Burn & Organ Donation

50 flashcards

What are the two main types of thermal burns?: Dry heat (e.g., sunburn, flame) and moist heat (e.g., scalds from hot liquids and/or steam).
What are the 2 main types of chemical burns, and how do they affect the body?: 1. Alkali - Liquefies proteins 2. Acids - Absorbed through the skin, causing toxicity to organs & increasing coagulation
How do you stop akali burns?: Call poison control to figure out a neutralizing agent as water doesn't work
How do electrical burns affect the body?: Known as the iceberg effect, the total body surface area (TBSA) may appear minimal, but significant internal damage can occur. Electrical current passes through the body and can hit any major organs ’ massive damage - Can lead to AKI and/or dysrhythmias
What are all the types of burns?: 1. Thermal 2. Contact 3. Chemical 4. Electrical 5. Radiation 6. Cold (Frostbite)
What are the classifications of burn depth?: 1. Superficial (1st degree) 2. Superficial Partial-thickness (2nd degree) 3. Deep Partial-thickness (2nd degree) 4. Full-thickness (3rd degree) 5. Deep full-thickness (4th degree).
How do you differentiate between the burn depths?: 1. Superficial (1st Degree) - Epidermis layer only - sunburn, painful, mild edema 2. Superficial Partial-thickness (2nd Degree) - Epidermis and 1/3 of dermis - blisters, very painful, mild edema 3. Deep Partial-thickness (2nd Degree) - Epidermis and 2/3 of the dermis - painful, moderate edema 4. Full-thickness (3rd Degree) - Epidermis and all of dermis - little to no pain, severe edema 5. Deep full-thickness (4th Degree) - All of the skin layers and deeper - painless, little to no edema
How does a nurse complete the primary assessment for a burn patient?: ABCDE's - Airway & Breathing - Circulation, Cardiac status, CPR - Disability, Deformity, Neurological Deficit - Expose, Examine, Environmental Control
What are the signs that a burn patient might have an inhalation injury?: 1. Enclosed space fire, explosion, chemicals (meth), steam 2. Soot on face and/or burns on face or neck 3. Singed nasal or facial hair 4. Hoarseness, sore throat, cough, difficulty swallowing, carbonaceous sputum 5. Hypoxia: SOB, dyspnea, disoriented, restless/confused
What are the signs/symptoms of carbon monoxide poisoning?: Lower Levels - Headache, fatigue, flu-like symptoms, weakness, dizziness, nausea, blurred vision, may appear intoxicated Higher Levels - Vomiting, confusion, heart palpitations - Progresses to seizures, coma, death
How can we tell when a burn patient needs to be intubated, and why is early intubation essential?: If they show any signs of inhalation injury or high carbon monoxide levels. - Pulse oximetry doesn't measure carbon monoxide Airway collapses quickly from rapid edema caused by inflammation from burn injuries, intubate early or it will be more difficult later on
What is the treatment for carbon monoxide poisoning?: 100% humidified O2 per non-rebreather mask
What do nurses assess for when it comes to circulation in burn patients?: 1. Bleeding 2. BP and Pulse - Absence of distal pulses with circumferential burns not indicative of hypotension - Hypotension is a late sign of hypovolemia 3. Circumferential burns 4. Cardiac monitor
What is the order of ABCs in a large thermal burn patient?: If unresponsive ’ circulation, airway, breathing If responsive ’ airway, breathing, circulation
How can nurses stop the burning in thermal burns?: Small Thermal Burns - Cover with a clean, cool, tap water-dampened towel - Cooling within 1 minute helps minimize the depth of injury Large Thermal Burns - Cover in a dry, warm sheet - Cool for no more than 10 minutes
What is the primary assessment vs. the secondary assessment/survey for burns?: Primary assessment isn't focused on the burn injury, focus on life and limb Secondary survey is once the patient's life is stabilized
What is included in the secondary survey for burn patients?: AMPLET - Allergies - Medications - PMHx - Last food or fluid intake - Events surrounding injury (inhalation concerns?) - Last Tetanus (immunization status). Administer tetanus vaccine if indicated
What is the Parkland formula for fluid resuscitation?: 4 mL x kg x TBSA %
How do you calculate TBSA % in burns?: Base it on the Rule of 9's - Only 2nd and 3rd degree burns are counted
What is the fluid resuscitation therapy for burn patients?: Lactated Ringer's is the preferred fluid Calculate the amount using the Parkland formula - ½ must be administered within the first 8 hours from time of injury - Balance out the rest in next 16 hours
What education for burn prevention should nurses give?: 1. Set the hot water to below 120 - 125 F 2. Avoid using accelerants on open flames 3. Practice fire drills at home 4. Smoke & carbon monoxide detectors & fire extinguishers 5. Don't smoke with oxygen or in bed 6. Avoid using space heaters near flammable objects
What is the timeline for the emergent phase of burn treatment?: Time required to resolve immediate problems resulting from injury, up to 72 hrs Ends when fluid & electrolyte mobilization and diuresis begin
What is the biggest concern during the emergent phase of burn treatment, and why?: Fluid mobilization and shift out of the vascular space ’ less fluids for the body as it pools up (edema) ’ hypovolemic shock
What makes circumferential burns dangerous?: Major risk for circulation problems as whole extremities are covered in burns - Tissue ischemia - Paresthesia - Necrosis
How do nurses manage burn patients during the emergent phase?: 1. Airway management: intubate early, positioning, suction 2. Fluid therapy: # IV sites, Parkland for fluid replacement 3. Hemodynamic monitoring ’ arterial line 4. Wound care: cleaning and debridement, heat the room, PPE! 5. Eye care for corneal burns: ointments, artificial tears 6. Prevention of contractures 7. Medication: pain, anxiety, tetanus, topical antimicrobial agents 8. Nutrition
What characterizes burn shock?: Extreme hypovolemic shock - Influx of sodium into the cell and potassium leaves the cell - Burns usually cause the opposite of hyponatremia with dehydration Severe dehydration s/s - Oliguria, lethargy, tachypnea, tachycardia with weak pulses, hypotension, low MAP, pale, clammy skin
What is the interventions and main treatment for burn shock?: Treatment - Aggressive fluid resuscitation directly into the intravascular space with LR for additional electrolytes Interventions 1. Early intubation, as aggressive fluid resuscitation treatment, will cause edema, potentially blocking the airway 2. Monitor temperature and keep the patient warm, as loss of skin will decrease their ability to regulate their own temperature 3. Diuretics to decrease edema
What is the timeline for the acute (wound healing) phase of burn treatment?: Begins with the mobilization of extracellular fluid and subsequent diuresis Ends when partial-thickness wounds are healed or full-thickness burns are covered by skin grafts
What are the priorities during the acute (wound healing) phase of burn treatment?: 1. Frequent assessment 2. Correct nutrition deficits 3. Daily weights 4. Monitor for early signs of infection, sepsis, and shock 5. Frequent ambulation or ROM exercises
What is the timeline for the rehabilitative (restorative) phase of burn treatment?: Begins when wounds have nearly healed, and the patient is engaging in some level of self-care
What is the focus during the rehabilitative (restorative) phase?: Minimizing skin and joint contractures through proper positioning, splinting, and exercise. Get the patient ready for discharge
What are the types of donors?: 1. Tissue Donor 2. Living Donor: organs you can donate while living - Part of the pancreas, a kidney, part of liver, part of intestine, a lobe of a lung 3. Organ Donor - Included: lungs, liver, pancreas, heart, kidney, intestine - Brain death criteria met
What organs can a living donor donate?: Part of the pancreas, a kidney, part of liver, part of intestine, a lobe of a lung.
What is the GIFT criteria for organ donation referral?: Refer all ventilated patients within 60 minutes of meeting any the following criteria: G: GCS d 5 I: Injured brain or critical lung condition F: Family mentions donation T: Talk of transition to palliative care.
What are the prerequisites before a patient is tested for brain death?: 1. Establish the irreversible and proximate cause of coma 2. Normal core temperature (36°C or 96.8°F) 3. SBP e 100 mm Hg 4. Organs are functioning with artificial support like vents
Is the criteria for neurological death/brain death determination?: 1. Must have the cause of death 2. Absence of brainstem reflexes - No PERRLA, cough, gag, response to stimuli, etc. 3. Apnea testing or ancillary testing if apnea testing is inconclusive or aborted
What is apnea testing, and what establishes brain death?: 1. PEEP 5, ventilator adjusted to PaCO2 normal levels, 100% FIO2 for 10 minutes 2. Patient is disconnected from the ventilator and connected to 6L of oxygen No spontaneous respirations with PaO2 >60 or has a 20 mmHg rise from baseline = positive apnea test/brain death
What are common ancillary testing in brain death determination?: Cerebral angiogram, CT, electroencephalography, or transcranial doppler ultrasonography
What is circulatory death?: Cardiac/circulatory death is when a vented, heart beating patient whom does not meet brain death criteria, and the family has chosen to remove the ventilator and allow their loved one to pass away
How long does cessation of life-saving treatment last to determine eligibility for donation after circulatory death?: There has to have a prediction of death within 60 minutes of withdrawal of life-sustaining treatment criteria made
If circulatory death doesn't occur within 60 minutes, what happens?: Most protocols dictate that if circulatory cessation does not occur within 60 minutes, the patient is returned to the ICU and the procurement of organs does not proceed
How is the donor managed before extraction?: 1. Get all the organs to optimal functions for the best chance at transplant 2. Electrolytes corrected 3. IV fluid resuscitation 4. Urine output at least 1ml/kg/hr 5. Left ventricle ejection fraction at least 45% 6. Lower vasopressor dose to meet at least 60 MAP - Try to wean off vasopressors but may need to keep for adequate BP
What is the time limit for tissue donation?: Must occur within 24 hours of cardiac death and the body must be cooled within 12 hours.
What are post-operative interventions for transplant patients?: 1. Pain relief measures, analgesic meds 2. Promote airway clearance and effective breathing pattern, turn, cough, deep breathe, incentive spirometry, positioning 3. Use strict asepsis with catheter 4. Monitor for s/s of bleeding 5. Encourage leg exercises, early ambulation, and monitor for s/s of DVT 6. Prevent infection by monitoring lab carefully b/c of immunosuppression 7. Monitor urinary function 8. Address psychological concerns
What are potential complications after a transplant?: 1. Hemorrhage and shock 2. Abdominal distention and paralytic ileus 3. Infection 4. Thromboembolism prevents perfusion to the new organ 5. Rejection
What are the signs of transplant rejection?: Oliguria, fluid retention, UTI symptoms, edema, fever, increased BP, tenderness over the transplant.
What are the 3 types of organ rejection?: Hyperacute rejection: within 24 hours Acute: within 3-14 days Chronic: after a year
Is the donor's family charged for the donation process?: The donor's family is not charged for the recovery and transplant process - Covered by Medicare, Medicaid, and Recipient's Insurance
What is the fiscal responsibility of the donor's family?: Life-Saving Efforts: life-saving flight, medications, ER/ICU interventions Funeral: arrangements made in honor of their loved ones
What is the requirement for donors regarding registration?: Donors need to be registered; families cannot make that decision for them.