Summary
Summary NUR 445 Critical Exam 4 Study Guide
- Course
- NUR 445
- Institution
- Indiana Wesleyan University
This is a comprehensive and detailed study guide on Exam 4 for Nur 445. *Essential!! *For Effective Exam Prep!!
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Burns Anatomy and Functions of the Skin
o Integumentary system
Largest organ
Epidermis
Outer protective barrier
Five layers
Dermis
Sebaceous and sweat glands
Blood vessels, nerves, etc
Two layers
Hypodermis
Layer of insulation
Pathophysiology and Etiology of Burn Injury
o Zones of Injury
Depends on extreme/extent of injury
Zone of coagulation
Most of where obstruction will happen
Most damaged skin death area
Zone of stasis
Depending on how quickly treatment is given depends on healing
Zone of hyperemia
Usually healed well
Vasodilation; increases healing process
Classification of Burn Injury
o Size of injury
Rule of nines
KNOW THIS
Estimates extent of burn in adult pts
Ex: front of torso + entire R arm = 27%
Rule of palms
From tip of finger to wrist is 1%
Lund and Browder
Most accurate; what is used in the hospital setting
o **identify pts age, weight; identifies prognosis of pt
,o Depth of Injury
Superficial
1st degree burns
Erythema, mild pain, mild discomfort and itching
Ex: sunburns
Minor burns that do not penetrate skin
Partial-thickness
2nd degree burn
A little deeper
Can be severe sunburns that cause blistering
Exposure burns to heat, friction
These get past epidermal layer, BUT still superficial
Healing in 7-21 days
Causes increased permeability causing leakage of fluid (blisters)
**LOSE a lot of fluid with these burns
Deep partial-thickness burns
Severe impairment of blood supply
Painful
Dry and white waxy layer
Complete epidermal damage and now reached the dermis
No fluid and drainage bc of poor blood supply
Takes 6 weeks to recover
, Can cause necrosis
Tx: surgical incision and skin grafting
Full thickness
All three layers are destroyed
VERY high risk for infection, fluid loss
Pain is gone; nerves are burned away
Skin CANNOT heal properly
Autograft
Int: for full thickness d/t improper healing
Additional Considerations
Frequent assessments d/t risk of infection; done for al burns except for
superficial to see how much fluid replacement is needed
o Types of Injury
Thermal burns
Exposure to heat
Longer hot item is in contact with tissue = worse the injury
Most of burns (most common)
Fires, hot water, sun, hot oil
Electrical burns
CANNOT use rule of 9s bc these type of burns are internal
Contact injury and exit injury
Most of the damage is inside body
Just assessing the surface is not enough
Severe damage to muscles…WATCH for rhabdomyolysis
Chemical burns
Acidic or alkalitic agents (alkalitic are more severe)
There is continuous damage if agent is not removed
Int: irrigate and flush it, remove clothing that contains that agent; do
NOT neutralize pt
Radiation burns
Least likely to see
Cancer pts with radiation exposure
o Location of Injury
If burn is greater than 10-15% of body; get to a burn center or specialized tx
If face, hands, feet, major joints, genetalia, perineum; get to a burn center!!
Functionality will be affected otherwise
o Pt age and history
Child and elder abuse
Large percentage have burn injuries
Int: watch for patterns that don’t fit the story
Even if you suspect any type of abuse, REPORT IT
High mortality; less than 2 or older than 60
Initial Emergency Burn Management
o Resuscitation phase (emergent)
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