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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 Examthermal 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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