BURNS

PERMANENT GRAFT

PT'S OWN SKIN, BOVINE COLLAGEN, ACELLULAR DERMAL MATRIX FROM DONATED HUMAN SKIN

FLUID REPLACEMENT POST BURNS

2-4ML X WT IN KG X TBSA(TOTAL BODY SURFACE AREA BURNED)

A patient is admitted to the emergency department with first- and second-degree burns after being involved in a house fire. Which of the following assessment findings would alert you to the presence of an inhalation injury (select all that apply)? A) Singed nasal hair B) Generalized pallor C) Painful swallowing D) Burns on the upper extremities E) History of being involved in a large fire

A,B,C,E Reliable clues to the occurrence of inhalation injury is the presence of facial burns, singed nasal hair, hoarseness, painful swallowing, darkened oral and nasal membranes, carbonaceous sputum, history of being burned in an enclosed space, and "cherry red" skin color.

The nurse is planning care for a patient with partial- and full-thickness skin destruction related to burn injury of the lower extremities. Which of the following interventions would the nurse expect to include in this patient's care (select all that apply)? A) Escharotomy B) Administration of diuretics C) IV and oral pain medications D) Daily cleansing and debridement E) Application of topical antimicrobial agent

A,C,D,E An escharotomy (a scalpel incision through full-thickness eschar) is frequently required to restore circulation to compromised extremities. Daily cleansing and debridement as well as application of an antimicrobial ointment are expected interventions used to minimize infection and enhance wound healing. With full-thickness burns, myoglobin and hemoglobin released into the bloodstream can occlude renal tubules. Adequate fluid replacement is used to prevent this occlusion. Pain control is essential in the care of a patient with a burn injury.

A nurse is caring for a patient with second- and third-degree burns to 50% of the body. The nurse prepares fluid resuscitation based on knowledge of the Parkland (Baxter) formula that includes which of the following recommendations? A) The total 24-hour fluid requirement should be administered in the first 8 hours. B) One half of the total 24-hour fluid requirement should be administered in the first 8 hours. C) One third of the total 24-hour fluid requirement should be administered in the first 4 hours. D) One half of the total 24-hour fluid requirement should be administered in the first 4 hours.

B Fluid resuscitation with the Parkland (Baxter) formula recommends that one half of the total fluid requirement should be administered in the first 8 hours, one quarter of total fluid requirement should be administered in the second 8 hours, and one quarter of total fluid requirement should be administered in the third 8 hours.

The nurse is caring for a patient with superficial partial-thickness burns of the face sustained within the last 12 hours. Upon assessment, the nurse would expect to find which of the following symptoms? A) Blisters B) Reddening of the skin C) Destruction of all skin layers D) Damage to sebaceous glands

B The clinical appearance of superficial partial-thickness burns includes erythema, blanching with pressure, and pain and minimal swelling with no vesicles or blistering during the first 24 hours.

When caring for a patient with an electrical burn injury, the nurse should question a health care provider's order for A) Mannitol 75 gm IV. B) Urine for myoglobulin. C) Lactated Ringer's at 25 ml/hr. D) Sodium bicarbonate 24 mEq every 4 hours.

C Electrical injury puts the patient at risk for myoglobinuria, which can lead to acute renal tubular necrosis (ATN). Treatment consists of infusing lactated Ringer's at a rate sufficient to maintain urinary output at 75 to 100 ml/hr. Mannitol can also be used to maintain urine output. Sodium bicarbonate may be given to alkalinize the urine. The urine would also be monitored for the presence of myoglobin. An infusion rate of 25 ml/hr is not sufficient to maintain adequate urine output in prevention and treatment of ATN.

A patient is admitted with first- and second-degree burns covering the face, neck, entire right upper extremity, and the right anterior trunk area. Using the rule of nines, the nurse would calculate the extent of these burns as being A) 9%. B) 18%. C) 22.5%. D) 36%.

C Using the rule of nines, the face and neck together encompass 4.5% of the body area; the right upper arm encompasses 9% of the body area; and the entire anterior trunk encompasses 18% of the body area. Since the patient has burns on only the right side of the anterior trunk, the nurse would assess that burn as encompassing half of the 18%, or 9%. Therefore adding the three areas together, the nurse would correctly calculate the extent of this patient's burns to cover approximately 22.5% of the total body surface area.

The nurse is caring for a patient with partial- and full-thickness burns to 65% of the body. When planning nutritional interventions for this patient, the nurse should implement which of the following dietary choices? A) Full liquids only B) Whatever the patient requests C) High-protein and low-sodium foods D) High-calorie and high-protein foods

D A hypermetabolic state occurs proportional to the size of the burn area. Massive catabolism can occur and is characterized by protein breakdown and increases gluconeogenesis. Caloric needs are often in the 5000-kcal range. Failure to supply adequate calories and protein leads to malnutrition and delayed healing.

ACID BURNS

DRY, LEATHERY SKIN

1ST DEGREE BURNS

EPIDERMIS LEVEL, CHILLS, RED, PAINFUL, MINIMAL EDEMA, SUPERFICIAL, DRY

COMPLICATIONS OF ELECTRICAL INJURY

FRACTURES, ACUTE TUBULARNEPHROSIS, CARDIAC/REPIRATORY ARREST, MYOGLOBUNIRIA, BREAKDOWN OF MUSCLES, NEURO IMPAIRMENT

CURLINGS ULCER

GI BLEED, SPECIFIC TO BURNS

ALKALINE BURNS

GRAY, SLIPPERY SKIN

RULE OF NINES DONE ON ADMIT AND 24 HOURS LATER

HEAD-9 FACE-4.5 BACK OF HEAD-4.5 LEG-18 ARM-9 TRUNK-18 BACK-18 SCROTUM-1

ARC

INN ELECTRICAL BURNS, WHEN ELECTRICITY GOES FROM ONE PLACE TO ANOTHER IN THE BODY.

TEMPORARY GRAFTS

PORCINE, CADAVER, PORCINE COLLAGEN

3RD DEGREE BURNS

LESS PAIN D/T NERVE ENDINGS DESTROYED, FULL THICKNESS, MUSCLE, BONE

FLUID REPLACEMENT OF CHOICE WITH BURNS

LR

2ND DEGREE BURNS

PARTIAL THICKNESS, EPIDERMIS GONE, DERMIS INJURED, PAINFUL, RAPID HEAT LOSS

ICEBERG METAPHOR

SURFACE BENEATH BURN MAY BE WORSE.