What adjustment, if any, needs to be made to the fluid resuscitation plan?
increase IV rate and watch fluid status closely
Leading cause of death in hospitalized patient
infection
Phases of healing
inflamatory-->proliferative-> maturation
A patient is admitted after being burned in a house fire. The nurse feels that the patient should be transferred to a burn center. Which factor is most important when determining whether or not to refer a patient to a burn center?
medical history, size and depth of injury
neurovascular assessments for burn patients
pulses, skin color, capillary refill, sensation
What are the goals of the rehabilitation phase of burn management?
recuperation and healing physically and emotionally
A patient with extensive burns is undergoing skin grafting. The nurse understands pain control is best achieved with what strategies during the early phase of recovery?
small doses of intravenous opioids titrated to effect
which zone is least affected by a burn injury
the peripheral zone
A patient is admitted to the burn unit with extensive burns after a house fire. The patient's vital signs and physical exam include a heart rate of 140 beats/min, a urine output of 25 mL/h, and clear lung sounds. The nurse knows that the patient's symptoms are most likely attributable to what cause?
underresusitation becuase of probable wound conversion( from partial thickness to full thickness)
Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours for a 75-kg patient with full-thickness burns to the anterior chest, perineum, and entire right leg.
1. 4x75x37(amt burned)=11100 2. 11100x.50=5,550(first 8 hours) 3. 11100x.25=2775(2nd 8 hours) 4. 11100x.25=2775(3rd 8 hours)
Contracture development leading to impaired physical mobility can occur after a major burn injury. Splints are applied to prevent or correct contractures. Priority nursing interventions concerning this therapy include which action?
Daily assessments for proper fit and effectiveness
The nurse is caring for a patient with extensive burns. Which zone of injury is the site of the most severe damage?
Zone of coagulation
The nurse is caring for a patient with extensive burns. Which intervention should be included in the nursing management plan to prevent cross-contamination and decrease the risk of infection in the burn-injured patient?
changing gloves and hand washing from area to area on the patient
The nursing management plan for a patient with full-thickness burns includes which intervention?
daily wound care with premedication
Less than 24 hours ago a patient sustained full-thickness burns, to his face, chest, back, and bilateral upper arms, in a house fire. He also sustained an inhalation injury. The patient was intubated and ventilated and is now showing signs of increasing agitation and rising peak airway pressures. The nurse suspects the patient's change in condition is due to which problem?
decreased pulmonary compliance(decreased chest wall expansion--> decreased compliance) +airway problems
A patient is brought to the emergency department after a house fire. He fell asleep with a lit cigarette, and the couch ignited. Total body surface area (TBSA) burn is estimated at 25% deep partial-thickness burns to areas of the chest, back, and left arm and 20% full-thickness burns to the right arm, right upper leg, and areas on the face. The patient's weight is estimated at 85 kg. What is the initial plan for fluid replacement?
5950ml/ first 8 and 5950 over the next 16
A patient is brought to the emergency department after a house fire. The patient sustained an inhalation injury. The nurse is aware that this injury predisposes the patient to the development of what complication?
ARDS
A patient involved in a house fire is brought by ambulance to the emergency department. The patient is breathing spontaneously but appears agitated and does not respond appropriately to questions. The nurse knows the patient has inhaled carbon monoxide and probably has carbon monoxide (CO) poisoning. What action should the nurse take next?
Administer 100% oxygen via a non rebreather mask(not taking back in the CO2 they are trying to get rid of
A patient is admitted after being burned in a car fire. The wound surface is red with patchy white areas that blanch with pressure but no blister formation. What kind of burn would the nurse document in the patient's record?
Deep dermal partial thickness burn AKA a second degree burn
A patient is admitted to the burn unit after a house fire. The patient sustained extensive burns to the chest, back, left arm, right arm, right upper leg, and areas on the face. The nurse is unable to obtain a palpable pulse or a Doppler pulse in the right arm. What procedure should the nurse anticipate next?
Escharectomy
According to the American College of Surgeons, burns to which body surfaces are best treated in a burn center?
FACE, GENITALIA, PERINEUM -feet and major joints
A patient is brought to the emergency department with extensive burns after a house fire. What is an important nursing intervention for this patient during the resuscitation phase?
IV opiates and pulses in both arms
A nurse is caring for a patient who was burned 2 weeks ago. The nurse knows the patient has entered the next phase of healing, which is characterized by rapid synthesis of collagen. What phase is the patient in?
PROLIFERATIVE;
A patient is admitted after being burned while lighting the barbecue. The injuries appear moist and red with some blister formation and the patient states they are very painful. What kind of burn would the nurse document in the patient's record?
Partial thickness 2nd degree burn
What physiologic process can result in excessive burn edema and shock in a patient with injuries totaling more than 50% total body surface area (TBSA) burn?
Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space.
A patient is admitted to the burn unit after an electrocution. The patient sustained extensive burns. The nurse should have a high degree of suspicion for what COMPLICATION associated with this type of burn injury?
Pneumonthorax
Identify in the correct order the five layers of the skin from the surface inward.
STRATUM: Corneum-->lucidium--> granulosum-->spinosum--> germinativum
Which topical antimicrobial agent is commonly used as a broad-spectrum and fights against gram-positive and -negative bacteria?
Silver Sulfadiazine
