Where do most burns occur?
At home
How often should smoke detector batteries be changed?
every 6-12 months
00:41
01:10
Flammable items
... [Show More] should be kept at least how far from heat sources?
3 feet
The water heat device should be set no higher than
120 degrees fahrenheit
Why does plasma seep out into the tissue after a burn?
Increased capillary permeability
When does the majority of plasma seepage occur?
first 24 hours (worry about shock!)
Why does the pulse increase after a burn?
compensation; every time there is a FVD, the pulse will increase
Why does the cardiac output decrease after a burn?
there is less volume to pump out
Why does the urine output decrease after a burn?
kidneys are either trying to hold on to fluid or they aren't being perfused adequately
Why is epinephrine secreted after a burn?
because epi and norepi make you peripherally vasoconstrict, blood is shunted to the vital organs
With a normal BP of 120/80, anytime the systolic BP drops below ______, the client will not have adequate organ perfusion; this can be very DANGEROUS
90
Why are ADH and aldosterone secreted after a burn?
to retain sodium and water with aldosterone and retain water with ADH; this will increase blood volume
00:02
01:10
Rule of 9's: Head and Neck
9%
Rule of 9's: Trunk (Front and Back)
36% total - front 18% and back 18%
Rule of 9's: Arm
9% each
Rule of 9's: Leg
18% each
Rule of 9's: Genitalia
1%
Partial thickness burns are also known as
first and second degree burns
Full thickness burns are also known as
third and fourth degree burns
If a burn is located on the face, neck, or chest
there could be interference with breathing
Burns: Risk Factors
-heart, lung, or kidney disease
-pre-existing diabetes or PVD can affect healing of
foot or leg burns
-other injuries that occurred when client was
burned
-higher mortality in very old and very young
Why is there a higher mortality among the very old and very young with burns?
-skin is very thin and they have less SQ fat
-the burn can go deeper and cause more complications
-body surface area is less in the very young
Burns: Treatment
Stop burning process
-wrap client in blanket to stop (absent flames do not guarantee this)
-cool water can stop
-NO more than 10 minutes (can cause extensive heat loss)
-remove jewelry because swelling will occur
-remove non-adherent clothing and cover burns with clean, dry cloth
What does a blanket do when stopping the burning process?
help hold in body heat and keep out germs
What is the number one cause of death with burns?
inhalation injury
inhalation injuries are usually caused by inhaling
carbon monoxide OR hydrogen cyanide
Normally, oxygen binds with
hemoglobin
Carbon monoxide ____________ __________ ______________ than oxygen; therefore
travels much faster; it gets to the hemoglobin first and binds
Is oxygen able to bind after carbon monoxide has?
no
The client becomes ____________ from carbon monoxide poisoning
hypoxic
Carbon Monoxide Poisoning: Treatment
100% oxygen
Why will 100% oxygen help treat carbon monoxide poisoning?
placing more O2 in the race to increase probability that O2 will bind before CO
Hydrogen Cyanide: Treament
100% oxygen
-an antidote may be given at the hospital
It would be important to determine if the burn occurred in ________________________________________
an open or closed space
If someone is burned in a closed space, they will have inhaled ___________ carbon monoxide and/or hydrogen cyanide so,
more; the risk for complications is increased
When you see a client with burns to the neck/face/chest, you should focus on
their airway
What might the primary healthcare provider do prophylactically?
intubation (the airway can swell and close off)
Indications of inhalation injury
-singed nose hair
-singed facial hair
-soot on face
-coughing up secretions with dark specks
-difficult swallowing
-wheezing
-blisters found on the oral/pharyngeal mucosa
-hoarseness
-substernal/intercostal retractions and stridor are bad signs
Is there more death with upper or lower body burns?
upper because of the effects on the airway
If a burn client's respirations are shallow what are they retaining?
CO2
Which acid base imbalance will burn client with shallow respirations have?
Respiratory acidosis
One of the most important aspects of burn management is
fluid replacement
We are giving large volumes of fluid so the client will need
at least 2 large bore IVs
What fluids will be used for fluid replacement?
crystalloids (LR) and colloids (albumin)
Why is it important to know what time the burn occurred?
because fluid replacement therapy (for the first 24 hours) is based on the time the injury occurred, not when the treatment was started
Common Rule for fluid replacement therapy
calculate the total amount of fluid needed for the first 24 hrs and then give half of the amount during the first 8 hours
To calculate the fluid replacement properly, you must know the client's
weight (in kg) and the TBSA affected
If the client is restless, it could suggest three problems
1. inadequate fluid replacement
2. pain
3. hypoxia
1. inadequate fluid replacement
2. pain
3. hypoxia
Which is the nurse's priority?
hypoxia
American Burn Association Fluid Requirement Formula
(2-4mL of LR) X (body weight in kg) X (% of TBSA burned) = total fluid requirement for first 24 hrs after burn
*4mLs used for electrical burns to prevent renal damage
How much fluid is given per 8 hours?
1st 8 hours: 1/2 total volume
2nd 8 hours: 1/4 total volume
3rd 8 hours: 1/4 total volume
Would you select a client's weight or their urine output to determine if their fluid volume is adequate?
urine output
Urinary output needs to be a minimum of
0.5 to 1 mL/kg/hr which is usually at least 30-50 mL/hr in an adult
What is the urinary output goal in client's with electrical injuries?
75-100 mL/hr
What is the required urinary output for children?
1mL/kg/hr
Albumin is administered ___________ first 24 hours
after; capillary permeability normal
Albumin does what
holds onto fluids in the vascular space
What does albumin do to the vascular volume?
increases it
What does albumin do to kidney perfusion
increases it
What does albumin do to blood pressure?
increases it
What does albumin do to cardiac output?
increases it
Albumin helps correct a ___________ because we are putting more fluid in the _____________ ________________
FVD; vascular space
When you start giving a client albumin, the vascular volume will
increase
What will happen to the workload of the heart when giving albumin?
increase (more volume to pump)
Albumin ALERT: If you stress the heart too much the client could go into
FVE
Albumin ALERT: if FVE occurs, what will happen to the cardiac output?
it will decrease
What is a measurement you could take hourly to ensure that an infusion is not overloading the client?
CVP
When giving a narcotic, especially IV, what is the most important reassessment you must make?
respirations
Why are IV pain meds preferred over IM with burns?
IV meds act quickly [Show Less]