- Email: [email protected]
Examination: Perioperaive Management of Burn Patients
JUNE 1999, VOL 69. NO 6
Examination PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
causes extreme retention of fluids. a. true b. false
1.Bums are classified as first, second, and third degree based on the location of the injury. a. true b. false
8.The primary cause of morbidity and mortality in patients with major bums is a. femur fractures. b. hemorrhagic shock. c. pulmonary complications. d. myocardial infarction.
2.Third-degree bums are called a. superficial partial thickness. b. full thickness. c. deep partial thickness. d. partial thickness.
9. Heat generated from thermal bums causes the
3.A second degree bum is characterized by 1. severe pain.
destruction of approximately -of a patient's red blood cells. a. 10% b. 15% c. 20% d. 25%
2. thick leathery lesions. 3. damage to the dermis. 4. damage to the vesicle structures. a. I , 2 and 3 b. 2 , 3 and 4 c. 1.3 and 4 4.A first-degree bum is also referred to as a super-
ficial partial thickness bum. a. true b. false serious sunbum that is erythematous and painful is called a a. first-degree bum. b. second-degree bum. c. third-degree bum. d. fourth-degree bum.
5.A
6.Deficits in blood volume, caused by the bum injury are due to transvascular migration of 1 . electrolytes. 2. protein. 3. vascular fluids. 4. IV fluids. a. 1 , 2 and4 b. 2, 3, and 4 c. 1, 3, and 4 d. I , 2, and 3 7.Hypertonic saline, when used in the bum patient,
1O.The following statements are true about skin grafts for bum patients except a. porcine grafts can be placed on debrided areas. b. porcine grafts have to be reconstituted using warm 120" F ( 4 8 ) normal saline. c. best results are observed with the use of autografts. d. unmeshed grafts are called sheet grafts. 1l.Intravenous fluids restore intravascular volume, increase cardiac output to ensure tissue and organ perfusion and a. increase peripheral peripheral vascular resistance. b. decrease peripheral vascular resistance. c. have no effect on vascular resistance. d. precipitate an increased metabolism. 1 2 S o m e of the substances released into the system because of bum wounds are a. histamine, serotonin, and thromboxane A2. b. histamine, serotonin, and throxine. c. histamine, serotonin, and triiodothyronine. d. histamine, serotonin, and thypinone.
1223 AORN JOURNAL
JUNE 1999, VOL 69, NO 6
13.Fluid resuscitation should be adjusted to the clinical response of the bum patient based on the patient’s a. heart rate. b. urinary output. c. base deficit. d. all of the above 1AColloids are used for restoring intravascular oncotic pressure and volume expansion. a. true b. false 1LCurling’s ulcers 1. are often seen within the first 72 hours of bum injury. 2. carry a low mortality rate if they perforate. 3. increase with higher total body surface area involvement. 4. may be prevented by the control of gastric pH by using antacids. a. 1,2,and3 b. 1,3, and4 c. 2,3, and 4 d. all of the above 1LThis type of bum is often associated with myoglobinuria and myoglobinemia. a. inhalation bums b. chemical bums c. electrical bums d. thermal bums 17.The OR is cooled in preparation for surgery on a bum patient because of the bum patient’s hypermetabolic state. a. true b. false 1BSuccinylcholine use is contraindicated in bum patients in the first 24 to 48 hours because it raises the patient’s serum levels. a. chloride b. calcium c potassium d. sodium 1aElastic bandages are often used to wrap debridement areas to reduce loss. a. blood b. tissue
c. temperature d. fluid =This form of skin grafting heals more quickly and causes less scarring. a. sheet graft b. meshed graft 21.This costly and time-consuming graft is from a skin biopsy of the patient. a. synthetic dermis b. cadaveric dermis c. porcine skin d. cultured skin =Heparin, when used in the bum patient, has been shown to reduce all of the following except a. resuscitation fluids. b. tissue swelling. c. prothrombin time. d. healing time. =Total destruction of hair follicles and sebaceous glands occurs in third-degree bums. a. true b. false =Signs and symptoms of inhalation injuries are 1. dyspnea. 2. hoarseness. 3. sooty sputum. 4. otorrhea. a. I , 2, and 3 b. 1, 2, and 4 c. 1, 3, and 4 d. 2, 3, and 4 25.A solution of 1:lOOO epinephrine in 1,000 mL normal saline is injected into the bum donor site to a. create a moist environment for grafting. b. increase sensation to the area. c. decrease blood loss during skin harvesting. d. none of the above
=Loss of the airway in a bum patient can be fatal because of facial and tissue swelling. a. true b. false =.Renal
1224 AORN JOURNAL
failure in bum patients can be caused by
JUNE 1999, VOL 69, NO 6
a. inadequate fluid resuscitation. b. acute tubular necrosis. c. toxic effects from antibiotics. d. all of the above
a. adipose b. stratum lucidum c. eschar d. stratum corneum
=An acceptable prep solution for bum patients is chlorhexidine gluconate. a. true b. false =Burned
tissue is also known as
AORN is accredited as a provider of continuing education in nursing by the Americon Nurses Credentialing Centefs Commissian on Accreditation.AORN recognizesthis activiv as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentioling Center‘s Commission on Accreditation approves or endorses ony product included in the activity. AORN maintains the following provider numbers: Alobamo ABNP0075, Colifomio BRNoo667, Florid0 27W 177. AORN is opproved as o provider of continuing nursing education by
3O.A is used on the fingers, toes, hands, and feet to debride burned tissue. a. Watson knife b. Weck knife c. dermatome d. cautery device the Kansas State Board of Nursing. This course offering is approved for Iwo contact hours. The Kansas State Board of Nursing approved provider number is L TO 1 14-0316. Professional nurses ore invited to submit monuscripts for the Home Study Program. Manuscripis or queries should be sent to Editor, AORN Joumol, 2 1 70 S Porker Rd, Suite 300, Denvw CO 8023 157 1 1. As with all manuscripts sent to the Joumol, papers submitted for Home Study Progroms should not have been previously pub lished or submitted simultant?ously to any other publicotion.
No Association Found Between Dietary Fat and Breast Cancer A new study by researchers at Harvard Medical School and Brigham and Women’s Hospital finds there is no association between dietary fat consumption and the risk of breast cancer, according to a March 9, 1999, press release from the American Cancer Society. In a 14-year follow-up evaluation of the Nurses’ Health Study, researchers found no evidence that lower intake of fat, including very low fat intake, or lower intake of specific types of fat was associated with a decreased risk of breast cancer. The study was reported in the March 1, 1999, issue of the Journal of the American Medical Association. The influence of fat on breast cancer risk has received intense study because dietary fat increases breast cancer in animal experiments and because breast cancer occurrence throughout the world is highly correlated with per capita fat consumption. Epidemiologic studies within developed countries, however, have not consistently found dietary fat consumption to be a risk factor. As the study concerns only a specific nutrient and a single cancer, representatives of the American Cancer Society indicate that it is unlikely to change
the federal or American Cancer Society dietary guidelines, which make broad recommendations about diet, physical activity, weight, and alcohol consumption, as these affect overall health. According to the release, there remains great interest in how nutritional factors in childhood and adolescence may contribute to the earlier age of menarche among Western women compared to girls in agrarian cultures such as rural China. Another interesting factor is that, in many countries, breast cancer risk is greater in taller women, suggesting that nutrients that influence rapid growth in childhood may affect cancer risk. According to the American Cancer Society, women can reduce their risk of breast cancer by maintaining a healthy body weight after menopause, minimizing alcohol consumption, and having regular mammography examinations. Study Finds No Association Between Dietary Fat Consumption and Risk of Breast Cancer (press release, Atlanta: American Cancer Society, March 9, 1999) 1-2. Available from www.cancer.or4/medidst0~/030999. html. Accessed 15 March 1999.
1226 AORN JOURNAL
JUNE 1999, VOL 69, NO 6
Answer Sheet PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-571 1 Or fax with credit card information to (303) 750-3212
Event # 99 102
Session # 5697
Program offered June 1999. 1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. 3. A score of 70%correct is required for credit. 4. Record the time required to complete the program ~~
5. Enclose fee: Members $10; Nonmembers $20.
Zip
State
Phone number ( If nonmember, please provide Social Security number ~
IR
0000000000 0 0 0 0 0 0 0 0 0 0 el 0000000000 0@@@@@@ s; @ @ @ 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
z
R
Session Number
The deadline for this program is July 3 I , 2000.
AORN (ID) # Name Address City State RN license #
ID/SS Number
~~
Fee enclosed or bill the credit card indicated 0 MasterCard 0Visa 0American Express Card # Expiration date Signature (forcredit card authorization)
1229 AORN JOURNAL
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 200000 300000 400000 500000 600000 700000 800000 900000 10 0000 0 1100000 1200000 1300000 I4 0 0 0 0 0 I500000 1600000 1700000 180 0 0 0 0 I900000
2100000 2200000 2300000 2400000 2500000 2600000 2700000 2800000 29 0 0 00 0 3000000 3100000 3200000 3300000 3400000 3500000 36 0 0 000 3700000 3800000 39 0 0 000
JUNE 1999, VOL 69, NO 6
Learner Evaluation PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5. 0BJECTIVES
Session Number
R
0000000000~ 0000000000 0000000000 0000000000
(High) (Low) 100000 200000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000
I200000 1300000 I4 00000 1500000
I600000 1700000 1800000 1900000 2000000 2100000
To what extent were the following objectives of this Home Study Program achieved? ( 1 ) Describe. the differences in bum categories. (2) Discuss the perioperative care of the bum patient. (3) Discuss the various methods used for skin grafting for the bum patient. PURPOSUGOAL
To provide a review of the pathophysiology of bum injuries and perioperative care of burn patients. CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) How well did the objectives relate to the overall goal?
no0000
2300000 2400000 2500000 2600000 27 000 00 2800000 29 00 000 3000000
TEST OUESTIONS/ANSWLRS
(9) Were they reflective of the content? (10) Were they easy to understand? ( 1 1 ) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
1230 AORN JOURNAL
Examination PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
causes extreme retention of fluids. a. true b. false
1.Bums are classified as first, second, and third degree based on the location of the injury. a. true b. false
8.The primary cause of morbidity and mortality in patients with major bums is a. femur fractures. b. hemorrhagic shock. c. pulmonary complications. d. myocardial infarction.
2.Third-degree bums are called a. superficial partial thickness. b. full thickness. c. deep partial thickness. d. partial thickness.
9. Heat generated from thermal bums causes the
3.A second degree bum is characterized by 1. severe pain.
destruction of approximately -of a patient's red blood cells. a. 10% b. 15% c. 20% d. 25%
2. thick leathery lesions. 3. damage to the dermis. 4. damage to the vesicle structures. a. I , 2 and 3 b. 2 , 3 and 4 c. 1.3 and 4 4.A first-degree bum is also referred to as a super-
ficial partial thickness bum. a. true b. false serious sunbum that is erythematous and painful is called a a. first-degree bum. b. second-degree bum. c. third-degree bum. d. fourth-degree bum.
5.A
6.Deficits in blood volume, caused by the bum injury are due to transvascular migration of 1 . electrolytes. 2. protein. 3. vascular fluids. 4. IV fluids. a. 1 , 2 and4 b. 2, 3, and 4 c. 1, 3, and 4 d. I , 2, and 3 7.Hypertonic saline, when used in the bum patient,
1O.The following statements are true about skin grafts for bum patients except a. porcine grafts can be placed on debrided areas. b. porcine grafts have to be reconstituted using warm 120" F ( 4 8 ) normal saline. c. best results are observed with the use of autografts. d. unmeshed grafts are called sheet grafts. 1l.Intravenous fluids restore intravascular volume, increase cardiac output to ensure tissue and organ perfusion and a. increase peripheral peripheral vascular resistance. b. decrease peripheral vascular resistance. c. have no effect on vascular resistance. d. precipitate an increased metabolism. 1 2 S o m e of the substances released into the system because of bum wounds are a. histamine, serotonin, and thromboxane A2. b. histamine, serotonin, and throxine. c. histamine, serotonin, and triiodothyronine. d. histamine, serotonin, and thypinone.
1223 AORN JOURNAL
JUNE 1999, VOL 69, NO 6
13.Fluid resuscitation should be adjusted to the clinical response of the bum patient based on the patient’s a. heart rate. b. urinary output. c. base deficit. d. all of the above 1AColloids are used for restoring intravascular oncotic pressure and volume expansion. a. true b. false 1LCurling’s ulcers 1. are often seen within the first 72 hours of bum injury. 2. carry a low mortality rate if they perforate. 3. increase with higher total body surface area involvement. 4. may be prevented by the control of gastric pH by using antacids. a. 1,2,and3 b. 1,3, and4 c. 2,3, and 4 d. all of the above 1LThis type of bum is often associated with myoglobinuria and myoglobinemia. a. inhalation bums b. chemical bums c. electrical bums d. thermal bums 17.The OR is cooled in preparation for surgery on a bum patient because of the bum patient’s hypermetabolic state. a. true b. false 1BSuccinylcholine use is contraindicated in bum patients in the first 24 to 48 hours because it raises the patient’s serum levels. a. chloride b. calcium c potassium d. sodium 1aElastic bandages are often used to wrap debridement areas to reduce loss. a. blood b. tissue
c. temperature d. fluid =This form of skin grafting heals more quickly and causes less scarring. a. sheet graft b. meshed graft 21.This costly and time-consuming graft is from a skin biopsy of the patient. a. synthetic dermis b. cadaveric dermis c. porcine skin d. cultured skin =Heparin, when used in the bum patient, has been shown to reduce all of the following except a. resuscitation fluids. b. tissue swelling. c. prothrombin time. d. healing time. =Total destruction of hair follicles and sebaceous glands occurs in third-degree bums. a. true b. false =Signs and symptoms of inhalation injuries are 1. dyspnea. 2. hoarseness. 3. sooty sputum. 4. otorrhea. a. I , 2, and 3 b. 1, 2, and 4 c. 1, 3, and 4 d. 2, 3, and 4 25.A solution of 1:lOOO epinephrine in 1,000 mL normal saline is injected into the bum donor site to a. create a moist environment for grafting. b. increase sensation to the area. c. decrease blood loss during skin harvesting. d. none of the above
=Loss of the airway in a bum patient can be fatal because of facial and tissue swelling. a. true b. false =.Renal
1224 AORN JOURNAL
failure in bum patients can be caused by
JUNE 1999, VOL 69, NO 6
a. inadequate fluid resuscitation. b. acute tubular necrosis. c. toxic effects from antibiotics. d. all of the above
a. adipose b. stratum lucidum c. eschar d. stratum corneum
=An acceptable prep solution for bum patients is chlorhexidine gluconate. a. true b. false =Burned
tissue is also known as
AORN is accredited as a provider of continuing education in nursing by the Americon Nurses Credentialing Centefs Commissian on Accreditation.AORN recognizesthis activiv as continuing education for registered nurses. This recognition does not imply that AORN or the American Nurses Credentioling Center‘s Commission on Accreditation approves or endorses ony product included in the activity. AORN maintains the following provider numbers: Alobamo ABNP0075, Colifomio BRNoo667, Florid0 27W 177. AORN is opproved as o provider of continuing nursing education by
3O.A is used on the fingers, toes, hands, and feet to debride burned tissue. a. Watson knife b. Weck knife c. dermatome d. cautery device the Kansas State Board of Nursing. This course offering is approved for Iwo contact hours. The Kansas State Board of Nursing approved provider number is L TO 1 14-0316. Professional nurses ore invited to submit monuscripts for the Home Study Program. Manuscripis or queries should be sent to Editor, AORN Joumol, 2 1 70 S Porker Rd, Suite 300, Denvw CO 8023 157 1 1. As with all manuscripts sent to the Joumol, papers submitted for Home Study Progroms should not have been previously pub lished or submitted simultant?ously to any other publicotion.
No Association Found Between Dietary Fat and Breast Cancer A new study by researchers at Harvard Medical School and Brigham and Women’s Hospital finds there is no association between dietary fat consumption and the risk of breast cancer, according to a March 9, 1999, press release from the American Cancer Society. In a 14-year follow-up evaluation of the Nurses’ Health Study, researchers found no evidence that lower intake of fat, including very low fat intake, or lower intake of specific types of fat was associated with a decreased risk of breast cancer. The study was reported in the March 1, 1999, issue of the Journal of the American Medical Association. The influence of fat on breast cancer risk has received intense study because dietary fat increases breast cancer in animal experiments and because breast cancer occurrence throughout the world is highly correlated with per capita fat consumption. Epidemiologic studies within developed countries, however, have not consistently found dietary fat consumption to be a risk factor. As the study concerns only a specific nutrient and a single cancer, representatives of the American Cancer Society indicate that it is unlikely to change
the federal or American Cancer Society dietary guidelines, which make broad recommendations about diet, physical activity, weight, and alcohol consumption, as these affect overall health. According to the release, there remains great interest in how nutritional factors in childhood and adolescence may contribute to the earlier age of menarche among Western women compared to girls in agrarian cultures such as rural China. Another interesting factor is that, in many countries, breast cancer risk is greater in taller women, suggesting that nutrients that influence rapid growth in childhood may affect cancer risk. According to the American Cancer Society, women can reduce their risk of breast cancer by maintaining a healthy body weight after menopause, minimizing alcohol consumption, and having regular mammography examinations. Study Finds No Association Between Dietary Fat Consumption and Risk of Breast Cancer (press release, Atlanta: American Cancer Society, March 9, 1999) 1-2. Available from www.cancer.or4/medidst0~/030999. html. Accessed 15 March 1999.
1226 AORN JOURNAL
JUNE 1999, VOL 69, NO 6
Answer Sheet PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
P
lease fill out the application and answer form below and the evaluation on the back of this page. Tear out the page from the Journal or make photocopies and mail to: AORN Customer Service c/o Home Study Program 2170 S Parker Rd, Suite 300 Denver, CO 8023 1-571 1 Or fax with credit card information to (303) 750-3212
Event # 99 102
Session # 5697
Program offered June 1999. 1. Record your identification number in the appropriate section below. 2. Completely darken the space that indicates your answer to the examination starting with question one. 3. A score of 70%correct is required for credit. 4. Record the time required to complete the program ~~
5. Enclose fee: Members $10; Nonmembers $20.
Zip
State
Phone number ( If nonmember, please provide Social Security number ~
IR
0000000000 0 0 0 0 0 0 0 0 0 0 el 0000000000 0@@@@@@ s; @ @ @ 0000000000 0000000000 0000000000 0000000000 0000000000 0000000000
z
R
Session Number
The deadline for this program is July 3 I , 2000.
AORN (ID) # Name Address City State RN license #
ID/SS Number
~~
Fee enclosed or bill the credit card indicated 0 MasterCard 0Visa 0American Express Card # Expiration date Signature (forcredit card authorization)
1229 AORN JOURNAL
0000000000 0000000000 0000000000 0000000000
Mark only one answer per question. 100000 200000 300000 400000 500000 600000 700000 800000 900000 10 0000 0 1100000 1200000 1300000 I4 0 0 0 0 0 I500000 1600000 1700000 180 0 0 0 0 I900000
2100000 2200000 2300000 2400000 2500000 2600000 2700000 2800000 29 0 0 00 0 3000000 3100000 3200000 3300000 3400000 3500000 36 0 0 000 3700000 3800000 39 0 0 000
JUNE 1999, VOL 69, NO 6
Learner Evaluation PERIOPERATIVE MANAGEMENT OF BURN PATIENTS
The following evaluation is used to determine the extent to which this Home Study Program met your leaming needs. Rate the following items on a scale of 1 to 5. 0BJECTIVES
Session Number
R
0000000000~ 0000000000 0000000000 0000000000
(High) (Low) 100000 200000 300000 400000 500000 600000 700000 800000 900000 1000000 1100000
I200000 1300000 I4 00000 1500000
I600000 1700000 1800000 1900000 2000000 2100000
To what extent were the following objectives of this Home Study Program achieved? ( 1 ) Describe. the differences in bum categories. (2) Discuss the perioperative care of the bum patient. (3) Discuss the various methods used for skin grafting for the bum patient. PURPOSUGOAL
To provide a review of the pathophysiology of bum injuries and perioperative care of burn patients. CONTENT
(4) Did this article increase your knowledge of the subject matter? (5) Was the content clear and organized? (6) Did this article facilitate learning? (7) Were your individual objectives met? (8) How well did the objectives relate to the overall goal?
no0000
2300000 2400000 2500000 2600000 27 000 00 2800000 29 00 000 3000000
TEST OUESTIONS/ANSWLRS
(9) Were they reflective of the content? (10) Were they easy to understand? ( 1 1 ) Did they address important points?
What other topics would you like to see addressed in a future Home Study Program? Would you be interested or do you know someone who would be interested in writing an article on this topic? Topic(s):
Author names and addresses:
1230 AORN JOURNAL