Medical Surgical Nursing Burns Exam Question and Answers
A&P of Burn injury
Answer: Immediate release of catecholamine and other mediators
-Increased BP and HR, vasoconstriction, disrupted blood flow
Increased capillary permeability
-Edema anywhere including lungs, third spacing, low Na, hypovolemia, massive fluid shifts
Decreased perfusion to GI system
-Paralytic ileus, abdominal distention, Curling's ulcer
Myoglobin and K released from cell damage
Answer: ATN (kidney damage), high K
Inflammatory response
Answer: Immunosuppression, risk of infection/sepsis, loss of ability to sweat
Increased demand on the metabolic system
Answer: massive catabolism and increased need for calories, increased body temp, increased 02
demand
RBC's hemolyzing causing hemoconcentration
Answer: High HCT, High HGB, increased blood viscocity
Thermal Burns
Answer: Most common burn injury
Flame, flash, scald, contact with hot objects
Can require escharotomy
Chemical Burns
Answer: Acids, alkalis, organic compounds
Alkalis are worse than acids
Can also cause systemic symptoms
Remove any dry chemical particles from the skin with a dry brush
Dilute with water to stop causing tissue destruction
Don't use neutralizing agents
White phosphorus (used in meth) embeds in the skin and ignites when exposed to air
Smoke/Inhalation Injuries
Answer: Suspect for any burns of the head, neck, chest or a burn that occurred in an enclosed space
Suspect if singed nasal hairs, hoarseness, coughing, airway redness, sore throat, carbon in sputum
Major predictor of mortality in burn patients
Lower airway injury is more likely from chemical exposure, can lead to pulmonary edema and ARDS
Administer 100% humidified oxygen by mask, perform frequent respiratory assessment
Carbon Monoxide Poisoning
Answer: displaces oxygen on the hemoglobin molecule causing carboxyhemoglobinemia and hypoxia
"Cherry red" skin, headache, n/v, unconsciousness or change in LOC and O2 sats
, Burns don't cause unconsciousness
Give 100% humidified oxygen
Electrical Burns
Answer: Current produces heat causing extensive tissue damage, also damage to nerves and vessels
Sparks can ignite clothing
Can cause muscle contractions so strong that bones are broken and falls are caused (always assume they
have cervical spine injury)
Most damage is below the skin (iceberg effect)
Can cause cardiac and renal problems
Need EKG/cardiac monitoring ASAP
Classification of Burns
Answer: Depth (degree - 1st, 2nd, full thickness, etc)
Extent in percent of TBSA (rule of 9s)
Location
Patient risk factors
Partial-thickness, superficial (1st degree)
Answer: -No blisters, red pink, dry, painful; only epidermis, heals in 5 days
Partial-thickness, deep (2nd degree)
Answer: -Blisters, red, shiny, wet, severe pain, some edema; includes part of dermis, heals in 1-2 weeks
Full-thickness (3rd & 4th degree)
Answer: -Lots of color variation - dry, waxy white, leathery, hard, no pain - all of epidermis and dermis
-can NOT grow new skin, requires skin grafts
Extent of Burn (Rule of 9s)
Answer: Primarily for adults
Add posterior and anterior sides of the body separately
Perineum is 1, each arm is 4.5%, head is 4.5%, each leg is 9%, torso is 18%
Don't include first degree burns when calculating, can be revised after edema resolves
Location of Burns
Answer: Burns to eyes, face, hands, feet and perineum are always considered serious
Circumferential burns to chest/back or extremities are serious
Other risk factors increasing burn classification
Answer: older adults
any pre-existing cardiovascular, respiratory or renal disease, diabetes, peripheral vascular disease
Alcoholism or drug abuse
Malnutrition
Any additional injuries besides the burn
Emergent burn injury
Answer: resuscitative care, resolve immediate life-threatening problems, usually lasts 48-72 hrs
-goal is to secure airway, maintain temp, and prevent hypovolemic shock
A&P of Burn injury
Answer: Immediate release of catecholamine and other mediators
-Increased BP and HR, vasoconstriction, disrupted blood flow
Increased capillary permeability
-Edema anywhere including lungs, third spacing, low Na, hypovolemia, massive fluid shifts
Decreased perfusion to GI system
-Paralytic ileus, abdominal distention, Curling's ulcer
Myoglobin and K released from cell damage
Answer: ATN (kidney damage), high K
Inflammatory response
Answer: Immunosuppression, risk of infection/sepsis, loss of ability to sweat
Increased demand on the metabolic system
Answer: massive catabolism and increased need for calories, increased body temp, increased 02
demand
RBC's hemolyzing causing hemoconcentration
Answer: High HCT, High HGB, increased blood viscocity
Thermal Burns
Answer: Most common burn injury
Flame, flash, scald, contact with hot objects
Can require escharotomy
Chemical Burns
Answer: Acids, alkalis, organic compounds
Alkalis are worse than acids
Can also cause systemic symptoms
Remove any dry chemical particles from the skin with a dry brush
Dilute with water to stop causing tissue destruction
Don't use neutralizing agents
White phosphorus (used in meth) embeds in the skin and ignites when exposed to air
Smoke/Inhalation Injuries
Answer: Suspect for any burns of the head, neck, chest or a burn that occurred in an enclosed space
Suspect if singed nasal hairs, hoarseness, coughing, airway redness, sore throat, carbon in sputum
Major predictor of mortality in burn patients
Lower airway injury is more likely from chemical exposure, can lead to pulmonary edema and ARDS
Administer 100% humidified oxygen by mask, perform frequent respiratory assessment
Carbon Monoxide Poisoning
Answer: displaces oxygen on the hemoglobin molecule causing carboxyhemoglobinemia and hypoxia
"Cherry red" skin, headache, n/v, unconsciousness or change in LOC and O2 sats
, Burns don't cause unconsciousness
Give 100% humidified oxygen
Electrical Burns
Answer: Current produces heat causing extensive tissue damage, also damage to nerves and vessels
Sparks can ignite clothing
Can cause muscle contractions so strong that bones are broken and falls are caused (always assume they
have cervical spine injury)
Most damage is below the skin (iceberg effect)
Can cause cardiac and renal problems
Need EKG/cardiac monitoring ASAP
Classification of Burns
Answer: Depth (degree - 1st, 2nd, full thickness, etc)
Extent in percent of TBSA (rule of 9s)
Location
Patient risk factors
Partial-thickness, superficial (1st degree)
Answer: -No blisters, red pink, dry, painful; only epidermis, heals in 5 days
Partial-thickness, deep (2nd degree)
Answer: -Blisters, red, shiny, wet, severe pain, some edema; includes part of dermis, heals in 1-2 weeks
Full-thickness (3rd & 4th degree)
Answer: -Lots of color variation - dry, waxy white, leathery, hard, no pain - all of epidermis and dermis
-can NOT grow new skin, requires skin grafts
Extent of Burn (Rule of 9s)
Answer: Primarily for adults
Add posterior and anterior sides of the body separately
Perineum is 1, each arm is 4.5%, head is 4.5%, each leg is 9%, torso is 18%
Don't include first degree burns when calculating, can be revised after edema resolves
Location of Burns
Answer: Burns to eyes, face, hands, feet and perineum are always considered serious
Circumferential burns to chest/back or extremities are serious
Other risk factors increasing burn classification
Answer: older adults
any pre-existing cardiovascular, respiratory or renal disease, diabetes, peripheral vascular disease
Alcoholism or drug abuse
Malnutrition
Any additional injuries besides the burn
Emergent burn injury
Answer: resuscitative care, resolve immediate life-threatening problems, usually lasts 48-72 hrs
-goal is to secure airway, maintain temp, and prevent hypovolemic shock
