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NUR 443 EXAM II QUESTIONS AND ANSWERS
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NUR 443 EXAM II QUESTIONS AND ANSWERS
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NUR 443 EXAM II QUESTIONS ANDANSWERS
What are the types of burns (5)? - Answer-Thermal (Heat Source)
- Flame
- Scold
- Contact with a hot object ex. grease, fire, radiant heat
Chemical
- Acid
- Alkalis
- Organic compound
ex. heavy industrial cleaning
Electrical
- Lightning, Electrical Current
ex. deep and can be very deceiving/destructive
*What's going on inside?
Radiation
- Sunlight
- radiation treatment (cancer)
Inhalation
- Exposure to upper airway and lung to burn source
ex. house fire, smoking
degree of burns - Answer-Superficial (First-degree burns)
Partial Thickness (Second-degree burns)
Full-thickness (Third-degree) burns
What are s/s of a first degree burn? - Answer-Superficial burn
blanching on pressure, pain and mild swelling, NO Blisters (but may appear or peel after
24 hrs0
What are s/s of a second degree burn? - Answer-Deep
Fluid filled vesicles that are red, shiny, wet, severe pain caused by nerve injury,
mild/mod edema
What causes first and second degree burns? - Answer-Scald
,Contact Burn
Chemical
Electric current
Flame
*PARTIAL Thickness Burns!
What are s/s of a third or fourth degree burn? - Answer-FULL Thickness
dry, waxy, leathery or hard skin
Insensitivity to pain because of NERVE DESTRUCTION
*May involve muscles, tendons, and bone
How do we measure the total body surface area of a burn? - Answer-Rules of Nines
**NEED TO KNOW
**REMEMBER ANTERIOR POSTERIOR -> DIVIDE NUMBER BY 2
4.5 face anterior
4.5 posterior
9 ant chest
9 posterior chest
9 abd
9 buttocks
What are location-related risk factors for burns? - Answer-Watch out for burns to:
Torso and Head
(Face, neck, chest and back --> BREATHING RISK)
Can be secondary to mechanical obstruction from edema and eschar (burned tissue)
**Smoke inhalation injuries
**NEED STABLE AIRWAYS!
What are the phases of burn treatment? - Answer-Emergent/resuscitative phase
**GREATEST RISK FOR SHOCK!
(Hypovolemia & Edema, intravascular depletion of fluids!!)
12-24 hrs
Acute phase
Lasts until wound healing and skin graft
Weeks to Months
,Rehabilitation phase
Patient is engaging in self-care
Goal: Pt back to functional role, self-care, ADLs "new norm"
Why do we see massive edema with a burn? - Answer-Response during emergent
phase
MASSIVE shift of fluids from vascular space to interstitial space as result of increased
cap permeability
What do we worry about systemically with burn injuries? - Answer-Burn shock
Organ injury
Cardiac response
Pulmonary response
GI response
Renal response
Immune response
Integumentary response
MODS
What will we see during the emergent phase of a burn? - Answer-Fluid/electrolyte shift
"Third Spacing"
Colloidal osmotic pressure decreases
Moe fluid shifting out of vascular space into interstitial spaces
EDEMA, INCREASE HR
LOW BP
K+ moves to EXTRACELLULAR SPACE
Na+ moves to
INTERSTITIAL SPACE
HCT and HBG - ELEVATED
BUN/CREATININE - ELEVATED
Na+ - DECREASED
GLUCOSE - INCREASE
K+ - INCREASED
What is the treatment for emergent phase of a burn? - Answer-FLUIDS!
LARGE bore IVs (2)
for >15% TBSA
*Fluid type depends on size/depth of burn, age, and individual considerations
, "Parkland" (Baxter) formula for fluid replacement
What is the Parkland formula? - Answer-4 mL LR x wt (kg) x (% of body SA burned)
50% in first 8 HR
25% in next 8 HR
25% in next 8 HR
What is the most accurate indicates of fluid resuscitation? - Answer-Urinary Output
What are indicators of fluid resuscitation? - Answer-- Mentation
- Skin color/temp
- HR
- BP (MAP >65)
- Urinary Output
- Specific Gravity
- Hemoconcentration (decrease in volume of plasma related to blood cells - we would
expect LESS concentrated blood)
- GI function
What are priorities with burn patients? - Answer-#1 FLUID RESUSCITATION
Stop burn
Airway
Analgesics
Monitor for shock
Prevent infection
Nutrition
Skin care *open method (atopic microbial - face), closed method (covered with gauze)
What is treatment for acute phase of a burn? - Answer-Body is still trying to reestablish
fluid/electrolyte balance
WATCH SERUM ELECTROLYTES CLOSELY (Na+/K+)!
HYPO (GI suctioning, D, excessive oral intake)
HYPERnatremia
(fluid resuscitation, tube feedings)
HYPO (V/D, GI suctioning)
HYPERkalemia
(renal failure, electrical burns with muscle damage - K+ released from damaged cells)
Other considerations:
Pain mgmt
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