Chapter 62: Management of patients with burn injuries

The nurse is monitoring for fluid and electrolyte changes in the emergent phase of burn injury for a patient. Which will be an expected outcome?

- Base-Bicarbonate deficit - Elevated hematocrit level - Sodium deficit

The nurse is monitoring a patient during the fluid remobilization phase of a burn injury. What expected findings should the nurse monitor for?

- Hemodilation - Increased urinary output - sodium deficit

According to the rule of 9's, brad has been burned over 13.5% of his body. According to the american burn association fluid resuscitation guide, how much fluid should he receive in the first 24 hours after the burn injury?

1944 mL: 2 mL lactated ringers x patients weight in kg, (72) x 96 TBSA (13.5), second, third, and fourth degree burns.

The nurse is planning the care care of a patient with a major burn. What outcome will be optimal during fluid replacement?

A urinary output of 30 mL/h

The nurse is applying an occlusive dressing to a burned foot. What position should the foot be placed in after application of the dressing?

Adduction

What factors have been instrumental in improving the survival rate for burn victims in the last 80 years?

Advances in burn care over the past 80 years have contributed to significant improvements in morbidity and mortality of patterns with burns. These advances include the introduction of systemic antibiotics and topical antimicrobials, advances in fluid resuscitation, aggressive nutrition, early excision and wound closure, the introduction of engineered tissue therapies, and the advent of specialized over time.

Describe the measures that can be taken to avoid the development of hypertrophic and keloid scars after a burn injury?

Preventative treatment modalities are used to prevent scar contractures and excess hypertrophic tissue. Compression is introduced early i burin wound treatment. Elastic bandage wraps are used initially to help promote adequate circulation, but they can also be used at the first from of compression for scar management, followed by elasticized tubular bandage until the patient can be measured for a customized garment.

What types of general emergency procedures should be employed at the burn scene?

Primary survey, prevention of shock, prevention of respiratory distress, detection and treatment of concomitant injuries, wound assessment, and initial care.

A person experiences leg burns from spilled charcoal lighter fluid. A family member extinguishes the flames. While waiting for an ambulance, what should the burned person do?

Be assisted into a bath of cool water while waiting for the emergency personnel.

Explain the pathophysiology of carbon monoxide poisoning?

Carbon monoxide, a byproduct of the combustion of organic materials, combines with hemoglobin to form carboxyhemoglobin, carboxyhemoglobin competes with oxygen with oxygen for available hemoglobin binding sites.

The nurse in the emergency department receives a patient who sustained a severe burn injury. What is the priority action by the nurse in this situation?

Establish a patent airway

The nurse is caring for a patient who sustained a fill thickness burn to the arm after being scalded with boiling water. How did the nurse determine that the patients burs are full thickness burns?

Identification by the destruction of the dermis and the epidermis.

Escharotomy

Linear excision made through the eschar to release the constriction of underlying tissue.

the nurse is caring for a patient who sustained a major burn. What serious GI disturbance should the nurse monitor for that frequently occurs with a major burn?

Paralytic ileus

Burn injuries are classified according to __________________________________, and _____________________________________________________.

the depth of the injury, the extent of the injured body surface area.

Debridement

Removal of foreign material and devitalized tissue until surrounding healthy tissue is exposed.

The three commonly used topical antibacterials for skin care are ______________________, _______________________, and ______________________.

Silver sulfadizine (Silvadene), silver nitrate, mafenide acetate(sulfomylon)

The nurse is providing wound care for a client with burns to the lower extremities. Which topical antibacterial agent carries a side effect of leukopenia that the nurse should monitor for within 48 hours after application?

Sulfadiazine, silver (Silvadene)

What are three zones of burn injury and what areas are involved with each?

The central area of the wound is termed the zone of coagulation due to the characteristic coagulation necrosis of cells that occurs. The surrounding zone, the zone of stasis, describes an area of injured cells that may remain viable but, with persistent decreased blood flow, will undergo necrosis within 24-48 hours. The zone of hyperemia, the outermost zone, sustains minimal injury and may fully recover over time.

The nurse is performing a secondary survey for a patient who sustained severe burns. What should the nurse include in this survey?

The secondary survey focuses on obtaining a history, the completion of the total body system assessment, initial fluid resuscitation, and provision of psychosocial support of the conscious patient.

The nurse is assessing a patient for signs of potassium shifting during the acute phase of burn injury. During which time frame should the nurse assess for signs of potassium shifting?

beginning on day 4 or 5

Burns that exceed ________________ of the TBSA are considered major burn injuries and produce both a local and a systemic inflammatory response.

one third

The three major bacteria responsible for infection in burn centers are _____________________, ________________________, and ___________________________.

pseudomonas, methicillin resistant staphylococcus , acinetrobacter

The leading cause of death in thermally injured patients is _____________________.

sepsis

The nurse is reviewing the lab studies for a patient during fluid remobilization after a major burn. What lab values observed by the nurse should be immediately reported?

serum sodium level of 140 mEq/L

Contracture

shrinkage of burn scar through collagen maturation

The nurse knows that which topical antibacterial agent does not penetrate eschar?

silver nitrate 0.5%

To meet early nutritional demands for protein, a 198 lb (90kg) burned patient will need to ingest a minimum of how much protein every 24 hours?

180 g/day

The resuscitation goal of fluid replacement therapy, post-burn injury, is a urinary output of _________ to__________________.

0.5 to 1.0mL/kg/h

A sample consensus formula for fluid replacement recommends that a balanced salt solution be administered in the first 24 hours of a burn in the range of 2 to 4 mL/kg/% of burn, with 50% of the total given in the first 8 hours postburn. A 176-lb (80-kg) man with a 30% burn should receive a minimum of how much fluid replacement in the first 8 hours?

2400 mL

Eschar

Devitalized tissue resulting from a burn or wound

Discuss why congestive heart failure is a potential complication of an acute burn.

Fluid overload may occur when fluid is mobilized from the interstitial compartment back into the intravascular compartment. If cardiac system cannot compensate for the excess volume, congestive heart failure may be a result.

Xenograft

Graft obtained from an animal of a species other than that of the recipient (ex: pigskin); also called a heterograft.

Homograft

Graft transferred from one human (living or cadaveric) to another human; also called allograft.

Fasciotomy

Incision made through the fascia to release constriction of underlying muscle.

When a patient sustains inhalation injury below the vocal cords, what is the usual cause?

Inhalation injury below the vocal cords results from inhaling the products of incomplete combustion or noxious gases and is often the source of the death at the scene of a fire.

What does the nurse prepare to assist with due to brads immediate condition?

Intubation and mechanical intubation, possible escharotomy to allow adequate chest expansion.

What does the depth of burn injury depend on?

The depth of the injury depends on the temperature of the burning agent and the duration of contact with the agent.

What two detrimental effects does radiation injury have?

The first is a thermal effect, which results in cutaneous burn injuries burn injuries. The second effect is damage to the cellular DNA, which may be localized or affect the whole body.

The two age groups that have increased morbidity and mortality from burn injuries are __________________ and ____________________.

Young children and older adults

Two pulmonary complications that occur secondary to inhalation injuries are _______________________ and ____________________________.

acute respiratory failure, and acute respiratory distress syndrome.

The nurse is administering an analgesic to a patient with major burns. What is the recommended route for administration for this patient?

intravenous

A patient will be receiving biologic dressings. The nurse understands that biologic dressings, which use skin from living or recently deceased humans, are known by which name?

homografts

The nurse is caring for a patient who is sustained severe burns to 50% of the body 3 days previously. What should the nurse report immediately when reviewing laboratory studied indicating massive cell destruction?

hyperkalemia

____________________ is the immediate consequence of ensuring fluid loss and results in decreased perfusion and oxygen delivery.

hypovolemia

Upon arrival at the emergency department, what indicators does the nurse have that brad may have inhalation injury as well as severe burn ?

if injury occurred in a small space ; burns on the face or neck; singed nasal hair; hoarseness, high pitched voice change, stridor, soot in the sputum; dyspnea or tachypnea, and other signs of reduced oxygen levels (hypoxemia); and erythema and blistering of the oral or pharyngeal mucosa.

Four signs of postburn sepsis include ____________________, ____________________, _____________________, and __________________________.

increased temperature, tachycardia, widened pulse pressure, flushed, dry skin in nonburned areas.