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Most burn deaths occur during _____ or ____
initial transport, at the scene
Burn mortality process
immediate smoke inhalation or incineration, 24 hrs hypovolemia, sepsis later
Pt burn extent is reassessed within ___ bc there are more clear demarcations and depths at this time
72 hrs
Rule of the palm
Pt’s hand including fingers is equal to 1% of body
Thermal burns are due to
external heat source
Bathing water should be under ___ degrees, water heater shouldn’t be higher than ___ for 5 mins
100, 120
Thermal burns types
flame, scald, contact
Radiation burn dt
prolonged exposure to UV or other radiation sources
Chemical burns dt
strong acids, alkalis, detergents, solvents
chemical burns are usually ____ or 2/2 ___
occupational, assault
the most dangerous chemical is
alkali
tx for chemical burns
remove clothes, flush eyes with water, neutralizing agent just wastes time
initial nursing assessment for burns
time and cause, first aid, past medical hx, meds, age, body weight
burns tx
stop burn process, abc assess, tx life threatening injuries, extent and deph of burn eval
abcde
airway, breathing, circulation, disability, environment
airway intervention
intubate
breathing intervention
100% o2 and continuous pulse ox
circulation interventions
LR start, insert foley
inhalation injury interventions
cyanide kit for chemicals, intubation, bronchoscopy in 6 hrs, nebs
cyanide kit is a ____ reconstituted to drip via __
powder, IV
Parkland formula for LR
4ml/kg/tbsa in first 24 hrs
For parkland formula give half of total in ___ hours, and give ___x in the next ___ hours
8, 2.5, 16
parkland formula fluid resuscitation includes fluids given by
ems
for kids under 5, instead of LR give
d5lr
Titrate fluids ____ based on ____
hourly, uop
If uop under goal increase fluids by ___, if over goal decrease by the same amount
10%
Adults uop goal
0.5ml/kg/hr or 30-50ml/hr
children uop goal
1ml/kg/hr
heparin neb role in inhalation burn injuries
prevents clots from forming in airway from sloughing and damage in airway
mucomyst/acetylcysteine role in inhalation injury
inactivates reactive substances from inhalation injury
albuterol role in inhalation injury
inflammation tx
in the initial emergent phase want to look for
edema
in acute phase fluids shift ____ from intravascular so there will be x3 issues
out, K, Na, coag
hematuria is bc hemochromogens signals damage to ___ and ___ in the muscle
rbc, myoglobin
glycosuria
release of glycogen in response to stress from the liver
burn victims dont use
diuretics
biggest cause of death is
hypovolemic shock
escharotomies def
majro burn of an extremity/torso swells
escharotomies happen when ____ burned skin becomes rigid and hard
full thickness
escharotomy process/patho
fluid resuscitation causes swelling, circulation compromised, loss of pulses, motor and nerve function + cyanosis
escharotomy need clinical
tightness, loss of peripheral pulse, numbness and tingling, deep throbbing pain,
pain mgmt in burn
consistent measurement tool, medicate before procedures, give prescribed meds, explain procedures and discomfort levels, verabalize pain experience
if on pca need to regularly assess
loc and rr
infection control in burns considerations
pnemonia, uti, wbcs daily, tetanus shot, high calories, culture wounds and secretions, antimicrobials
wound care is not started until patient is
stable
wound dressings common
xeroform, silver sulfadiazine, kerlix, bacitracin, dermex, adaptic
biosynthetic graft has inner layer of matrix of fibers and outer layer of
silicone
biosynthetic allows for regrowth of ___ skin layer, and once it grows the silicone and removed and replaced with ____ skin graft
dermal, epidermal
allograft is from ___ and used to promote ____ healing prior to autograft
person, wound bed
xeroraft is from ___ and is temporary to ____ and ____ control for ___ burns
animals, cover and pain, superficial
isograft is between
twins
skin gun uses ____ and healing is days instead of weeks-months
stem cells
physical mobility interventions for burns
active/passive rom, splints, alignment, pain meds
delirium tremens happens in 5% cases of withdrawal in 12-24 hrs. S/s include
hallucinations, hyperthermia, htn, tachycardia, disorientation, agitation, diaphoresis
physical assessment for withdrawal
vs, ciwa-ar (higher score means need more benzos), skin/musculoskeletal for falls/accidents, tremors, tongue fasciculations
the s/s of withdrawal that is hard to replicate is
tongue fasciculations
history assessment for withdrawal
bac, how long and how muhc, is pt honest, do they want to quit, how long since last use
meds for normie alcohol withdrawal
diazepam/lorazepam or other benzos
why are benzos used to tx alcohol withdrawal?
alcohol desensitized to gaba, when alcohol stopped body has gaba overload. benaos kill off gaba
alc withdrawal severe cases tx
phenobarbital or propofol
phenobarbital role
barbituate that decrease seizure and symptoms
propofol role
intubated and sedated to prevent seizures
alcoholism causes ___ issues bc GI can’t absorb nutrients, even if they are eating the right foods
gi
alcohol withdrawal nutrition txs
thiamine, mg, phosphate, K, folate, vitamins
why give thiamine for withdrawal?
wernicke’s encephalopathy prevention
nursing tx for alc withdrawal
vs and ciwa q2-4hrs, seizure precautions, meds, limit setting, reality orientation dont go w them in delusion, family support
suicide top 3 questions
suicide is ___ leading cause of death ages 10-34 after trauma and firearms are most common method
2nd
nursing assessment questions for suicide
do you want to kys, if yes plan, plan yes what is the plan, previous attempts
main assessment physical for suicide is
skin
medical tx for suicidality
ssri, snri, benzos, hydroxyzine, quetiapine
anxiety meds
benzos and hydroxyzine
quetiapine indications
bpd, schizoaffective, depression
quetiapine moa
blocks serotonin, dope, and histamine receptors
suiciders can still od on their ___ so don’t give too much of their prescription
antidepressants
suicide remove stuff
cords, call lights, shower curtains, garbage bags, pillows, hand sani
beta blockers moa
block catecholamines centrally and peripherally. For BP, HR, and anxiety attacks
beta blockers od symtpoms
bradycardia, arrhythmias, hypothermia, ams, resp depression, hypoglycemia
assessment for beta blocker od
vs, renal uop, ams, resp statuss
med tx for beta blocker od
vasopressors, fluids
Ca channel blocker od symtpoms
hyperglycemia
Serotonin syndrome SS
acetaminophen OD assessment findings
resp, diarrhea from lactulose, uop, fluids, bleeding, ams, jaundice
Acetaminophen toxicity leads to
fulminant hepatic failure, AKI, metabolic acidosis, cerebral edema, death
ODs can be cleaned out with
gastric lavage
opioids make up ___ of ods
70%
opioids od nursing assessment
bradypnea, o2 down, ams, myois small pupils
72 hrs is for ___ ill or ___ dependent
mentally, chemically
72 hr hold rules
clinician ordered, written not verbal or phone, needs clear documented reason
nurse role in 72 hr hold
document progress note, provide rights in written form, cont assessment to see if hold is needed, comm with provider to get rid of it faster, secure pt room and belongings, call behavioral emergency if pt attempts to leave or combative
restraint image
restraints risk
increased confusion/agitation, fear, anger, loss of dignity, depression, pressure ulcers, incontinence, ptsd
chemical restraints common
haloperidol, olanzapine
nonviolent pt restraint methods
pt safety, all four rails raised, posy vest
nonviolent restraint nursing role
document q2h, circulation, rom, reposition, offer foods and fluids and elimination
violant restraint nurse role
document q15min, circulation, rom, skin, foods and fluids and elimination q2h
nonviolent renewed every ___ hrs, violent renewed every __ hrs
24, 4
Nonviolent can be removed when
pt reorients and keeps lines/tubes/drains safe
violent restraints removed if
no aggression within 1 hours, demonstrate control over behavior
if restraints are removed need
a new order
Note
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