NMNC 4510 Exam #2 Questions Answered Correctly Rated A+
Thermal Burns:
Cause?
What are cold thermal injuries? - Answers - caused by: flame, flash, scald, contact w/ hot objects
- cold thermal injuries = frostbite
What do we do for frostbite? (2) - Answers - don't want to cool it down, want to gradually rewarm the pt
- will sometimes use heparin to try to break up microclots
Electrical burns? (5)
What can cause them? (3) - Answers - probably going to have more injury to the body.
- nerves and blood vessels have least resistance to electricity and it's going to follow that least path of
resistance.
- can have a deeper burn because electricity damages muscles and tissues.
- trauma can co-occur.
- can affect the heart (EKG monitoring)
- causes: people that cook meth, kids chewing on electrical wires, chain of people.
Chemical burns? (2)
Nursing care? (3)
What can cause them? (2) - Answers - don't feel them right away but then they deepen and progress.
- can continue for up to 72 hrs. after exposure to chemical, depending on chemical.
- risk for the nurse because chemical can easily get on us.
- dry chemical - brush it off and then copious amounts of irrigation (neutralize it w/ water, some react to
water).
- call poison control center!
,- causes: cement, car crash victim laying in gasoline.
Initial tx of burns? (4) - Answers - stop the burning!!
- tar: can cool surface but underneath the surface is still hot and burning (water will not help) - mineral
oil removes tar.
- can apply cool, clean, damp towel if <10% burn.
- clean, dry sheet then transport for larger burn.
#1 priority w/ burns? - Answers AIRWAY! AIRWAY! AIRWAY!
- burns swell even in person initially has an intact airway.
Signs of inhalation injury? (4) - Answers - wheezes and stridor: injuries to bronchioles themselves, pt is
having constriction, cannot fix this w/ epi because vessels are damaged.
- drooling: pt cannot swallow, may lead to airway compromise.
- deep, sexy, hoarse voice: ask if this is baseline, high suspicion of injury and airway compromise!
- no lung sounds = really bad sign - airway is closed!
Inhalation injuries:
How do we measure the amount of CO in the pts body?
Biggest risks for inhalation injuries? (2) - Answers - smoke inhalation often kills before the initial burn:
bronchioles are burned = no gas exchange!
- carboxy hemoglobin level: measures amount of CO in pts body.
- if pt has high CO, can be converted to cyanide - pt gets cyanide antidote.
- at risk for CO and cyanide poisoning!
Inhalation injuries: bronchoscopy? (4) - Answers - need to clear all the soot out of their bronchioles.
- often get it w/in 6-12 hrs.
- usually done daily until we start to see improvement.
- high on level of interventions, but not before ABCs.
Burns:
Pediatric concerns? (2)
, Elderly concerns? (4) - Answers - pediatric: a lot of the time, this is a sign of abuse; smaller airways.
- elderly: have trouble moving around, skin is thinner, cannot withstand higher temperatures and may
suffer burns at lower temps., hard time healing burns.
What kind of burns need to be transported to burn center? (6)
What does CO poisoning look like? How do we treat it? (2) - Answers - any burns over face, hands, feet,
genitalia, perineum, or major joints.
- cherry red appearance of skin: can use hyperbaric chamber or put them on high flow O2 to flush out
CO.
Escharotomy?
Fasciotomy? (2) - Answers - escharotomy: incision through eschar, cut through tissue that's scarred and
damaged and no more.
- fasciotomy: incision through fascia due to swelling, done for circumferential burns.
Burn Resuscitation:
Emergent (resuscitation) phase? (5) - Answers - up to 72 hours
- assess life threats
- hypovolemic shock and edema: injury to vessels = leaky and sodium, water, albumin, etc. escape into
third space.
- catecholamine response: HR ↑, BP ↑ but then drops due to hypovolemia.
- hypothermia: no ability to thermoregulate.
Lab values to pay attention to in emergent phase? (3) - Answers - H&H: as we lose plasma water into 3rd
space or environment H&H ↑, blood becomes hemoconcentrated.
- may see ↑ in K+ because skin cells are destroyed - when cells die, they release intracellular K+
- ↓ in sodium for first 24 hrs. - moving out of leaky vessels.
Burn Resuscitation:
Emergent Phase Management? (3)
Desired uo?
Cardiac parameters? (3)
Fluid titration? - Answers - colloid solutions/FFP
Thermal Burns:
Cause?
What are cold thermal injuries? - Answers - caused by: flame, flash, scald, contact w/ hot objects
- cold thermal injuries = frostbite
What do we do for frostbite? (2) - Answers - don't want to cool it down, want to gradually rewarm the pt
- will sometimes use heparin to try to break up microclots
Electrical burns? (5)
What can cause them? (3) - Answers - probably going to have more injury to the body.
- nerves and blood vessels have least resistance to electricity and it's going to follow that least path of
resistance.
- can have a deeper burn because electricity damages muscles and tissues.
- trauma can co-occur.
- can affect the heart (EKG monitoring)
- causes: people that cook meth, kids chewing on electrical wires, chain of people.
Chemical burns? (2)
Nursing care? (3)
What can cause them? (2) - Answers - don't feel them right away but then they deepen and progress.
- can continue for up to 72 hrs. after exposure to chemical, depending on chemical.
- risk for the nurse because chemical can easily get on us.
- dry chemical - brush it off and then copious amounts of irrigation (neutralize it w/ water, some react to
water).
- call poison control center!
,- causes: cement, car crash victim laying in gasoline.
Initial tx of burns? (4) - Answers - stop the burning!!
- tar: can cool surface but underneath the surface is still hot and burning (water will not help) - mineral
oil removes tar.
- can apply cool, clean, damp towel if <10% burn.
- clean, dry sheet then transport for larger burn.
#1 priority w/ burns? - Answers AIRWAY! AIRWAY! AIRWAY!
- burns swell even in person initially has an intact airway.
Signs of inhalation injury? (4) - Answers - wheezes and stridor: injuries to bronchioles themselves, pt is
having constriction, cannot fix this w/ epi because vessels are damaged.
- drooling: pt cannot swallow, may lead to airway compromise.
- deep, sexy, hoarse voice: ask if this is baseline, high suspicion of injury and airway compromise!
- no lung sounds = really bad sign - airway is closed!
Inhalation injuries:
How do we measure the amount of CO in the pts body?
Biggest risks for inhalation injuries? (2) - Answers - smoke inhalation often kills before the initial burn:
bronchioles are burned = no gas exchange!
- carboxy hemoglobin level: measures amount of CO in pts body.
- if pt has high CO, can be converted to cyanide - pt gets cyanide antidote.
- at risk for CO and cyanide poisoning!
Inhalation injuries: bronchoscopy? (4) - Answers - need to clear all the soot out of their bronchioles.
- often get it w/in 6-12 hrs.
- usually done daily until we start to see improvement.
- high on level of interventions, but not before ABCs.
Burns:
Pediatric concerns? (2)
, Elderly concerns? (4) - Answers - pediatric: a lot of the time, this is a sign of abuse; smaller airways.
- elderly: have trouble moving around, skin is thinner, cannot withstand higher temperatures and may
suffer burns at lower temps., hard time healing burns.
What kind of burns need to be transported to burn center? (6)
What does CO poisoning look like? How do we treat it? (2) - Answers - any burns over face, hands, feet,
genitalia, perineum, or major joints.
- cherry red appearance of skin: can use hyperbaric chamber or put them on high flow O2 to flush out
CO.
Escharotomy?
Fasciotomy? (2) - Answers - escharotomy: incision through eschar, cut through tissue that's scarred and
damaged and no more.
- fasciotomy: incision through fascia due to swelling, done for circumferential burns.
Burn Resuscitation:
Emergent (resuscitation) phase? (5) - Answers - up to 72 hours
- assess life threats
- hypovolemic shock and edema: injury to vessels = leaky and sodium, water, albumin, etc. escape into
third space.
- catecholamine response: HR ↑, BP ↑ but then drops due to hypovolemia.
- hypothermia: no ability to thermoregulate.
Lab values to pay attention to in emergent phase? (3) - Answers - H&H: as we lose plasma water into 3rd
space or environment H&H ↑, blood becomes hemoconcentrated.
- may see ↑ in K+ because skin cells are destroyed - when cells die, they release intracellular K+
- ↓ in sodium for first 24 hrs. - moving out of leaky vessels.
Burn Resuscitation:
Emergent Phase Management? (3)
Desired uo?
Cardiac parameters? (3)
Fluid titration? - Answers - colloid solutions/FFP
