Exam (elaborations)
Exam (elaborations) NUR 241
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NUR 241 - Critical Care II"Formulated by Top Scholars Worldwide"
describe first degree/superficial burns - -correct ans- -involve epidermis only, pink-red color, mild edema
and pain, peeling of dead skin, rapid healing (3-7) minimal scarring (think sunburn)
what is burn severity determined by - -correct ans- -burn depth, burn size, and burn location
how are first degree burns treated - -correct ans- -silvadene, solarcaine, NO ice (can make worse due to
constriction)
describe 2nd degree/superficial partial thickness burns - -correct ans- -involve epidermis and upper
layer of dermis, pink, moist, blistered, moderate edema, intense pain, blanches with pressure, heal in 2-
4 weeks w/minimal scarring
how are second degree burns treated - -correct ans- -wound care (can use santyl to debride), bacitracin,
aquacel AG
describe deep partial thickness burns - -correct ans- -extend deeper in to dermal layer, appears pale or
mottled, white ish/sloughing, moderate edema, intense pain, heals 3-6 weeks
what do deep partial thickness burns require that superficial generally dont - -correct ans- -excision of
the wound and possible skin grafting or aquacel AG
describe full thickness/third degree burns - -correct ans- -all the way through dermis in to subcutaneous
tissue, dry, leathery, not painful, *does not blanch*, weeks to months of healing, significant scarring,
loss of function, grafts are required
,describe full thickness that extends in to muscle and bone/4th degree burns - -correct ans- -destruction
of muscle, tendons and bones, wound is blackened/charred, no pain or edema, amputation may be
necessary
what can infection do to burns - -correct ans- -convert it - it can make the burn even worse. could go
from 2nd to 3rd degree from infection
Infection control is VERY important for burns - good handwashing, gowns/gloves etc for all, no live
flowers, no linens from home, change gloves frequently - -correct ans- -
describe the rule of nines - -correct ans- -adult - legs, front chest/trunk, and back = 18%, head and arms
- 9% and genitals =1%
babies - head 18%, front and back chest 18%, legs 14% arms 9%
what is the lund and browder method - -correct ans- -precise method of measuring extent of burned
area - helps us determine how much fluid needs to be resuscitated
what is burn shock - -correct ans- -begins with inflammatory response - increased capillary permeability
causes a fluid shift causing edema, hypotension, tachypnea, tachycardia and oliguria
describe burn edema and how it can manifest - -correct ans- -in burns less than 25% of the body surface
area, edema will be in the burn wound
in burns greater than 25% of body surface, edema can be in non affected tissues as well
how long after a burn does burn edema form - -correct ans- -small to moderate burns - 8-12 hours after
extensive burns 12-24 hours after
capillary membrane permeability returns to normal within 18-36 hours
, how is fluid resuscitation done with burn patients - -correct ans- -use least amount of fluid to maintain
adequate organ perfusion, LR is fluid of choice. volume infused is titrated
what formula is used to determine the fluid resuscitation needed for burn patients - -correct ans- -
Parkland formula
what is the parkland formula - -correct ans- -4mL x weight in kg x %TBSA
how are fluids given with the parkland formula - -correct ans- -the amount calculated will be given over
24 hours. 1/2 will be given over 8 hours, the other half will be given over 16 hours
*fluids needs to be calculated using the time of injury as a starting point in parkland formula* - -correct
ans- -
if it is determined that fluids need to be slowed down or sped up how do we calculate that for parkland
formula - -correct ans- -increase or decrease the fluid by 1/3 - so if we were giving 463mL an hour and it
needed to be increased, we would take 463 x .33 to get 615 mL
what can be used to clean a wound out - -correct ans- -hydrotherapy, immersion, or Vashe to clean it
(neutral pH and kills bacteria), can also do mechanical or chemical debridement
what are wounds covered with after debridement/cleaning - -correct ans- -antibicrobial creams like
bacitracin, santyl, sulfamylon, occassionally silvadene, dry gauze then covers the wound
what is bacitracin - -correct ans- -antibiotic ointment, does not penetrate eschar, can be used on face
and superficial partial thickness burns (1st and 2nd degree)
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