Berzabal, Jane Arian I.
NDA
SELF-ASSESSMENT
1. The two age groups that have increased morbidity and mortality from burn injuries are young
children and elderly.
2. Burns that exceed one third of the total body surface area (TBSA) are considered major burn injuries
and produce both a local and systemic inflammatory response.
3. Hypovolemia is the immediate consequence of ensuing fluid loss and results in decreased perfusion
and oxygen delivery.
4. Two pulmonary complications that occur secondary to inhalation injuries are the acute respiratory
failure, and acute respiratory distress syndrome.
5. The leading cause of death in thermally injured patients is sepsis.
1. Discuss why Cardiac Failure is a potential complication of an acute burn:
Fluid overload may occur when fluid is mobilized from the interstitial compartment back into
the intravascular compartment. If cardiac system cannot compensate for the excess volume,
congestive heart failure may be a result.
2. What does the depth of burn injury depend on?
The depth of the injury depends on the temperature of the burning agent and the duration of
contact with the agent.
3. What are the three zones of burn injury and what are involved with each?
The central area of the wound is termed the zone of coagulation due to the characteristic
coagulation necrosis of cells that occurs. The surrounding zone, the zone of stasis, describes an area of
injured cells that may remain viable but, with persistent decreased blood flow, will undergo necrosis
within 24-48 hours. The zone of hyperemia, the outermost zone, sustains minimal injury and may fully
recover over time.
4. What types of general emergency procedures should be employed at the burn scene?
Primary survey, prevention of shock, prevention of respiratory distress, detection and treatment
of concomitant injuries, wound assessment, and initial care.
5. When a patient sustains inhalation injury below the vocal cords, what is th e usual
cause?
Inhalation injury below the vocal cords results from inhaling the products of incomplete
combustion or noxious gases and is often the source of the death at the scene of a fire.
Berzabal, Jane Arian I. NDA
Consider the following scenario and answer the questions:
Jason Dy, 22 years old, sustained full-thickness burns on his anterior chest, face and neck and when he
was trying to start a charcoal fire to prepare dinner for his father. His father sprayed him with water
from a hose and took him to the hospital. On arrival, Jason was s emi-conscious and in respiratory
distress. Jason weighs 72 kgs.
1. Upon arrival at the emergency department, what indicators do the nurse have that Jason may have an
inhalation injury as well as the severe burns?
If injury occurred in a small space ; burns on the face or neck; singed nasal hair; hoarseness, high
pitched voice change, stridor, soot in the sputum; dyspnea or tachypnea, and other signs of reduced
oxygen levels (hypoxemia); and erythema and blistering of the oral or pharyngeal mucosa.
2. What does the nurse prepare to assist with due to Jason’s immediate condition?
Intubation and mechanical intubation, possible escharotomy to allow adequate chest expansion.
3. According to the rule of 9’s, Jason has been burned over 13.5% of his body. According to the American
Burn Association (ABA), fluid resuscitation guide, how much fluid should he receive in the first 24 hours
after the burn injury?
1944 mL: 2 mL lactated ringers x patients weight in kg, (72) x 96 TBSA (13.5), second, third, and
fourth degree burns.
Answer the following questions:
1.The newly admitted client has burns on both legs. The burned areas appear white and leather-like. No
blisters or bleeding are present, and the client states that he or she has little pain. How should this injury
be categorized?
A. Superficial
B. Partial-thickness superficial
C. Partial-thickness deep
D. Full thickness
2. The newly admitted client has a large burned area on the right arm. The burned area appears red, has
blisters, and is very painful. How should this injury be categorized?
A. Superficial
B. Partial-thickness superficial
Berzabal, Jane Arian I. NDA
C. Partial-thickness deep
D. Full thickness
3. The burned client newly arrived from an accident scene is prescribed to receive 4 mg of morphine
sulfate by IV push. What is the most important reason to administer the opioid analgesic to this client by
the intravenous route?
A. The medication will be effective more quickly than if given intramuscularly.
B. It is less likely to interfere with the client’s breathing and oxygenation.
C. The danger of an overdose during fluid remobilization is reduced.
D. The client delayed gastric emptying.
4.Which client factors should alert the nurse to potential increased complications with a burn injury?
A. The client is a 26-year-old male.
B. The client has had a burn injury in the past.
C. The burned areas include the hands and perineum.
D. The burn took place in an open field and ignited the client’s clothing.
5.What clinical manifestation should alert the nurse to possible carbon monoxide poisoning in a client
who experienced a burn injury during a house fire?
A. Pulse oximetry reading of 80%
B. Expiratory stridor and nasal flaring
C. Cherry red color to the mucous membranes
D. Presence of carbonaceous particles in the sputum
