NURSING 232 EXAM 3 QUESTIONS AND ANSWERS
Causes of burns - CORRECT ANSWER✅✅Hot water
House fires
Campfires
Fireworks
Candles
Abuse
MVA
Fire play
Electrical burns - CORRECT ANSWER✅✅Can result in cardiac arrest, metabolic acidosis
Chemical burns - CORRECT ANSWER✅✅Household cleaners, fertilizers, drain cleaners
Inhalation burns - CORRECT ANSWER✅✅Smoke, etc
Thermal burns - CORRECT ANSWER✅✅-Most common
-Flame, grease, contact, scalds, frostbite
-Splash burns to lower extremity- sign of child abuse
Skin - CORRECT ANSWER✅✅Largest organ
Epidermis - CORRECT ANSWER✅✅Acts as barrier to hold in moisture and protect against infection
Dermis - CORRECT ANSWER✅✅Cushions the body from stress and strain; contains nails, hair follicles,
sebaceous glands. 30-45 X thicker than epidermis
,Hypodermis - CORRECT ANSWER✅✅Also called subcutaneous tissue; acts as insulation and protects the
internal organs from variations in temperature
Classification of burn injury - CORRECT ANSWER✅✅Extent (Rule of nines)
Depth
Location
Patient Risk Factors
Rule of nines - CORRECT ANSWER✅✅To approximate the percentage of burned surface area; divides
the body into sections.
1st degree burn - CORRECT ANSWER✅✅Superficial, pain, redness, swelling
2nd degree burn - CORRECT ANSWER✅✅Partial thickness, pink to cherry red, wet and shiny, serous
exudate, painful, blisters, nerve injury, regeneration
3rd degree burn - CORRECT ANSWER✅✅Full thickness, dry and waxy, white to dark brown/black, nerve
endings destroyed, eschar
Burn location/special considerations - CORRECT ANSWER✅✅-Face, eyes, hands, arms, ears, and
perineum require vigilant nursing care
-For some, unable to open eyes bc of swelling
-Ears and nose susceptible to infection (poor blood supply)
-Ears free of pressure (no pillows, rolled towel under shoulders)
-Hands and arms extended and elevated on pillows (decrease edema)
-Splints (decrease contracture)
-Buttocks and perineum- increased infection
Phases of burn management - CORRECT ANSWER✅✅Prehospital, emergent, acute, rehabilitation
,Prehospitalization burn phase - CORRECT ANSWER✅✅-Small thermal wounds ( < 10% TBSA) cover w a
clean, cool, tap water towel
-Large burns: focus on ABC's; cool no more than 10 min, remove as much burned clothing as possible
-Chemical burn: brush dry chemical from skin before irrigation, flush area with copious amounts of NS or
water
-Never cover with ice: causes more damage
Emergent burn phase - CORRECT ANSWER✅✅-Concern is hypovolemic shock and edema formation
-Lasts up to 72 hours (ends when fluid mobilization begins)
-Water, sodium, and protein (esp. albumin) move into interstitial space (second spacing)
-Third spacing
-Decreased BP, increased HR, decreased UO
-Increased HCT, electrolyte imbalances
Airway- burns - CORRECT ANSWER✅✅-Soot around nares, on tongue
-Singed nasal hairs
-Darkened nasal or oral membranes
-Singed eyelashes
-Redness of throat or mouth
-Obstructions from edema
Circulation- burns - CORRECT ANSWER✅✅-Monitor BP, pulse
-Hemolysis of RBC
-Thrombosis of capillaries
-Carboxyhemoglobinemia (carbon monoxide poisoning): skin cherry red when severe, treated with 100%
O2
Urinary system- burns - CORRECT ANSWER✅✅-Acute Tubular Necrosis (ATN): myoglobin (from muscle
cell breakdown) and hemoglobin (from RBC breakdown) are released into bloodstream and occlude
renal tubules; occurs with full thickness and major electrical burns
, -Hypovolemic: renal ischemia
Fluid resuscitation- burns - CORRECT ANSWER✅✅-Lactated ringers for first 24 hrs (Parkland formula: LR
4 mL/kg/% TBSA burn- for total fluid req. first 24 hrs)
-Any burn > 10% in children and > 15% in adults requires resuscitation
-Colloids (albumin): given 12-24 hrs post burn when capillary permeability is normal or near normal
Pain management- burns - CORRECT ANSWER✅✅-Must pre medicate 1/2 hour w oral meds
-Burn pt require multiple doses or more than recommended dosing
-Be an advocate for your pt; burns are extremely painful
-Pain medications: morphine, hydromorphone, oxycodone, acetaminophen
-Closely observe VS and oxygenation
Wound care during emergent phase- burns - CORRECT ANSWER✅✅-Debridement
-Dressings
-Open: antimicrobial w/o dressings, basically just ointment, mostly for facial burns
-Closed: sterile gauze over topic antimicrobial, some antimicrobial dressing can be in place for 3-14 days
Medications- burns - CORRECT ANSWER✅✅-Silver sulfadiazine (antimicrobial)
-Mafenide acetate cream (anti infective)
-Mupirocin cream (antimicrobial)
-Bacitracin ointment (antimicrobial)
-Tetanus immunization
-Enoxaparin (anticoagulant): watch for bleeding with vigorous debridement
Acute phase- burns - CORRECT ANSWER✅✅-Mobilization of extracellular fluid
-Diuresis
-Ends when partial thickness wounds are healed or full thickness wounds are grafted
-Weeks to months
Causes of burns - CORRECT ANSWER✅✅Hot water
House fires
Campfires
Fireworks
Candles
Abuse
MVA
Fire play
Electrical burns - CORRECT ANSWER✅✅Can result in cardiac arrest, metabolic acidosis
Chemical burns - CORRECT ANSWER✅✅Household cleaners, fertilizers, drain cleaners
Inhalation burns - CORRECT ANSWER✅✅Smoke, etc
Thermal burns - CORRECT ANSWER✅✅-Most common
-Flame, grease, contact, scalds, frostbite
-Splash burns to lower extremity- sign of child abuse
Skin - CORRECT ANSWER✅✅Largest organ
Epidermis - CORRECT ANSWER✅✅Acts as barrier to hold in moisture and protect against infection
Dermis - CORRECT ANSWER✅✅Cushions the body from stress and strain; contains nails, hair follicles,
sebaceous glands. 30-45 X thicker than epidermis
,Hypodermis - CORRECT ANSWER✅✅Also called subcutaneous tissue; acts as insulation and protects the
internal organs from variations in temperature
Classification of burn injury - CORRECT ANSWER✅✅Extent (Rule of nines)
Depth
Location
Patient Risk Factors
Rule of nines - CORRECT ANSWER✅✅To approximate the percentage of burned surface area; divides
the body into sections.
1st degree burn - CORRECT ANSWER✅✅Superficial, pain, redness, swelling
2nd degree burn - CORRECT ANSWER✅✅Partial thickness, pink to cherry red, wet and shiny, serous
exudate, painful, blisters, nerve injury, regeneration
3rd degree burn - CORRECT ANSWER✅✅Full thickness, dry and waxy, white to dark brown/black, nerve
endings destroyed, eschar
Burn location/special considerations - CORRECT ANSWER✅✅-Face, eyes, hands, arms, ears, and
perineum require vigilant nursing care
-For some, unable to open eyes bc of swelling
-Ears and nose susceptible to infection (poor blood supply)
-Ears free of pressure (no pillows, rolled towel under shoulders)
-Hands and arms extended and elevated on pillows (decrease edema)
-Splints (decrease contracture)
-Buttocks and perineum- increased infection
Phases of burn management - CORRECT ANSWER✅✅Prehospital, emergent, acute, rehabilitation
,Prehospitalization burn phase - CORRECT ANSWER✅✅-Small thermal wounds ( < 10% TBSA) cover w a
clean, cool, tap water towel
-Large burns: focus on ABC's; cool no more than 10 min, remove as much burned clothing as possible
-Chemical burn: brush dry chemical from skin before irrigation, flush area with copious amounts of NS or
water
-Never cover with ice: causes more damage
Emergent burn phase - CORRECT ANSWER✅✅-Concern is hypovolemic shock and edema formation
-Lasts up to 72 hours (ends when fluid mobilization begins)
-Water, sodium, and protein (esp. albumin) move into interstitial space (second spacing)
-Third spacing
-Decreased BP, increased HR, decreased UO
-Increased HCT, electrolyte imbalances
Airway- burns - CORRECT ANSWER✅✅-Soot around nares, on tongue
-Singed nasal hairs
-Darkened nasal or oral membranes
-Singed eyelashes
-Redness of throat or mouth
-Obstructions from edema
Circulation- burns - CORRECT ANSWER✅✅-Monitor BP, pulse
-Hemolysis of RBC
-Thrombosis of capillaries
-Carboxyhemoglobinemia (carbon monoxide poisoning): skin cherry red when severe, treated with 100%
O2
Urinary system- burns - CORRECT ANSWER✅✅-Acute Tubular Necrosis (ATN): myoglobin (from muscle
cell breakdown) and hemoglobin (from RBC breakdown) are released into bloodstream and occlude
renal tubules; occurs with full thickness and major electrical burns
, -Hypovolemic: renal ischemia
Fluid resuscitation- burns - CORRECT ANSWER✅✅-Lactated ringers for first 24 hrs (Parkland formula: LR
4 mL/kg/% TBSA burn- for total fluid req. first 24 hrs)
-Any burn > 10% in children and > 15% in adults requires resuscitation
-Colloids (albumin): given 12-24 hrs post burn when capillary permeability is normal or near normal
Pain management- burns - CORRECT ANSWER✅✅-Must pre medicate 1/2 hour w oral meds
-Burn pt require multiple doses or more than recommended dosing
-Be an advocate for your pt; burns are extremely painful
-Pain medications: morphine, hydromorphone, oxycodone, acetaminophen
-Closely observe VS and oxygenation
Wound care during emergent phase- burns - CORRECT ANSWER✅✅-Debridement
-Dressings
-Open: antimicrobial w/o dressings, basically just ointment, mostly for facial burns
-Closed: sterile gauze over topic antimicrobial, some antimicrobial dressing can be in place for 3-14 days
Medications- burns - CORRECT ANSWER✅✅-Silver sulfadiazine (antimicrobial)
-Mafenide acetate cream (anti infective)
-Mupirocin cream (antimicrobial)
-Bacitracin ointment (antimicrobial)
-Tetanus immunization
-Enoxaparin (anticoagulant): watch for bleeding with vigorous debridement
Acute phase- burns - CORRECT ANSWER✅✅-Mobilization of extracellular fluid
-Diuresis
-Ends when partial thickness wounds are healed or full thickness wounds are grafted
-Weeks to months
