Chap. 51: Patient with Burns

The nurse is caring for a patient with 70% total body surface area chemical burns. Which approach should the nurse anticipate to meet this patient's nutritional needs? 1) Parenteral nutrition 2) Duodenal tube feedings 3) Nasogastric tube feedings 4) Six small high-calorie meals per day

ANS: 2 In large burn injuries, longer nutritional support is required, and placement of a duodenal feeding tube is often recommended to help prevent aspiration and allow for feeding up to and during procedures.

A victim of a house fire is brought to the emergency department for burn treatment. What assessment finding indicates that the patient may have an inhalation injury? 1) Coughing 2) Soot on the face 3) Singed facial hair 4) Heart rate 98 bpm

ANS: 3 Patients with an inhalation injury may present with singed facial hair.

A patient is ending the first year of recovery after having burns to both legs. Which observation indicates that the patient needs to be encouraged to wear the pressure garment? 1) Skin warm and moist 2) Pedal pulses present but faint 3) Scattered areas of scarring noted 4) Nonpitting edema of both ankles

ANS: 3 Specialty pressure garments are intended to provide continuous and uniform pressure over the area of burn to prevent hypertrophic scarring. These garments are to be worn 23 hours a day for up to a year or more after injury in some patients. The presence of scarring indicates the garment has not been worn consistently.

The nurse is evaluating care provided to a patient with burns during the emergent phase. Which data indicates that additional fluid resuscitation is required? 1) Blood pH 7.39 2) Heart rate 112 bpm 3) Blood pressure 110/60 mm Hg 4) Central venous pressure 2 mm Hg

ANS: 4 Indications of adequate fluid resuscitation include a central venous pressure between 5-10 mm Hg. A pressure of 2 mm Hg indicates fluid volume deficit. More fluid would be indicated.

The nurse is evaluating nutritional teaching provided to a patient recovering from 24% total body surface area burns. Which information indicates that teaching has been effective? 1) Weight loss 3 kg 2) Serum protein level 7.1 g/dL 3) Serum albumin level 2.8 g/dL 4) +1 pitting edema of lower extremities

ANS: 2 A normal serum protein level is 6.4 to 8.3 g/dL.

The nurse is assisting with the secondary survey of a patient with 50% total body surface area electrical burns. Which test would be a priority for this patient? 1) Chest x-ray 2) Bronchoscopy 3) CT scan of the head 4) 12-lead electrocardiogram

ANS: 4 A 12-lead electrocardiogram is indicated for an electrical injury.

A patient recovering from 25% total body surface area burns has a low-grade fever. What should the nurse do to reduce this patient's risk of developing an infection? 1) Follow contact precautions 2) Implement protective isolation 3) Use sterile technique for all dressing changes 4) Administer prophylactic antibiotics as prescribed

ANS: 1 Cross-contamination among burn patients is common, and as a result, isolation guidelines are widespread practices among burn centers. Contact precautions may be used when entering all patient rooms.

The nurse is preparing an educational tool to instruct community members on burn prevention. What should the nurse include as the most common injury in children under age 5? 1) Scald 2) Flame 3) Chemical 4) Carbon monoxide poisoning

ANS: 1 Scald injuries are most prevalent in children under the age of 5.

It is documented that a patient has superficial partial-thickness burns over both anterior lower arms. What should the nurse expect when assessing this patient? 1) Dry with no blisters 2) Waxy appearance and cherry red in color 3) Dry leathery appearance and pale or brown in color 4) Open or closed blisters, mild edema, easily blanches

ANS: 4 A superficial partial-thickness burn has blisters that may be closed or open and weeping; pink or red; mild edema; and blanches easily.

A patient with 35% total body surface area burns is in the rehabilitative phase of care. Which approach should be used to reduce the risk of developing contractures? 1) Apply splints 2) Physical therapy two hours a day 3) Passive range of motion exercises 4) Occupational therapy one hour every other day

ANS: 1 Splinting is the most common method used to help prevent the formation of contractures.

A patient with several deep partial-thickness burns asks how long it will take for the burn to heal. What should the nurse respond to this patient? 1) "More than two weeks." 2) "Within one to two weeks." 3) "Within 24 to 72 hours." 4) "You will need skin grafts."

ANS: 1 The majority of deep partial-thickness burns take more than two weeks to heal.

The nurse is caring for a patient who sustained chemical burns. What would have caused these injuries? Select all that apply. 1) Lime 2) Gasoline 3) Bleach 4) Fabric softener 5) Hydrofluoric acid

ANS: 1, 2, 3, 5 1. Lime can cause a chemical burn. 2. Gasoline can cause a chemical burn. 3. Bleach can cause a chemical burn. 5. Hydrofluoric acid can cause a chemical burn.

A patient is diagnosed with several superficial partial-thickness burns. What treatment would be indicated for this patient? Select all that apply. 1) Apply bacitracin ointment 2) Cover with a nonadherent bandage 3)Apply mafenide acetate 10% cream 4)Wash with antiseptic soap and warm water 5)Apply collagenase and cover with roll gauze

ANS: 1, 2, 4 1. Care of a superficial partial-thickness burn includes applying bacitracin ointment. 2. Care of a superficial partial-thickness burn includes covering with nonadherent bandage. 4. A superficial partial-thickness burn is to be washed with antiseptic soap and warm water.

A patient has been recovering for 18 months from burns that affected 60% total body surface area. For which problems should the nurse anticipate providing continuing care to this patient? Select all that apply. 1) Anxiety 2) Depression 3) Spiritual distress 4) Body image disorder 5) Post-traumatic stress disorder (PTSD)

ANS: 1, 2, 4, 5 The burn patient may endure many psychological and emotional challenges throughout his or her lengthy course of treatment and recovery. The patient may experience anxiety, depression, body image disorder, and PTSD.

The school nurse is preparing material for National Fire Prevention week. What information should be added to the classroom posters? Select all that apply. 1) Never leave a burning candle unattended. 2) Set heating pads on "low" when sleeping. 3) Keep a flashlight and telephone near the bed. 4) Check smoke alarm batteries every six months. 5) Never use the oven as a method to warm the home.

ANS: 1, 3, 4, 5 1. To prevent fires, never leave a burning candle unattended. 3. To respond to a fire, keep a flashlight and telephone near the bed. 4. To prevent fires, check smoke alarm batteries every 6 months. 5. To prevent fires, never use the oven as a method to warm the home.

A patient has full-thickness burns over 30% of total body surface area. Which intervention will least likely provide comfort initially to this patient? 1) Elevate injured extremities 2) Medicate for pain around the clock 3) Apply medicated ointment to all areas 4) Elevate the head of the bed 30 degrees

ANS: 2 A full-thickness burn involves destruction of the epidermis, the dermis, and portions of the subcutaneous tissue. All epidermal and dermal structures are destroyed including hair follicles, sweat glands, and nerve endings. As a result of the extensive damage to the nerve endings, full-thickness burns are insensate to palpation and often are not painful. Pain medication would be least likely to provide comfort to this patient initially.

A patient with deep partial-thickness wounds is receiving enzymatic debridement. What assessment made by the nurse would indicate that wound care treatment has been successful? 1) Gray wound bed 2) Separation of eschar 3) Development of eschar 4) Presence of purulent exudate

ANS: 2 Enzymatic debridement involves the application of a proteolytic ointment that hastens eschar separation.

A patient recovering from full-thickness burns rates pain as a 9 on a scale of 0 to 10 when hydrotherapy is performed. For which type of pain should this patient be treated? 1) Referred 2) Procedural 3) Background 4) Breakthrough

ANS: 2 Procedural pain is associated with therapeutic activities such as wound care and physical therapy.

The nurse is caring for a patient with 45% total body surface area thermal burns. Which laboratory value change would be expected? 1) Increased pH 2) Increased sodium 3) Increased potassium 4) Decreased hematocrit

ANS: 3 Hyperkalemia is expected because of massive cellular trauma causing the release of potassium into extracellular fluid.

A patient recovering from deep and full thickness burns is nauseated. Which medication should the nurse provide to help this patient? 1) Ranitidine (Zantac) 2) Esomeprazole (Nexium) 3) Metoclopramide (Reglan) 4) Polyethylene glycol (Miralax)

ANS: 3 Metoclopramide (Reglan) promotes stomach emptying and decreases nausea.

A patient comes into the emergency room seeking treatment for radiation burns. What should be considered prior to providing care to this patient? 1) Pathway of flow through the body 2) Duration of contact with the agent 3) Type, dose, and length of exposure 4) Temperature to which the skin is heated

ANS: 3 The severity of a radiation burn is dependent upon the type, dose, and length of exposure.

A patient with 55% total body surface area burned received two-thirds of the required fluid resuscitation. For which potential problem should the nurse prepare to provide care to this patient? 1) Increased zone of stasis 2) Increased zone of hyperemia 3) Increased zone of coagulation 4) Decreased zone of coagulation

ANS: 3 The zone of stasis immediately surrounds the zone of coagulation and is characterized by damaged cells and impaired circulation. It is this area of the burn that is most at risk for conversion if the patient does not receive adequate resuscitation. Improper resuscitation or under-resuscitation may cause the burn to become deeper because of limited blood flow, causing the zone of stasis to convert into the zone of coagulation.

A victim of a car fire is confused, dizzy, and nauseated. What diagnostic test should be done to determine if this patient is experiencing carbon monoxide poisoning? 1) Chest x-ray 2) Bronchoscopy 3) Pulse oximeter 4) Carboxyhemoglobin level

ANS: 4 Because carbon monoxide binds to the hemoglobin molecule with an affinity 200 times greater than that of oxygen, tissue hypoxia results when carbon monoxide levels are above normal. Carboxyhemoglobin levels will detect the amount of carbon monoxide in the patient.

A patient is admitted for a suspected inhalation injury. What should the nurse emphasize when caring for this patient? 1) Increase oral fluids 2) Turn in bed every two hours 3) Monitor strict intake and output 4) Deep breathing and coughing every hour

ANS: 4 Deep breathing and coughing should be done every hour to assist with airway clearance and mobilization of secretions.

An 11-year-old child received burns over both upper and lower arms, both hands, anterior upper and lower legs, anterior chest, and the neck. Using the following as a guide, what is this child's total body surface area burned? 1) 30 % 2) 42 % 3) 57 % 4) 65 %

ANS: 4 Feedback: Select the percentage burn column for 10-14-year-old. The neck is 2; the anterior trunk is 13; the right upper arm is 4; the right lower arm is 3; the left upper arm is 4; the left lower arm is 3; the right hand is 2.5; the left hand is 2.5; the right thigh is 9; the left thigh is 9; the right lower leg is 6.5; and the left lower leg is 6.5. The total body surface area burned is 65%. The other answer choices are miscalculations or incorrect use of the graphic provided.

The nurse is caring for a patient with 50% total body surface area burns. Which finding indicates that burn shock is resolving? 1) Heart rate 112 bpm 2) Respirations 24 per minute 3) Blood pressure 90/60 mm Hg 4) Urine output 800 mL over 2 hours

ANS: 4 In the postburn shock phase, which begins 24 to 48 hours after injury, the capillaries begin to regain integrity. Burn shock slowly begins to resolve, and the fluid gradually returns to the intravascular space. Urinary output continues to increase secondary to patient diuresis.

The nurse is caring for a patient who sustained electrical burns. Why should the nurse monitor this patient for compartment syndrome? 1) Potential for undiagnosed injuries 2) Injuries from being thrown bruise soft tissue 3) Electrical current alters integrity of blood vessels 4) Fluid seeps from intravascular spaces into the interstitium

ANS: 4 Pulses are closely monitored in all affected extremities for the first 48 hours postinjury in order to assess for the potential development of compartment syndrome. As fluid seeps from the intravascular spaces into the interstitium, pressure within the tissues continues to rise and confines swelling inside muscle compartments.

A patient weighing 187 lbs. has 38% total body surface area burns. Using the Parkland formula, how much fluid should this patient receive over the first eight hours after the burn occurred? Record your answer as a whole number. ______

ANS: 6460 mL Feedback: First calculate the patient's weight in kg by dividing the weight in lbs. by 2.2 or 187/2.2 = 85 kg. Next use the formula 4 mL x kg of body weight x TBSA % to calculate the total fluid amount needed. For this patient that would be 4 mL x 85 x 38 = 12,920 mL. Since one-half of the total fluid amount should be provided in the first 8 hours, divide the total amount of fluid by 2 or 12,920/2 = 6460 mL. The patient should receive 6460 mL of fluid in the first 8 hours after the burn injury.