Exam 3 Study Guide - Burns / Unit 8
Exam 3 Study Guide: Unit 8 Burns
Advanced Med-Surg 265 | Instructor Lecture Video Study Guide
EXAM ALERT / Instructor Emphasis
Burns are not just skin injuries. They cause local and systemic problems: fluid/electrolyte
shifts(potassium), protein loss, sepsis risk, metabolic/endocrine changes, respiratory, cardiac,
hematologic, immune, renal, GI, neurologic, and thermoregulation problems.
Fluid resuscitation is the prime objective of initial burn treatment. Know the Parkland formula and the first
8 hours/next 16 hours rule.
Burn below the waist: priority is fluids. Burn above the waist: priority is airway first.
Minimum urine output goal: at least 30 mL/hr. This tells you kidneys are perfusing.
Carbon monoxide poisoning: cherry-red face + house fire/smoke exposure = give 100% O2 fast.
1. Big Picture: What Burns Do to the Body
Burns result from direct contact or exposure to thermal, chemical, electrical, or radiation sources.
Burn injury creates both local tissue destruction and systemic body-wide effects.
The major systemic issue is massive fluid shifting out of the vascular space into the interstitial space due to
inflammation and capillary leak.
The burn patient can look swollen/edematous but still be intravascularly depleted, similar to distributive shock
physiology.
The larger and deeper the burn, the higher the risk for hypovolemic shock, infection/sepsis, airway injury, renal
injury, electrolyte imbalance, and death.
2. Burn Depth Classifications
Burn Classification Depth / Tissue Involved Key Findings / Nursing Meaning
Superficial / First-degree Top epidermal layer only. Looks like a sunburn. Red, painful, usually no
major tissue loss.
Superficial partial-thickness / Epidermis and upper dermal Blistering occurs. Painful. Tissue damage is
Second-degree involvement. deeper than first-degree.
Deep partial-thickness / Deep Extends into the dermis, including Significant injury, swelling, and pain. Higher
second-degree vascular dermal layer. risk for complications and scarring.
Full-thickness / Third-degree Burned through the dermis and Necrosis and swelling. Will not heal normally
toward subcutaneous tissue. due to massive tissue loss; often needs
grafting.
Fourth-degree Extends past dermis/subcutaneous Very dangerous. Viable tissue is limited;
tissue into muscle and bone. healing is extremely difficult.
EXAM ALERT / Instructor Emphasis
Full-thickness and fourth-degree burns are severe because tissue loss prevents normal healing and often
requires surgical management/grafting.
3. Causes / Types of Burns
Type Examples What to Remember
Dry heat House fires, brief exposure to high Severity increases with higher temperature and
temperature sources, flames. longer exposure.
Moist heat / scalds Hot liquids, oils, water, steam. Steam and hot liquids can cause deep injury
quickly.
Contact burns Hot metal, tar, grease. Can cause full-thickness injury.
Chemical burns Acids, alkaline agents, pool chemicals, brush Can cause local burns plus systemic toxic
removers, dry cleaners, effects, especially kidney/liver toxicity. Remove
gasoline/disinfectants. contaminated clothing.
Electrical burns Electric current travels through body to Grand masquerader: skin wound may look
Created from instructor lecture transcript - Study guide format
, Exam 3 Study Guide - Burns / Unit 8
ground. small, but internal tissue damage can be severe.
Assess entrance and exit wounds. Put patient
on cardiac monitor.
Radiation burns Sun, x-rays, radiation therapy, industrial Can injure deeply and “cook” tissue from
exposure. inside/out with high exposure. Wear
lead/protective gear.
EXAM ALERT / Instructor Emphasis
Chemical burn rule: brush off dry chemicals first; flush liquid chemicals with copious water. Do not
activate dry powder chemicals with water before removing them.
Electrical burn rule: always look for both entrance and exit wounds and monitor the heart because
electrical current can affect cardiac conduction.
4. Phases of Burn Injury
Phase Time Frame / Definition Main Focus
Emergent / Resuscitative From onset of injury until completion of Airway, breathing, circulation, fluid
phase fluid resuscitation. resuscitation, shock prevention,
assessment of inhalation injury.
Acute / Healing / Intermediate Usually begins around 36-48 hours after Wound care, infection prevention, fluid
phase injury; from beginning of diuresis to wound shifts returning to vascular space, monitor
closure. fluid overload.
Rehabilitation / Restorative From wound closure to return to optimal Mobility, contracture prevention, pressure
phase physical and psychosocial function. garments, graft care, nutrition,
psychosocial support, discharge planning.
5. Pathophysiology: Why Burns Cause Shock-Like Problems
Circulation to burned skin is disrupted immediately. Surviving cells can become hypoxic because they are not
getting oxygenated blood.
After initial vasoconstriction, blood vessels near the burn dilate and leak fluid into interstitial spaces.
Capillary leak syndrome: continuous leak of plasma from vascular space into interstitial space. This occurs in
burned and unburned tissue.
Excess weight gain occurs during the first 12 hours and may continue 24-36 hours because fluid is shifting and
resuscitation fluids are being given.
Protein shifts into interstitial spaces and pulls more water out of the vascular space because of oncotic/colloid
pressure.
The stress response causes sodium retention. Water follows sodium, which contributes to edema and fluid shifts.
Cell death/crenation releases intracellular potassium into the vascular space, causing hyperkalemia risk.
Vascular dehydration causes hemoconcentration. Blood becomes thick/viscous, decreasing blood flow and
worsening tissue hypoxia.
EXAM ALERT / Instructor Emphasis
Burns can cause hyperkalemia early because damaged cells release potassium.
Burns can cause hyponatremia because sodium shifts into edema/interstitial fluid and water follows.
Thick, hemoconcentrated blood worsens perfusion and tissue hypoxia.
6. System Effects of Burns
Body System Expected Problems / Cues
Cardiovascular Tachycardia from compensation; diminished pulses; hypotension from fluid shifts;
decreased cardiac output; prolonged capillary refill; third spacing. Hyperkalemia can
cause dysrhythmias.
Respiratory Inhalation injury, airway edema, pulmonary edema, ARDS, carbon monoxide poisoning,
chest wall restriction/pain. Above-waist burns increase airway concern.
Renal Hypovolemia can cause pre-renal failure. Waste products/sludge can contribute to post-
Created from instructor lecture transcript - Study guide format
Exam 3 Study Guide: Unit 8 Burns
Advanced Med-Surg 265 | Instructor Lecture Video Study Guide
EXAM ALERT / Instructor Emphasis
Burns are not just skin injuries. They cause local and systemic problems: fluid/electrolyte
shifts(potassium), protein loss, sepsis risk, metabolic/endocrine changes, respiratory, cardiac,
hematologic, immune, renal, GI, neurologic, and thermoregulation problems.
Fluid resuscitation is the prime objective of initial burn treatment. Know the Parkland formula and the first
8 hours/next 16 hours rule.
Burn below the waist: priority is fluids. Burn above the waist: priority is airway first.
Minimum urine output goal: at least 30 mL/hr. This tells you kidneys are perfusing.
Carbon monoxide poisoning: cherry-red face + house fire/smoke exposure = give 100% O2 fast.
1. Big Picture: What Burns Do to the Body
Burns result from direct contact or exposure to thermal, chemical, electrical, or radiation sources.
Burn injury creates both local tissue destruction and systemic body-wide effects.
The major systemic issue is massive fluid shifting out of the vascular space into the interstitial space due to
inflammation and capillary leak.
The burn patient can look swollen/edematous but still be intravascularly depleted, similar to distributive shock
physiology.
The larger and deeper the burn, the higher the risk for hypovolemic shock, infection/sepsis, airway injury, renal
injury, electrolyte imbalance, and death.
2. Burn Depth Classifications
Burn Classification Depth / Tissue Involved Key Findings / Nursing Meaning
Superficial / First-degree Top epidermal layer only. Looks like a sunburn. Red, painful, usually no
major tissue loss.
Superficial partial-thickness / Epidermis and upper dermal Blistering occurs. Painful. Tissue damage is
Second-degree involvement. deeper than first-degree.
Deep partial-thickness / Deep Extends into the dermis, including Significant injury, swelling, and pain. Higher
second-degree vascular dermal layer. risk for complications and scarring.
Full-thickness / Third-degree Burned through the dermis and Necrosis and swelling. Will not heal normally
toward subcutaneous tissue. due to massive tissue loss; often needs
grafting.
Fourth-degree Extends past dermis/subcutaneous Very dangerous. Viable tissue is limited;
tissue into muscle and bone. healing is extremely difficult.
EXAM ALERT / Instructor Emphasis
Full-thickness and fourth-degree burns are severe because tissue loss prevents normal healing and often
requires surgical management/grafting.
3. Causes / Types of Burns
Type Examples What to Remember
Dry heat House fires, brief exposure to high Severity increases with higher temperature and
temperature sources, flames. longer exposure.
Moist heat / scalds Hot liquids, oils, water, steam. Steam and hot liquids can cause deep injury
quickly.
Contact burns Hot metal, tar, grease. Can cause full-thickness injury.
Chemical burns Acids, alkaline agents, pool chemicals, brush Can cause local burns plus systemic toxic
removers, dry cleaners, effects, especially kidney/liver toxicity. Remove
gasoline/disinfectants. contaminated clothing.
Electrical burns Electric current travels through body to Grand masquerader: skin wound may look
Created from instructor lecture transcript - Study guide format
, Exam 3 Study Guide - Burns / Unit 8
ground. small, but internal tissue damage can be severe.
Assess entrance and exit wounds. Put patient
on cardiac monitor.
Radiation burns Sun, x-rays, radiation therapy, industrial Can injure deeply and “cook” tissue from
exposure. inside/out with high exposure. Wear
lead/protective gear.
EXAM ALERT / Instructor Emphasis
Chemical burn rule: brush off dry chemicals first; flush liquid chemicals with copious water. Do not
activate dry powder chemicals with water before removing them.
Electrical burn rule: always look for both entrance and exit wounds and monitor the heart because
electrical current can affect cardiac conduction.
4. Phases of Burn Injury
Phase Time Frame / Definition Main Focus
Emergent / Resuscitative From onset of injury until completion of Airway, breathing, circulation, fluid
phase fluid resuscitation. resuscitation, shock prevention,
assessment of inhalation injury.
Acute / Healing / Intermediate Usually begins around 36-48 hours after Wound care, infection prevention, fluid
phase injury; from beginning of diuresis to wound shifts returning to vascular space, monitor
closure. fluid overload.
Rehabilitation / Restorative From wound closure to return to optimal Mobility, contracture prevention, pressure
phase physical and psychosocial function. garments, graft care, nutrition,
psychosocial support, discharge planning.
5. Pathophysiology: Why Burns Cause Shock-Like Problems
Circulation to burned skin is disrupted immediately. Surviving cells can become hypoxic because they are not
getting oxygenated blood.
After initial vasoconstriction, blood vessels near the burn dilate and leak fluid into interstitial spaces.
Capillary leak syndrome: continuous leak of plasma from vascular space into interstitial space. This occurs in
burned and unburned tissue.
Excess weight gain occurs during the first 12 hours and may continue 24-36 hours because fluid is shifting and
resuscitation fluids are being given.
Protein shifts into interstitial spaces and pulls more water out of the vascular space because of oncotic/colloid
pressure.
The stress response causes sodium retention. Water follows sodium, which contributes to edema and fluid shifts.
Cell death/crenation releases intracellular potassium into the vascular space, causing hyperkalemia risk.
Vascular dehydration causes hemoconcentration. Blood becomes thick/viscous, decreasing blood flow and
worsening tissue hypoxia.
EXAM ALERT / Instructor Emphasis
Burns can cause hyperkalemia early because damaged cells release potassium.
Burns can cause hyponatremia because sodium shifts into edema/interstitial fluid and water follows.
Thick, hemoconcentrated blood worsens perfusion and tissue hypoxia.
6. System Effects of Burns
Body System Expected Problems / Cues
Cardiovascular Tachycardia from compensation; diminished pulses; hypotension from fluid shifts;
decreased cardiac output; prolonged capillary refill; third spacing. Hyperkalemia can
cause dysrhythmias.
Respiratory Inhalation injury, airway edema, pulmonary edema, ARDS, carbon monoxide poisoning,
chest wall restriction/pain. Above-waist burns increase airway concern.
Renal Hypovolemia can cause pre-renal failure. Waste products/sludge can contribute to post-
Created from instructor lecture transcript - Study guide format
