thermal injuries-burns

  1. classification of burns:
    first degree (superficial)
    how far does it go?
    what are the causes?
    EPIDURAL layer

    sunburn, UV light, minor flash injuries, mild radiation burns
  2. classification of burns:
    what might the skin look like?
    • pink to bright red
    • slight edema
    • mild pain

    • tx:
    • mild analgesia
    • water soluble lotion
  3. classification of burns:
    second degree burn (partial thickness)
    how deep does it go?
    through layers of dermis
  4. classification of burns:
    partial thickness two types?
    • superficial partial-thickness
    • deep partial-thickness

    (type depends on depth of burn thru the layers of the dermis)
  5. classification of burns:
    what can cause a superficial partial thickness burn?
    • flash flame
    • dilute chemical agent
    • hot surface
  6. classification of burns:
    what can cause deep partial-thickness burn?
    • hot liquids, solids
    • flash or direct flame
    • radiant energy
    • chemical agents
  7. classification of burns:
    what might superficla partial thickness burns look like?
    • bright red
    • moist glistening appearance BLISTER
    • PAIN in response to air or heat
  8. classification of burns:
    what might a deep partial thickness burn look like?
    • pale and waxy
    • moise or dry BLISTER
    • PAIN in response to air or heat
  9. classification of burns:
    treatment for partial thickness burns?
    • analgesia
    • skin substitutes
    • grafting may be necessary
  10. classification of burns:
    third degree burn aka?
    full thickness burns
  11. classification of burns:
    third degree burns go how deep?
    • all layers of skin
    • may extend to subq fat, connective tissue, muscle, bone
  12. classification of burns:
    what can cause third degree burns?
    • prolonged contact with:
    • flames
    • steam
    • chemicals
    • high-voltage electrical current
  13. classification of burns:
    what do 3rd degree burns look like?
    • pale
    • waxy
    • yellow
    • brown
    • mottled
    • charred
    • nonblanching skin
  14. classification of burns:
    3rd degree burns. do they still have sensation?
    • NO NO NO
    • since receptors were destroyed
  15. classification of burns:
    how to treat 3rd degree burns?
    usual tx is skin grafting
  16. what is parkland formula?
    TBXA (%) x Wt (kg) x 4mL

    • give 1/2 total requirements in 1st 8 hrs
    • then give 2nd half over the next 16 hrs
  17. hypovolemic shock aka?
    burn shock
  18. how does hypovolemic shock manifest itself in the CARDIOVASCULAR system?
  19. what happens immediately after injury(burn) to 24 hrs after?
    fluid shift (3rd spacing)

    *we'll see weight gain; edema
  20. where does the fluid shift during 3rd spacing (burns)?
    intracellular > intravascular >interstitial

    *^ permeability -> ^ intracellular edema -> ^ osmosis
  21. when does FLUID REMOBILIZATION happen (burn shock)?
    48-72 hrs after injury
  22. what happens during FLUID REMOBILIZATION?
  23. what's the normal urine loss?
    30-50 ml/hr
  24. when a severely burned pt is in the diuretic phase, how much urine do they lose?
  25. what can cause arrhythmias?
    • >40% tbsa (total body surface area) loss
    • electrolyte shifts and cellular damage
    • peripheral vascular alteration -> compartment syndrome
  26. in a burn patient, what might wheezing indicate
    partial obstruction
  27. burns to the airway?
    (can happen thru direct inhalation)
    • inflammation
    • interstitial pulm edema
    • hoarseness
    • raspy cough
    • drooling
    • black mouth

    • (resp manifestations can also be a systemic response)
    • inflammation
    • intersitial pulm edema
    • upper airway
    • smoke poisoning
    • CO poisoning
  28. Gi manifestations of burn?
    • paralytic ileus
    • stress (curling's) ulcer
    • ischemic bowel > bacterial dislocation > sepsis > multiple organ dysfunction (MOD)
    • *dysfunction r/t SIZE of BURN WOUND
  29. what can cause paralytic ileus in burns?
    • decrease blood flow
    • decreased sympathetic tone
  30. what can cause stress (curling's) ulcers in burns?
    • increased stress
    • decreased blood flow

    tx: h2 antagonist
  31. (burns) urinary system manifestations?
    • early stages:
    • decrease renal blood flow = decrease GFR
    • myoglobinuria (from muscle breakdown) - dark concentrated urine
    • progresses to renal failure

    • NI:
    • uo and color
    • I & Os
    • BUn
    • creatinine
  32. immune system manifestations for burns?
    • compromised system d/t stress response
    • open wounds and decrease immune function

    *infection and sepsis is the leading cause of death in acute phase

    • s/s of infection:
    • ^wbc
    • purulence
  33. in a burn pt, how much can the RESTING metabolic rate increase by?
  34. what can cause increased metabolic and catabolic rates in burn patients?
    heat and water loss
  35. what happens to a burn pts metabolism?
    loss of h2o and heat ->^ metabolic & catabolic rates -> increase caloric needs -> resting metabolic rates ^50-100%

    • increased secretion
    • activated stress response
    • extent of injury dictates caloric needs
    • increase in core body temp
  36. what are the 3 stages of treatment for the burn patient?
    • 1. emergent (rescusitative stage)
    • 2. acute phase
    • 3. rehabiliation stage
  37. this stage's onset in 24-48 hrs.
    urine is heavily concentrated.
    decreased CO. increased HR.
    emergent-resuscitative stage
  38. what is the priority for the first stage of treatment (burns)
    • airway management (intubation)
    • fluid resuscitation - crystalloids
    • IV - 2x large bored
    • pain meds - morphine IV
    • abx
  39. what is the most common cause of death in the emergent-resuscitative stage?
    • burn shock
    • *restore circulation volume to decrase risk
    • *replace elctrolytes
    • *maintain adequate urine output
  40. (burns) when does the acute phase happen?
    • 36-48 hrs til wks, months, years
    • begins w/ diuresis (fluid shift)
    • ends with would closure - wounds are healed
  41. (burns) what is the patient at risk for in the acute stage?
    • fluid depletion
    • hypokalemia
    • hyponatremia
  42. why is burn patient at risk for fluid depletion in the acute stage?
    massive UO (diureses)
  43. what is the priority in the acute phase (burns)?
    • monitor electrolytes
    • meet patients increased caloric needs (TPN)
    • wound management
    • monitor for s/s of infection
    • prevent sepsis
    • pain management
  44. this stage begins with wound closure. (burns)
    rehabilitative stage
  45. what are the priorities in the rehabilitative stage? (burns)
    • prevent contractures and scars
    • pt returns to work, fam, & social roles
    • vocation, occupation, physical, psychosocial rehab
    • *restore optimal health status and FUNCTION
  46. NO DIURETICS in the stage. think EDEMA! (burns)
    emergent - resuscitative stage
  47. when pt reaches the ER, what does hx the does staff obtain pertaining to the burn injury?
    • 1. time of injury
    • 2. causative agent
    • 3. early tx of burn
    • 4. client's past med hx
    • 5. clients age and body wt
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thermal injuries-burns