Lippincott Burns

There has been a fire in an apartment building, and it has spread to seven apartment units. Victims have suffered burns, minor injuries, and broken bones from jumping from windows. Which persons can be safely transported to a healthcare facility after victims with more emergent problems have been transported first? Select all that apply 1. female Pt who is pregnant w/no apparent injuries 2. male who is 50 with no injuries, rapid respirations and coughing 3. 10 year-old child with apparent simple fracture of humerus 4. 20-year-old female with 1st degree burns on hands and forearms 5. 75-year-old male with 2nd degree burns on both legs

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1. There has been a fire in an apartment building. All residents have been evacuated , but many are burned. Which clients should be transported to a burn center for treatment? Select all that apply. 1. An 8-year-old with third-degree burns over 10% of his body surface area (BSA). 2. A 20 -year-old who inhaled the smoke of the fire. 3. A 50-year-old diabetic with first- andsecond-degree burns on his left forearm (about 5% of his BSA). 4. A 30-year-old with second-degree burns on the back of his left leg. 5. A 40-year-old with second-degree burns on his right arm (about 10% of his BSA).

1. 1, 2, 3. Clients who should be transferred to a burn center include children under age 10 or adults over age 50 with second- and third-degree burns on 10% or greater of their BSA, clients between ages 11 and 49 with second- and third-degree burns over 20% of their BSA , clients of any age with third-degree burns on more than 5% of their BSA, clients with smoke inhalation, and clients with chronic diseases, such as diabetes and heart or kidney disease.

3. During the emergent (resuscitative)phase of burn injury, which of the following indicates that the client is requiring additional volume with fluid resuscitation? 1. Serum creatinine level of 2.5 mg/ dL (221 μmol/ L). 2. Little fluctuation in daily weight. 3. Hourly urine output of 60 mL. 4. Serum albumin level of 3.8 (38 g/ L).

3. 1. Fluid shifting into the interstitial space causes intravascular volume depletion and decreased perfusion to the kidneys. This would result in an increase in serum creatinine. Urine output should be frequently monitored and adequately maintained with intravenous fluid resuscitation that would be increased when a drop in urine output occurs. Urine output should be at least 30 mL/ h. Fluid replacement is based on the Parkland or Brooke formula and also the client's response by monitoring urine output, vital signs, and CVP readings. Daily weight is important to monitor for fluid status. Little fluctuation in weight suggests that there is no fluid retention and the intake is equal to output. Exudative loss of albumin occurs in burns, causing a decrease in colloid osmotic pressure. The normal serum albumin is 3.5 to 5 g/ dL (35 to 50 g/ L).

The nurse is to administer an ATB to a client with burns, but there is no medication in the client's medication box. What should the nurse do FIRST? 1. Inform unit shift coordinator 2. Contact HCP 3. Call pharmacy 4. Borrow medication from another client

3. Call pharmacy By contacting pharmacy to report absence of medication they can bring the medication to the client's box.

The nurse is assessing a client with a burn injury using the "rule of nines" to determine: 1. amount of body surface area burned 2. rehabilitation needs 3. respiratory needs 4. type of IV fluids required

1. amount of body surface area burned

The nurse is assessing the effectiveness of fluid resuscitation during the emergency period of burn management. Which finding indicates that adequate fluid replacement has been achieved in the client? 1. increase in body weight 2. fluid intake less than UOP 3. UOP >35mL/hr 4. BP 90/60

3. UOP >35mL/hr

The nurse establishes the goal of preventing the development of a stress ulcer in a burn client. Which would most likely contribute to the achievement of this goal? 1. implementing relaxation exercises 2. administering a sedative PRN 3. providing a soft, bland diet 4. administering famotidine as ordered

4. administering famotidine as ordered

The nurse is caring for a client who has deep-partial thickness and full-thickness burns. During the emergent (resuscitative) phase of burn management, the nurse should assess the client for a fluid shift from the: 1. intracellular to extracellular compartment 2. extracellular to intravascular compartment 3. interstitial to intravascular compartment 4. intravascular to interstitial compartment

4. intravascular to interstitial compartment

5. The nurse is caring for a client with severe burns who is receiving fluid resuscitation. Which of the following indicates that the client is responding to the fluid resuscitation? 1. Pulse rate of 112. 2. Blood pressure of 94/ 64. 3. Urine output of 30 mL/ h. 4. Serum sodium level of 136 mEq/ L (136 mmol/ L).

5. 3. Ensuring a urine output of 30 to 50 mL/ h is the best measure of adequate fluid resuscitation. The heart rate is elevated, but is not an indicator of adequate fluid balance. The blood pressure is low, likely related to the hypervolemia, but urinary output is the more accurate indicator of fluid balance and kidney function. The sodium level is within normal limits.

A client's burn wounds are being cleaned twice a day in a hydrotherapy tub. Which intervention should be included in the plan of care before a hydrotherapy tx is initiated? 1. limit food and fluids 45 mins before to prevent N & V 2. increase IV flow rate to offset fluids lost during the therapy. 3. apply a topical ATB cream to burns to prevent infection 4. administer pain medications 30 minutes before therapy to help manage pain

4. administer pain medications 30 minutes before therapy to help manage pain

What is the primary goal of nursing care during the emergent phase after a burn injury? 1. replace lost fluids 2. Prevent infection 3. control pain 4. promote wound healing

1. replace lost fluids most important to prevent the complication of hypovolemic shock from occurring.

10. The nurse should plan to begin rehabilitation efforts for the burn client: 1. Immediately after the burn has occurred. 2. After the client's circulatory status has been stabilized. 3. After grafting of the burn wounds has occurred. 4. After the client's pain has been eliminated.

10. 2. Rehabilitation efforts are implemented as soon as the client's condition is stabilized. Early emphasis on rehabilitation is important to decrease complications and to help ensure that the client will be able to make the adjustments necessary to return to an optimal state ofhealth and independence . It is not possible to completely eliminate the client's pain; pain control is a major challenge in burn care.

11. During the early phase of burn care, the nurse should assess the client for? 1. Hypernatremia. 2. Hyponatremia. 3. Metabolic alkalosis. 4. Hyperkalemia.

11. 4. Immediately after a burn, excessive potassium from cell destruction is released into the extracellular fluid. Hyponatremia is a common electrolyte imbalance in the burn client that occurs within the first week after being burned. Metabolic acidosis usually occurs as a result of the loss of sodium bicarbonate.

15. The rate at which IV fluids are infused is based on the burn client's: 1. Lean muscle mass and body surface area (BSA) burned. 2. Total body weight and BSA burned. 3. Total BSA and BSA burned. 4. Height and weight and BSA burned.

15. 2. During the first 24 hours, fluid replacement for an adult burn client is based on total body weight and BSA burned. Lean muscle mass considers only muscle mass; replacement is based on total body weight . Total surface area is estimated by taking into account the individual's height and weight.

16. The nurse is conducting a focused assessment of the gastrointestinal system of a client with a burn injury . The nurse should assess the client for: 1. Paralytic ileus . 2. Gastric distention. 3. Hiatal hernia. 4. Curling's ulcer.

16. 4. Curling's ulcer, or gastrointestinal ulceration, occurs in about half of the clients with a burn injury. The incidence of ulceration appears proportional to the extent of the burns, and the ulceration is believed to be caused by hypersecretion of gastric acid and compromised gastrointestinal perfusion. Paralytic ileus and gastric distention do not result from hypersecretion of gastric acid and stress. Hiatal hernia is not necessarily a potential complication of a burn injury.

8. An advantage of using biologic burn grafts such as porcine (pigskin) grafts is that they: 1. Encourage the formation of tough skin. 2. Promote the growth of epithelial tissue 3. Provide for permanent wound closure. 4. Facilitate the development of subcutaneous tissue.

8. 2. Biologic dressings such as porcine grafts serve many purposes for a client with severe burns. They enhance the growth of epithelial tissues, minimize the overgrowth of granulation tissue, prevent loss of water and protein, decrease pain, increase mobility, and help prevent infection. They do not encourage growth of tougher skin, provide for permanent wound closure, or facilitate growth of subcutaneous tissue.

.13. A client is receiving fluid replacement with lactated Ringer's after 40% of the body was burned 10 hours ago. The assessment reveals temperature 36.2 ° C, heart rate 122 , blood pressure 84/ 42, Central venous pressure (CVP) 2 mm Hg, and urine output 25 mL for the last 2 hours. The IV rate is currently at 375 mL /h. Using the SBAR (Situation-Background-Assessment-Recommendation) technique for communication, the nurse calls the health care provider with a recommendation for: 1. Furosemide (Lasix). 2. Fresh frozen plasma. 3. IV rate increase. 4. Dextrose 5%.

13. 3. The decreased urine output, low blood pressure, low CVP, and high heart rateindicate hypovolemia and the need to increase fluid volume replacement. Furosemide is a diuretic that should not be given due to the existing fluid volume deficit. Fresh frozen plasma is not indicated. It is given for clients with deficient clotting factors who are bleeding . Fluid replacement used for burns is lactated Ringer's solution, normal saline, or albumin.

14. After the initial phase of the burn injury, the client's plan of care will focus primarily on: 1. Helping the client maintain a positive self-concept. 2. Promoting hygiene. 3. Preventing infection. 4. Educating the client regarding care of the skin grafts.

14. 3. The inflammatory response begins when a burn is sustained. As a result of the burn, the immune system becomes impaired. There are a decrease in immunoglobulins, changes in white blood cells, alterations of lymphocytes, and decreased levels of interleukin. The human body's protective barrier, the skin, has been damaged. As a result, the burn client becomes vulnerable to infections. Education and interventions to maintain a positive self-concept would be appropriate during the rehabilitation phase. Promoting hygiene helps the client feel comfortable; however, the primary focus is on reducing the risk for infection.

Using the Parkland formula, calculate the hourly rate of fluid replacement with lactated Ringer's solution during the first 8 hours for a client weighing 75 kg with total body surface area (TBSA) burn of 40%. _______________ mL/ hour.

18. 750 mL/hour. Lactated Ringer's solution 4 mL × weight in kg × TBSA; half given over the first 8 hours and half givenover the next 16 hours.

The nurse is assessing a client who is 2 years of age and in the ED for burns on both lower feet, legs, and buttocks. The only area not burned from the waist down is the inside of the back of the knee. The parents inform the nurse that the child stepped into the bathtub and sat down in the water when it was too hot. What should the nurse do in order of priority? 1. Provide fluid resuscitation and pain medications 2. Assess burn depth in different areas 3. Document parent-child interactions 4. Report incident to authorities

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2. The nurse is assessing an 80-year-old client who has scald burns on the hands and both forearms (first- and second-degree burns on 10% of the body surface area). What should the nurse do first? 1. Clean the wounds with warm water. 2. Apply antibiotic cream. 3. Refer the client to a burn center. 4. Cover the burns with a sterile dressing.

2. 3. The nurse should have the client transported to a burn center. The client's age and the extent of the burns require care by a burn team and the client meets triage criteria for referral to a burn center. Because of theage of the client and the extent of the burns, the nurse should not treat the burn. Scald burns are not at high risk for infection and do not need to be cleaned, covered, or treated with antibiotic cream at this time.

6. Which of the following activities should the nurse include in the plan of care for a client with burn injuries to be carried out about one-half hour before the daily whirlpool bath and dressing change? 1. Soak the dressing. 2. Remove the dressing. 3. Administer an analgesic. 4. Slit the dressing with blunt scissors.

6. 3. Removing dressings from severe burns exposes sensitive nerve endings to the air, which is painful. The client should be given a prescribed analgesic about one-half hour before the dressing change to promote comfort. The other activities are done as part of the whirlpool and dressing change process and not one-half hour beforehand.

7. The client with a major burn injury receives total parenteral nutrition (TPN). The expected outcome is to: 1. Correct water and electrolyte imbalances. 2. Allow the gastrointestinal tract to rest. 3. Provide supplemental vitamins and minerals. 4. Ensure adequate caloric and protein

7. 4. Nutritional support with sufficient calories and protein is extremely important for a client with severe burns because of the loss of plasma protein through injured capillaries and an increased metabolic rate . Gastric dilation and paralytic ileus commonly occur in clients with severe burns, making oral fluids and foods contraindicated. Water and electrolyte imbalances can be corrected by administration of IV fluids with electrolyte additives, although TPN typically includes all necessary electrolytes. Resting thegastrointestinal tract may help prevent paralytic ileus, and TPN provides vitamins and minerals ; however, the primary reason for starting TPN is to provide the protein necessary for tissue healing.

9. Which of the following factors would have the least influence on the survival and effectiveness of a burn victim's porcine grafts? 1. Absence of infection in the wounds. 2. Adequate vascularization in the grafted area. 3. Immobilization of the area being grafted . 4. Use of analgesics as necessary for pain relief.

9. 4. Analgesic administration to keep a burn victim comfortable is important but is unlikely to influence graft survival and effectiveness. Absence of infection, adequate vascularization, and immobilization of the grafted area promote an effective graft. CN: Physiological adaptation;

12. Which of the following clients with burns will most likely require an endotracheal or tracheostomy tube? A client who has: 1. Electrical burns of the hands and arms causing arrhythmias. 2. Thermal burns to the head, face, and airway resulting in hypoxia . 3. Chemical burns on the chest and abdomen. 4. Secondhand smoke inhalation.

12. 2. Airway management is the priority in caring for a burn client. Tracheostomy or endotracheal intubation is anticipated when significant thermal and smoke inhalation burns occur. Clients who have experienced burns to the face and neck usually will be compromised within 1 to 2 hours. Electrical burns of the hands and arms, even with cardiac arrhythmias, or a chemical burn of the chest and abdomen is not likely to result in the need for intubation. Secondhand smoke inhalation does influence an individual's respiratory status but does not require intubation unless the individual has an allergic reaction to the smoke.

The nurse is assessing an older adult who is living with his sons family. The client has scald burns on the hands and both forearms (10% first and second degree) The nurse should first: 1. cleanse wounds with warm water 2. apply ATB cream 3. call fro transport to hospital 4. cover burns with sterile dressing

3. call fro transport to hospital Client's age and extent of burns require care by a healthcare team.

A child with partial and full-thickness burns is admitted to the pediatric unit. What should the priority be at this time? 1. preventing wound infection 2. evaluating VS frequently 3. maintaining fluid and electrolyte balance 4. managing child's pain

3. maintaining fluid and electrolyte balance

4. A client is admitted to the hospital after sustaining burns to the chest, abdomen , right arm, and right leg. The shaded areas in the illustration indicate the burned areas on the client's body. Using the "rule of nines," estimate what percentage of the client's body surface has been burned. 1. 18%. 2. 27%. 3. 45%. 4. 64%.

4. 3. According to the rule of nines, this client has sustained burns on about 45% of the body surface. The right arm is calculated as being 9%, the right leg is 18%, and the anterior trunk is 18%, for a total of 45%.

17. In the acute phase of burn injury, which pain medication would most likely be given to the client to decrease the perception of the pain? 1. Oral analgesics such as ibuprofen (Motrin) or acetaminophen (Tylenol). 2. Intravenous opioids. 3. Intramuscular opioids. 4. Oral antianxiety agents such as lorazepam (Ativan).

17. 2. The severe pain experienced by burn clients requires opioid analgesics. In addition, opioids such as morphine sedate and alleviate apprehension. Oral analgesics such as ibuprofen or acetaminophen are unlikely to be strong enough to effectively manage the intense pain experienced by the client who is severely burned. Because of the altered tissue perfusion from the burn injury, intravenous medications are preferred . Antianxiety agents are not effective against pain.

The mother calls the nurse to report that her toddler has just been burned on the arm. The nurse should advise the mother to first: 1. pack arm in ice, then take child to closest ED 2. rub burned area with ATB ointment and then call child's HCP 3. run cool water over burned area, then wrap in clean cloth 4. call child's HCP immediately and then wrap arm in clean cloth

3. run cool water over burned area, then wrap in clean cloth once this is done then she should call HCP ice can only cause more damage and ATB ointment should not be applied until extent of burn evaluated.

The nurse is caring for a client who has severe burns on the head, neck, trunk, and groin areas. Which position would be most appropriate for preventing contractures? 1. high-fowlers 2. semi-fowlers 3. prone 4. supine

4. supine