CH25 Burns

10. 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? · "Autografts are procured from both live and deceased donors." · "Autografts can be placed at the bedside or in the operating room." · "Autografts can transmit disease and be rejected." · "Autografts provide permanent coverage and are the least expensive."

· "Autografts provide permanent coverage and are the least expensive."

3. 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. · 28% · 23.5% · 45.5% · 16%

· 23.5% 𝘏𝘢𝘭𝘧 𝘰𝘧 𝘓 𝘢𝘳𝘮 = 4.5% 𝘌𝘯𝘵𝘪𝘳𝘦 𝘓 𝘭𝘦𝘨 = 18% 𝘗𝘦𝘳𝘪𝘯𝘦𝘶𝘮 = 1%

6. Using the Parkland formula for fluid resuscitation and 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 torso, perineum, and entire right leg. · 2775 mL · 5550 mL · 8325 mL · 11,100 mL

· 5550 mL

17. 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 according to ABA consensus (3mL)? · 5738 mL of Lactated Ringer solution (LR) for the first 8 hours; then 5738 mL of LR over the next 16 hours · 2868 mL of normal saline (NS) for the first 8 hours; then 5737 mL of hypertonic NS over the next 16 hours · 11,475 mL of dextran evenly divided over the first 24 hours · 11,475 mL of LR evenly divided over the first 24 hours

· 5738 mL of Lactated Ringer solution (LR) for the first 8 hours; then 5738 mL of LR over the next 16 hours

8. 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? · Ask the practitioner to order a STAT chest radiograph. · Apply a pulse oximeter to one of his unburned fingers. · Call the local hyperbaric chamber to check on its availability. · Administer 100% oxygen via a nonrebreathing mask.

· Administer 100% oxygen via a nonrebreathing mask. -𝘛𝘩𝘦 𝘵𝘳𝘦𝘢𝘵𝘮𝘦𝘯𝘵 𝘰𝘧 𝘤𝘩𝘰𝘪𝘤𝘦 𝘧𝘰𝘳 𝘤𝘢𝘳𝘣𝘰𝘯 𝘮𝘰𝘯𝘰𝘹𝘪𝘥𝘦 𝘱𝘰𝘪𝘴𝘰𝘯𝘪𝘯𝘨 𝘪𝘴 𝘩𝘪𝘨𝘩-𝘧𝘭𝘰𝘸 𝘰𝘹𝘺𝘨𝘦𝘯 𝘢𝘥𝘮𝘪𝘯𝘪𝘴𝘵𝘦𝘳𝘦𝘥 𝘢𝘵 100% 𝘵𝘩𝘳𝘰𝘶𝘨𝘩 𝘢 𝘵𝘪𝘨𝘩𝘵-𝘧𝘪𝘵𝘵𝘪𝘯𝘨 𝘯𝘰𝘯𝘳𝘦𝘣𝘳𝘦𝘢𝘵𝘩𝘪𝘯𝘨 𝘮𝘢𝘴𝘬 𝘰𝘳 𝘦𝘯𝘥𝘰𝘵𝘳𝘢𝘤𝘩𝘦𝘢𝘭 𝘪𝘯𝘵𝘶𝘣𝘢𝘵𝘪𝘰𝘯. -𝘛𝘩𝘦 𝘩𝘢𝘭𝘧-𝘭𝘪𝘧𝘦 𝘰𝘧 𝘤𝘢𝘳𝘣𝘰𝘯 𝘮𝘰𝘯𝘰𝘹𝘪𝘥𝘦 𝘪𝘯 𝘵𝘩𝘦 𝘣𝘰𝘥𝘺 𝘪𝘴 4 𝘩𝘰𝘶𝘳𝘴 𝘢𝘵 𝘳𝘰𝘰𝘮 𝘢𝘪𝘳 (21% 𝘰𝘹𝘺𝘨𝘦𝘯), 2 𝘩𝘰𝘶𝘳𝘴 𝘢𝘵 40% 𝘰𝘹𝘺𝘨𝘦𝘯, 𝘢𝘯𝘥 40 𝘵𝘰 60 𝘮𝘪𝘯𝘶𝘵𝘦𝘴 𝘢𝘵 100% 𝘰𝘹𝘺𝘨𝘦𝘯 (464).

16. 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? · Clean the wounds and remove blisters. · Assess the airway and provide 100% oxygen. · Place a urinary drainage catheter and assess for myoglobin. · Place a central intravenous access and provide antibiotics.

· Assess the airway and provide 100% oxygen.

13. 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 assessment for proper fit and effectiveness · Removal of splints during showers and dressing changes · Allowing for frequent breaks from splint use · Passive and active range of motion may be used instead of splints

· Daily assessment for proper fit and effectiveness

23. The nursing management plan for a patient with full-thickness burns includes which intervention? · Daily replacement of autografts · Daily wound care with premedication · Weekly wound care until all eschar is debrided · Surgical skin grafting within 8 hours of admission

· Daily wound care with premedication

5. 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? · Uncontrolled pain · Hypovolemia · Worsening hypoxemia · Decreased pulmonary compliance

· Decreased pulmonary compliance -𝘍𝘶𝘭𝘭-𝘵𝘩𝘪𝘤𝘬𝘯𝘦𝘴𝘴 𝘣𝘶𝘳𝘯𝘴 𝘵𝘰 𝘵𝘩𝘦 𝘤𝘩𝘦𝘴𝘵 𝘸𝘢𝘭𝘭 𝘤𝘢𝘯 𝘭𝘦𝘢𝘥 𝘵𝘰 𝘳𝘦𝘴𝘵𝘳𝘪𝘤𝘵𝘪𝘰𝘯 𝘰𝘧 𝘤𝘩𝘦𝘴𝘵 𝘸𝘢𝘭𝘭 𝘦𝘹𝘱𝘢𝘯𝘴𝘪𝘰𝘯 𝘢𝘯𝘥 𝘥𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘤𝘰𝘮𝘱𝘭𝘪𝘢𝘯𝘤𝘦 (462). -𝘋𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘤𝘰𝘮𝘱𝘭𝘪𝘢𝘯𝘤𝘦 𝘳𝘦𝘲𝘶𝘪𝘳𝘦𝘴 𝘩𝘪𝘨𝘩𝘦𝘳 𝘷𝘦𝘯𝘵𝘪𝘭𝘢𝘵𝘰𝘳𝘺 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦𝘴 𝘵𝘰 𝘱𝘳𝘰𝘷𝘪𝘥𝘦 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵 𝘸𝘪𝘵𝘩 𝘢𝘥𝘦𝘲𝘶𝘢𝘵𝘦 𝘵𝘪𝘥𝘢𝘭 𝘷𝘰𝘭𝘶𝘮𝘦𝘴 -𝘊𝘭𝘪𝘯𝘪𝘤𝘢𝘭 𝘮𝘢𝘯𝘪𝘧𝘦𝘴𝘵𝘢𝘵𝘪𝘰𝘯𝘴 𝘰𝘧 𝘤𝘩𝘦𝘴𝘵 𝘸𝘢𝘭𝘭 𝘳𝘦𝘴𝘵𝘳𝘪𝘤𝘵𝘪𝘰𝘯 𝘪𝘯𝘤𝘭𝘶𝘥𝘦 𝘳𝘢𝘱𝘪𝘥, 𝘴𝘩𝘢𝘭𝘭𝘰𝘸 𝘳𝘦𝘴𝘱𝘪𝘳𝘢𝘵𝘪𝘰𝘯𝘴; 𝘱𝘰𝘰𝘳 𝘤𝘩𝘦𝘴𝘵 𝘸𝘢𝘭𝘭 𝘦𝘹𝘤𝘶𝘳𝘴𝘪𝘰𝘯; 𝘢𝘯𝘥 𝙨𝙚𝙫𝙚𝙧𝙚 𝙖𝙜𝙞𝙩𝙖𝙩𝙞𝙤𝙣

15. 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? · Superficial partial-thickness burn · Moderate partial-thickness burn · Deep dermal partial-thickness burn · Full-thickness burn

· Deep dermal partial-thickness burn

21. 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? · Escharotomy · Silver Sulfadiazine application · Splint application · Xenograft application

· Escharotomy

19. 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/hr, and clear lung sounds. What adjustment, if any, needs to be made to the fluid resuscitation plan? · Continue as planned; everything looks good. · IV rate should be decreased and colloids started. · IV rate should be increased and fluid status closely watched. · Fluids should be switched to packed red blood cells.

· IV rate should be increased and fluid status closely watched.

1. What is a leading cause of death in the hospitalized burn patient? · Smoke inhalation · Infection · Burn shock · Renal failure

· Infection

18. 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? · Intravenous opiates and assessment of pulses in both arms · Oral anti-inflammatory drugs and preparation for insertion of an arterial line · Measurement of sedimentation rate and systemic antibiotics · Application of splints and initiation of total parenteral nutrition

· Intravenous opiates and assessment of pulses in both arms

11. A patient has a partial-thickness burn wound that is being treated with porcine xenograft (pigskin). The nurse knows that pigskin usually dissolves in 5 to 7 days because of what reason? · Presence of infection · Lack of blood supply · Lack of lymphatic drainage · Contamination of the graft

· Lack of blood supply

4. 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? · Superficial (first-degree) burn · Partial-thickness (second-degree) burn · Deep dermal partial-thickness (second-degree) burn · Full-thickness (third-degree) burn

· Partial-thickness (second-degree) burn 𝘈 𝘱𝘢𝘳𝘵𝘪𝘢𝘭-𝘵𝘩𝘪𝘤𝘬𝘯𝘦𝘴𝘴 (𝘴𝘦𝘤𝘰𝘯𝘥-𝘥𝘦𝘨𝘳𝘦𝘦) 𝘣𝘶𝘳𝘯 𝘮𝘢𝘺 𝘢𝘱𝘱𝘦𝘢𝘳 𝘸𝘦𝘵 𝘢𝘯𝘥 𝘸𝘦𝘦𝘱𝘪𝘯𝘨, 𝘮𝘢𝘺 𝘤𝘰𝘯𝘵𝘢𝘪𝘯 𝘣𝘶𝘭𝘭𝘢𝘦, 𝘢𝘯𝘥 𝘢𝘳𝘦 𝘦𝘹𝘵𝘳𝘦𝘮𝘦𝘭𝘺 𝘱𝘢𝘪𝘯𝘧𝘶𝘭 𝘢𝘯𝘥 𝘴𝘦𝘯𝘴𝘪𝘵𝘪𝘷𝘦 𝘵𝘰 𝘢𝘪𝘳 𝘤𝘶𝘳𝘳𝘦𝘯𝘵𝘴 (459).

25. According to the American College of Surgeons, burns to which body surfaces are best treated in a burn center? (Select all that apply.) · Arms · Perineum · Chest · Shoulder joint · Genitalia · Face · Hands

· Perineum · Shoulder joint · Genitalia · Face · Hands

7. 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? · The heat from the burn leads to immediate vascular wall destruction and extravasation of intravascular fluid. · A positive interstitial hydrostatic pressure occurs in the dermis leading to burn wound edema. · Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space. · Capillary permeability decreases in burned and unburned tissue, leading to hypovolemia.

· Plasma colloid osmotic pressure is decreased because of protein leakage into the extravascular space. -𝘗𝘭𝘢𝘴𝘮𝘢 𝘤𝘰𝘭𝘭𝘰𝘪𝘥 𝘰𝘴𝘮𝘰𝘵𝘪𝘤 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦 𝘪𝘴 𝘥𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥 𝘢𝘴 𝘢 𝘳𝘦𝘴𝘶𝘭𝘵 𝘰𝘧 𝘱𝘳𝘰𝘵𝘦𝘪𝘯 𝘭𝘦𝘢𝘬𝘢𝘨𝘦 𝘪𝘯𝘵𝘰 𝘵𝘩𝘦 𝘦𝘹𝘵𝘳𝘢𝘷𝘢𝘴𝘤𝘶𝘭𝘢𝘳 𝘴𝘱𝘢𝘤𝘦. 𝘗𝘭𝘢𝘴𝘮𝘢 𝘪𝘴 𝘵𝘩𝘦𝘯 𝘧𝘶𝘳𝘵𝘩𝘦𝘳 𝘥𝘪𝘭𝘶𝘵𝘦𝘥 𝘸𝘪𝘵𝘩 𝘧𝘭𝘶𝘪𝘥 𝘳𝘦𝘴𝘶𝘴𝘤𝘪𝘵𝘢𝘵𝘪𝘰𝘯. 𝘛𝘩𝘦 𝘰𝘴𝘮𝘰𝘵𝘪𝘤 𝘱𝘳𝘦𝘴𝘴𝘶𝘳𝘦 𝘪𝘴 𝘥𝘦𝘤𝘳𝘦𝘢𝘴𝘦𝘥, 𝘢𝘯𝘥 𝘧𝘶𝘳𝘵𝘩𝘦𝘳 𝘧𝘭𝘶𝘪𝘥 𝘦𝘹𝘵𝘳𝘢𝘷𝘢𝘴𝘢𝘵𝘪𝘰𝘯 𝘤𝘢𝘯 𝘰𝘤𝘤𝘶𝘳 (463).

24. 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? · Wound phase · Inflammatory phase · Proliferative phase · Maturation phase

· Proliferative phase

22. 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? · Rhabdomyolysis · Stress ulcers · Pneumothorax · Venous thromboembolism

· Rhabdomyolysis

14. Which topical antimicrobial agent is commonly used as a broad-spectrum agent and is activated by the wound moisture? · Silver · Bacitracin · Mafenide acetate cream · Silver sulfadiazine

· Silver

12. 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? · Large doses of opioids given intramuscularly · Intravenous opioids used in combination with oral antidepressants · Large doses of opioids given subcutaneously · Small doses of intravenous opioids titrated to effect

· Small doses of intravenous opioids titrated to effect

2. 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? · The size and depth of burn injury and the burning agent · The age and present medical history of the patient · The depth of the burn injury and the presence of soot in the sputum · The medical history of the patient and the size and depth of the burn injury

· The medical history of the patient and the size and depth of the burn injury 𝘉𝘶𝘳𝘯𝘴 𝘢𝘳𝘦 𝘤𝘭𝘢𝘴𝘴𝘪𝘧𝘪𝘦𝘥 𝘱𝘳𝘪𝘮𝘢𝘳𝘪𝘭𝘺 𝘢𝘤𝘤𝘰𝘳𝘥𝘪𝘯𝘨 𝘵𝘰 𝘵𝘩𝘦 𝘴𝘪𝘻𝘦 𝘢𝘯𝘥 𝘥𝘦𝘱𝘵𝘩 𝘰𝘧 𝘪𝘯𝘫𝘶𝘳𝘺. 𝘏𝘰𝘸𝘦𝘷𝘦𝘳, 𝘵𝘩𝘦 𝘵𝘺𝘱𝘦 𝘢𝘯𝘥 𝘭𝘰𝘤𝘢𝘵𝘪𝘰𝘯 𝘰𝘧 𝘵𝘩𝘦 𝘣𝘶𝘳𝘯 𝘢𝘯𝘥 𝘵𝘩𝘦 𝘱𝘢𝘵𝘪𝘦𝘯𝘵'𝘴 𝘢𝘨𝘦 𝘢𝘯𝘥 𝘮𝘦𝘥𝘪𝘤𝘢𝘭 𝘩𝘪𝘴𝘵𝘰𝘳𝘺 𝘢𝘳𝘦 𝘢𝘭𝘴𝘰 𝘴𝘪𝘨𝘯𝘪𝘧𝘪𝘤𝘢𝘯𝘵 𝘤𝘰𝘯𝘴𝘪𝘥𝘦𝘳𝘢𝘵𝘪𝘰𝘯𝘴 (458).

20. 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/hr, and clear lung sounds. The nurse knows that the patient's symptoms are most likely attributable what cause? · Blood loss associated with burns and pain. · Hemodynamic stability related to adequate fluid resuscitation. · Over-resuscitation related to overestimation of the burn area involved. · Under-resuscitation because of probable wound conversion.

· Under-resuscitation because of probable wound conversion.

9. 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 · Peripheral zone · Zone of stasis · Zone of hyperemia

· Zone of coagulation