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Why will WBC be elevated in a burn patient?
Because burns cause a systemic inflammatory response.
Your burn patient has an elevated lactate levels. What complication may you suspect?
Sepsis.
Rationale: Tissues release lactic acid when they do not receive enough oxygen.
___________ thickness burns will not self regenerate and require skin grafting.
Full thickness burns
What is the best indicator of adequate perfusion?
Urine output of at 30- 60 mLs/hour
systolic
What types of dressings do you NOT put on burns?
For the love of god do not put a dry dressing on it.
If blood loss occurs a CBC will show decreased what?
hemoglobin and hematocrit
An increased creatinine and decreased GFR indicates what complication?
A patient presents to the ER with burns to his hands and feet. Which type of burn would you suspect caused these injuries?
Electrical Burn. Rationale: All Electrical burns have an entry and exit wound.
What is the main reason for electrolyte imbalance in burn patients?
Fluid shift
You are the home care nurse assessing a new client with a superficial partial second degree burn. How long might you anticipate this client requiring wound care?
The healing time is generally 21-28 days.
What labs are tested in a burn trauma panel?
EVERYTHING
ABGs, CO, ALT, AST, BUN, Creatinine, Pt PTT, blood type and screen, Urinalysis, CBC, lactate, c-relative proteins, ethanol,
When assessing for compartmental syndrome, what are the 5 P's you are looking for?
1) Pulselessness
2)Pain
3) Pallor
4) Parasthesia
5) Paralysis
A women enters the ER with a burn to her forearm from boiling water. Upon assessment, it appreas dry, pale, waxy with no blanching. What degree of burn is this?
Deep Partial Thickness
Your patient is an 8 year old weighing 32 kg. The BSA is 25%. Use parklands formula to determine how much fluid the child would receive in the first 8 hours. AND GO!
1600 mL in the first 8 hours
What is the main anagesic used in a pediatric burn patient and what complication do you monitor for?
intranasal fentanyl
monitor for respiratory depression
use narcan when reps are less than 8
You ABG results for a burn patient are pH of 7.28 and HCO3 of 17 and a CO2 of 31. What condition does this indicate?
Partially Compensated Metabolic Acidosis
When completing an assessment of a burn patient, what finding indicated possible pulmonary/airway damage? (7 total but list at least 4)
1) Hx of burn occuring in enclosed area
2) Burns on face or neck
3) singed nasal hair
4) hoarsens, dry cough/stridor, stooy sputum,
5) blood sputum
6) labored breathing or tachypnea
7) Hypoxemia
8)Erythema and blistering to the oral mucosa
What type of burn should a nurse watch for in a patient receiving treatment for cancer? How do you care for it?
Radiation burn
-Gently wash with normal saline as the skin is easily irritated. Prescription creams can be used as well (calendula, antibacterial cream)
Cerebral edema and seizures can result from which electrolyte imbalance?
Severe hyponatremia. Hyponatremia occurs due to extracellular depletion.
What is an important factor when providing initial care for a dry chemical burn? (powder)
The nurse must brush away any residual powder before flushing with water, as the water can activate the chemical powder.
In pediatric burn patients does hyper or hypoglycemia occur and why?
Hyperglycemia
Rationale: increased glucogensis occurs, decreased glucose uptake and reduced glucose clearance (due to insulin resistance) STRESS RESPONSE!!!
Scenario: Patient presents to the ER after being in a burning building for 1 hour. They are complaining of headache, malaise, tachypnea, dizziness, weakness. Vitals are: RR 125, BP 125/86, SP02 96% on RA, Pulse 125. They appear cherry red in the face. What complication do you suspect?
Carbon Monoxide Poisoning
Rationale: hemoglobin has a higher affinity for c02 opposed to 02
How do you calculate burn severity?
In a burn, where does sodium shift and where does potassium shift and why?
Massive cellular trauma causes release of K into ECF causing hyperkalemia
Large amount of Na is lost in trapped edema fluid and exudate and shift into cells at K shifts out of the cell causing hyponatremia.
When determining the depth of a burn the following needs to be considered/ assessed? (5 factors to consider)
1) How the injury occurred
2)Causative agent
3) Temperature of the burning agent
4) Duration of contact with the agent
5) Thickness of the skin (degree)