Burn pathophysiology 1
A patient has a 2nd degree burns on anterior upper and lower left arm, anterior upper and lower right arm, upper anterior torso, and lower anterior torso. The TBSA is
What is 27%
Expectoration of carbon particles in the sputum is a cardinal sign that that patient has this.
What is lower airway inhalation injury? The treatment for this is aggressive pulmonary toilet in order to maintain airway patency and clear viscous sputum. This is best done naturally (ie not when patient is intubated and mechanically ventilated).
In regard to fluid resuscitation on a burn patient, the preferred IV fluid is this.
What is Lactated Ringers?
Because burns are contaminated wounds, this is given to the patient if immunization status is not current or unknown.
What is tetanus prophylaxis?
Airway obstruction caused by upper airway edema can take as long as this to develop.
What is 48hrs?
In order to prevent contractures and hypertrophic scaring, this is implemented aggressively from day one of admission.
What are passive and active range-of-motion exercises?
Burn injuries that that affect more than approximately this TBSA are considered major as they trigger local and systemic effects.
What is 20%? With injuries this great, the systemic inflammatory response to a severe burn injury signals the release of pro-inflammatory and anti-inflammatory cytokines, prompting hypermetabolism effects that produce organ dysfunction, a pronounced catabolic response, systemic compromise, and potential mortality.
With an electrical burn injury, the patient’s urine may be red because the kidneys are trying to excrete _______ that result from _______injury.
What is myoglobin and muscle?
Fluid resuscitation is initiated when TBSA is this.
What is 20% or greater.
If a patient is victim to a lightning strike, a baseline this is warranted as well as continuous this.
What is EKG and cardiac monitoring?
This (these) is (are) an ominous physical sign(s)/symptom(s), as they are late signs of impending airway obstruction.
What are stridor and dyspnea?
Keeping in mind the modulation of hypermetabolism in a burn patient, this may be given to improve protein synthesis and metabolism.
What is Oxandrolone (anabolic steroid).
When a burn injury occurs, there is an immediate decrease in this that precedes the loss the plasma volume.
What is cardiac output? systemic inflammation → capillary permeability→ ↑plasma loss→ peripheral edema (interstitium)→catecholamine release→vasoconstriction→↓tissue perfusion → hypovolemic shock 2ndary to intravascular volume loss
In regard to GI alteration in a burn injury patient, this may be administered in order maintain intestinal barrier function through avoidance of colonization of pathogenic microorganism.
What are probiotics?
For a thermal/chemical burn patient (adult), the ABA fluid resuscitation formula is this.
For electrical burns it is
What is 2ml LR x pt’s weight (kg) x %TBSA (2nd, 3rd, 4th degree burns).
4ml LR x pt’s weight (kg) x %TBSA (2nd, 3rd, 4th degree burns).
A burn patient’s ABG show elevated carboxyhemoglobin. This is evidence that the patient is suffering from this and warrants 100% of this.
What is CO poisoning and humified oxygen via non-rebreather at 15LPM?
Although research results are mixed, as it relates to management of pulmonary complications, this drug may be administered because it is thought to have some effect on the inflammatory cascade and formation of fibrin casts in the airway.
What is nebulized heparin?
Because patients with burns are hypermetabolic, they display tachycardia, tachypnea, and elevated temperature. Hence, detecting the early and subtle signs of this condition requires a high index of suspicion and very close monitoring.
What is Sepsis/SIRS?
Unlike trauma injuries which often result in blood loss, only this is lost in the burn injury.
What is plasma?
The patient’s is losing sensation of his left hand related to restrictive defects in left upper arm due to burn injury edema.
What is a fasciotomy?
In regard to ABA fluid resuscitation, half of the calculated volume is given in _______hrs. The second half is given over________hrs.
What is 8 and 16.
A client with 3rd degree burn injury to anterior and posterior torso and complete left and right upper limbs is having difficulty taking deep breaths. The RN is keen to anticipate ______due to likely worsening________.
Escharotomy and compartment syndrome.
As capillaries regain integrity at 48 hours or more after the burn, fluids shift from the interstitial to the intravascular compartment and diuresis begins. If cardiac or kidney function is inadequate, this may occur, and symptoms of this may emerge.
What is fluid overload and heart failure?
When applying circumferential dressings to a burn wound, they should be applied from ______ to ________ to promote return of excess fluid into the central circulation.
What is distally to proximally? Also in the case of hand or foot burns, the fingers and toes should be wrapped individually to promote mobility and function while healing.
Immediately after a burn injury, this results because of massive cell destruction.
What is hyperkalemia?
The greatest volume of intravascular fluid leak occurs between this time frame after the burn injury.
What is 24-36 hrs? And it peaks between 6-8 hrs.
An 80kg patient that has suffered 3rd degree thermal burns is receiving fluid resuscitation. The patient’s urine output per hour should be between this.
What is 40-80ml/hr? (0.5ml to 1ml/kg/h).
The nurse is caring for a burn patient. The provider has just ordered Histamine-2 blockers for the patient. The nurse knows that is ordered to prevent this.
What is Curling’s syndrome. The provider may also order antacids.
Because of the loss of epidermal barrier, the presence of transmissible bacteria, and the ubiquity of mold species in the environment, it is important that the nurse implement this plan of care.
What is infection prevention?
As it relates to dressing changes, this is not advised for burn care because of the possibility of removing viable epithelial cells along with necrotic tissue.
What is wet-to-dry? The preferred is wet-to-wet or wet-to-moist.