NURS 4750 EXAM 4
What layer of skin is affected in a full thickness burn?
all layers down to or past the fat, fascia, muscle, or bone
Assessment of a ____ burn: thick, dry, and leathery appearance;
insensate, creates eschar, does not blanch
full thickness
A full thickness burn on abdomen could lead to
increased intra-abdominal pressure
A full thickness burn requires
grafting
Extent of injury is expressed as
percentage of total body surface area (%TBSA)
What is the rule of nines?
- Head
- Face
- Arm
- Anterior torso
- Chest
- Posterior torso
- Leg
- Genitalia
- Head: 9% (Face: 4.5%)
- Arm: 9%
- Anterior torso: 18% (Chest: 9%)
- Posterior torso: 18%
,- Leg: 18%
- Genitalia: 1%
What are some methods used to estimate the extent of injury?
- Rule of nines
- Patient's palm method: size of the patient's hand is roughly 1% of
patient's surface area
- Lund and Browder chart: very specific, what's used in burn centers
What method is used for estimating the extent of injury for
splotchy, irregular, scattered burns
patient's palm method
What method for estimating the extent of injury is used in burn
centers?
Lund and Browder chart
What electrolyte abnormalities happen in response to burns in the
first 24-48 hours? (Potassium, Sodium, H&H)
- Hyperkalemia
- Hyponatremia
- Increased H&H
Patients are at risk for ____ with burns because of hyponatremia
Hypovolemic shock
What fluid shift happens in the first 24-48 hours after a burn
injury?
fluid shifts to extravascular space - rapid extensive edema through the
whole body (not just burn areas)
Burns more than ____% TBSA require fluid resuscitation
20%
When is the diuretic phase of a burn injury?
,48-72 hours after injury
What happens in the diuretic phase of a burn injury?
(Intravascular volume, GFR, Sodium, Potassium, Protein, ABG,
metabolic rate)
- Intravascular volume is increased - GFR increased
- Hyponatremia and hypokalemia
- Anemia
- Dec. serum protein
- Metabolic acidosis
- Very high metabolic rate
What is the systemic response to a burn? (cardiovascular - CO,
HR, contractility, afterload)
- Decreased intravascular volume --> decreased CO --> increased HR
and vasoconstriction leading to decreased oxygen delivery
- Decreased contractility, decreased BP
- Increased SVR and increased afterload
CO increases ____ hours after injury as evidenced by normal CO
and tissue perfusion
24-30 hours
What is the systemic response to a burn? (renal - intravascular
volume, GFR, UO)
- Initial drop in intravascular volume --> decreased GFR --> prerenal
AKI with inadequate fluid resuscitation
- Oliguria
Burns could be what type cause of an AKI?
prerenal
What is the systemic response to a burn? (GI)
, - Ischemia (especially in full thickness)
- Curling's ulcers
- Paralytic ileus, decreased peristalsis
What are some signs of a Curling's ulcer?
abdominal pain and distention, blood in stool or emesis
What is a curling's ulcer?
stress ulcer as a result of burns
What med do you give a burn patient to prevent a curling's ulcer?
H2 antagonists prophylactically: Pepcid, Protonix
In burns, patients are in a _____ state, 100% to 200% above basal
rates
hypermetabolic
What type of diet for burn patients?
- Increased calories (5,000) and protein
- May need supplements: enteral feedings (oral and enteral are
preferred)
Being in a hypermetabolic state from a burn injury can last for
how long after burn?
months to 3 years
What is the first phase of treatment for a burn injury and how
long does it last?
Resuscitative phase - first 48 hours after injury (includes prehospital
time - clock starts at the time of the burn injury)
What is the primary focus of care in the resuscitative phase of
treatment for a burn injury?
What layer of skin is affected in a full thickness burn?
all layers down to or past the fat, fascia, muscle, or bone
Assessment of a ____ burn: thick, dry, and leathery appearance;
insensate, creates eschar, does not blanch
full thickness
A full thickness burn on abdomen could lead to
increased intra-abdominal pressure
A full thickness burn requires
grafting
Extent of injury is expressed as
percentage of total body surface area (%TBSA)
What is the rule of nines?
- Head
- Face
- Arm
- Anterior torso
- Chest
- Posterior torso
- Leg
- Genitalia
- Head: 9% (Face: 4.5%)
- Arm: 9%
- Anterior torso: 18% (Chest: 9%)
- Posterior torso: 18%
,- Leg: 18%
- Genitalia: 1%
What are some methods used to estimate the extent of injury?
- Rule of nines
- Patient's palm method: size of the patient's hand is roughly 1% of
patient's surface area
- Lund and Browder chart: very specific, what's used in burn centers
What method is used for estimating the extent of injury for
splotchy, irregular, scattered burns
patient's palm method
What method for estimating the extent of injury is used in burn
centers?
Lund and Browder chart
What electrolyte abnormalities happen in response to burns in the
first 24-48 hours? (Potassium, Sodium, H&H)
- Hyperkalemia
- Hyponatremia
- Increased H&H
Patients are at risk for ____ with burns because of hyponatremia
Hypovolemic shock
What fluid shift happens in the first 24-48 hours after a burn
injury?
fluid shifts to extravascular space - rapid extensive edema through the
whole body (not just burn areas)
Burns more than ____% TBSA require fluid resuscitation
20%
When is the diuretic phase of a burn injury?
,48-72 hours after injury
What happens in the diuretic phase of a burn injury?
(Intravascular volume, GFR, Sodium, Potassium, Protein, ABG,
metabolic rate)
- Intravascular volume is increased - GFR increased
- Hyponatremia and hypokalemia
- Anemia
- Dec. serum protein
- Metabolic acidosis
- Very high metabolic rate
What is the systemic response to a burn? (cardiovascular - CO,
HR, contractility, afterload)
- Decreased intravascular volume --> decreased CO --> increased HR
and vasoconstriction leading to decreased oxygen delivery
- Decreased contractility, decreased BP
- Increased SVR and increased afterload
CO increases ____ hours after injury as evidenced by normal CO
and tissue perfusion
24-30 hours
What is the systemic response to a burn? (renal - intravascular
volume, GFR, UO)
- Initial drop in intravascular volume --> decreased GFR --> prerenal
AKI with inadequate fluid resuscitation
- Oliguria
Burns could be what type cause of an AKI?
prerenal
What is the systemic response to a burn? (GI)
, - Ischemia (especially in full thickness)
- Curling's ulcers
- Paralytic ileus, decreased peristalsis
What are some signs of a Curling's ulcer?
abdominal pain and distention, blood in stool or emesis
What is a curling's ulcer?
stress ulcer as a result of burns
What med do you give a burn patient to prevent a curling's ulcer?
H2 antagonists prophylactically: Pepcid, Protonix
In burns, patients are in a _____ state, 100% to 200% above basal
rates
hypermetabolic
What type of diet for burn patients?
- Increased calories (5,000) and protein
- May need supplements: enteral feedings (oral and enteral are
preferred)
Being in a hypermetabolic state from a burn injury can last for
how long after burn?
months to 3 years
What is the first phase of treatment for a burn injury and how
long does it last?
Resuscitative phase - first 48 hours after injury (includes prehospital
time - clock starts at the time of the burn injury)
What is the primary focus of care in the resuscitative phase of
treatment for a burn injury?
