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29 Cards in this Set
- Front
- Back
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layers of skin
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epidermis - 5 layers
dermis hypodermis - areolar/adipose subq tissue/smooth muscle |
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epidermis
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2 layers of interest
stratum corneum - outer, dead keratinized cells stratum germinativum - epithelial cells are produced |
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dermis
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sweat/sebaceous glandd
hair follicles CT capillaries, nerves may extend into epidermis |
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functions of skin
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protect
barrier sensory heat regulation excretion/absorption production of vitamin D - allows for calcium to be absorbed body image |
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severity of burns
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BSA
depth location age PMH cause |
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superficial thckness
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first degree
epidermis only sunburn - red/swollen, dry, painful heals within 2-7 days, fluid, cool compress, tylenol |
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partial thickness
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second degree
superfical/deep epidermis/dermis injured OR totally destroyed wet, blisters, weeps, edema, hypertrophic scarring, risk for infection, may graft |
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full thickness
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3rd or 4th degree
epidermis/dermis destroyed hard, leathery, waxy, brown/yellow/black no painful - will not regenerate 4th degree = bone/muscle burned graft/amputate |
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rule of 9s
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each arm 9% (front/back each 4.5%)
each leg 18% (front/back each 9%) torso 18% front, 18% back head 9% (front/back each 4.5%) hand 1% each |
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lund and browder
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factors in age
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why BSA
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fluid/nutrition needs
4mLxtotal kgx%of body burned 1/2 in first 8 hours 1/2 in second 16 hours |
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thermal burns
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hot or cold
fire, flash, scald zone of coagulation = dead/damaged tissue zone of stasis = surronding area zone of hyperemia |
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chemical burns
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acid vs alkali burns = alkali are harder to neutralize
remove clothing - lavage with water 20-30 minutes tissue damage up to 72 horus |
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electrical burns
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entry and exit site (exit usually lower)
possible cardiac arrest possible thermal burn other traumatic injuries |
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CV system effects
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vasodilation - increased capillary permeabililty
proteins leak - water/electrolytes leak hypovolemic shock d/t 3rd spacing + thick blood risk for srythmias |
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renal system
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ATN d/t decreased perfusion + myoglobins
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GI system
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ileus + ulceration d/t decreased perfusion
curlings ulcers, gastritis, ischemic enterocolitis |
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neurological system
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confusion to coma d/t decreased perfusion and CO
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respiratory system - smoke inhalation
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CO poisoning- takes place of O2
early/late sx - flue, red skin, dizzy, to syncope, convulsions, cardiac arrest chemical pneumonitis - inflamed mucosa/edema/hemorrhage/spasm, ARDS d/t decreased surfactant |
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respiratory system- thermal injuries
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upper airway -
edema, occlusion, = scope + airway if suspected blisters on face/mouth, singed hair, difficulty swallowing lower airway |
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metabolic system
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hypermetabolism - stress, healing, loss of heat, fever,infection
increased protein needs - loss through wounds, increased breakdown, increased metabolic rate, -nitrogen balance |
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immune system - sepsis
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loss of integument
eschar - necrotitric materials nutritional deficits - cannot fight infection suppressed immune response |
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integumentary system
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decreased wound healing
scar formation - hypertrophic |
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msk system
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muscle atrophy
scar contactures bone deformity hypertrophic bone formation |
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emergent phase of burn treatment
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initial phase - shock , decreased CO
fluid mobilizes, remobilizes diuretic stage |
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acute phase
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diuresis until wounds healed, covered with skin grafts
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rehab phase
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restore fx, psychosocial issues
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FVD interventions
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2 large bore IV cathetars
foley cath fluid resucciation vaseline labs, chest x-ray Na/K |
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assess adequate fluid replacement
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UO, SG
pulse, BP aterial pH sensorium CVP,PCWP, CO assess for overload labs |
