HURST Review: Burns

Where do most burns occur? At home How often should smoke detector batteries be changed? every 6-12 months Flammable items should be kept at least how far from heat sources? 3 feet The water heat device should be set no higher than 120 degrees fahrenheit Why does plasma seep out into the tissue after a burn? Increased capillary permeability When does the majority of plasma seepage occur? first 24 hours (worry about shock!) Why does the pulse increase after a burn? compensation; every time there is a FVD, the pulse will increase Why does the cardiac output decrease after a burn? there is less volume to pump out Why does the urine output decrease after a burn? kidneys are either trying to hold on to fluid or they aren't being perfused adequately Why is epinephrine secreted after a burn? because epi and norepi make you peripherally vasoconstrict, blood is shunted to the vital organs With a normal BP of 120/80, anytime the systolic BP drops below ______, the client will not have adequate organ perfusion; this can be very DANGEROUS 90 Why are ADH and aldosterone secreted after a burn? to retain sodium and water with aldosterone and retain water with ADH; this will increase blood volume Rule of 9's: Head and Neck 9% Rule of 9's: Trunk (Front and Back) 36% total - front 18% and back 18% Rule of 9's: Arm 9% each Rule of 9's: Leg 18% each Rule of 9's: Genitalia 1% Partial thickness burns are also known as first and second degree burns Full thickness burns are also known as third and fourth degree burns If a burn is located on the face, neck, or chest there could be interference with breathing Burns: Risk Factors -heart, lung, or kidney disease -pre-existing diabetes or PVD can affect healing of foot or leg burns -other injuries that occurred when client was burned -higher mortality in very old and very young Why is there a higher mortality among the very old and very young with burns? -skin is very thin and they have less SQ fat -the burn can go deeper and cause more complications -body surface area is less in the very young Burns: Treatment Stop burning process -wrap client in blanket to stop (absent flames do not guarantee this) -cool water can stop -NO more than 10 minutes (can cause extensive heat loss) -remove jewelry because swelling will occur -remove non-adherent clothing and cover burns with clean, dry cloth What does a blanket do when stopping the burning process? help hold in body heat and keep out germs What is the number one cause of death with burns? inhalation injury inhalation injuries are usually caused by inhaling carbon monoxide OR hydrogen cyanide Normally, oxygen binds with hemoglobin Carbon monoxide ____________ __________ ______________ than oxygen; therefore travels much faster; it gets to the hemoglobin first and binds Is oxygen able to bind after carbon monoxide has? no The client becomes ____________ from carbon monoxide poisoning hypoxic Carbon Monoxide Poisoning: Treatment 100% oxygen Why will 100% oxygen help treat carbon monoxide poisoning? placing more O2 in the race to increase probability that O2 will bind before CO Hydrogen Cyanide: Treament 100% oxygen -an antidote may be given at the hospital It would be important to determine if the burn occurred in ________________________________________ an open or closed space If someone is burned in a closed space, they will have inhaled ___________ carbon monoxide and/or hydrogen cyanide so, more; the risk for complications is increased When you see a client with burns to the neck/face/chest, you should focus on their airway What might the primary healthcare provider do prophylactically? intubation (the airway can swell and close off) Indications of inhalation injury -singed nose hair -singed facial hair -soot on face -coughing up secretions with dark specks -difficult swallowing -wheezing -blisters found on the oral/pharyngeal mucosa -hoarseness -substernal/intercostal retractions and stridor are bad signs Is there more death with upper or lower body burns? upper because of the effects on the airway If a burn client's respirations are shallow what are they retaining? CO2 Which acid base imbalance will burn client with shallow respirations have? Respiratory acidosis One of the most important aspects of burn management is fluid replacement We are giving large volumes of fluid so the client will need at least 2 large bore IVs What fluids will be used for fluid replacement? crystalloids (LR) and colloids (albumin) Why is it important to know what time the burn occurred? because fluid replacement therapy (for the first 24 hours) is based on the time the injury occurred, not when the treatment was started Common Rule for fluid replacement therapy calculate the total amount of fluid needed for the first 24 hrs and then give half of the amount during the first 8 hours To calculate the fluid replacement properly, you must know the client's weight (in kg) and the TBSA affected If the client is restless, it could suggest three problems 1. inadequate fluid replacement 2. pain 3. hypoxia 1. inadequate fluid replacement 2. pain 3. hypoxia Which is the nurse's priority? hypoxia American Burn Association Fluid Requirement Formula (2-4mL of LR) X (body weight in kg) X (% of TBSA burned) = total fluid requirement for first 24 hrs after burn *4mLs used for electrical burns to prevent renal damage How much fluid is given per 8 hours? 1st 8 hours: 1/2 total volume 2nd 8 hours: 1/4 total volume 3rd 8 hours: 1/4 total volume Would you select a client's weight or their urine output to determine if their fluid volume is adequate? urine output Urinary output needs to be a minimum of 0.5 to 1 mL/kg/hr which is usually at least 30-50 mL/hr in an adult What is the urinary output goal in client's with electrical injuries? 75-100 mL/hr What is the required urinary output for children? 1mL/kg/hr