MDC4 – Examination Blueprint – Exam 2

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MDC4 – Examination Blueprint – Exam 2
Burns
 Causes
o Thermal
 Dry Heat – Flame - explosion
 Moist heat - Steam
 Contact – Burst of flame/stove
o Chemical – Upper airway can also be involved – acidic compounds
 Find out the chemical that caused the burn to create proper treatment
o Electrical – Cannot see extent of the injury since it enters and exits but mainly internal
 It’s hard to determine the extent of damaged from this type of burn because the damage can
extend under the skin. This is known as the “iceberg effect”.

o Radiation -
o Smoke- related Brun Injury – inhalation near flames can still lead to death
 Skin changes
o Massive fluid loss through evaporation
o Reduced ability to sweat
o Partial – thickness burns: exposed nerve endings
o Full-thickness burns: Nerve endings destroyed
o Reduced activation of vitamin D
o Change in physical identity
 Health Promotion
o Monitor water temp (<140)
o Sunscreen
o No smoking in bed, Lighters matches out of reach of kids
o Care of fire places
o No Flame near O2
o Smoke detectors & Planned escape routes
 Classification of Burn Injury
o Minor burns – Partial-thickness <10%, Full-thickness <2%
 Less than 60, no electrical, and no additional injuries
o Moderate burn – Partial-thickness 15 – 25%, Full-thickness 2 – 10%
 Same as Minor
o Major burn – Partial-thickness >25%; full-thickness >10%



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 Older than 60, electrical, and additional injury
 Class of burns (1st & 2nd degree burns can heal without interventions)
o 1st degree – Superficial thickness – Only the epidermis – Sunburn (pink to red)
o 2nd degree – Superficial/Deep Partial thickness – Dermis Layer
 Superficial blisters up (Pink to red with blisters)
 Deep is into the middle of the dermis without blisters Red and inflamed (Red to white with soft
and dry eschar)
o 3rd degree – Full/Deep thickness – Hypodermis – closes to the muscle – Shows muscle (Black, brown,
yellow, white, red severe edema and hard eschar with yes and no pain)
 Deep Full thickness – Black with absent edema, pain, blisters, and hard eschar
 Complication-eschar, burn shock, stridor, Infection
o Eschar – A dry and dark necrotic tissue - must be removed to assist tissue heal
 Escharotomy – surgical incision through areas of burnt skin to release the eschar and its
constrictive effects, resorts distal circulation, and allow adequate ventilation
 Fasciotomy – a surgery to relieve swelling and pressure in a compartment of the body (deeper
incision to the muscle layer)
o Burn shock is a unique combination of hypovolemic, distributive, and cardiogenic shock. Burns lead to
severe hypovolemia and massive edema (Tachycardia, shallow breathing, Hypotension)
o Stridor – due to an inhalation injury
o Infection due open wounds that can lead to infected bacteria.
 Curling Ulcers: treatment & escharotomy
o Curling ulcers – stress induced ulcer of the stomach or duodenum due to extreme physical stress like a
massive burn.
 Treatment – Fluids - skin grafts - Fluid overload S&S
o Fluids – LR w/ Parkland formula
o Skin graft is the skin removed from a donor area and transferred to the wound and sutured in place
 Grafts are done in the acute phase to reduce the time patients are at risk for infection and sepsis
(covers a deeply burned area to cover and open wound)
 Assess for bleeding, Drainage, and DO NOT encourage exercise with the grafted arm.
o Pain management with meds such as Morphine sulfate, Dilaudid, Fentanyl
 NOT IM or Oral – IM due to edema and is painful for the patient/ Oral no due to reduced
adsorption and motility of GI
 Phase of Burn Injury management – Emergent/Resuscitative Phase, Acute Phase, Rehabilitative Phase
o Resuscitation/Emergent – Onset of the burn and lasts until completion of fluid resuscitation for the first
24 hours – Most important is ABCs during this time – and Fluid administration LR or 0.9% Na Chloride


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 It is effective if there is 30 mL/hr or more/ Systolic greater than 90 effective & HR less
than 120
 Monitor for signs of inhalation injury – Facial burns, nasal or scalp hair singed, Black or blood
sputum, poor O2 stats, wheezing/stridor, hoarseness, WEIGHT! (Accurate since fluids are done
based on patient weight)
 Hyperkalemia!!! – peaked T waves a
 Hyponatremia
 H/H will be elevated when the body is dry – More concentrated blood when the fluid is low
 Surgical Interventions – Trache, chest tube, escharotomy – stops in the subQ fat, Fasciotomy –
tissue is cut to the muscle in order to relieve pressure due to leathery skin adding pressure,
Debridement – removal of nonviable tissues
o Acute – 48 – 72 hours after the burn this is capillary permeability can return and urinary output should
increase if not the renal cand cardiac functions can lead to hypovolemic shock & manifest HF
 Monitor Urine output, EKG in electrical burns, Decreased peristalsis and adsorption
 Monitor for pneumonia, infection, and sepsis
 Diet is implemented with high calories and protein – electrolytes need to be monitored due to
all the fluids being given to the patient
 Major wound care – change gloves when handling multiple wounds to stop spread form wound
to wound
 Wash Hands DO NOT USE HAND SANITIZER
 ROM assistance & Psychosocial assistance for self-esteem
o Rehabilitative – This is when the burn begins to close and ends when the patient has reached optimal
level of functioning.
 NO MORE OPEN SOURS – wear pressure garments for scaring and water based lotion
 ROM exercise


 Total body surface area (TBSA) – Rule of Nines Leg front & Back are 9 – whole arm is 9 -




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