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Medical Surgery Burns 1
Terms in this set (41)
Where do most burns occur?
in the home
After a burn, why does plasma seep out into the tissue?
because of increased capillary permeability
When does the majority of this leaking occur?
the first 24 hours
Does the pulse increase?
yes anytime you are in FVD the pulse will go up
What happens to the cardiac output?
it decreases because there is less volume to pump out
What happens to urinary output?
because the kidneys are either trying to hold on to the fluid or they are not being per fused properly
Following a burn the body secreted epinephrine, why?
it makes you vaso constrict and shunts blood to the vital organs
What is the danger of a low systolic blood pressure
the client will not have adequate organ per fusion <90
After burns aldosterone is secreted, why?
to retain sodium and water
After burns ADH is secreted, why?
to retain water
How does ADH and Aldosterone affect the blood volume
it causes it to go up
What is the most common airway injury associated with burns?
carbon monoxide poisoning
Describe the affects carbon monoxide has on hemoglobin:
normally oxygen binds with hemoglobin but carbon monoxide travels much faster than oxygen, therefore it gets to the hemoglobin first and binds and oxygen can no longer bind to it
what does carbon monoxide cause the patient to be, and how do you treat them?
What is the best question to ask to determine the possibility of airway injury in a fire?
was the fire in a closed space
What observations would cause you to think airway injury in a fire?
burns and singed hair to the neck/face/chest
what might the HCP have to do prophetically?
intubation (they do it before its required because of impending swelling
how is the percentage of the body burned determined
rule of nines
head and neck:9%
trunck front: 18%
trunck back: 18%
arm: 9% each
Leg: 18% each
When is the rule of nines conducted?
upon arrival and after a few days
What is one of the most important aspects of burn management?
Is it important to know the time a burn occurred, why?
yes, because fluid therapy for the 1st 24 hours is based on the time the injury occurred, not when the treatment was started.
What is a common rule in calculating fluid replacement for the first 24 hours?
Calculate what is needed for the first 24 hours and give half of the volume calculated during the first 8 hours. This is the Parkland formula.
What important things do you need to calculate the fluid replacement properly?
the clients weight in kg
the TBSA or total body surface area affected
what does a restless burn client indicate
inadequate fluid replacement
what is the priority action in treating restlessness in the burn client?
pain never killed anyone
to determine if a burn clients fluid output is adequate would you measure their weight or their urine output?
urine output (burns are the exception normally its weight)
critical thinking: a client weighing 235lbs has a 30% total body surface area burn. The HCP order is titrate IV fluids to maintain urinary outpu at 0.5ml/kg/hr. what is the desired output? (whole number)
53ml always round off at the end
A client is wrapped in a blanket to stop the burning process. Since the flames are gone does that mean the burning process has stopped?
what else could be done to stop the burning process?
How did the blanket help?
holding in body heat and keeping out germs
Do you need to remove jewelry, why?
yes because of swelling and they get hot
Do you need to remove clothing
yes, remove non adherent clothing and cover burn with a dry clean cloth
what are some common signs of airway injury in a burn
singed nose hair
singed facial hair
coughing up stuff with dark flecks in it
blisters on the oral or pharyngeal mucosa
Do you think there are more deaths with upper or lower body burns?
A clients respirations are shallow. You know they are retaining ___________. There fore they may have which acid base imbalance? ______________
CO2 and respiratory acidosis
Why would you administer albumin to a burn patient?
You know albumin holds on to fluid in the vascular space which:
increases vascular volume
increases kidney perfusion
increases cardiac output
How does administering albumin help correct fluid volume deficit?
it helps by putting more fluid into the vascular space
What will happen to the vascular volume when you start giving the client albumin?
the volume will increase
How does this increase in vascular volume affect the workload of the heart?
it increases it
what concerns should have about the clients heart during fluid replacement and albumin therapy?
if you stress the heart too much
the client could be thrown in to FVE, if this happens the cardiac output will decrease, you will have crackles and wet lung sounds
in a client who is receiving fluids rapidly, what is a measurement you could take hourly to insure you arent overloading the clients heart?
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