Burns

what lines/tubes do they need

2 large bore IV or central, NG, Foley

Parkland forumla

4 ml X BSA (%) x weight (Kg)

What should the urine output be after fluid replacement

0.5-1.0 ml/kg in adults

direct exposure to heat source --> cellular destruction

thermal burn

Four types of burns

thermal, chemical, electrical, radiation

large fluid and protein shifts between vascular and interstitial spaces

third spacing

when does fluid resuscitation start

time of burn injury starts the clock, NOT when resuscitation was started

What does a nurse need to initially identify on a burn victim

time of injury, type of burn, related trauma

Systemic Effects of Burn Injuries

Fluid and Electrolyte Imbalances Hypothermia compromised respiratory system dysrhythmias hypovolemic shock, integumentary infection

what is the parkland formula used for?

Fluid resuscitation in burns

Rule of 9's adult

Head = 9% Chest (front) = 9% Abdomen (front) = 9% Upper/mid/low back and buttocks = 18% Each arm = 9% (front = 4.5%, back = 4.5%) Groin = 1% Each leg = 18% total (front = 9%, back = 9%)

what crystalloid solutions are given in burns?

LR 0.9% normal saline 0.45% normal saline

what initial interventions after ABCs

vitals, lines/tubes, pain management, tetanus immunization status, foley catheter, core temperature, psychosocial support

What are the nursing considerations relating to weight in third spacing?

weight is the most accurate measurement of fluid

what colloid solutions are given in burns?

whole blood PRBCs FFP

two ways an electrical burn can occur

alternating current and direct current

What does ABCs include

assessing for inhalation injury pulse assessments, chest/abdominal constriction

hallmark sign of differing symptoms between partial and superficial

blistering

characteristics of partial/second degree burns

blisters and weeps, risk for infection and scarring

how do burns affect the respiratory system

burn to the chest and can't breathe properly, burn your airway, hair is burned around the mouth, voice is hoarse, stridor

what do third degree burns look like

charred, waxy white

direct contact between skin and acids, alkaline agents, organic compounds

chemical burns

how is an escharotomy done

cut an "H" shape

how can burns affect the GI system

decreased peristalsis, paralytic ileus, stress ulcers

Characteristics of full thickness burns

dry, insensate to light tough and pin prick, high risk for infection

what lab values do we monitor?

electrolytes- fluid loss, sodium, potassium, and chloride leave the cell --> dysrhythmias

how can we promote skin integrity

saran wrap acts as skin

Types of burn depths

superficial, partial thickness, full thickness, fourth degree

what is a burn injury caused by

exposure to heat, chemicals, radiation, and electricity

what should you look for with inhalation injury

facial burns, singed nasal hairs, soot in upper airways, voice changes

how is the fluid administered using the parkland formula

give half of the solution for first 8 hours and the other half of the solution for the next 16 hours

an example of alternating current

households

how can a burn affect immune system

increased risk for infection

what are you at an increased risk for with increasing depth

infection and scarring

characteristics of fourth degree burn

involves muscle or bone

an example of direct current

lighting strike

why are fourth degree burns not painful?

nerves are damaged

independent nursing interventions for airway

oxygen, positioning, suctioning, assess the airway, oropharyngeal airway, nasopharyngeal airway

what are the characteristics of superficial thickness burn

painful, does not blister, does not scar

Planning

prevent of potential complications maintain nutrition skin integrity pain and discomfort physical mobility, coping strategies

purpose of the skin

protect against infection, pathogens, thermoregulation, holds in fluid

what nutrient is important for burns

protein for proper wound healing

this type of burn is caused by sunburn, radiation treatment, nuclear power accidents

radiation burns

how can burns affect urinary system

reduced renal blood flow and GFR, myoglobinuria, hemoglobinuria

Interventions

remove burn source, restoring normal fluid balance, monitoring VS continuously, monitoring pulses, monitor lab values

how does one stop the burning process

remove clothing/jewelry and flush

how do we remove the burn source

removing clothes, remove them from the fire, take of jewelry, flush and wash the area