Chapter 26 Care of patients with burns

Which statement provided by the student nurse indicates the need for further teaching about nursing interventions performed during the nonsurgical management of a patient with burns?

"Allow the patient to ambulate every 2 hours initially."

During discharge teaching, which patient response suggests further instruction is needed related to self-management of burn wounds and the healing process?

"Once I'm discharged I can stop wearing the tight compressing garments over my dressings."

The registered nurse is teaching a student nurse about the main functions of the skin. Which statement made by the student nurse indicates a need for further teaching?

"Skin prevents the activation of vitamin D when exposed to the sun."

Which statement given by the student nurse indicates a need for further learning about burn injuries that require grafting?

"Superficial partial-thickness burn injuries require grafts."

Which statement made by the student nurse indicates a need for further teaching about the important factors of standard wound dressing and the number of gauze layers to be used?

"The number of gauze layers depends on the cause of the injury."

The registered nurse is teaching a student nurse about the effects of burn injuries to the skin. Which statement made by the student nurse indicates effective learning?

"The sweat and oil glands in the palm are affected during deep burn injuries."

A patient sustains a deep full-thickness wound to the arm and hand and asks the nurse why there isn't any pain since it is so deep. What would be the nurse's best response?

"This happens due to the destruction of the nerve endings present in the dermis layer."

What is the chronological order of vascular change events that occur immediately after a burn injury?

1.Activation of macrophages 2.Release of chemicals 3.Constriction of blood vessels 4.Thrombosis of blood vessels 5. Formation of necrosis 6. Formation of deeper injuries

The health care provider has ordered a blood transfusion for a female patient with serious electrical burns. What hematocrit level reflects the need for transfusion when symptoms of hypoxia are present?

18%

A 65-year-old patient who survived a fire accident is admitted to the hospital. The patient suffers from deep partial-thickness wounds, mostly on the anterior shoulder. Which position may help prevent contractures?

Abduction and external rotation

An older patient has suffered a 45% body surface area burn from a house fire. Which complication is the patient at greater risk of developing because of age-related changes?

Acute kidney injury

What safety measures should be taken to prevent fire accidents at home? Select all that apply

Avoid smoking when drinking alcohol. Develop at least two planned escape routes.

What safety measures should be taken to prevent fire accidents at home? Select all that apply.

Avoid smoking when drinking alcohol. Develop at least two planned escape routes.

A patient with burns has pulmonary edema. Which drug will likely be administered to the patient?

Beta blockers

Which serum blood level must be monitored in a patient who developed metabolic acidosis as a consequence of a burn injury?

Bicarbonate

Which anatomical structures are absent in a histological section of the epidermis?

Blood vessels

Which method is used in assessing the measurement of burns in a patient whose weight and height are in proportion?

Body area is divided into multiples of 9%

What precautionary measure must individuals take to prevent fires?

Chimneys must be cleaned once in a year.

Which topical agent is typically used on a burn wound for rapid debridement?

Collagenase

Which part of the skin helps in the healing process after a burn injury?

Epithelial cells

Which findings would be seen in a patient with a full-thickness burn injury? Select all that apply.

Eschar Severe edema

A patient is admitted with an electrical burn injury. Which nursing intervention is a priority for this patient?

Evaluate the urine volume and color.

A patient with full-thickness burns to the lower extremities has had emergent fasciotomies. What assessment parameter does the nurse monitor to evaluate the effectiveness of the fasciotomies?

Improved distal pulses

To position a patient's burned upper extremities appropriately, how does the nurse position the patient's elbow?

In a neutral position

Which alteration observed in a patient rescued from a fire indicates pulmonary injury?

Inability to swallow fluids

What metabolic changes result from a burn injury? Select all that apply

Increase in aldosterone secretion Increase in catecholamine secretions Increase in antidiuretic hormone secretion

What metabolic changes result from a burn injury? Select all that apply.

Increase in aldosterone secretion Increase in catecholamine secretions Increase in antidiuretic hormone secretion

What is the cause of a Curling's ulcer, which develops within 24 hours after a severe burn? Select all that apply

Increased hydrogen ion production Reduced gastrointestinal blood flow Decreased gastric mucus production

A patient with burns who was admitted to the hospital 3 days ago develops paralytic ileus. Which pathophysiological phenomenon may be the cause of the patient's condition?

Increased secretion of epinephrine

A patient who underwent treatment for severe burns complains to the primary health care provider of respiratory discomfort. Which physiological change may be causing this discomfort?

Leakage of capillaries

A patient's burn injury was caused by an exposure to pool chemicals. Which laboratory result does the nurse monitor closely for possible signs of organ injury?

Liver function tests

A patient who was successfully fluid resuscitated following a burn injury begins diuresis 3 days after admission. Once diuresis begins, which complications would the nurse monitor for? Select all that apply.

Hypotension Hyponatremia Metabolic acidosis

A patient sustains severe burn injuries from contact with a hot liquid. Which type of burn injury would the nurse anticipate?

Moist heat injury

A patient with a severe burn injury is prescribed gentamicin sulfate. Which nursing intervention is most appropriate related to this medication?

Monitoring creatinine clearance

What is the most essential intervention performed by the nurse to prevent complications when administering mafenide acetate topically for a patient with burn wounds?

Premedicating for pain before application of the drug

Which interventions take priority during the first 24 to 48 hours after a patient receives minor burn injuries? Select all that apply.

Providing emotional support to the patient Maintaining the patient's body temperature Keeping the patient comfortable with analgesics

While monitoring a patient with a burn injury the nurse observes that the cardiac output is 3.5 liters/minute. Which nursing intervention is done to prevent further complications?

Providing fluid replacement for the patient

In assessing a patient in the rehabilitative phase of burn therapy, which priority problem does the nurse anticipate?

Reduced self-image

Which physiologic outcome describes the goal of topical sulfadiazine in the care of a patient with a burn injury?

Reduction of bacterial growth in the wound and prevention of sepsis

How does the nurse determine accurate calorie requirements for a patient with burns?

Using indirect calorimetry

Which physiological action of carbon-monoxide manifests as "cherry red" coloration of skin in a patient with carbon-monoxide poisoning?

Vasodilating effect

Which type of burn shows desquamation 2 to 3 days after the injury?

Superficial full-thickness wound

A patient has been admitted to the hospital with a burn injury. The wounds appear to be pink in color with moisture and blanch when pressure is applied. Which burn injury does the patient have?

Superficial partial-thickness wounds

A patient is admitted to the hospital with a burn injury and blisters all over the body. Which type of burn injury has blisters as a characteristic feature?

Superficial partial-thickness wounds

Which type of burn injury heals without scar formation?

Superficial partial-thickness wounds

A patient is exposed to excessive sunlight and develops sunburn. The skin appears red in color with mild edema. Which degree of burn does the nurse identify?

Superficial wounds

A patient develops a skin injury after working in the sunlight for a long time. Which type of wound does the nurse suspect?

Superficial-thickness wound

Which burn injury is characterized by desquamation?

Superficial-thickness wound

Which factors indicate that a patient's burn wounds are becoming infected? Select all that apply.

Tachycardia Dry, crusty granulation tissue Edema of the skin around the wound

The nurse is assessing the wound of a patient who was burned while burning leaves in the yard. Which assessment finding of the burned areas on the patient's feet, legs, and hands suggests a deep partial-thickness injury?

The area is red and dry and blanches slowly when firm pressure is applied

A 3-year-old child was injured when placed in extremely hot bath water. The water was more than 50 °C. The child's skin was yellow at the injury site with severe edema and pain. What should the nurse infer?

The child has full-thickness wounds.

A patient arrives in the emergency department with burns as a result of spilling boiling water while cooking. Which assessment finding of the burned areas on the tops of both hands and chest does the nurse use as a basis to document a probable full-thickness injury?

Thrombosed blood vessels are visible beneath the skin surface.

The patient is a burn victim who is noted to have increasing edema and decreased urine output as a result of the inflammatory compensation response. What does the nurse do first?

Titrate fluid replacement

Why is positive end-expiratory pressure (PEEP) provided to the patients with major burns?

To increase the lung volume

Which instructions are essential to prevent contractures in a patient with burns to the head, neck, and hip area? Select all that apply.

"Avoid using pillows." "Use the trochanter roll." "Place a towel roll under the neck."

The registered nurse is teaching a student nurse about the effect of electrical burns on the human body. Which statements made by the student nurse indicate effective learning? Select all that apply.

"Electrical burns cause full-thickness wounds." "Electrical burns cause deep full-thickness wounds."

When teaching fire safety to parents at a school function, which advice does the school nurse offer about the placement of smoke and carbon monoxide detectors?

"Every bedroom should have a separate smoke detector."

The registered nurse is teaching a student nurse about the different severity levels in burn injuries based on the amount of total body surface area (TBSA) affected. Which statement made by the student nurse indicates effective learning?

"Full-thickness wounds that affect 10% of the TBSA are major level injuries."

The nurse is caring for a patient with burns. Which question does the nurse ask the patient and family to assess their coping strategies?

"How have you handled similar situations before?"

Which statements of the student nurse about measures taken to provide complementary and alternative therapy for pain reduction in burn patients need correction? Select all that apply.

"I should apply cold compresses to the patient." "I should massage the burn area gently to reduce the pain transmission." "I should ensure that procedures are performed when the patient is asleep."

A nurse is conducting an information session on burn prevention for a group of adults. Which statements made by a member of the group indicate effective learning? Select all that apply.

"I should refrain from smoking when drinking alcohol." "I should have my chimney cleaned annually." "I should use sunscreen and wear protective clothing to prevent sunburns."

What is the most appropriate response by the nurse when a patient's family asks about the time needed for the patient's deep partial-thickness burns to heal?

"It may take 2 to 6 weeks for the wound to heal."

A patient spilled a large open frying pan of hot cooking grease and received burns to the entire anterior chest and abdomen, the entire anterior section of the left arm, and the anterior portion of the left leg from the groin to the knee. At what percentage of total body surface area does the nurse calculate the injury using the rule of nines?

25% to 27%

What is the initial bolus dose of morphine through patient-controlled analgesia (PCA)?

5 to 10 mg of morphine

Which of the following skin grafts are obtained from human cadavers?

Allograft

Which systemic signs of infection can be seen in the patient with burn injuries?

Altered level of consciousness

A patient has been admitted to the health care facility after an electrical burn to the lower extremity, exposing the muscles and bone. On diagnosis, infection is found in the lower extremity. What is the most appropriate treatment method for the patient?

Amputation

An escharotomy must be performed in a patient admitted for burns. Which statement accurately describes this procedure?

An incision is made through the burn eschar

A patient with a burn injury to the face, neck, upper body, and hands begins wheezing on exhalation and reports difficulty swallowing 4 hours after the injury. Which action would the nurse take first?

Apply oxygen and notify the Rapid Response Team

A patient with 32% total body surface area burns has a hematocrit of 54% 10 hours after a burn injury and 8 hours after fluid resuscitation was started. Which action would the nurse take?

Assess the patient's blood pressure and urine output.

How long must a patient with burns wear pressure garments after undergoing biological dressing?

At least 23 hours per day

The nurse is caring for a patient who is on mechanical ventilation because of severe burns. Which medication is appropriate for this patient?

Atracurium

Which type of grafting method is preferred in regards to reducing the risk of infection?

Autograft

Which physiologic effect may indicate mild carbon monoxide poisoning?

Decreased visual acuity

A lab assistant sustained an accident while carrying ammonia to the lab and is admitted to the emergency room. The patient reports severe pain with a red skin color, moderate edema, and eschar that is soft and dry. What type of wound did this patient sustain?

Deep partial-thickness wounds

Which type of burn injury can convert to a deeper injury due to tissue hypoxia?

Deep partial-thickness wounds

Which part of the skin varies in depth in the human body?

Dermal appendages

Which type of burn injury is caused by an open flame?

Dry heat

Why do blisters not form in deep partial-thickness wounds?

Due to the thick dead tissue layer which sticks to the underlying dermis

Which type of injury is called a "grand masquerader" of burns?

Electrical injury

A patient with burn injuries states, "I feel so helpless." Which nursing intervention is most helpful for this patient?

Encouraging participation in wound care

Which parts of the body are most affected when exposed to high temperatures for short durations? Select all that apply.

Face Ears Feet

What type of burn injury may require the nurse to remove smoldering clothing and metal objects that are close to the patient's body?

Flame burns

A patient with burn injuries is being admitted. Which priority does the nurse anticipate within the first 24 hours?

Fluid resuscitation

Which degree of burn may result in reduced excretory ability of the skin?

Full-thickness wound

Which type of burn injuries includes an escharotomy as a part of the treatment plan?

Full-thickness wounds

A patient with a burn injury is receiving treatment in the hospital. There is redness of the skin with moderate edema and pain. The symptoms do not decrease even after proper treatment for 6 weeks. Which type of burn injury uses grafting as a part of the treatment plan to reduce the healing time of the injury? Select all that apply.

Full-thickness wounds Deep full-thickness wounds Deep partial-thickness wounds

A patient sustained chemical burns and is admitted to the emergency room. The patient shows black coloring to the skin with severe edema and no damage to the eyes or face. Eight percent of the total body surface area (TBSA) is injured. What should the nurse infer about the degree of burn?

Full-thickness wounds at a moderate level

The nurse is reviewing a medication record for an older adult patient recently admitted to the burn unit with severe burns to the upper body from a house fire. The nurse plans to contact the health care provider if the patient is receiving which medication?

Furosemide

A patient with an electrical burn is being resuscitated with fluids. The nurse reports a decrease in urine output from 50 mL/hr to 15 mL/hr. Which order does the nurse question?

Furosemide 40 mg IV

A patient with partial-thickness burns of the face and chest caused by a campfire is admitted to the burn unit. The nurse plans to carry out which health care provider request first?

Give oxygen per face mask.

What is the characteristic of a burn caused by brief contact with a hot plate?

Heals in about 2 weeks

After reviewing a patient with burn injuries, what other assessments should a primary health care provider perform before initiating treatment? Select all that apply.

Health history Age, weight, and height Circumstances of the injury

The nurse finds that the patient with burns has developed a low-grade fever. Which patient condition could be the reason for developing a low-grade fever?

Hypermetabolic condition

The nurse is reviewing the orders for a patient admitted with 25% body surface area burns. Which order does the nurse clarify with the health care provider?

Hold omeprazole

A patient with severe burn injuries develops cellular potassium loss. What would the patient have?

Hyperkalemia

A patient receives a prescription for collagenase for the treatment of burns. To decrease the risk of infection, the nurse expects what else to be included on the patient's plan of care?

Polysporin powder

Which method must be employed during hydrotherapy for the debridement of a wound in the patient with acid burns?

Nonviable tissue must be removed by forceps.

Which wound assessment characteristics suggest a superficial partial thickness burn injury?

Painful

A newly admitted patient has deep partial-thickness burns. The nurse expects to see which clinical manifestations?

Painful red and white blisters

Which type of burns result in a reduction in the activation of vitamin D when exposed to sunlight?

Partial-thickness burns

Which clinical manifestation is indicative of wound healing for a patient in the acute phase of burn injury?

Scar tissue formation

Which is considered a late complication of burn injuries?

Scarring

What is the priority management care provided by the nurse to a patient who is suffering from inhalation injury after a major burn accident?

Securing the airway

The nurse is caring for a patient who has a severe burn injury and is receiving fluid resuscitation. The nurse should assess which laboratory findings to determine the patient's response to the therapy? Select all that apply.

Serum creatinine levels Blood urea nitrogen levels

A patient who was rescued from an explosion is provided fluid resuscitation. Which factor should be assessed in the patient after providing fluid resuscitation?

Serum sodium levels

Which factor differentiates full-thickness wounds from deep full-thickness wounds?

Severity of edema

Which assessment is the nurse's highest priority in caring for a patient in the acute phase of burn injury?

Signs of infection

Which physiological change will result in loss of function from contracture formation in a 65-year-old patient with burn injuries who is admitted to the hospital?

Slower healing time

After assessing a patient with burn injuries, the primary health care provider confirms damage to the lower airway. What is the most common cause of lower airway damage?

Smoke

While reviewing the laboratory profile of a burn patient in the resuscitation phase, the nurse finds the patient's glucose level to be 120 mg/dL. Which is the most likely cause for this?

Stress response

A patient with no other underlying diseases is receiving treatment for a burn injury after an accidental fire. The patient's skin color is red with moderate swelling and eschar that is soft and dry. How long should the injury take to heal as per the nurse's estimation?

The healing time is about 2 to 6 weeks.

A patient is admitted to the hospital after sustaining an electrical injury where more than 25% of the body was burned. Black coloring of the skin with exposure of muscles, bones, and a fractured hand was observed on diagnosis. What should the nurse infer?

The patient has deep full-thickness wounds.

A patient experienced an accident while transporting acid to a chemical factory. The patient's skin color is pink with mild swelling, and blisters were observed. The total body surface area (TBSA) had 1% burns. The wounds are pink, moist, and blanch when pressure is applied. What should the nurse infer?

The patient has partial-thickness wounds at a minor level.

A patient that sustained injuries to the skin from accidental acid spillage presents to the emergency room with a skin color that appears pink and mild edema with blisters. What should the nurse infer from the burns?

The patient has superficial partial-thickness wounds.

Which interventions specifically manage secondary wound infection following a burn injury? Select all that apply.

Vigorous fluid resuscitation Use of antibiotics with infection Improved critical care monitoring

When is grafting required in the treatment of burn injuries?

When there is absence of skin cells

Which rationale best supports the intravenous (IV) administration of fentanyl to a burn patient?

Which rationale best supports the intravenous (IV) administration of fentanyl to a burn patient?

Several patients have been brought to the emergency department after an office building fire. Which patient is at greatest risk for inhalation burn injury?

Young adult who suffered burn injuries in a closed spac