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Neuro 260
Burns
| Question | Answer |
|---|---|
| What type of burn only involves the epidermis? | Superficial Thickness Burn |
| What is the besk kind of example for a superficial thickness burn? | a sunburn |
| This type of burn will have some redness with some mild edema, pain and increased sensitivity to heat. | Superficial Thickness Burn |
| How long will it take a superficial thickness burn to heal? | Withing 3-5 days without scarring. |
| What type of burn involves the upper 1/3 of the dermis? | Superficial Partial Thickness Burn |
| This type of burn will have blisters and will blanch when pressure is applied. | Superficial Partial Thickness Burn |
| How long does it take a superficial partial thickness burn to heal? | It takes 10-21 days without scarring. |
| This type of burn will not scar and there may be some minor pigment changes that occur. | Superficial Partial Thickness Burn |
| This type of burn involves areas deeper into the dermis beyond the upper 1/3. | Deep Partial Thickness Burn |
| This type of burn wound is dry and red with areas of whitness in deeper parts. | Deep Partial Thickness Burn |
| With this type of burn the patient will have moderate edema and some blistering may take place, but not always. | Deep Partial Thickness Burn |
| How long does it take for a deep partial thickness burn to heal? | It takes 3-6 weeks to heal without surgery. If grafting is done, it will heal faster. |
| This type of partial thickness burn will usually develop scarring. | Deep Partial Thickness Burn |
| This type of burn will destroy the epidermis and the dermis. All the dermal structures are destroyed. | Full Thickness Burn |
| How long does it take for the skin to regenerate in patients with full thickness burns? | The skin cannot regenerate, all dermal structures are destroyed. |
| This type of burn appears white, yellow, brown, and black and eschar develops. | Full Thickness Burn |
| In this type of wound, the wound itself is not painful because the nerve endings are destroyed, but the edges will be. | Full Thickness Burn |
| This type of burn requires skin grafting for closure. | Full Thickness Burn |
| An extensive burn may involve fat, fascia, tendon and bone. This would be considered what type of burn? | Deep Full Thickness Burn (Fourth Degree) |
| This kind of burn is considered leather forever. | Deep Full Thickness Burn |
| This type of burn extends down into the fascia and tissues. | Deep Full Thickness Burn |
| If a limb like a finger experiences a deep full thickness burn, what will most likely be the result? | The patient will probably have to have it amputated because there will be nothing to salvage. |
| What is the healing time for patients with Deep Full thickness Burns? | It is a very lengthy healing time. It could take weeks to months. |
| What is the difference between escharatomy and fasciotomy? | Escharatomy is an incision in the eschar to relieve pressure from edema. Fasciotomy is an incision into the fascia to allow skin expansion and it is deeper than an escharotomy. |
| If a patient has a broken bone, are they more likely to have a fasciotomy or an escharotomy? | Fasciotomy because they do not have any eschar. |
| What is the purpose fo classifying burns? | To determine where the patient needs to go. |
| This classification of burn will go to the ER or outpatient clinic to be treated. | Minor |
| This classification of burn includes deep partial thickness burns less than 15% and full thickness burns less than 2%. There can be no hand, feet, face, eyes, ears or perinium burns. | Minor - ER/Outpatient |
| This classification of burn will go to the hospital and perhaps a burn unit to be treated. | Moderate |
| This classification of burn includes deep partial thickness burns less than 15% to 25% and full thickness burns less than 2% to 10%. There can be no hand, feet, face, eyes, ears or perinium burns. | Moderate - Hospital/Perhaps Burn Unit |
| This classification of burn will go to the Burn Unit for treatment. | Major |
| This classification of burn includes partial thickness burns greater than 25% and full thickness burns greater than 10%. Any involvement of hands, feet, face, eyes, ears or perinium burns will go here as well. | Major - Burn Unit |
| What classification of burns would a patient who has experienced inhalation, fracture, or other trauma go to. | Major - Burn Unit |
| Where will patients with electrical burns be sent. | Major - Burn Unit |
| What type of burns are the most frequent in toddlers? | Hot water scalds. |
| Flame related burns are more common in _____ children | older |
| In the rule of nines, what number is assigned to the legs? | 18 each leg |
| What type of a burn would a burn caused by a flame (dry heat) be considered? | A thermal burn |
| What type of a burn would a burn caused by scalding (moist heat-liquids or steam) be considered? | a thermal burn |
| What type of a burn would a burn caused by contact with hot surfaces or materials be considered? | a thermal burn |
| The internal injury caused by this type of injury may be worse than the external injury. | electrical injury |
| When talking about electrical injuries, the amount of current and the length of exposure = | the degree of injury |
| Why could an electrical burn cause cardiac dysrhythmias or arrest? | Becaue an electrical burn can cause extensive vascular damage. |
| What are persons who have had an electrical burn going to be evaluated for much earlier than others as they get older in life? | Cataract Formation |
| Why could an electrical burn cause Renal problems? | An electrical burn could cause internal hemorrhaging and we are not able to see this on the outside. |
| What happens to the muscles if a patient experiences an electrical burn? | Muscle damage can occur causeing the release of myoglobin which can plug up the kidneys. |
| Why is the urine of a burn patient a dark color? | It is due to the increase of circulating RBC's which can be called hemoglobin urea or myoglobin urea. |
| Why do we use Triponin to determine cardiac status instead of myoglobin? | Because Triponin is more specific to cardiac status and myoglobin is only indicative of muscle damage. |
| Because a burn patient has extra RBC's circulating along with the myoglobin, what do we need to do for the patient? | We need to make sure they get lots of fluids. If the kidneys can't handle the extra fluids, temporary dialysis may be necessary. |
| In these types of burns common in children, a large area can be involved and active bleeding can be present. | Pediatric Electrical Burns of the Mouth |
| What treatment might children need if they have a burn to the mouth? | They may need plastic surgery. |
| Why might an infant with burns need a feeding tube? | Inability to use their sucking mechanisms, because of damage, or because of pain. |
| In these types of burns the amount of damage depends on the concentration of the agent, quantity of the agent, length of exposure, mechanism of action and depth of penetration. | chemical burns |
| This type of chemical that can cause burns is used at refineries and is a really good rust remover. | Hydrofluoric Acid |
| This type of chemical is found in insecticides and fertilizing production and can cause burns. | Hydrofluoric Acid |
| How is hydrofluoric acid absorbed? | It is absorbed through the skin. |
| If a patient is exposed to hydrofluoric acid, what should they do? | They need to get immediate attention. |
| Large concentrated exposures of this chemical can burn right through the skin and destroy bone. | Hydrofluoric Acid |
| The symptoms from this chemical that can cause burns may not appear immediately. | Hydrofluoric Acid |
| If a patient is exposed to hydrofluoric acid and there is bone destruction, what is a potential complication we need to monitor the patient for? | HYPOcalcemia which can lead to cardiac problems and could even cause arrest or death. |
| How much hydrofluoric acid would a person have to be exposed to for it to be deadly? | Enough to cover the sole of the foot. |
| What type of chemical burn is calcium gluonate gel applied to? | a hydrofluoric acid burn |
| This chemical is like battery acid and is used to remove paint in indrustries. | Sulfuric Acid |
| What type of a burn does sulfuric acid cause? | a thermal burn |
| This type of chemical is used in refineries to clean out impurities in gasoline. | sulfuric acid |
| What could chemical pneumonia cause? | Burns on the inside of the lungs that become inflamed and cause scarring of the lungs. |
| What is an MSDS? | A material safety data sheet kept on each unit that is used in case of being exposed to a chemical. |
| How do we treat chemical burns? | Brush off any dry chemical.Remove all clothing and jewelry.Determine what type of chemical.Flush with copious amount of water.DO NOT neutralize unless you are sure of the chemical and the appropriate agent. |
| How do we treat radiation burns? | Protect yourself.Remove patient from radiation source.Send to the nearest designated radiation decontamination center. |
| What will happen if a patient receiving radiation receives burns? | Treatment will have to be stopped until the burn is healed and then resumed again. |
| Why does distributive shock develop quickly after a major burn or injury? | hypovolemia |
| What causes hypovolemia after a major burn or injury? | The capillaries become permeable and the fluids leak from the vascular space in to the interstitial space. (fluid shift) |
| Once a patient has hypovolemia, what does that then lead to? | decreased circulating volume |
| If the patient has developed decreased ciruculating volume, what will that lead to? | decreased venous return |
| If the burn patien develops decreased venous return, what can happen to the patient? | They will develop decreased stroke volume. |
| What will decreased stroke volume lead to in the burn patient? | decreased cardiac output |
| If the patient has decreased cardiac output, what will happen to their cellular oxygen supply? | it will decrease |
| If the cellular oxygen supply is decreased, what will this impair? | tissue perfusion |
| If we have impaired tissue perfusion what will this cause? | Impaired cellular metabolism. |
| What two things can cause hypovolemia? | hemorrhage or dehydration |
| This stage of shock is the early, reversible, and compensatory stage. | Stage 1 |
| In this stage of shock hyperventilation causes respiratory alkalosis and this leads to vasoconstriction. | Stage 1 |
| This stage of shock is the intermediate or progressive stage. | Stage 2 |
| In this stage blood is shunted to vital organs like the brain, lungs and heart. | Stage 2 |
| In stage 2 of shock, what causes ischemia? | Less circulating volume in the arms and legs. |
| What will ischemia in stage 2 of shock lead to? | hypoxia - not enough oxygen is getting to the extremities. |
| If a patient is experiencing cellular hypoxia, what can that lead to? | production of lactic acid which then leads to metabolic acidosis |
| What causes lactic acid buildup? | anaerobic metabolism |
| What kind of signs and symptoms might the patient with ischemia have? | Cold, crying and in a lot of pain. |
| This stage of shock is the refractory or irreversible stage of shock. | Stage 3 |
| In this stage of shock, blood remains pooled in capillaries, arterial BP is too low to perfuse organs, extreme acidosis occurs, possible DIC and multisystem organ failure occurs. | Stage 3 |
| How long does the emergent phase of a burn injury last? | approximately 48 hours |
| Why might we see oliguria in the emergent phase of a burn injury? | Because there is not enough circulating volume. |
| Why might we see hypoproteinemia in the emergent phase of a burn injury? | Because plasma is going out to interstitial spaces and is no longer circulating. |
| Why might we see hypokalemia in the emergent phase of a burn injury? | Because cells die and release K+. |
| Why might we see hypernatremia in the emergent phase of a burn injury? | Because sodium follows water and is opposite of potassium. |
| Why might we see an increased Hct in the emergent phase of a burn injury? | Hemoconcentration caused by low volume. |
| Why might we see metabolic acidosis in the patient in the emergent phase of a burn injury? | Because of lactic acid buildup. |
| When does the diutetic stage of a burn injury begin? | Approximately 48 hours after the onset of the injury. |
| During this stage of a burn injury, the patient will have increased intravascular volume, blood volume, and renal function and diuresis. | Diuretic Stage of Burn injury |
| Why is there an increase of blood volume, intravascular volume, and renal function in the diuretic stage of a burn injury. | Because the fluid shifts back into the intravascular space from the interstitial space. |
| What is important to remember about the kidneys during the diuretic stage of burn injuries. | The body can only handle all the extra fluid coming back into the intravascular volume if the patient has good kidney function. |
| What are the signs and symptoms of hypokalemia? | Alkalosis, shallow respirations, irritability, confusion, drowsiness, weakness, fatigue, arrhythmias - irregular rate or tacycardia, lethargy, thready pulse, and decreased intestinal motility. |
| What could the decreased intestinal motility caused by hypokalemia cause. | Nausea, vomiting, and an ileus. |
| What is the normal range for calcium? | 9.0-11.0 |
| What is the normal range for phosphorus? | 3.0-4.5 |
| What happens to the potassium levels in acidosis? | The potassium levels go up. |
| What are the signs and symptoms of hyperkalemia? | Muscle twitches, cramps, parasthesia, irritability and anxiety, decreased BP, dysrhythmias - irregular rhythm, abdominal cramping, and diarrhea. |
| What type of acid base imbalance will shock cause? | metabolic acidosis |
| What are the signs and symptoms of hypernatremia? | lethargy, weakness, irritability, and edema |
| What is the normal range for sodium? | 135-145 |
| What are the signs and symptoms of hypocalcemia? | tetany, spasms, parasthesias, muscle aches |
| This buffering mechanism is the strongest buffer system we have and it comes from the lungs. | Carbonic Acid |
| This buffer system in one of the stronger buffer systems we have and it comes from the kidneys. | Sodium Bicarbonate |
| This buffer system is active in intracellular fluids and is not very powerful. | phosphate |
| This buffer system is a blood borne buffer in plasma that combines to get rid of the hydrogen. | Protein |
| What buffer system is not effective with someone who has burns? | Protein |
| What response is very rapid to correct an acid-base balance? | respiratory regulation |
| How does respiratory regulation regulate the acid-base balance? | It eliminates or retains carbon dioxide. |
| HYPOventilation will cause what acid-base problem? | respiratory acidosis |
| Not breathing well or enough, smoke inhalation, pneumonia, OD, respiratory depression or respiratory arrest will cause what acid base condition? | respiratory acidosis |
| What are the signs and symptoms of respiratory acidosis? | Dizziness, LOC changes, mental cloudiness, weakness, dull headache which is caused by decreased O2 or ischemia in brain cells. |
| A patien who has COPD may have respiratory acidosis, but what has been happening for quite a long time? | compensation |
| HYPERventilation will cause what adic-base problem? | respiratory alkalosis |
| Breathing too fast, too much, having panic attacks, fever, anxiety, exercise, or altitude changes can cause what acid base imbalance? | respiratory alkalosis |
| What are the signs and symptoms of respiratory alkalosis? | Dizziness and lightheadedness, inability to concentrate. |
| What acid base imbalance will smoke inhalation cause? | respiratory acidosis |
| What is surfactant and what can inhalation of smoke do to it? | It is the oil that coats your lungs to help collapse and re-expand them and it can be decreased by smoke inhalation. |
| What can atelectasis do to the alveoli? | It can collapse them. |
| If the patient has metabolic acidosis, the respiratory system will compensate by | hyperventilating |
| If the patient has metabolic alkalosis, the respiratory system will compensate by | hypoventilating |
| Why might a patient suffer from asphyxia if involved in a fire? | The fire consumes all available oxygen. |
| Inhalation of smoke will cause diminished | surfactant |
| What happens to Hgb when CO is present? | Hgb prefers to bind with CO rather than O2 and this causes decreased o2 to the tissues. |
| Why wont pulse oximeter readings be correct if the patien is experience carbon monoxide poisoning? | Because the pulse oximeter cannot tell the difference between CO and O2. |
| These are the ultimate regulator of acid-base balance. | kidneys |
| What regulator of acid-base balance carefully excretes/conserves hydrogen ions and bicarbonate? | kidneys |
| In what acid-base imbalance are increased amounts of bicarb excreted in the urine? | alkalosis |
| In what acid-base imbalance do the tubules excrete H+ and increase reabsorption of HCO3 back into the blood. | acidosis |
| What causes the renal changes in burn injury patients? | Decreased renal blood flow and cellular debris. |
| Hypovolemia leads to renal artery _______. | constriction |
| This type of acid can form from proteins released by damaged cells. | Uric acid |
| Too much acid buildup, loss of base, and lactic acidosis (anaerobic metabolism in a burn patient) are causes of what acid-base imbalance? | metabolic acidosis |
| What are the signs and symptoms of metabolic acidosis? | Altered LOC, increased respirations, rate, depth, and effort, nausea and vomitting. |
| Loss of acid, too much base kept in, steroid administration, and diuretic therapy are causes of what acid-base imbalance? | metabolic alkalosis |
| If you give a patient too much sodium bicarb, the patient will end up in | metabolic alkalosis |
| With a spontaneous pneumothorax, what acid-base imbalance will the patient have? | respiratory acidosis |
| What effect of the cardiac system can increased potassium levels cause? | Cardiac Dysrhythmias |
| How many units of regular insulin do we give the burn patient with HYPERkalemia to force the potassium back into the cells? | We give 10 units and an amp of 50% dextrose. |
| This measure to treat HYPOkalemia protects cardiac muscles from the effects of hyperkalemia, but doesn't lower the potassium. | Calcium Gluconate |
| This is used to exchange potassium for sodium intestinally lowering potassium levels. | Kayexelate |
| In a burn patient we should anticipate hyperkalemia to subside after how long and why? | 36-48 hours once the cells are done dying the release of potassium should stop. |
| What effects can decreased blood flow and sympathetic stimulation have on the GI system? | decreased motility and paralytic ileus |
| What are the assessment findings in a patient with a paralytic ileus? | Hypoactive or absent bowel sounds, distended stomach,vomiting, pain. |
| What drug increases peristalsis? | Reglan |
| Burn patients are also at risks for what kind of ulcers? | Curlings Ulcer (stress ulcer) |
| What are the signs of a stress ulcer? | pain and distention |
| What are the 5 primary care objectives of care of the burn patient? | Preserve the body function, prevent infection, restore skin integrity, provide support and comfort, restore a normal living pattern to the patient. |
| What are the three phases of burn care? | Emergent or Resuscitative, Acute, Rehabilitation |
| When assessing the airway of a burn patient what do we look for? | Singed nasal hairs, inhaled ashes, smooke or soot. Burns to face, neck or upper chest. Swelling on the inside. Difficulty breathing or displays of wheezing. |
| When determining the need to intubate a burn patient what do we need to take in to consideration? | We need to determine whether doing it now because of swelling is the best option. |
| What temperature do we need to maintain the body of a burn injury patient? | 99 |
| What is the goal of fluid resuscitation in the burn patient? | To keep urine output 30-50 ml/hr for adults and to keep the serum sodium at 140. |
| The goal of fluid resuscitation for younger kids is | To keep urine output at at least 1ml/hour in kids less than 30kg. |
| Why dont we give colloids (albumin) to burn patients right away? | We need to wait until after 24 hours because they are proteins and they will end up in the interstitial spaces. |
| At the end of 24 hours, the amount and type of fluids are based on what? | The patient's specific fluid volume and electrolyte imbalances and his/her response to treatment. |
| What is the main objective of fluid therapy. | To compensate for hypovolemia. |
| The goal of this therapy for burn patientst is to reestablish sodium balances, restore circulating volume, profide adequate perfusion, correct acidosis, improve renal function, and compensate for water and Na in interstitial space. | Fluid Therapy |
| How do we assess fluid resuscitation? | Urinary output. Weighing is not effective because of fluid shifts. |
| If a child who is a burn patient has a change in LOC what does this mean? | The child needs more fluid. |
| This type of arrhythmia is normal after a major burn. | sinus tachycardia |
| What might the HR be in a patient following a major burn? | 110-125 and it may increase |
| If we decrease the pain in the burn patient, that might help in decreasing what? | anxiety or fear |
| Burns and ischemia can cause | pain |
| What is the expected outcome of pain and anxiety management of the burn injury patient? | Patient can participate in care and still be comfortable. |
| What is the drug of choice for burn injury patients? | morphine |
| What anti-anxiety meds might be used with burn injury patients? | Ativan and Xanax |
| What must we always have readily available for the burn injury patient receiving opioids? | Narcan |
| What is the oral form of fentanyl called | AC-TIC |
| What medications might be used for sedation or pain relief in burn injury patients? | versed or fentanyl |
| What kind of a diet will the burn injury patient need to be on? | High calorie, with 1.5-3 g protein a day. |
| How do we evaluate nutritional intake? | Wound healing, daily weights (later in care) and total proteins and albumin. |
| What is the primary purpose of albumin? | To maintain colloidal pressure. |
| If the patient has a decrease in albumin they may have an increase in | edema |
| This lab is more sensitive and indictive of nutritional status than albumin. | Pre-albumin |
| Comorfidities affect albumin, but not | pre-albumin |
| The best way to feed a patient is | intestinal |
| What determines an NG or a G tube? | temporary or long term |
| What is the benefit of TPN? | the patient can get more calories from this method |
| If a patient has a paralytic ileus, what would the best method of feeding be? | TPN |
| If a patient is receiving PPN, what is the maximum about of glucose that can be received this route, and why? | 20% glucose because the glucose would fry the peripheral veins. |
| What do we worry about before we address the burn wound? | hemodynamic stability and ventilator |
| What are the objectives of wound management? | Prevention of infection, removal of devitalized tissue, and closure of the wound. |
| What kind of solution do we use to clean the burn wound? | non irritating solution |
| What do we do to prevent infection of the burn wound? | Apply antimicrobial agents. Meticulous local wound care. Vigilant surveillance. |
| What will happen to the vital signs if a patient is going septic? | May or may not have a fever, BP will increase and HR will go up. |
| This antimicrobial readily penetrates the eschar and is the agent of choic when a burn wound becomes infected. | Sulfamylon |
| This antimicrobial may cause a burning sensation when applied so taking pain management into consideration is important. | Sulfamylon |
| Prolonged use of this antimicrobial can cause metabolic acidosis because it has acetate in it. | Sulfamylon |
| Someone with 5-10% TBSA may not experience metabolic acidosis with sulfamylon while someone with ______ will. | 30-40% |
| This antimicrobial is broad spectrum but it has no action against fungal infections. | sulfamylon |
| This antimicrobial can penetrate full thickness burns. | sulfamylon |
| This antimicrobial has a sulfa base so you should ask about allergies. | silvadene |
| When this antimicrobial is applied, the patient gets a cool and soothing sensation. | silvadene |
| This antimicrobial has a limited penetration of eschar and has a sulfa base. | silvadene |
| This antimicrobial forms a loose yellow film that must be debrided daily. | silvadene |
| This antimicrobial can cause transient leucopenia. | silvadene |
| This antimicrobial is both an antibacterial/antifungal. | silvadene |
| This antimicrobial is painless on application and has a limited penetration of eschar. | silver nitrate |
| This antimicrobial agent must be maintained in contact with the wound through of dressings. | silver nitrate |
| Why can't we use silver nitrate on the face? | It could cause corneal staining. |
| This antimicrobial is very HYPOtonic so it is important to note whether we are treating a 10% or 30% TBSA patient. | silver nitrate |
| This antimicrobial can cause major electrolyte imbalances and black discoloration of the wound. | silver nitrate |
| What are petroleum mineral oil based antimicrobials primarily used on? | donor sites |
| When treating burn wounds, antimicrobial agents are applied | generously - like butter on bread |
| What are some of the components of non-surgical treatment of burn wounds? | Remove exudate and necrotic tissue, clean the area, stimulate granulation and revascularization, apply dressings, ROM. |
| The removal of eschar and other cellular debris from the burn wound. | debridement |
| What are the different types of mechanical debridement? | Hydrotherapy or whirlpool, friction/gauze. and enzymes. |
| Surgical debridement is usually done under | twilight |
| The sooner a wound is covered, the sooner we can | start covering them |
| Why are we worried about hemodynamic stability before we do the wound? | If you don't have good circulating volume, it doesn't matter what we do. |
| What does early excision of the burn wound do? | It decreases incidence of infection, improves functional and cosmetic results and decreases LOS. |
| When do we perform excision of the burn wound? | Earlier the better, usually within 2 days. |
| When assessing a patient regarding excision and grafting, what implications will be addressed first. | Cosmetic implications. Example: face before arms. |
| When is revascularization dramatically increased to the burn area? | 4 days after the injury |
| Why may we have more blood loss when cleaning the wound 4 days after the injury? | Because of collateral circulation. |
| This method of excision removes successive thin layers of eschar to a level of tissue viability. It is like peeling a potato. | Tangential Excision |
| With this method of excision there is significant blood loss. | tangential excision |
| This method of excision allows for a better cosmetic appearance. | tangential excision |
| This method of excision is the excision of the burn wound to the level of fascia. | fascial excision |
| This type of excision is good for large full thickness burns. | fascial excision |
| When is it best to perform a fascial excision and why? | In the edematous state because it helps separate the burn area from the viable tissue. |
| Autografting occurs after | burn wound excision |
| These two types of grafts use the epidermis and a portion of the dermis and are usually taken from the buttocks or thighs. | split thickness graft |
| This is a split thickness graft that allows for the graft to be expanded to cover large areas when there are limited donor sites for harvesting. | meshed autograft |
| The wider the mesh ratio, the greater the time required for | The graft to close and the more prone these wounds become for hypertrophic scarring. |
| This split thickness graft gives an excellent cosmetic appearance and there is less wound contraction and long term scarring than a meshed graft. | sheet autograft |
| These types of split thickness grafts require more donor sites than meshed autograft and it is difficult to apply them on irregular surfaces. | sheet autograft |
| What type of split thickness grafts should be used on the faces and hands if possible. | sheet autograft |
| This type of graft takes both layers, the epidermis and the dermis and is used for severe wounds. | Full thickness graft |
| Why are full thickness grafts used for severe wounds? | Because the fill in better. |
| Where are full thickness grafts taken from? | The abdomen or the back. |
| What will be used to cover a full thickness graft? | A split thickness graft. |
| What type of a wound does the donor site become? | A partial thickness wound. |
| When skin is grown in a lab from keratinocytes from the patient's skin. | CEA (Cultured Epidermal Autograft) |
| This is a manmade skin treatment that is permanent. It has two layers. The inner regenerates dermis and the outer protects from infection and heat loss. | Integra |
| Where is the donor part for Integra? | There is not a donor part, it is manmade. |
| These can cover partial thickness wounds to promote healing or serve as temporary wound covers after burn excision when no autografts are available. THEY ARE NOT PERMANENT! | Biological and Synthetic Dressings |
| This is cadaver skin and becomes vascularized and creates a favorable subgraft environment. | Allograft |
| How long can Allograft stay on? | 7 days |
| This is pig skin and does not become vascularized,but does create a favorable subgraft environment. | Xenoderm |
| This is a synthetic skin cover ov collagen designed to accelerate healing. | Biobrane |
| This synthetic dressing is a silicone film that you are able to visualize the wound throug. | biobrane |
| What happens to the color of the biobrane as healing occurs? | it turns opaque |
| How often does biobrane need to be changed? | 7-10 days |
| What are the benefits of biobrane? | Controls evaporation and fluid loss, doesn't allow bacteria in and decreases infections. |
| What kind of a wound would biobrane be used on? | A wound or burn that is expected to heal on its own, one that does not require grafting. |
| What are the three complications of burns | infection, keloid formulation and contracture formulation |
| Why are geriatric burn patients at a greater risk for infection than adults? | Age affects immune system and comorbidities can affect geriatric risks. |
| Why are pediatric burn patients at a greater risk for infection than adults? | They have an immature immune system, and immature inflammatory response. They are also susceptible to communicable diseases. |
| If an autograft doesn't take or separates from the wound bed, we should suspect what? | infection |
| Autograft peeling is usually a sign of | infection |
| What should we monitor regulary to prevent infection? | cultures and labs |
| If we have a patient with a burn wound, we cannot forget the other areas that may become infected like what? | pneumonia, UTI, IV sites, central lines or peripheral lines |
| Burn wounds are changed with type of technique? | sterile |
| Abnormal fibrous proliferations of the dermis. (growths) | keloid formations |
| These are also called hypertrophic scars. | keloid formations |
| What people are keloid formations most common in. | dark skinned people |
| How do we treat keloid formations? | surgical removal combined with other therapy such as steroid injections or low dosed radiotherapy to kil the abnormal cells. |
| Fibrosis of connective tissue in skin, fascia, muscle or a joint capsule that prevents normal mobility. | contractures |
| What kind of non surgical management is there for contracturs? | Positioning with full ROM, maintain patien tin neutral position with minimal flexion. Splints may help in maintaining position. |
| What position predisposes patients to contractures? | A position of joint flexion which is usually a position of comfort for the burn patient. |
| What position should the patient be maintained in to prevent contracture of the skin? | The patient should be kept in a neutral position with minimal flexion. |
| How often should ROM be performed to prevent contractures? | at least 3 times a day |
| How often should ROM be performed on hands with burn injuries? | every hour while awake |
| This therapy can be used for prevention of hypertrophic scar development and contractures. | pressure therapy |
| What different ways can pressure therapy be delivered? | Scar massage, ace wrapping, prefavricated pressure garments, custom garments |
| When does rehabilitation begin? | It begins with admission to the burn unit. |
| What is the emphasis of rehabilitation? | Psychosocial adjustment, prevention of scars and contractures, and resumption of pre-burn activity. |
| What abnormal cardiovascular findings are expected for the burn injury patient? | Slow capillary refill, increased heart rate. |
| What abnormal pulmonary findings are expected for the burn injury patient? | Rapid respiratory rate. |
| What abnormal hepatic/RENAL findings are expected for the burn injury patient? | Release of glycogen stores and increased metabolism. |
| What abnormal Gastrointestinal findings are expected for the burn injury patient? | Blood in stool, decreased function, slow or no motility, decreased bowel sounds, abdominal distention, nausea and vomiting. |
| What abnormal genitourinary findings are expected for the burn injury patient? | Decreased urine output, concentrated urine. |
| What abnormal integumentary findings are expected for the burn injury patient? | Extremities pale and cool, edema, and fluid retention. |
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4th semester jjc
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