eaq burn management

The patient in the emergent phase of a burn injury is being treated for pain. What medication should the nurse anticipate using for this patient?

Intravenous (IV) morphine sulfate

The nurse is providing education to a patient who is in the rehabilitation phase of burn recovery after burning the arm with scalding water. Which of these statements by the patient indicates a need for further instruction?

"After a month, I will be able to go to the beach to get a tan."

rehabilitative phase goals

the goals of this phase are designed so that the client can gain independence and achieve maximal function, promote wound healing, minimize deformities, increase strength and function, provide emotional support

resuscitation / emergent phase goal

the primary goal is to maintain a patent airway, admin IV fluids to prevent hypovolemic shock, and preserve cital organ function

anti-burn scar support garments are usually prescribed to be worn ____________ hours a day until the burn scar tissue has matured, which takes 18 to 24 months

18

Fluid resuscitation is an important intervention in burn patients. The nurse recognizes that what fluid is recommended for the first 24 hours after a burn?

2 to 4 mL lactated Ringer's/kg/%TBSA burned Fluid resuscitation is an important intervention in burn management. It helps to replenish the fluid loss caused by burns and maintain the fluid and electrolyte balance. The fluid recommendation for the first 24 hours is 2 to 4 mL lactated Ringer's/kg/%TBSA burned. A fluid volume of 1 to 2 mL lactated Ringer's/kg/%TBSA burned would be inadequate to meet the patient's requirement. Volumes of 6 to 8 mL lactated Ringer's/kg/%TBSA burned and 8 to 10 mL lactated Ringer's/kg/%TBSA burned may cause fluid overload.

what is the urine output goal for a burn patient

30 to 50mL per hour

A burn patient has not received any active tetanus immunization within the previous 12 years. What is the primary nursing measure to help prevent the development of tetanus in the patient?

Administer tetanus immunoglobulin

A nurse is attending to a patient with extensive burns. What prophylactic treatment should the nurse plan to prevent a Curling's ulcer in this patient? Select all that apply.

Antacids H2-histamine blockers Proton pump inhibitors Antacids are used prophylactically to neutralize the acids present in the stomach. H2-histamine blockers (e.g., ranitidine) are used to inhibit histamine, which causes an increase in acid levels. Proton pump inhibitors (e.g., esomeprazole) help to inhibit the secretion of hydrochloric acid, which increases as a stress response to the decreased blood flow to the gastrointestinal tract after burns. Antidiarrheals are useful in providing symptomatic relief for diarrhea. They cannot prevent a Curling's ulcer. Calcium channel blockers have no effect on protecting the gastrointestinal tract or on preventing development of Curling's ulcers.

A patient is admitted to the burn center with burns of the face, upper chest, and hands after fireworks exploded in the patient's garage, catching the patient's shirt on fire. On assessment, the nurse notes that the patient is coughing up black sputum, has singed nasal hair, darkened oral and nasal membranes, and smoky breath with increasing shortness of breath and hoarseness. Which of these actions would be the most appropriate for the nurse to take next?

Anticipate the need for endotracheal intubation and notify the health care provider. Inhalation injury results from exposure of the respiratory tract to intense heat or flames with inhalation of noxious chemicals, smoke, or carbon monoxide. The nurse should anticipate the need for endotracheal intubation and mechanical ventilation, because this patient is demonstrating signs of severe respiratory distress. The nurse should also obtain vital signs and ABGs and insert a Foley, but these interventions are not a priority at this time. A sputum sample is not necessary at this time.

A patient has 20% total body surface area (TBSA) burns from a brush fire. For the past week, the patient's wounds have been debrided and covered with a silver-impregnated dressing. Today the nurse noticed that the partial-thickness burn wounds have been fully debrided. What would be the nurse's priority intervention for wound care at this time?

Apply fine-meshed petroleum gauze to the debrided areas.

When attending to a patient with severe burns, what precautions should the nurse take to maintain adequate nutrition? Select all that apply.

Assess bowel sounds every eight hours. Begin early enteral feeding with smaller-bore tubes. Begin the feedings slowly at a rate of 20 to 40 mL/hr.

A nurse is attending to a patient with partial-thickness burns on the face, including corneal burns. What should she do to protect the eyes of the patient? Select all that apply.

Use antibiotic ointments. Instill methylcellulose eye drops. Arrange for ophthalmology examination.

A nurse is attending to a patient who has sustained full-thickness burns covering more than 20% of total body surface area (TBSA). Which initial interventions should the nurse perform as a part of emergency burn management? Select all that apply.

Begin fluid replacement. Cover burned areas with dry dressings. Establish IV access with two large-bore catheters.

A patient has sustained thermal injuries amounting to approximately 30% of his or her total body surface area. What action should the nurse take first?

Check for a patent airway, breathing, and circulation. The first step in the management of a person who has sustained thermal injuries on 10% or more of his or her body surface is to assess the airway, breathing, and circulation. If the injury is less than 10% of total body surface area, then it would be appropriate to cover the burned area with a clean, cool, damp towel, but only after the airway, breathing, and circulation have been checked. It is not appropriate to cover the patient's afflicted area with ice, because this can cause hypothermia and vasoconstriction, which would further reduce the blood flow to the injury site. Immersing the patient or the patient's afflicted area in cool water may cause extensive heat loss.

A patient is suspected to have a smoke inhalation burn and carboxyhemoglobinemia. In what order should the nurse perform the treatment interventions?

Correct 1.Check for a patent airway and soot around nares and tongue. Correct 2.Check for the adequacy of ventilation. Correct 3.Check for the patient's pulse. Correct 4.Elevate any burned limbs above the heart to decrease pain and swelling.

The nurse collaborates with the health care team regarding the treatment of partial-thickness second-degree burn to the chest, abdomen, and both anterior thighs sustained by a patient. Which treatment does the nurse recognize as appropriate and within the scope of nursing practice?

Daily wound cleaning with debridement and sterile dressing changes

Which intervention would the nurse provide when caring for a patient with a burn injury who is in the in the acute phase?

Encourage and assist patient with self-care as possible

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, what dietary choices should the nurse implement?

High-calorie and high-protein foods

An 82-year-old patient is moving into an independent living facility. What is the best advice the nurse can give to the family to help prevent this patient from being accidentally burned in the new home?

Install tap water anti-scald devices

When caring for a patient with an electrical burn injury, which prescription from the health care provider should the nurse question?

Lactated Ringer's at 25 mL/hr 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 2 to 4 mL/kg/% total body surface area (TBSA), a rate sufficient to maintain urinary output at 75 to 100 mL/hr. An infusion rate of 25 mL/hr is not sufficient to maintain adequate urine output in prevention and treatment of ATN. Mannitol also can be used to maintain urine output. The urine would be monitored also for the presence of myoglobin. Sodium bicarbonate may be given to alkalinize the urine.

The patient in the acute phase of burn care has electrical burns on the left side of the body, type 2 diabetes mellitus, and a serum glucose level of 485 mg/dL. What should be the nurse's priority intervention to prevent a life-threatening complication of hyperglycemia for this burned patient?

Maintain fluid balance This patient most likely is experiencing hyperosmolar hyperglycemic syndrome (HHS). HHS dehydrates a patient rapidly. Thus HHS combined with the massive fluid losses of a burn tremendously increases this patient's risk for hypovolemic shock and serious hypotension. This is clearly the nurse's priority, because the nurse must keep up with the patient's fluid requirements to prevent circulatory collapse caused by low intravascular volume. There is no mention of blood loss. Fluid resuscitation will help to correct the pH and serum potassium abnormalities.

While treating a patient who is administered initial emergency burn care and is in the acute phase of burns, what actions should the nurse perform as a part of respiratory therapy? Select all that apply.

Monitor for signs of complications.4. Continue assessing oxygenation needs.5 .Continue to monitor respiratory status.The nurse should monitor for signs of respiratory complications of burns to plan for appropriate respiratory therapy. Continue assessing oxygenation needs to plan for any alternations in oxygen supply. Continue to monitor the respiratory status to ensure proper breathing and circulation. Avoiding supplemental oxygen is not advisable, as oxygen needs may be assessed and started as required. Preparing for discharging the patient needs to be planned in the rehabilitation phase after the patient has recovered.

When teaching patients and caregivers about the strategies to reduce burn injuries, what essential instructions does the nurse give? Select all that apply.

Never leave burning candles unattended or near windows or curtains. Ensure an electrical power source is shut off before beginning repairs. Check temperature of bath water with the back of hand or bath thermometer.

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 recommendation?

One-half of the total 24-hour fluid requirement should be administered in the first 8 hours.

Fluid resuscitation with the ____________________________recommends that one half of the total fluid requirement should be administered in the first eight hours, one quarter of total fluid requirement should be administered in the second eight hours, and one quarter of total fluid requirement should be administered in the third eight hours.

Parkland (Baxter) formula

resuscitation phase

begins with the initiation of fluids, ends when capillary integrity returns to near normal levels and large fluid shifts have decreased. amount of fluid administered is based on clients weight and extent of injury. note that most fluid replacement formulas are calculated from the time of injury and not from the time of arrival to the hospital

The patient received a cultured epithelial autograft (CEA) to the entire left leg. What should the nurse include in the discharge teaching for this patient?

Refer the patient to a counselor for psychosocial support

A patient with partial-thickness burns is now allowed oral feedings. What nursing interventions should the nurse perform to maintain the patient's nutrition? Select all that apply.

Suggest a high-protein diet. Suggest a high-carbohydrate diet Ask caregivers to get the patient's favorite food..

the hematocrit level _______________ as a result of plasma loss; this initial ________________ falls to below normal by the third or fourth day after the burn as a result of red blood cell damage and loss at the time of injury

increase; increase

rehabilitative phase of burn injury

overlaps acute phase of care extends beyond hospitalization

A nurse is involved in the wound care of patients on the burn management unit. What precautions should the nurse take while performing wound care? Select all that apply.

The nurse wears personal protective equipment. The nurse uses sterile gloves when applying sterile dressings. The nurse uses nonsterile gloves when removing contaminated dressings.

Parkland (Baxter) Formula

Total first 24hr Volume to receive: 4mL per kg per % of Total Body Surface Area -1/2 in first 8 hrs (total volume) -1/4 in second 8 hrs -1/4 in last 8 hrs

Discussing the need for both home care following discharge and the need for reconstructive surgery occur during the _______________________________

rehabilitation phase.

physical therapy for burn patients

splinting to prevent contractures, range of motion to reduce edema and maintain muscle and joint strength, scarring is controlled by elastic wraps

what prophylaxis is prescribed during a burn injury

tetanus

priority nursing actions burn injury

assess for airway patency, admin O2, obtain VS, initiate IV and fluid replacement, Elevate extremities, keep pt warm and NPO

acute phase of burn injury goal

the emphasis during this phase is placed on restorative therapy and the phase continues until wound closure is achieved

resuscitaiton/emergent phase

begins at the time injury and ends with the restoration of normal capillary permeability. duration usually 48-72 hours includes prehospital care and emergency department care

acute phase of burn injury

begins when the patient is hemodynamically stable, capillary permeability is restored and diuresis has bugun, usually begins 48 to 72 hours after time of injury, focus on infection control, wound care, wound closure, nutritional support, pain management, and physical therapy

resuscitative phase goal

the goal is to prevent shock by maintaining adequate circulating blood volume and maintaining vital organ perfusion

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

catabolism

Burn patients must protect healed burn areas from _________________________for about three months to prevent hyperpigmentation and sunburn injury. They should always wear sunscreen when they are outside. Water-based moisturizers are appropriate for itching. Pressure garments and masks should never be worn over unhealed wounds and, once a wearing schedule has been established, are removed only for short periods while bathing. Pressure garments are worn up to 24 hours a day for as long as 12 to 18 months. The range-of-motion exercises are important to prevent contractures that may develop as new tissue shortens.

direct sunlight

Beginning fluid replacement occurs in the _____________________

emergent phase.

what electroytes shift in the first stage of a burn injury

hyponatremia and hyperkalemia occur