Question 1

Contracture development leading to impaired physical mobility can occur after a major burn injury.Splints are applied to prevent or correct contractures.Priority nursing interventions concerning this therapy include which action?

Accepted Answer

Splints can be used to prevent or correct contracture or to immobilize joints after grafting.If splints are used,they must be checked daily for proper fit and effectiveness.Splints that are used to immobilize body parts after grafting must be left on at all times,except to assess the graft site for pressure points during every shift.Splints to correct severe contracture may be off for 2 hours per shift to allow burn care and range-of-motion exercises.

Question 2

Using the "rule of nines," calculate the percent of injury in an adult who was injured as follows: the patient sustained partial and full-thickness burns to half of his left arm,his entire left leg,and his perineum.

Accepted Answer

The arm represents 4.5%,the leg 18%,and the perineum 1%,totaling 23.5%.

Question 3

What is a leading cause of death in the hospitalized burn patient?

Accepted Answer

Preventing infection in burn patients is a true challenge and involves complex decision making.Considerable debate has been going on about the infection control precautions to use with burn patients.The burn wound is the most common source of infection in burn patients.

Question 4

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.What is the nurse's first priority?

Accepted Answer

The first priority of emergency burn care is to secure and protect the airway.All patients with major burns or suspected inhalation injury are initially administered 100% oxygen.

Question 5

A patient is admitted after being burned in a house fire.The nurse feels that the patient should be transferred to a burn center.Which factor is most important when determining whether or not to refer a patient to a burn center?

Accepted Answer

Burns are classified primarily according to the size and depth of injury.However,the type and location of the burn and the patient's age and medical history are also significant considerations.Recognition of the magnitude of burn injury,which is based on the above-mentioned factors,is of crucial importance in the overall plan of care and in decisions concerning patient management and appropriate referral to a burn center.

Question 6

A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.Total body surface area (TBSA)burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient's weight is estimated at 85 kg.What is the initial plan for fluid replacement?

Accepted Answer

Per the Parkland formula,you would administer 5950 mL of Lactated Ringer (LR)solution for the first 8 hours and 5950 mL of LR over the next 16 hours (4 mL ´ 85 kg ´ 45% = 15,300 mL in first 24 hours).

Question 7

A patient is brought to the emergency department with extensive burns after a house fire.What is an important nursing intervention for this patient during the resuscitation phase?

Accepted Answer

Pain management in burn injuries must be addressed early and frequently reassessed to determine the adequacy of interventions.Intravenous opiates,such as morphine sulfate,are indicated and titrated to effect.Edema formation may cause neurovascular compromise to the extremities; assessments are necessary to evaluate pulses,skin color,capillary refill,and sensation.

Question 8

The nurse and a new graduate nurse are caring for a patient with extensive burns.They are discussing skin grafts.Which statement indicates the new graduate understood the information?

Accepted Answer

An autograft is a skin graft harvested from a healthy,uninjured donor site on the burn patient and then placed over the patient's burn wound to provide permanent coverage of the wound.Autografts must be done in the operating room and are the least expensive.Homografts can transmit disease and be rejected.

Question 9

A patient with extensive burns is undergoing skin grafting.The nurse understands pain control is best achieved with what strategies during the early phase of recovery?

Accepted Answer

Initially after burn injury,narcotics are administered intravenously in small doses and titrated to effect.The constant background pain may be addressed with the use of a patient-controlled analgesia device.When hemodynamic stability has occurred and gastrointestinal function has returned,oral narcotics can be useful.Intramuscular or subcutaneous injections must not be administered because absorption by these routes is unpredictable because of the fluid shifts that occur with burn injury.

Question 10

The nurse is caring for a patient with extensive burns.Which intervention should be included in the nursing management plan to prevent cross-contamination and decrease the risk of infection in the burn-injured patient?

Accepted Answer

Cross-contamination by direct contact is a significant source of infection and a subsequent cause of sepsis.Effective handwashing technique cannot be overemphasized.Nurses must wash their hands and change gloves when moving from area to area on the same patient.For example,after changing the chest dressing,which may be contaminated with sputum from the tracheostomy,hands must be washed and gloves changed before the nurse moves to the legs.Gowns,gloves,and masks should be worn whenever contact with body fluids occurs.These garments also must be changed and hands washed before caring for a different patient.Maintaining patient-specific dressings and topical agents is recommended.Equipment such as thermometers,intravenous pumps,and stethoscopes should be designated for each patient or,when shared,should be cleaned with appropriate bactericidal cleansers between patients.

Question 11

A patient has a partial-thickness burn wound that is being treated with porcine xenograft (pigskin).The nurse knows that pigskin usually dissolves in 5 to 7 days because of what reason?

Accepted Answer

After the pigskin is in place,it may be dressed with antibacterial-impregnated dressings or other forms of dressings.Pigskin usually is removed or dissolves because of a lack of blood supply in 5 to 7 days.The pigskin is packaged in a variety of ways and in various sizes.It can be treated with silver sulfadiazine and can be meshed or nonmeshed.Pigskin can be used for temporary coverage of full- and partial-thickness wounds,burn wounds,and donor sites.

Question 12

A patient is admitted after being burned in a car fire.The wound surface is red with patchy white areas that blanch with pressure but no blister formation.What kind of burn would the nurse document in the patient's record?

Accepted Answer

Deep-dermal partial-thickness (second-degree)burns involve the entire epidermal layer and deeper layers of the dermis.A deep-dermal partial-thickness burn usually is not characterized by blister formation.Only a modest plasma surface leakage occurs because of severe impairment in blood supply.The wound surface usually is red with patchy white areas that blanch with pressure.

Question 13

A patient is admitted to the burn unit with extensive burns after a house fire.The patient's vital signs and physical exam include a heart rate of 140 beats/min,a urine output of 25 mL/h,and clear lung sounds.What adjustment,if any,needs to be made to the fluid resuscitation plan?

Accepted Answer

Desired clinical responses to fluid resuscitation include a urinary output of 0.5 to 1 mL/kg/h; a pulse rate lower than 120 beats/min; blood pressure in normal to high ranges; a central venous pressure less than 12 cm H₂O or a pulmonary artery occlusion pressure less than 18 mm Hg; clear lung sounds; clear sensorium; and the absence of intestinal events,such as nausea and paralytic ileus.

Question 14

Which topical antimicrobial agent is commonly used as a broad-spectrum and fights against gram-positive and -negative bacteria?

Accepted Answer

Silver sulfadiazine (SSD; Silvadene cream)is a broad-spectrum antimicrobial agent with bactericidal action against many gram-negative and -positive bacteria associated with burn wound infection.Mafenide acetate cream penetrates through burn eschar and is bacteriostatic against many gram-negative and -positive organisms.Its use is limited because the application is uncomfortable for the patient because it creates a burning sensation,and it is rapidly absorbed,requiring dressing changes two or three times daily.It is used routinely for coverage of small wounds.Bacitracin ointment is a topical agent applied to superficial burns and facial burns.Bacitracin is effective against gram-positive organisms but not against gram-negative organisms or fungal organisms.Silver has long been used for the treatment of wounds because of its broad-spectrum bacteriostatic properties.The wound moisture activates the silver and releases it into the wound.An advantage of silver dressings is that the dressing does not need to be changed daily because of the sustained release of silver.Silver dressings should be used judiciously and limited to 4 to 6 weeks despite the current absence of negative systemic or local consequences.

Question 15

Using the Parkland formula for fluid resuscitation and your knowledge of injury calculations using the "rule of nines," calculate the estimated fluid requirements during the first 8 hours for a 75-kg patient with full-thickness burns to the anterior chest,perineum,and entire right leg.

Accepted Answer

In a 75-kg person with a 37% burn injury (based on a rule of nines calculation: 18%-chest,1%-perineum,18%-right leg = 37% total body surface area [TBSA] burn),the Parkland formula estimates fluid resuscitation needs at 4 mL ´ 37 ´ 75 = 11,100 mL.In the first 8 hours after injury,half of the calculated amount of fluid is administered.This amount equals 5550 mL.

Question 16

A patient involved in a house fire is brought by ambulance to the emergency department.The patient is breathing spontaneously but appears agitated and does not respond appropriately to questions.The nurse knows the patient has inhaled carbon monoxide and probably has carbon monoxide (CO)poisoning.What action should the nurse take next?

Accepted Answer

The treatment of choice for carbon monoxide (CO)poisoning is high-flow oxygen administered at 100% through a tight-fitting nonrebreathing mask or endotracheal intubation.The half-life of CO in the body is 4 hours at room air (21% oxygen),2 hours at 40% oxygen,and 40 to 60 minutes at 100% oxygen.The half-life of CO is 30 minutes in a hyperbaric oxygen chamber at three times the atmospheric pressure.Currently,the use of hyperbaric oxygen is of controversial benefit in care of burn patients.

Question 17

What physiologic process can result in excessive burn edema and shock in a patient with injuries totaling more than 50% total body surface area (TBSA)burn?

Accepted Answer

Negative interstitial hydrostatic pressure represents an edema-generating mechanism and occurs for approximately 2 hours after injury.Additionally,plasma colloid osmotic pressure is decreased as a result of protein leakage into the extravascular space.Plasma is then further diluted with fluid resuscitation.Thus osmotic pressure is decreased and further fluid extravasation can occur.

Question 18

A patient is admitted after being burned while lighting the barbecue.The injuries appear moist and red with some blister formation and the patient states they are very painful.What kind of burn would the nurse document in the patient's record?

Accepted Answer

A light to bright red or mottled appearance characterizes superficial second-degree burns.These wounds may appear wet and weeping,may contain bullae,and are extremely painful and sensitive to air currents.The microvessels that perfuse this area are injured,and permeability is increased,resulting in leakage of large amounts of plasma into the interstitium.This fluid,in turn,lifts off the thin damaged epidermis,causing blister formation.Despite the loss of the entire basal layer of the epidermis,a burn of this depth will heal in 7 to 21 days.

Question 19

Less than 24 hours ago a patient sustained full-thickness burns,to his face,chest,back,and bilateral upper arms,in a house fire.He also sustained an inhalation injury.The patient was intubated and ventilated and is now showing signs of increasing agitation and rising peak airway pressures.The nurse suspects the patient's change in condition is due to which problem?

Accepted Answer

Circumferential full-thickness burns to the chest wall can lead to restriction of chest wall expansion and decreased compliance.Decreased compliance requires higher ventilatory pressures to provide the patient with adequate tidal volumes.

Question 20

The nurse is caring for a patient with extensive burns.Which zone of injury is the site of the most severe damage?

Accepted Answer

The central zone,or zone of coagulation,is the site of most severe damage,and the peripheral zone is the least.The central zone is usually the site of greatest heat transfer,leading to irreversible skin death.

Quiz 35: Burns