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    Hurst Review Burns

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    2K views14 pages

    Hurst Review Burns

    Uploaded by

    DelindaEvans
    Hurst Review Burns

    Copyright:

    © All Rights Reserved
    Download as PDF or read online from Scribd
    Flag for inappropriate content
    of 14
    “The risk of death increases in the very and thé very , -Where do most bums occur? “After a bum many different pathophysiolo changes occur. WHY? a. Why does pilasmarseepsoutintorthertissue? Increased permeabilit b. (WHEHldoes the majority of this occur’? c. Why does the pullsertrorense? Anytime you're ina___, the pulse will 4. Why does the cardiaerourpubeleereast? Less ____to pump out. c. Why does the urinte'sttptttdeerease? Kidneys are either trying to on or they aren't being Why is fp? Makes you _ , shunts blood to vital organs i Retain = with aldosterone and Retain _ with ADH jood volume will go ihe ss the most oom ry? : -poisoning ns pn bod Carbon monoxide jobin first and binds. ..Can oxy an “run much faster” than n bind now? yes or No sat monitor picks up is bound to the Hb then the sat may monoxide poisoning ee -From this information, do you think it would be important to determine if the bum occurred in an open or closed space? -When you see a patient with bums to the neck/face/chest you had better think what? "What might the MD do prophylactically? il -A patient is burned over 40% of their body. How do you think this is determined? *Estimate of Total Body Surface Area ‘The Rule of Nines is different for ehildren. The head and neck are 21% of the body's surface area Each arm and hand is 10% of the body’s surface area Each leg and foot is 13.5% of the body's surface area “The chest and stomach are 13% of the body's surface area The back is 13% of the body’s surface area ‘The buttocks are 5% ofthe body’s surface area ‘The groin is 1% of the body's surface area -One of the most important aspects of burn management is__ 18 Hurst Review Services TCHTDADRARERERARADARARRRARADDDDADDDDDO94994880 - Vascular volume? - Kidney perfusion? -BP? + Cardiac output? -Will this help correct a fluid volume deficit? -When you start giving a patient albumin, you know that the vascular volume will Therefore, what will happen to the workload of the heart? -If you stress the heart TOO MUCH the patient could he thrown into fluid volume -If this occurs, what will happen to CO? -Lung sounds? -Any patient who is receiving fluids rapidly, what you could measure hourly (hint: heart) to ensure you're not overloading the patient? -Is it important to know that the burn occurred at 11:00 p.m.? = Why? Fluid therapy (for the first 24 hours) is based on the time the injury not ‘when treatment was Common rule: Calculate what is needed for the first___hours and give half of the volume calculated during the first 8 hours. This is the Formula. 1° 8 hours = of total volume 2 8 hours = % of total volume 3" 8 hours = % of total volume ‘NO matter what formula the doctor uses. ‘The formula will tell the amount of fluid the patient will gt per hour. This patient may be receiving as much as 500 mil/hr or more! -To calculate fluid replacement properly you also need to know the patient’s and TBSA affected. Hurst Review Services 9 -If the patient is restless does it mean fluid replacement is inadequate, pain, or hypoxia? *Nurse’s Priority: -Which of the following would you choose to determine if a patient’sfluid:volumerisadequate? Their weight or their urine output? -A patient's respirations are shallow. You know they are retaining what?___Therefore, which acid-base imbalance will they have? -A patient has an order for morphine that states: “2-4 mg of morphine IV Q 2 hours pm pain.” If the patient is complaining of pain (4/10) what dosage would the nurse give to the patient? -Why are IV pain meds preferred over IM with burns? -Why is the patient given a tetanus toxoid plus the immune globulin? () Tetanus Toxoid: immunity) *takes 2-4 weeks to get the AB's Q) Immune globulin: protection immunity) -Do you think there is more death with upper or lower body bums? -A patient has a circumferential burn on their arm. (1)What does this mean? (2) What should you be chetkin; -If'a patient’s vascular checks in this arm are bad the doctor may do what procedure to relieve pressure’ (relieves _and restores cut through the — Doe (hich will relieve the and restore the , but the cut is much deeper into the tissue, cut goes throughWhe eschar and the fascia) -A patient was wrapped in a blanket to stop the burning process. Since the flames are ‘gone does that mean the burning process had stopped? -What else could have been done to stop the buming process? -The blanket helped by... Holding in the —_______,and kept out - Jewelry? ay injury? -A foley catheter was inserted so you could measure urine output. *How often will this need to be monitored? 20 Hurst Review Services it possible that when you insert the catheter that no urine will return? Why? Kidneys are either attempting to he fluid or they might not be being __ adequately. -What would ypu do if the urine was browndared2s -If there is no urine output or if it is less than 20mV/hour, you would start worrying about? What drugs might bg ordered to increase diuresis? SAREPASROES He patient win vegin to'diurese. Why? Because fluid is going back into the _space. Now we have to worry about flvid'voluinie. ~ Urine output? ~The patient's serum K+ level is 5.8. - K+ likes to live inside OR outside of the cell? -With a burn, what happens to cells? -So, what happens to the number of K+ in the serum (vascular space)? Electrolyte imbalance? hypokalemia OR Hyperkalemia -Why do you think MylantawyProtonixtyand Pepeid®) are ordered Antacids: aluminum hydroxide, Amphogel®, or magnesium. hydroxide, Milk of Magnesia® H2 Antagonist: Zantac ®, Pepcid ®,Axid ® Proton Pump Inhibitors: Protonix ®, Nexium® -Why do you think the doctor wants the patient to be NPO Und Have aA NOPhooked to suction? -Ifa patient doesn't have bowel sounds, what will happen to the abdominal girth” -Do you think the patient will need more or les calories?

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