Burns Chap 51
A nurse is caring for an adolescent client who has burn wounds on her face and hands. Which of the following statements by the client indicates that she has adapted to her changed body image? A. May I go with my family to the visitors lounge? B. I'll see my friends when I get home C. My dad is coming to visit. Can you fix my hair for me? D. I told my cousins I'm in protective isolation
A
Describe a thermal burn
A result of a flash, scald, or contact with hot objects of flames and common causes include house fires, car fires, cooking accidents, or injuries of careless smoking
What are common signs of inhalation injury? A. Facial burns B. Singed facial hair C. Bradypnea D. Carbon in the sputum E. Erythema on the arms and legs
A. Facial burns B. Singed facial hair D. Carbon in the sputum Along with tachypnea
A patient was admitted to the hospital with superficial burns. Which clinical manifestation is likely to be observed in the patient? Select all that apply. A. Mild erythema B. Hypersensitivity C. Waxy appearance D. Wet blisters E. Leathery skin
A. Mild erythema B. Hypersensitivity Waxy appearance is a manifestation of a deep partial thickness burn. Wet blisters are a manifestation a deep partial thickness burn. Leathery skin is a manifestation of a full thickness burn
Describe a radiation burn
Associated with the industrial use of ionizing radiation, nuclear accidents, and therapeutic radiation treatment Sunburn is the most common type of radiation burn
A nurse is caring for a client who has a prescription for silver sulfadiazine cream to be applied to her burn wounds. The nurse should evaluate the client which of the following laboratory findings? A. Hyponatremia B. Leukopenia C. Hyperchloremia D. Elevated BUN
B. Leukopenia
A nurse is elevating the laboratory values of a client who is in the resuscitation phase following a major burn. Which of the following laboratory findings should the nurse report? A. Hemoglobin 10g/dL B. Sodium 132 mEq/L C. Albumin 3.6g/dL D. Potassium 4.0 mEq/L
B. Sodium 132 mEq/L Anticipate a low sodium level due to the sodium being trapped in interstitial space
Which abnormal laboratory finding would the nurse anticipate for a patient experiencing the early stages of burn shock after an electrical burn? A. Decreased hematocrit B. Hypokalemia C. Increased hemoglobin D. Hypernatremia
C. Increased hemoglobin Destruction of red blood cells result in free hemoglobin being released into the body following a major burn injury
What is treatment for a partial thickness burn? A. "I should pop the blisters to promote healing" B. "I should change the dressing at least once every 2 days" C. "I should wash the area with cold water and apply ice if a blister is broken" D. "I should apply a Bacitracin ointment and cover with a non adherent bandage"
D. "I should apply a Bacitracin ointment and cover with a non adherent bandage"
A nurse is assessing a client who sustained partial-thickness and deep partial-thickness burns 72 hours ago. Which of the following findings should the nurse report to the provider? A. Edema in the burned extremities B. Severe pain at burn sites C.Urine output of 30mL/hr D. Temperature of 39.1 degrees of celsius (102.4 degrees F)
D. Temperature of 39.1 degrees C Indicates infection
Describe a electrical burn
Electrical injury is caused by electrical currents flowing through the body and may occur by direct contact with the source, by an arc between two objects, or because of a flame injury caused by ignition of the surroundings
What are lab values that you expect to see after a burn?
Elevated hemoglobin due to loss of fluid volume Low sodium Low albumin Elevated potassium
Describe a chemical burn
Examples include those caused by cement, gasoline, lime, hydrofluoric acid, and bleach
Describe a deep partial thickness burn
It may cause pain in various areas with decreased sensation May require more than 2 weeks for healing Includes the epidermis and the deep portions or bottom layers of the dermis
Describe a full thickness burn
Often referred to as eschar as it destroys the epidermis, dermis, and portions of the subcutaneous tissue Will not heal without excision and grafting Leathery skin
Describe a superficial burn
Will heal in 3 to 7 days