Review Questions
If a patient came in with an inhalation injury, what type of oxygen would you give them?
100% O2 with nonrebreather
Which 2 types of burns do not heal on their own?
3rd and 4th degree burns ALWAYS needs skin grafts, they cannot heal on their own. (Note: 2nd degree (partial) CAN heal on their own but sometimes they do skin grafts)
What is the time frame that diaphoresis starts after a major burn injury?
48-72 Hours after patient was burned diaphoresis begins, occurs during the acute stage.
Initial fluid resuscitation requirements are calculated based on the following parameters: A. Age, total body surface area burned, patient weight, and cause of burn injury B. Injury mechanism (flame or nonflame), total body surface area burned, and patient weight C. Total body surface area burned, patient weight, and the presence of inhalation injury D. Age category (adult or child), patient temperature, and total body surface area burned
A. Age, total body surface area burned, patient weight, and cause of burn injury
How do you collect a specimen to test for Group Beta Strep?
An anal/rectal swab is performed and sent to the lab for testing.
What nursing implications would you teach to someone about car seat safety?
Appropriate installation Appropriate size for child Appropriate seat based off infant/child's age Weight, and height Infants are always in rear facing car seats.
Which type of graft is permanent?
Autografts is the only skin graft that is permanent, all other skin grafts (allograft, amniotic membranes, Sheet grafts (nonmeshed), Meshed grafts, xenografts, mesh grafts) are temporary until patient is healed/stable enough to get an autograft.
A superficial partial-thickness (second-degree) burn is characterized by: A. Charred gray skin or black skin B. Blistered skin with pink or moist base C. White waxy and dry skin D. Reddened skin without blisters
B. Blistered skin with pink or moist base
What are the two manifestations with electrical burns that are different than the other kinds of burns?
Cardiac arrest and CNS defect
Appropriate initial management of a patient with a documented inhalation injury includes: A. Fluid restriction to minimize lung injury B. Colloid infusion to decrease extravascular lung water C. Prophylactic antibiotics to decrease the incidence of pneumonia D. 100% humidified oxygen to decrease carboxyhemoglobin levels
D. 100% humidified oxygen to decrease carboxyhemoglobin levels
What are some nursing implications/interventions for a patient that has an infection?
Educating them about proper handwashing, staying away from sick people, take medicines as prescribed. Remove layers of blankets/clothes from the fevered patient, perform aseptic technique with any procedures you perform on patient. If patient does have any of these signs or has a fever, tell the charge nurse and she will call healthcare provider.
What are some diagnostic tests that will show you that a patient has an infection?
Elevated WBC, CBC with diff (looking at WBC, normal WBC is 4-10, if higher than 10 then there is an infection) culture and sensitivity (shows UTI) stool culture (shows C-Diff).
What vital signs/assessments would you see on a patient that has an infection?
Fever (temp higher than 101.5) tachycardia (HR over 100 bpm), Decreased urinary output (UO less than 30 mL/hr) Hypotension (less than 100/60), chills diaphoresis tachypnea (fast breathing)
What are the signs of infection?
Fever, redness, swelling
What type of burn heals in 3-5 days WITHOUT treatment?
First Degree (Superficial)
What happens to fluid requirements when you enter the acute phase from the resuscitative phase?
Fluid requirements are lower. (Note: At the end of the acute phase, when the wound closes, rehabilitative phase begins. The main focus during the resuscitative phase is ABC's, airway patency, stopping the burn process, getting patient back to homeostasis (fluids, fluids). The main focus during the acute phase is wound healing, skin grafts are normally placed during the Acute stage. PT, mental health, pain, counseling occurs in the last stage, which is rehabilitation.)
For a burn patient, what pain medication and what route would you perform?
Morphine (or another opioid) administered intravenously (IV). (Note: We would not give IM or SubQ injections in a burn patient due to edema/swelling, it could also cause the medication to travel elsewhere to an incorrect part of the body. 2 large bore IV's should be present, and start lactate ringers at 500mLs per hour).
Which patients are at a high risk for infection and why?
Newborns have an immature immune system. Young children are at risk for infection since they touch their eyes, nose, mouth constantly and do not perform/understand why handwashing is important. The elderly population is at risk for infection because of them having a decreased/slowed immune system, most likely has long-term chronic conditions, not active as much, and has thinner skin. Cancer patients are at a high risk of infection since their immune system is destroyed/ weakened because of chemo/radiation treatments.
What is the single best indicator of adequate fluid resuscitation in the resuscitative phase of burns?
Patient is producing urine. Measure patient's urinary output hourly. (UO is the quickest indicator that this stage has ended.)
If you have a patient brought into the ED with chemical burns, what would you do?
Remove all clothing and apply/wash patient with water (do not use ice-cold water). (Note: With any type of burn, if clothing is attached to the skin, do NOT try to pull/remove the clothes from the skin. Remove jewelry, since it can hold heat.)
What is the chain of infection? What is a good way to break the chain of infection?
The chain of infection is: Etiological agent (the bacteria/virus), Reservoir (Where the bacteria is/grows), Portal of exit from reservoir Method of transmission (how bacteria/virus is transmitted to other) Portal of entry (Bacteria/virus enters someone's body). You break the chain of infection by performing good/Proper hand hygiene, wearing PPE
What are the stages of the infection process?
The first stage is the Incubation Period, when infection enters the body. The 2nd stage is the Prodromal Stage, infection is in the body, but no symptoms are present. The 3rd stage is the Illness stage, symptoms show, person realizes they are sick. The 4th stage is the Convalescent stage, person is returning to normal state and symptoms are no longer present.
You have a patient in labor that is group beta strep positive, what is the significance and what normally does a healthcare provider order and why?
They order an antibiotic (Penicillin usually, if pt is allergic then a different type of antibiotic will be ordered) to be administered to the mother during labor, so when the baby is delivered, he/she will not contract GBS.
What are some goals we would have for a patient that has been in a motor vehicle accident and their leg was stuck under the vehicle?
We want the patient's vital signs stabilized, regained mobility, proper healing with no signs of infection, efficient perfusion/pulses present in patient's affected leg.
How do you know the resuscitative phase has ended and the acute phase has begun?
When diaphoresis begins (when the patient's body starts producing urine output)
Which would be the anticipated therapeutic outcome of an escharotomy procedure performed for a circumferential arm burn. a. The return of distal pulses b. Decreasing edema formation c. Brik bleeding from the injury site d. The formation of granulation tissue
a. The return of distal pulses
The nurse is assisting with caring for a client who is receiving intravenous fluids and who has sustained full-thickness burn injuries of the back and legs. The nurse understands that which would provide the most reliable indicator for determining the adequacy of the fluid resuscitation? a. Vital signs b. Urine output c. Mental status d. Peripheral pulse
b. Urine output
The nurse is caring for a client who has just been admitted to a nursing unit after receiving flame burns to the face and chest. The nurse notes a hoarse cough, and the client is expectorating sputum with black flecks. The client suddenly becomes restless, and his color is becoming dusky. Based on this data, which interpretation would the nurse make? a. The client is hypotensive b. Pain is present from the burn injury c. The burn probably caused laryngeal edema, which has occluded the airway d. The client is afraid and is having a panic attack as a result of the unfamiliar surroundings.
c. The burn probably caused laryngeal edema, which has occluded the airway
The client arrives at the emergency department after a burn injury that occurred in their home basement and an inhalation injury is suspected. Which would the nurse anticipate as being prescribed for the client? a. Oxygen via nasal cannula at 10 L b. Oxygen via nasal cannula at 15 L c. 100% oxygen via an aerosol mask d. 100% oxygen via a tight-fitting, nonrebreather face mask
d. 100% oxygen via a tight-fitting, nonrebreather face mask
The nurse is caring for a client with circumferential burns on both legs. Which leg position is appropriate for this type of a burn. a. A dependent position b. Elevation of the knees c. Flat, without elevation d. Elevation about the level of the heart.
d. Elevation about the level of the heart.