Concepts: Burns

Electrical burns

-Worried about electrical cardio changes in the Hr Take an ECG to see if there are changes

contractures

-a condition of shortening and hardening of muscles, tendons, or other tissue, often leading to deformity and rigidity of joints.

Chemical burns

-can has electro cardio changes -Get an ECG on them

A nurse is assessing the adequacy of a client's intravenous fluid replacement therapy during the first 2 to 3 days after sustaining full-thickness burns to the trunk and right thigh. What assessment will provide the nurse with the most significant data? Weights every day Urinary output every hour Blood pressure every 15 minutes Extent of peripheral edema every 4 hours

Urinary output every hour

Superficial Partial thickness burns (2nd degree)

Wet/Moist Blisters Red or Pink -Blanchable -Painful to touch -Heals in 7-21 days -No graft necessary (usually) -Only pop there blisters if over the joint

Parkland formula

What percentage burn do you start fluid resuscitation? - 2-4 ml per kilogram of body weight per TBSA (2-4ml/kg/%TBSA)= fluids given in the first 24 hours. Example: Patient weighs 72 kg and has 45% TBSA. How much fluid will the patient get in the first 24 hours? 2mls vs 3mls vs 4mls? -½ fluids given in the first 8 hours, ¼ in the second 8 hours, ¼ in the third eight hours (or ½ in first 8 hours, ½ in the remaining 16 hours) TBSA% X Kg. X 2-4mL

The nurse is caring for a client with wound dressings to the burns on 55% of the body. The dressing changes are very painful, and the client rates them 7/10 on the pain scale. The client has morphine 2 mg to be administered by mouth every 2 hours as needed. When planning the client's care, when does the nurse decide to administer the medication? 15 minutes before the dressing change 60 minutes before the dressing change Along with a stool softener each time it is administered Only if the client rates pain between 8 and 10 on the pain scale

60 minutes before the dressing change

Example . Patient weighs 95 kg, and is admitted with a 35% TBSA burn. The provider orders fluid resuscitation using the Parkland formula at 4ml/kg. How much LR should the patient get in the first 8 hours? How much fluid is that per hour?

95 X35 X 4= 13,300 24 hours First 8 hours: 13,300/2= 6,650 Second 8 hours: 6,650/2= 3,325 third 8 hours: 3,325 6,650/8= 831.25 ml/hr in the first 8 hours

A nurse is assessing the adequacy of a client's intravenous fluid replacement therapy during the first 2 to 3 days after sustaining full-thickness burns to the trunk and right thigh. What assessment will provide the nurse with the most significant data? Urinary output

A client with extensive burns has an indwelling urinary catheter so that urine output can be measured hourly. Urinary output reflects circulating blood volume; it is the most reliable, immediately available information to assess fluid needs. Although daily weights reflect fluid retention or loss, they are not as immediately accurate as hourly urine measurements. A blood pressure reading may indicate hypervolemia or hypovolemia, but it is not as accurate an indicator of fluid replacement as hourly urine output. Peripheral edema may have many causes; it is not an effective indicator of fluid balance.

Prioritazation

Airway -swelling -third spacing -wheezes -Stridor Epi wont help -vessels are damaged -drooling is a sign that they can't swallow -singed nose hairs -if you hear no lung sounds that is very bad Put ET tube in -Bronscopy 6-12 hours -Hand, feet, head= transfer to trauma center

A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? Colitis Gastritis Stress ulcer Metabolic acidosis

An ulcer of the upper gastrointestinal tract is related to excessive secretion of stress-related hormones, which increases hydrochloric acid production. Histamine H2 antagonists decrease acid secretion. Colitis is not a complication of burns. Gastritis is not a complication of burns. Metabolic acidosis is not a complication of burns unless hypermetabolism or renal failure occurs; metabolic acidosis is not treated with H2 antagonists.

A nurse is caring for a client who is experiencing the second (acute) phase of burn recovery. The common client response the nurse expects to identify during this phase of burn recovery is an increase in what? diuresis

As fluid returns to the vascular system, increased renal flow and diuresis occur. An increase in the serum sodium level (hypernatremia) is not a common response identified during the second (acute) phase of burn recovery. An increase in the hematocrit level indicates hemoconcentration and hypovolemia; in the second phase of burn recovery, hemodilution and hypervolemia occur. During the second phase of burn recovery, potassium moves back into the cells, decreasing serum potassium.

Which wound care is given to a client with severe burn injuries during the acute phase? Assess extent and depth of burns Provide daily shower and wound care Remove dead and contaminated tissue Assess the wound daily and adjust the dressing

Assess the wound daily and adjust the dressing In the acute phase, wound care is given by assessing the wound daily and adjusting the dressing if necessary according to the protocols. Assessing the extent and depth of burns is performed in the emergent phase. Providing a daily shower and removing the dead and contaminated tissue (debride) is performed in the emergent phase.

Full thickness

Dry -Waxy white or charred, leathery appearance (stained glass) - Non-blanchable -Painless -Will not heal without surgical intervention -Grafts necessary

First degree burns

Dry Closed Red Blanchable Painful to touch No graft necessar

The primary healthcare provider instructs the nurse to monitor serum creatinine and blood urea nitrogen in a client who is on therapy for burn wounds. Which medication most likely has been prescribed to the client? Nitrofurantoin Mafenide acetate Silver sulfadiazine Gentamicin sulfate

Gentamicin sulfate may cause nephrotoxicity in the client; therefore the client who is prescribed this drug should be carefully monitored for serum creatinine and blood urea nitrogen. The client on nitrofurantoin should be closely observed for signs of allergic reactions. Blood gas and serum electrolyte levels should be monitored in clients on mafenide acetate. In clients who are on silver sulfadiazine, wounds should be monitored for infections.

Deep partial thickness (stage 3)

Moist or Waxy Dry Thin or Broken Blisters Mottled or Splotchy appearance Non-Blanchable Can feel pressure but not pinpoint sensations Heals in 21+ days Requires skin graft

While caring for a client with a burn injury and in the resuscitation phase, the nurse notices that the client is hoarse and produces audible breath sound on exhalation. Which immediate action would be appropriate for the safe care of the client? Select all that apply.

Providing oxygen immediately Notifying the rapid response team oarseness of voice, difficulty in swallowing, or an audible breath sound on exhalation after a burn injury indicates an impaired airway. Therefore the client should be given oxygen immediately. The rapid response team should also be notified for further management. This occurrence should not be considered a normal observation. An IV line should be initiated for fluid replacement only once the client's airway is patent. An ECG is obtained when the client suffers from electrical burns.

A 6-year-old child has partial-thickness burns of the face and upper chest. What is the priority nursing assessment for the first 24 hours? Wound sepsis Pulmonary distress Fear and separation anxiety Fluid and electrolyte imbalance

Pulmonary distress Inhalation burns are usually present with facial burns, regardless of the depth; the immediate threat to life is asphyxia resulting from irritation and edema of the respiratory passages and lungs. Although wound sepsis is a possible complication, it will not be evident until the third to fifth day. Although the child is probably fearful, maintaining a patent airway is the priority. This child is too old for separation anxiety; however, complications related to stress may occur later. Fluid losses may be extremely high but reach their maximum about the fourth day; the initial priority is maintaining a patent airway.

A client who sustained burn injuries due to a fire and explosion has a carbon monoxide level of 14%. Which pathophysiologic risk is increased in the client? Stupor Vertigo Convulsions Slight breathlessness

Slight Breathlessness Slight breathlessness may occur when the carbon monoxide level is 14%. Stupor and vertigo may result when the carbon monoxide level is in between 21% and 40%. When the level of carbon monoxide reaches between 41% and 60%, coma or convulsions may occur.

A nurse is administering a histamine H2 antagonist to a client who has extensive burns. The nurse explains to the client that this drug is given prophylactically during the first few weeks after extensive burns. What complication of burns will it prevent? Colitis Gastritis Stress ulcer Metabolic acidosis

Stress ulcer

Tetanus shots with pts who have gotten burns and haven't had one in a while

Tetanus may occur following burns [2-4]. In our observation tetanus was secondary to the application of poultice on burn injuries. The risk of tetanus increases strongly after a burn and the burnt area is an easy entry point for tetanus in the days following the burn.

Thermal burns

•Flame, flash, scald, contact with hot objects •https://www.youtube.com/watch?v=JfIRx764-88 •Cold thermal injuries: Frostbite -cast form so give heparin

Initial treatment

•Stop the burning! •Ice? Butter? •Chemical burns/tar burns -Irrigation with water -Larger burns: clean/ dry sheet

Rehabilitation phase

•4-6 weeks •Scar formation/contractures •Scars are not stronger than regular tissue! •Pressure garments

Acute phase

•48-72 hours after injury •Patient is stable, fluids move back into the cells. •Diuresis begins. •Burn Debridement -infection is huge on this phase •Wound care: Often done daily, very painful for patient. They will often need large doses of analgesics and sedatives during their dressing change.

Emergent phase continued

•Address the life threats •Monitor everything (ABCs, vital signs, pulse checks, hourly labs, fluid resuscitation, urine output, wound care, diagnostics, feeding tube insertion, pain management, temperature, medications such as insulin) •Lots and lots of collaboration with providers, RT, PT/OT, Dietary, Case management, patient and family.

Split thickness skin Graft (stsg)

•Autograft (taken from patient) -Cadaver graft is not a permanent graft but used as infection dressing

Initial treatment 2

•Burning has been stopped •Triage has been done •Your patient is now in the Emergent phase of burn management.

Escharotomies/Fasciotomies

•Escharotomy: Incision through eschar Fasciotomy: Incision through the fascia due to swelling

Emergent (resuscitation) phase

•Up to 72 hours •Assess the life threats • Hypovolemic shock and edema: vessels damaged •Catecholamine response: hyper metabolic state/ increased BP then decreased •Hypothermia •What is an additional circulatory concern as the patient starts to third-space, especially in circumferential burns? What might be some signs and symptoms? -Increased HCT and HGB -Increase potassium since cells die and release it -Urine output for marker of adequate perfusion -Urine output 0.5mL/kg/hr: higher output in electrical burns Cardiac parameters: MAP> 65, BP> 90, HR<120 -Give colloids or FFP Vitamin C to decrease free radicals -it is a diacritic so we cant use urine output as a marker if given -Place NGT tube to give lost of nutrition