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Care/ concerns for burn patients in each stage of the process (pre-hospital, emergent resuscitative phase, acute phase, and rehab phase
Terms in this set (29)
What needs to be done pre-hospital to improve patient outcome?
- Remove person from source
- Stop the burning
- Remove jewelry, non-adherent clothing, and contact lenses
- keep warm
- identify life-threatening injuries
How should burning be stopped?
- tap temp water
- roll or smother
If the patient has a large burn area how do you keep them warm?
- what don't you do?
- cover with clean and dry blanket
- don't immerse in cool water b/c it will cause excessive heat loss
What is the goal in the emergent/ resuscitative phase
resolve immediate problems first
What interventions should be done for a burn patients airway especially if is caused by inhalation?
- Early intubation before excessive swelling occurs
- HOB ^ if intubated or head involved to help decrease swelling
What do you want to check right away if an inhalation burn is suspected?
- Check ABGs,
How much O2 do you want to give a burn patient and via what source?
- 100% O2
- humidified via mask or ET
- wean as tolerated
When might a escharotomy be indicated for a burn patient?
- if there is a circumferential full-thickness burn to the thorax b/c it can produce eschar which will decrease chest expansion
- how is hypovolemic/ burn shock caused?
- d/t fluid shift loss of water, electrolytes, and proteins to the interstitial spaces, fluid loss and/ or evaporation
Since fluid resuscitation is a critical intervention, what needs to be done within the first 24 hours to prevent fluid volume deficit?
- 4 ml of LR/kg/% burned is given in first 24 hours
When does the clock start for you to begin fluid resuscitation?
- when does the 1st half of fluid need to be infused?
- calculated from time of injury
- half in first 8 hours, half over next 16
With fluid replacement IV access may be a problem so what needs to be done?
- Need 2 large bore IVs (14-16G)
How is pain treated with a burn patient?
- with a full thickness burn why might a patient not have pain right away?
- Narcotics and sedatives
- nerve destruction
How do you prevent heat loss in the emergent/ resuscitate phase?
- Use fluid/ blood warmers
- limit skin exposure
- maintain warm environmental temperatures
What Electrolytes do you have to keep a close eye on?
- Na+ and K+ will shift with fluid shifting
- K+ d/t liberation from damaged cells
- b/c of massive wounds what are these patients prone to and what do you need to give?
- clean, debride, dress
- prone to tetanus (give TD)
How long does the acute phase last for?
- after 48 hours
When do fluid and lyte requirements decrease?
- what needs to be monitored closely
- requirements decrease if a patient is diuresing
- monitor wts and I&O's
- what do you want to watch for?
- what are interventions to implement to decrease the chance of possible complications
- watch for compromise and pneumonia
- suctioning, re-positioning, C&DB, and early ambulation
When it comes to enzymatic agents what are they used for?
- debridement of necrotic tissue
When is grafting indicated?
- full thickness and deep partial thickness
What is used for pain management of a burn victim?
- three different types of meds
- analgesics (opiods- first IV then PO)
What should be given to help with itching since that may also be uncomfortable?
- topicals and antihistamines
What does a burn patients diet need to include?
- when should this type of diet be implemented?
- ^ protein and ^ carb diet
What pre-injury psychiatric disorders frequently exist in burn patients?
- Depression, mood disorders, AODA
What goes on in the Rehab phase?
- teaching patient how to resume self cares post injury
Since burn patients are risk for contractures, what are interventions that can be done to prevent them?
- anti-deformity positioning
Since burn patients are at risk for excessive scarring how do you prevent that?
- by using burn garments to keep pressure on the scars, keep them flat
What other types of patients might you see on a burn unit?
Those with exfoliative and necrotizing skin disorders such as
toxic epidermal necrolysis (usually r/t drug reaction)
Stevens-Johnson Syndrome (ditto)
staphylococcal scalded skin
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