NURSING
HESI Critical Care Cardiac Neuro.pdf

2 superficial partial thickness burn second degree

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2. Superficial Partial Thickness burn: second degree. Burn through epidermis and into part of dermis . Pink, wet, shiny. Start having blisters . 3. Deep Partial Thickness burn: second degree. Burn all the way through dermis . Can sometimes heal on own or will need grafting. Wet, red, white. Treatment depends on where it is and how deep it is. 4. Full Thickness Burns: burn through subq layer and through muscle or fat. Very dry and leathery. Typically not painful because once you have gone through subq layer, you burn through nerve endings. Burns do not happen uniformly ; may have area of 4 th degree burn and as you come to edges, you can have deep partial or superficial partial burn; so just because your pt has 4 th degree burn doesn’t mean they won’t have pain bc those edges will hur t. Extent: When someone has been burned, it is important we determine how much pts body has been burned. Different ways to determine. Lindon Router Chart: very specific. Rule of Nines: (more commonly used). Only need to know adult (not child or infant). Starting from top: head is 9% (4.5 in front, 4.5 back). Entire trunk is 18% (divide right in middle. Chest 9%, abd 9%). Back is 18%. Arms 9% each (4.5 front, 4.5 back). Legs are 18% each (9% front, 9% back). Perineal area is 1%. Back head (4.5), left arm (9), upper back (9), entire left leg (18) = 45% We do rule of nines because it helps us do IV fluid resuscitation. We have to know how much of body has been burned so we know how much fluid to give to pts. Pathophysiology: Burn affects skin. Loss of skin affects loss of fluid and temp regulation. Other part of burn is inflammat ory response and third space shift and body’s response. Looks like shock (hypovolemic). We’re not going to pee. We’re at risk for ileus. Lungs are not getting perfused. Thermal burns: Fluid loss. Fire. Chemical burns: Base burns are worse than acid burns. When you get burn with acid or base, you get protein denaturation (breaks down pro in skin). When you get burned by acid, once you wipe acid off skin, the pro breakdown stops. When you get burnt by base, the breakdown of pro in skin does not stop = why base burns are worse. Ex. Oven cleaner is base. Organic compound are the worst of the three. They will deeply penetrate the skin (penetrate the deepest). Electrical burns: Get a lot of internal damage. Ex. Struck by lightning or touch wires. See dysrhythmias, muscle tetany, and spinal cord injury. Depends on what you touch, pts can get thrown causing fractures & spinal cord injuries. When pts have been in burns, we are also concerned about Inhalation injuries : Worried about airway obstruction, trouble breathing Facial burns, difficulty breathing, stridor, use of accessory muscles, abnormal breath sounds, sut around pts mouth (phlegm has sut; black stuff) Redness and swelling during endoscopy Carbon monoxide poisoning can occur with some pts who have been burned. Released as result of burning material.
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  • Fall '18
  • Traumatic brain injury

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