Vascular Changes
What causes third-spacing in burn injuries?
Increased capillary permeability due to the inflammatory response.
What is the first sign of burn shock?
Tachycardia
What is a sign of inhalation injury?
Singed nasal hairs, soot in mouth/nose, hoarseness.
Why does the gut slow down in burns?
Blood is shunted away from GI tract → decreased perfusion → ileus.
Expected urine output in burn patient?
Greater than or equal to 30–50 mL/hr in adults.
Name 2 signs of hypovolemic shock in burn patients.
Hypotension and tachycardia.
What is the Parkland formula?
4 mL x body weight (kg) x % TBSA burned = 24-hour fluid requirement (½ in first 8 hrs, ½ in next 16 hrs).
First action if you suspect airway compromise?
Prepare for early intubation.
What is Curling’s ulcer and how to prevent it?
Stress ulcer from decreased GI perfusion. Prevent with PPIs or H2 blockers.
What does dark brown urine indicate?
Myoglobinuria (muscle breakdown, especially from electrical burns).
Explain the role of albumin in burn management.
Albumin helps restore oncotic pressure and pull fluid back into the vascular space during fluid resuscitation (usually given after initial 24 hours).
How do you assess fluid resuscitation adequacy in a burn patient?
Monitor urine output (target ≥ 30–50 mL/hr), BP, heart rate, mental status.
Why may a burn patient develop ARDS?
Inflammatory mediators increase capillary permeability → pulmonary edema.
Why start enteral nutrition early?
Maintains gut integrity, prevents bacterial translocation, supports healing.
Why do burn patients develop AKI?
Decreased renal perfusion or nephrotoxicity from myoglobin or sepsis.
Case: A patient has massive edema but low BP. What’s happening and what’s your nursing priority?
Third-spacing is leading to hypovolemia. Priority: Start/continue IV fluid resuscitation and monitor vitals.
Case: Persistent hypotension despite fluids. Next step?
Evaluate for ongoing fluid loss or other causes; may need colloids or vasopressors. Consider invasive monitoring.
Case: Hoarse voice, singed hairs. Priorities?
Secure airway ASAP. High-flow O₂, anticipate intubation. Monitor SpO₂ and ABGs.
Case: Abdominal distention, no bowel sounds. Interventions?
NPO, insert NG tube, monitor for ileus, notify provider.
Case: BUN/Cr rising, UO <10 mL/hr. What do you do?
Notify provider. May need fluid bolus, assess for AKI, adjust meds.
Rapid Response: Swelling under the burn dressing. What’s your concern?
Compartment syndrome. May require escharotomy to relieve pressure.
Rapid Response: Which electrolyte imbalance is common early and causes arrhythmias?
Hyperkalemia from cell lysis.
Rapid Response: SpO₂ dropping despite oxygen. What do you suspect?
Inhalation injury, CO poisoning, or ARDS. Consider carboxyhemoglobin level.
Rapid Response: NG tube not draining, firm abdomen. Concern?
Bowel obstruction or perforation. Requires immediate evaluation.
Rapid Response: Burn + kidney disease—how to adjust care?
Careful fluid management, monitor electrolytes and renal labs closely. May need dialysis. Avoid nephrotoxic drugs.