What are the pathophysiologic changes after a burn?
Increased capillary permeability
Fluid volume deficit
Epinephrine secretion for vasodilation
ADH secretion to increase blood volume
Aldosterone secretion to increase blood volume
Decreased blood pressure and then increased blood pressure
What chemicals are secreted during a burn?
Epinephrine secretion for vasodilation
ADH secretion to retain water and increase blood volume
Aldosterone secretion to retain sodium and water and increase blood volume
How can shock occur?
Heat damage causes increased capillary permeability leading extreme third spacing.
Why does the blood pressure decrease then increase
Epinephrine causes vasodilation decreasing BP, then fight/fight hormones kick in causing vasoconstriction increasing the BP.
Why does the urine output decrease?
Kidneys are not being perfused or they are trying to hold on to volume to compensate and not die.
How does carbon monoxide cause hypoxia?
CO has a greater affinity for hemoglobin that O2. All of the hemoglobin binds with CO instead of O2 and cannot transport O2.
Why is it important to determine if the burn took place in an enclosed space or not?
Closed space burns have more potential for airway injury.
What may the doctor do prophylactically for airway burns?
Intubate or trach them (least invasive first) b/c airway will swell
What is the rule of nines?
Estimate of Total Body Surface Area that was burned
Genitalia = 1%
Left arm = 9%
Right arm = 9%
Left leg = 18%
Right leg = 18%
Head and Neck = 9 %
Front of Trunk = 18%
Back of Trunk = 18%
Why is it important to determine the time that the burn occurred?
Fluid therapy for the first twenty four hours is based on the time the injury occurred, NOT when the treatment was started.
What is the Parkland formula?
Calculate what fluid is need for the first 24 hours and give HALF OF THE VOLUME CALUCATED DURING THE FIRST 8 HOURS.
2nd 8 hrs = 1/4 of the volume
3rd 8 hrs = 1/4 of the volume
(4mL of LR)(body weight in Kg)(TBSA burned) = total fluid requirement for the first 24 hours after the burn
What are some signs of airway injury?
singed facial/nasal hair
soot on their face
coughing black or black speckled sputum
blisters on oropharyngeal mucosa
If a client's respirations are shallow what can you assume?
poor gas exchange
they are retaining CO2 and in respiratory acidosis
What are the effects of albumin?
Increased kidney perfusion
Increased WORKLOAD ON THE HEART
What is a major risk when giving a person albumin?
Workload on the heart increases causing stress on the heart. If the heart is stressed too much, the pt will go into FLUID VOLUME EXCESS. The CO will decreased b/c the heart is failing and the lungs will sound WET.
When a client is rapidly receiving fluids, what HOURLY measurement can be made to ensure that you are not overloading the heart?
sudden jump in CVP means the right atria is filling very fast.
Why are IV pain meds preferred over IM in burn patients.
For IM to work, muscles must be perfused
Explain active immunity,
Body takes an active role in production of antibodies.
Takes TIME to develop.
About 2-4 weeks to develop their own immunity.
Explain passive immunity?
lasts about three months
Body just sits back and passively accepts the antibodies
what are the complications of burns?
pressure and poor perfusion to tissues
What is a fasciotomy
relieves the pressure and restores the circulation but the cut is much DEEPER into the tissue-- cut through the eschar and the fascia.
Why would you get no urine output after inserting a foley?
It's in the vagina.
Kidneys are not producing urine b/c they are not being perfused or they are trying to conserve fluid.
What should you know about mannitol?
can crystalize in sln especially if it gets cold
utilize an in line filter
observe for CLARITY before administration
DO NOT refrigerate
Why does the client begin to diurese after 48 hours?
Fluid returns to the vasculature, now fluid volume excess is a concern. Will see an increase in U/O
What causes paralytic ileus
Due to lack of blood flow. Blood is shunted away from intestines to vital organs.
Will a burn pt need more calories?
Yes, they are in a hypermetabolic state.
Increased protein, calories and Vit C
For GI feedings, what should you measure to ensure that the supplement is moving through the GI tract?
Hold feedings at 150 CC's
Always return residuals to the tum tum.
What lab work indicates proper nutrition and a positive nitrogen balance?
What lab is best for total nutrition?
PREALBUMIN-- shows a shorter term change, more sensitive for total nurition
How do we prevent contractures?
Wrap each finger separately
Hyper extend the neck (head back) as its healing
Don't use pillows
Why is it necessary to remove eschar?
So new tissue can regenerate and it's bacterial breeding ground.
What are Sutilanis (Travase) and Collagenase (Santyl)?
enzymatic drug that eats dead tissue. Used for debridement.
What are the precautions with these debridement drugs?
Don't use on face
Don't use if pregger
Don't use over large nerves
Don't use if area is opened to a body cavity (will eat away internal organs)
Talk about hydrotherapy.
Used for debridement
be sure to medicate for pain before undergoing this therapy.
What are the common drugs used with burns?
Silver Sulfadiazine (Silvadene)
Mafenide Acetate (Sulfamylon)
What should we know about Silver Sufadiazine (Slivadene)?
if rubs off apply more
can lower the WBC
can cause a rash
What should we know about Mafenide Acetate (Sulfamylon)?
can cause acid base problems
if it rubs off apply more
What are some things to worry about with -MYCIN drugs?
Ears and kidneys
Ototoxicity (hearing loss)
Check BUN and creatinine. If increasing, assume nephrotoxic.
If UO decreasing, assume nephrotoxic.
Explain skin grafting.
Remove dead, burned tissue until healthy tissue is seen.
Take good skin from donor site and place over burned area.
What do we do with the donor site?
Cover with transparent dressing until bleeding stops, then it may be left to open air.
What is the Q-tip rolling thing?
Order to roll sterile Q-tips over the graft with steady gentle pressure from center of graft to outer edges to get air and serous drainage out b/c they interfere with adhering the tissue graft.
What do you do with a chemical burn?
Remove client from chemical
If its a powder-- first brush it off
Next flush with water for 15-20 minutes
Don't wait for doctor to flush!
Why is a client with an electrical burn placed on a spine board with a C-collar?
electrical injuries occur in high places
muscle contractions can cause fractures
force of electricity can throw the victim