NCM 112 Client Care and Burn Injuries

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What primary focus does the course NCM 112 emphasize in terms of client care?

Care for clients with fluid and electrolyte imbalances. (correct)

Therapeutic communication in nursing.

Preventative health measures for chronic illnesses.

Management of respiratory diseases.

Which unit of the course specifically addresses renal disorders?

Unit II: Fluid and Electrolyte Imbalances in Renal Disorders. (correct)

Unit I: Basic Nursing Principles.

Unit IV: Chronic Disease Management.

Unit III: Infectious and Inflammatory Responses.

What role is expected of learners after completing the course?

To conduct independent research on nursing theories.

To provide a nursing care plan for at-risk and sick adult clients. (correct)

To manage their own healthcare facilities.

To teach nursing principles to peers.

Who is mentioned as the course developer for NCM 112?

Prof. Merlie Q. Espiritu, RN, MAN. Signup and view all the answers

Which accrediting body awarded Level 2 Status to the college offering this course?

Accrediting Agency of Chartered Colleges and Universities in the Philippines Inc (AACCUP). Signup and view all the answers

What area experiences the least damage in a burn injury?

Zone of hyperemia Signup and view all the answers

What is the primary mechanism through which burn injuries progress after initial damage?

Release of local mediators and changes in blood flow Signup and view all the answers

At what temperature will tissue destruction occur in just 5 seconds?

60°C (140°F) Signup and view all the answers

Which of the following is not a consequence of major burn injuries?

Increased insulin sensitivity Signup and view all the answers

What type of burn injury does radiation exposure primarily cause?

Thermal burns and DNA damage Signup and view all the answers

What physiological response initially occurs but may become counterproductive after a burn injury?

Compensatory adaptive responses Signup and view all the answers

Which statement best describes the nature of electrical burns?

They can lead to devastating and complex burn injuries. Signup and view all the answers

What is a common outcome of severe burn injuries on the metabolic rate?

Increased metabolic rate (hyper-metabolism) Signup and view all the answers

What is the primary cause of death at the scene of a fire related to lower airway injury?

Inhalation of products of incomplete combustion Signup and view all the answers

Which symptom is considered the cardinal sign of lower airway injury due to smoke inhalation?

Expectoration of carbon particles Signup and view all the answers

How does carbon monoxide poisoning affect oxygen transportation in the body?

Displaces oxygen from hemoglobin to form carboxyhemoglobin Signup and view all the answers

What is one of the consequences of muscle injury from electrical burns concerning kidney function?

Release of myoglobin leading to red urine Signup and view all the answers

Which of the following is NOT a contributing factor to altered kidney function post-burn injury?

Compromised skin integrity Signup and view all the answers

Which alteration in kidney function may result from hemoglobin and myoglobin occluding renal tubules?

Acute tubular necrosis Signup and view all the answers

What happens to the body's thermoregulation after severe burn injury?

Inability to regulate body temperature Signup and view all the answers

What immune-related consequence occurs due to burn injuries?

Systemic release of cytokines causing dysfunction Signup and view all the answers

What is the peak time for fluid leak after a burn injury?

6 to 8 hours Signup and view all the answers

What complication can arise from untreated edema in burn injuries?

Tissue ischemia Signup and view all the answers

In which phase should a nurse conduct a primary survey and monitor circulation for burn patients?

Emergent/resuscitative phase Signup and view all the answers

What physiological changes occur in the hours following a burn injury?

Capillary integrity decreases Signup and view all the answers

What is an essential intervention for severe edema following a burn?

Escharotomy or fasciotomy Signup and view all the answers

How long does intrinsic diuresis last in a previously healthy adult after a burn?

7 days to 2 weeks Signup and view all the answers

What initiates the extensive shift of intravascular fluid and electrolytes in burns greater than 30% TBSA?

Inflammatory mediators Signup and view all the answers

What can be a consequence of circumferential burns as edema forms?

Compartment syndrome Signup and view all the answers

What is the primary goal of wound care for burn patients?

To prevent wound deterioration by removing nonviable tissue Signup and view all the answers

What is recommended for wound cleaning to prevent infection?

Gentle cleaning with mild soap and water Signup and view all the answers

What should be done regarding hair in and around the burn area?

Clip short or shave hair except for eyebrows Signup and view all the answers

What should the water temperature be maintained at during wound cleaning to prevent hypothermia?

37.8°C (100°F) Signup and view all the answers

Why is culture conducted on admission for burn patients?

To screen for antibiotic-resistant bacteria Signup and view all the answers

What is a recommended strategy for preventing cross-contamination during wound care?

Thorough decontamination of equipment and use of plastic liners Signup and view all the answers

What role does family presence play during wound care?

It can improve patient and family satisfaction Signup and view all the answers

What must be closely monitored due to the use of systemic antibiotics in burn patients?

Culture sensitivities to combat antibiotic resistance Signup and view all the answers

What is the primary advantage of using autografts for burn wound closure?

They are less likely to be rejected by the immune system. Signup and view all the answers

What factor can contribute to partial or total graft loss after an autograft procedure?

Presence of blood, serum, or necrotic tissue between the graft and recipient site. Signup and view all the answers

What is the main purpose of using occlusive dressings postoperatively for graft care?

To immobilize the graft and maintain a humid environment. Signup and view all the answers

What is a common timeframe for the first dressing change after grafting?

2 to 5 days after surgery. Signup and view all the answers

Which of the following statements about Cultured Epithelial Autograft (CEA) is true?

CEA involves culturing full-thickness biopsies of unburned skin. Signup and view all the answers

What is a primary concern during the early postoperative period following a skin graft?

Minimizing bleeding beneath the graft. Signup and view all the answers

How soon after surgery can a patient typically begin exercising the grafted area?

5 to 7 days after surgery. Signup and view all the answers

What is one of the main uses of split-thickness grafts?

To minimize healing time by preserving sweat glands and hair follicles. Signup and view all the answers

Study Notes

Course Information

Course: NCM 112: Care of Clients with Problems in Fluids and Electrolytes
Developer: Prof. Merlie Q. Espiritu, RN, MAN
Email: [email protected]/[email protected]

Course Description

Covers concepts, principles, theories, and techniques for nursing care management of at-risk and sick adult clients.
Focuses on alterations in oxygenation, fluid, electrolytes, infectious diseases, inflammatory responses, immunologic responses, and cellular disorders (acute and chronic).
Learners are expected to develop nursing care plans.

Course Outline

Week 10 & 12: Unit II: Fluid and Electrolyte Imbalances in Renal Disorders
Week 13 & 14: Unit III: Fluid and Electrolyte Imbalances of Patient with Burn Injury
Week 15 & 17: Unit IV: Fluid and Electrolyte Imbalances of Patient with Neurogenic Disorders
Week 18: Final Examination

Rationale (Management of Patient with Burn Injury)

Module aims to teach students about concepts, theories, and principles of fluid and electrolyte imbalances in burn injury patients.
Module enables students to formulate comprehensive care plans for these patients.

Instructions for Users

Students will complete preparatory activities to assess understanding of the topics.
Developmental activities involve application, discussion, and analysis of patient cases from burns.

Burn Incidences

Estimated 180,000 burn-related deaths annually, largely in low- and middle-income countries.
Significant morbidity, including prolonged hospitalizations, disfigurement, and disability (DALYs).
Rates of child deaths from burns are higher in low- and middle-income countries.

WHO (World Health Organization) 2023 Recommendations

Enclose fires, use safer cook stoves, and use less hazardous fuels.
Promote safer cook stoves, particularly those designed with stability, and prevent access by children.
Promote fire safety education and the use of fire safety equipment (e.g., detectors, sprinklers).
Promote using fire-retardant fabrics for children's sleepwear.

First Aid: What to do and What not to do

What to Do: Remove clothing, extinguish flames, use cool water, apply a blanket, or use other fire extinguishing liquids, use cool running water, remove or dilute chemicals.
What not to do: Do not use paste, oil, haldi (turmeric), or raw cotton; do not apply ice; do not leave uncovered; do not apply other materials directly to the wound.

Overview of Burn

Involves destruction of skin layers, potentially life-threatening.
Associated imbalances arise from alterations in skin and internal body membranes, and the effect of heat on body water and solutes.

Causes of Burns

Thermal Burns: Dry or moist heat (e.g., flames, steam, hot liquids, frostbite).
Mechanical Burns: Caused by friction or abrasion (e.g., rubbing against surfaces).
Electrical Burns: Due to faulty wiring, high voltage lines, lightning, or immersion in electrically charged water.
Chemical Burns: Result from direct contact, ingestion, inhalation, or injection.
Radiation Burns: Typically associated with sunburn or radiation therapy.

Burn Severity Determination

Factors include age, depth of burn, percentage of body surface area burned, presence of inhalation injury, other injuries, and location (face, perineum, hands, feet).
A TBSA of more than 40% is a high-risk condition for mortality and morbidity.

Burn Depth Types (Superficial, Partial Thickness, Deep Partial Thickness, Full Thickness).

Superficial: Dry, red, easily blanching, sometimes painful.
Superficial Partial Thickness: Moist, red, blanching, blisters, very painful.
Deep Partial Thickness: Drier, more pale, less blanching, less pain.
Full Thickness: Dry, leathery texture, variable color (white, brown, black), loss of pin prick sensation.

Extent of Body Surface Area (TBSA)

Rule of Nines: A common method to estimate the extent of burns.
Lund and Browder Method: A more detailed method, which considers the patient's age
Palmer Method: Used for scattered or extensive burns.

Burn Center Referral Criteria

Partial-thickness burns exceeding 10% TBSA.
Burns involving face, hands, feet, genitalia, or perineum.
Third-degree (full-thickness) burns.
Electrical burns.
Chemical burns
Inhalation injury
Patients with existing medical problems or those with concomitant trauma
Children with burn injuries in facilities that lack pediatric care expertise.

Pathophysiology of Burn Injury

Chemical or heat injury at one site causes the damage to spread to other tissues.
Involves coagulation, protein denaturation, or ionization.

Zones of Burn Injury (Coagulation, Stasis, Hyperemia)

Coagulation: Central area of necrosis.
Stasis: Surrounding area of decreased blood flow.
Hyperemia: Outermost zone with minimal injury, potentially recovering.

Management

Fluid resuscitation calculations based on TBSA.
Serum creatinine kinase levels indicate muscle injury.
IV fluids titrated to maintain urine output.
Monitor myoglobin levels in urine.
Sequential surgical debridement.

Cardiovascular Alterations

Initial decrease in cardiac output.
Vasoconstriction and increased workload of the heart.
Hypovolemia due to blood loss and capillary leakage.

Respiratory Alterations

Obstruction from edema (upper airway injury).
Damage to lower airways from smoke inhalation.
Causes inflammation, mucous production, atelectasis, and hypoxia.

Gastrointestinal Alterations

Impaired motility and absorption.
Possible nausea, vomiting, and paralytic ileus
Increased risk of ulcers (Curling's ulcers).

Quality and Safety Nursing Alert

Maintain a patent airway.
Provide humidified oxygen.
Administer appropriate fluids based on appropriate parameters.
Monitor hydration and electrolyte balance.
Early excision and care of the burn wounds.

Infection Prevention/Control

Wound care and cleaning are crucial to prevent wound deterioration and infection.
Use of barrier techniques, environmental procedures, appropriate topical antimicrobials, and close monitoring of signs of infection.

Wound Cleaning

Gentle cleaning with mild soap and water.
Short hair and shaven hairs around the burn area.
Avoidance of ointments and creams unless in specific cases.

Topical Antibacterial Therapy

Effective against gram-positive and gram-negative organisms and fungi.
Penetrates eschar but is not systemically toxic
Cost-effective and available to patients.

Wound Debridement

Removal of nonviable tissue and foreign bodies to support healing and to prevent infections.
Removal of devitalized tissue through techniques such as chemical or surgical methods, and natural débridement.

Autografts

Preferred autologous method of definitive burn wound closure.
Donor site healing involves a range of processes, and minimizing healing time is important.

Care of the Graft Site/Donor Site

Protection and immobilization of the graft from injury.
Maintenance of a humid environment and cleaning.

Pain Management

Assess pain frequently and provide appropriate pain management strategies.
Provide pain management and analgesic/anxiolytic medications.
Use other methods like positioning, relaxation to ease painful situations.

Rehabilitation Phase

Burn rehabilitation is a multifaceted effort.
Rehabilitation strategies address psychological recovery.
Patients' outlook, motivation, and support system are crucial.

Critical Thinking Activities (Questions Included)

Includes prompts to discuss possible complications and interventions for patients with smoke inhalation injuries and burns.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz delves into key concepts from the NCM 112 course, focusing on client care, the specifics of renal disorders, and the impacts of burn injuries. Test your knowledge on burn mechanisms, consequences, and physiological responses, essential for nursing practice.