Grand Glance
This is less severe with deeper injury.
What is pain response? Why- due to the destruction of nerve endings.
These are the areas of the body that, when burned, require referral to a burn center regardless of TBSA.
What are the face, hands, genitals, feet, and major joints? Why- these areas of the body are more prone to complications and may require intensive management to preserve function.
These are the potential complications of inadequate fluid resuscitation
What are Shock, conversion, and organ failure? Why- Distributive and hypovolemic shock--> hypoxia
This is a burn prevention task of the inpatient RN.
What is patient education? Specifically with home oxygen/ smoking.
This assessment may look great but the patient is still hypoxic. (give the why).
What is oxygen saturation- this is due to the affinity of carbon monoxide, which is 200x stronger to hemoglobin than that of Oxygen. Arterial blood gas (ABG) analysis with CO-oximetry is the gold standard, as it measures actual oxyhemoglobin and detects hidden hypoxemia.
These may declare themselves and get worse over time.
What are burn injuries- especially from electrical sources? Why- the tissues damaged most are usually below the superficial level of the skin due to the insulating properties of skin. This will die off and allow the injury to be fully seen over time.
What are skin grafts? Why- all epithelial elements and structures are destroyed, preventing spontaneous healing.
This is the second movement of fluid that happens around 48-72 hours and how to know it is happening.
What is the diuretic phase and increased urine output due to the reduction in cytokine release and fluid moving back to the vascular space from the interstitial space?
This is the first goal of the emergent phase.
What is stopping the burn? -remove clothes, jewelry, decontaminate
These increase the likelihood of inhalation injury.
What are confined spaces, confusion, burns to upper body, singed facial hair, soot in sputum, and voice changes?
This is the reason that sepsis and infection are such a problem post-burn injuries.
What is immunocompromised due to a lack of a skin barrier.? Why- Burn patients have lost the immune barrier, but they also may "look" septic when they are not, which can make infection hard to identify. Temp and trends are informative in watching for infection.
This is the best way to increase the post-burn patient's nutrition due to the hypermetabolic state that can last for years.
What is Enteral nutrition? why- without supplementation healing can be impaired, early enteral feeding is associated with improved outcomes.
This amount of urine output indicates that we have adequate fluid resuscitation in place.
What is 0.5ml/kg/hr -1ml/kg/hr. (1ml/kg/hr = the goal for all patients with electrical burns or myoglobin present in urine). Why- this indicates t, if we have not attained this urine output, more fluid needs to be given.
This is the acid /base imbalance expected in burn injury and why.
What is Metabolic acidosis: Vascular dehydration = reduced blood volume and hemo-concentration
Trauma = release of potassium into extracellular fluid (hyperkalemia)
Sodium traps in edema fluid and shifts into cells as potassium is released (hyponatremia)
This is the most common cause of death in the initial phase of burn injury. (must list symptoms)
What is carbon monoxide poisoning? CM: headache, confusion, nausea, dizziness, vomiting, dyspnea, may have a pink or flushed appearance.
This helps to indicate the likelihood of systemic involvement and burn shock.
What is rule of 9's or total body surface area calculations? Why- over 20% TBSA burned increases risk of systemic involvement and burn shock requiring fluid resuscitation.
This is necessary for managing increased acidic secretions.
What is a nasogastric tube? why- this id due to the increased acid produced by the stress response that may contribute to ulcer formation. The NG tube allows for decompression, helps protect against aspiration, and then can aide in delivery of medications and nutrition.
This is required to determine adequate fluid resuscitation via accurate urine output.
What is a foley catheter? why- accurate hourly output is needed to assess the adequacy of our fluid dosig.
This is the amount of time for the first half of the fluid resuscitation to be administered
What is 8 hours post burn? why- to mitigate the effect of burn shock in severe burns.
These are indications for prophylactic intubation. - must include rationale.
What is any sign of inhalation injury or respiratory difficulty? why- because swelling will quickly limit the ability to obtain an airway if a protective one is not established- bonus* tracheostomy supplies should be kept at bedside should the airway become dislodged and need an emergent procedure to reestablish airway.
Presence of inhalation injury, patient age, past medical history, and concomitant injury, as well as burn location.
What are the factors that determine the severity of a burn and determine patient outcome? Why- age and PMH are the biggest indicators of burn outcomes. Even small burns can be fatal in older adults (thinner skin, less immune function, cardiac issues limiting ability to manage large fluid shifts).
This finding may indicate extensive muscle damage.
What is myoglobinuria? This may cause renal function compromise and because of this frequent renal assessments should be done.
This is the amount of LR needed to resuscitate a patient who weighs 70kg and is burned over 50% of their TBSA (including first infusion rate and time, and second infusion rate and time).
What is 7,000 mL- 3,500 mL in the first 8 hours at a rate of 438ml/hr and 3,500 mL over 16 hours at a rate of 218 ml/hr?
This is the pathophysiological explanation for what is happening after a major burn, which can cause burn shock.
What is: Burns > 20% BSA produce local and systemic response (major burns) which cause a systemic response = release of cytokines into systemic circulation which causes fluid shifts (electrolytes and water move to interstitial space and out of the vascular space/ shock = in tissue hypoperfusion and organ hypofunction.
What is compartment syndrome? Escharotomy (surgical incision through the eschar) or fasciotomy (surgical incision deeper through the fascia) with the intention of removing the "tourniquet" of swelling to restore perfusion. Assessments should be performed distal to the injury hourly with comparisons bilaterally. This is especially important with large or circumfrential burns.