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NRS 440 - Final Exam Questions and Answers Fully Solved

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NRS 440 - Final Exam

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NRS 440 - Final Exam

thermal burns - answer caused by flame, flash, scald, or contact with hot objects

most common type of burn

severity of injury depends on:
-temperature of burning agent
-duration of contact time

smoke inhalation burns - answer from inhalation of hot air or noxious chemicals

cause damage to respiratory tract

major predictor of mortality in burn victims

need to be treated quickly

more prone to ARDS and pneumonia

monitor ABGs

types of inhalation injuries: metabolic asphyxiation - answercarbon monoxide (CO)
poisoning

CO is produced by incomplete combustion of burning materials

inhaled CO displaces oxygen: hypoxia, carboxyhemoglobinemia, death

hypoxia and ultimately death when CO levels are 20% or greater

treat with 100% humidified O2

CO poisoning may occur in the absence of burn injury to the skin
-can look fine on outside, but dying on inside

suspect when person was in closed area w/ fire

types of inhalation injuries: upper airway injury - answerinjury to mouth, oropharynx,
and/or larynx

thermally produced

,hot air, steam, or smoke

swelling may be massive and rapid onset
-eschar and edema may compromise breathing
-swelling from scald burns can be lethal

damage to mucus membranes; may need immediate intubation

reliable clues to this injury:
-presence of facial burns
-singed nasal hair
-hoarseness, painful swallowing (new)
-darkened oral and nasal membranes
-carbonaceous sputum (blackish)
-history of being burned in enclosed space
-clothing burns around chest and neck

types of inhalation injuries: lower airway injury - answerinjury to trachea, bronchioles,
and alveoli

injury is r/t length of exposure to smoke or toxic fumes

pulmonary edema may not appear until 12-24hrs after burn
-dyspnea, tachycardia, chest pain, cough, fatigue, SOB, tachypnea, wheezing,
sweating, water retention
-manifests as ARDS -> capillary permeability

severity of injury - answerdetermined by:
-depth of burn
-extent of burn in % of TBSA
-location of burn
-patient risk factors

depth of burn - answerused to be 1st, 2nd, 3rd, ad 4th degree, but is now according to
depth of skin destruction
-superficial partial-thickness burn: involves the epidermis (sunburn)
-deep partial-thickness burn: involves the dermis
-full-thickness burn: involves all skin elements, nerve endings, fat, muscle, bone (initially
no pain)`

extent of burn: lund-browder chart - answerdetermines the total body surface area
(TBSA)

more accurate bc considers body size

, extent of burn: rule of nines - answerdetermines the total body surface area (TBSA)

used for initial assessment

sage burn diagram

location of burn - answerseverity of burn injury is determined by location of burn wound
-face, neck, chest -> respiratory obstruction (edema & eschar)
-hands, feet, joints, eyes -> self-care (ROM & self-esteem)
-ears, nose, buttocks, perineum -> infection (poor circulation & infection)

circumferential burns of extremities can cause circulation problems distal to burn (watch
swelling bc decreased circulation in distal areas -> O2 and pulses)

pts may also develop compartment syndrome

complications: dyspnea, pneumonia, delirium

patient risk factors - answerpre-existing CV, respiratory, and renal disease contribute to
poorer px

DM and PVD contribute to poor healing and gangrene

physical debilitation renders pt less able to recover: alcoholism (liver and poor nutrition),
drug abuse, malnutrition (poor healing)

concurrent fx, head injuries, or other trauma leads to a more difficult time recovering

phases of burn management: emergent/resuscitative phase - answerfrom paramedic ->
hospital

time required to resolve immediate problems resulting from injury

up to 72 hours

primary concerns: hypovolemic shock and edema

nursing/collaborative management: airways management: emergent/resuscitative phase
- answerairway management:
-early endotracheal intubation: remove after 3-6 days
-escharotomies of the chest wall: incision to remove fibrous tissue
-fiberoptic bronchoscopy
-humidified air and 100% O2

high fowler's, cough/deep breathe/IS, repositioning

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