Final (BURNS)

What is the normal range for creatinine levels?

0.6 to 1.2mg/dL

What's a normal serum albumin level?

3.4 to 5.4 g/dL

There has been a fire in an apartment building. All residents have been evacuated, but many are burned. Which clients should be transported to a burn center for treatment? SATA A. An 8 year old with third degree burns over 10% of the TBSA. B. A 50 year old diabetic with first and second degree burns on the left forearm (about 5% of TBSA) C. A 20 year old who inhaled the smoke of a fire D. A 30 year old with second degree burns on the back of the left leg (about 9% of TBSA) E. A 40 year old with second degree burns on the right arm (about 10% of TBSA)

A, B, C Clients who should be transferred to a burn center include children under age 10 or adults over age 50 with second and third degree burns on 10% or greater of their TBSA, clients between ages of 11 and 49 with second and third degree burns over 20% of their TBSA, clients of any age with third degree burns on more than 5% of their TBSA, clients with smoke inhalation, and clients with chronic diseases such as diabetes, heart, or kidney disease.

During the emergent (resuscitative) phase of burn injury, which finding indicates that the client requires additional volume with fluid resuscitation? a. Serum creatinine level of 2.5 mg/dL b. Little fluctuation in daily weight c. Hourly urine output of 60ml d. Serum albumin level of 3.8mg/dL

A. Increase in serum creatinine Fluid shifting into the interstitial space causes intravascular volume depletion and decreased perfusion to the kidneys. This would result in an increase in serum creatinine.

An advantage of using biological burn grafts such as porcine (pigskin) grafts is that they: A. Encourage the formation of tough skin B. Promote the growth of epithelial tissue C. Provide for permanent wound closure D. Facilitate the development of subcutaneous tissue

B. Biologic dressings such as porcine grafts serve many purposes for a client with severe burns. They enhance the growth of epithelial tissues, minimize the overgrowth of granulation tissue, prevent loss of water and protein, decrease pain, increase mobility, and help prevent infection.

The nurse is caring for a client with severe burns who is receiving fluid resuscitation. Which of the following indicates that the client is responding to then fluid resuscitation? A. A pulse rate of 112 bpm B. Blood pressure of 94/64 mmHg C. Urine output of 30 ml/h D. Serum sodium level of 136 mEq/L

C. Ensuring a urine output of 30 to 50 ml/h is the best measure of adequate fluid resuscitation.

A client is admitted to the hospital after sustaining burns to then chest, abdomen, right arm, and right leg. Using the rule of 9's, estimate the % of the clients TBSA has been burned? A. 18% B. 27% C. 45% D. 64%

C. 45% According to the rule of nines, the right arm is calculated as 9%, the right leg is 18%, and the anterior trunk is 18% for a total of 45%.

The nurse is assessing an 80 year old client who has scald burns on the hands and both forearms (first and second degree burns on 10% of the TBSA) What should the nurse do first? A. Clean the wounds with warm water B. Apply antibiotic cream C. Refer the client to a burn center D. Cover the burns with a sterile dressing

C. The nurse should have the client transferred to a burn center. The clients age and the extent of the burns require care by a burn team, and the client meets triage criteria for referral to a burn center. Because of the age of the client and the extent of the burns, the nurse should not treat the burn. Scald burns are not at high risk for infection and do not need to be cleaned, covered or treated with antibiotic cream at this time.

Which factor would have the least influence on the survival and effectiveness of a burn victims porcine grafts? A. Absence of infection in the wounds B. Adequate vascularization in the grafted area C. Immobilization of the area being grafted D. Use of analgesics as necessary for pain relief

D. Analgesic administration to keep a burn victim comfortable is important but is unlikely to influence graft survival and effectiveness. Absence of infection, adequate vascularization, and immobilization if the grafted area promote an effective graft.

The nurse is conducting a focused assessment of the gastrointestinal system of a client with a burn injury. The nurse should assess the client for: A. Paralytic ileus B. Gastric distention C. Hiatal hernia D. Curling's ulcer

D. Curlings Ulcer, or gastrointestinal ulceration, occurs in about half of the clients with a burn injury. The incidence of ulceration appears proportional to the extent of the burns, and the ulceration is believed to be caused by hypersecretion of gastric acid and compromised gastrointestinal perfusion.

During the early phase of burn care, the nurse should assess the client for: A. Hypernatremia B Hyponatremia C. Metabolic alkalosis D. Hyperkalemia

D. Immediately after a burn, excessive potassium from cell destruction is released into the extra cellular fluid.

The client with a major burn injury receives TPN. The expected outcome is to: A. Correct water and electrolyte imbalances B. Allow the gastrointestinal tract to rest. C. Provide supplemental vitamins and minerals D. Ensure adequate caloric and protein intake

D. The primary reason for starting TPN is to provide the protein necessary for tissue healing.

In the acute phase of burn injury, which pain medication would most like be given to the client to decrease the perception of pain. A. Oral analgesics such as ibuprofen or acetaminophen B. Intravenous opioids C. Intramuscular opioids D. Oral anti anxiety agents such as Lorazepam

Severe pain caused by burn clients requires opioid analgesics

After the initial phase of the burn injury, the clients plan of care will focus primarily on: A. Helping the client maintain a positive self concept B. Promoting hygiene C. Preventing infection D. Educating the client regarding care of the skin grafts

C. The inflammatory response begins when the burn is sustained. As a result of the burn, the immune system becomes impaired. There are a decrease in immunoglobulins, changes in white blood cells, alterations in lymphocytes, and decreased levels of interleukin. The human body's protective barrier, the skin, has been damaged. As a result, the burn client becomes vulnerable to infections.

The rate at which IV fluids are infused is based on the burn clients: A. Lean muscle mass and BSA burned B. Total body weight and BSA burned C. Total BSA and BSA burned D. Height and weight and BSA burned

B. During the first 24 hours, fluid replacement for an adult burn client is based on total body weight and BSA burned.

The nurse should plan to begin rehabilitation efforts for a burn client: A. Immediately after a burn has occurred B. After the clients circulatory status has been stabilized C. After grafting of the burn wounds has occurred D. After the clients pain has been eliminated

B. Rehab efforts are implemented as soon as the clients condition is stabilized. Early emphasis on rehab is important to decrease complications and to help ensure that the client will be able to make adjustments necessary to return to an optimal state of health and independence.

Which client with burns will most likely require an endotracheal or tracheostomy tube? A client who has: A. Electrical burns of the hands and arms causing arrhythmias B. Thermal burns to the head, face, and airway resulting in hypoxia C. Chemical burns on the chest and abdomen D. Secondhand smoke inhalation

B. Airway management Is the priority in caring for a burn client. Tracheostomy or endotracheal intubation is anticipated when significant thermal and smoke inhalation burns occur. Clients who have experienced burns to the face and neck usually will be compromised within 1 to 2 hours.

At about one-half hour before the daily whirlpool bath and dressing change, the nurse should: A. Soak the dressing B. Remove the dressing C. Administer an analgesic D. Slit the dressing with blunt scissors

C. Removing dressings from severe burns exposes sensitive nerve endings to the air, which is painful. The client should be given a prescribed analgesic about a half hour before the dressing change to promote comfort.

A client is receiving fluid replacement with LR after 40% of the body was burned 10 hours ago. The assessment reveal a temp of 97.1, HR 122 bpm, BP 84/42 mmHg, CVP 2 mmHg, and urine output 25ml for the last 2 hours. The IV rate is currently at 375ml/h. Using SBAR, the nurse calls the HCP with a recommendation for: A. Furosemide B. Fresh frozen plasma C. IV rate increase D. Dextrose 5%

C. The decreased urine output, low BP, low CVP, and high HR indicate hypovolemia and the need to increase fluid volume replacement.