BURNS M.GARDNER NUR-224
BURNS • Occurs when there is injury to the tissues of the body as a result of heat transfer from one site to another. • Injury from exposure to heat, chemicals, radiation or electric current
BURNS • Approximately 1.1 million people require medical attention of burns every year, and about 4,500 persons die from burns and associated inhalation injuries every year. • Most burns occur in the home. • Young children and the elderly are at high risk for burn injuries.
BURNS • Affect peoples of all age groups, socioeconomic groups • Males have greater then twice the chance of burn injury than women • Age group – 20-40 years of age • 5th most common cause of death from unintentional injury
TYPES OF BURNS • Thermal • Chemical • Smoke & Inhalation injury • Electrical • Cold Thermal injury
THERMAL BURNS • Caused by flames, flash, scald or contact with hot objects. • Most common type of burn • Occur most often in children/older adults
CHEMICAL BURNS • Caused by direct skin contact, from acids, & organic compounds • Found in many household cleaners, lab chemicals • Remove the client from the burning agent & quickly remove the chemical from the skin
SMOKE & INHALATION INJURY • Result from the inhalation of hot air/noxious chemicals damage to tissue of the respiratory tract. • Client’s with smoke inhalation injuries must be observed for signs of respiratory distress.
ELECTRIC BURNS • Cause tissue damage & result from heat generated by the flow of electric current through the body. • Only one with an exit wound • Damage cannot be judged from the size/depth of the wound
SEVERITY BURN INJURY • Age of the patient • The nature of the burning agent • Depth of the burn • Extent of the burn calculated by (TBSA) • Location of the burn • Presence of inhalation of injury
DEPTH OF BURNS Categorized according to depth of skin destruction: • Superficial Partial -Thickness • Partial –Thickness Skin • Full –Thickness Skin
SUPERFICIAL PARTIAL-THICKNESS SKIN Superficial (first-degree) • Least severe • Limited to the first 2/3 layers of the epidermis • Redness, mild swelling & pain , minor pigment changes • Sunburn is considered 1st degree burn
DEEP PARTIAL -THICKNESS SKIN • Deep (second degree) • Usually involve the entire epidermis and upper dermis • Blisters, edema • Severe pain nerve injury • Will heal within 2-4 weeks with minimal scarring
FULL-THICKNESS SKIN Third/Fourth Degree Burns • Destruction of skin through all layers of epidermis & dermis • Hard, leathery, eschar (burn scabs) • Edema is present • Sensation is minimal or absent/pain free • Possible involve of muscles, tendons & bones.
EXTENT OF BURN INJURY • Two commonly used guidelines to determine the total body surface area affected to the extent of the burn wound are: • Lund-Browder chart • Rule of nines
RULE OF NINES • Easy to remember • Estimated % of total body surface area (TBSA )in the adult is arrived by sectioning the body surface areas with numerical value related to nine. • Considered adequate for initial assessment of an adult burn patient.
RULE OF NINE’S • Head & Neck -- 9% • Right arm – 9% • Left arm - 9% • Trunk - 36% • Left leg -18% • Right leg -18% • Perineum -1%
LUND-BROWDER CHART • More accurate pt.’s age, in proportion to relative body-area size , is taken into account.
PATHOPHYSIOLOGY • Hemodynamic instability • loss of capillary integrity • shift of fluid -- sodium, proteins from intravascular space interstitial space.
ALTERATIONS • Cardiovascular • Fluid/electrolyte • Pulmonary • Immunologic • Renal • Thermoregulatory • Gastrointestinal
ON THE SCENE CARE • Remove the person from the source of the burn & the burning process • Prevent further injury • Maintain V/S, initiate CPR(if necessary) • Rescuers must protect themselves from the burning process
ON THE SCENE CARE • adhered clothing leave in place • wrap the client in a clean sheet/blanket • no food/fld. by mouth • place in position to prevent aspiration
PHASES OF BURN MANAGEMENT • Emergent phase (resuscitative) • Acute phase (wound healing) • Rehabilitative phase (restorative)
EMERGENT PHASE • Onset of injury to completion of fluid resuscitation • Patient is transported to emergency department • Fluid resuscitation is begun • Foley catheter is inserted • Patient with burns exceeding 20–25% should have an NGT inserted and placed to suction • Rule of Nine’s • Focus on onset of hypovolemic shock & edema formation
EMERGENT PHASE • Patient is stabilized and condition is continually monitored • Patients with electrical burns should have ECG • Address pain; only IV medication should be administered • Psychosocial consideration and emotional support should be given to patient and family
NURSING MANAGEMENT • Aseptic management – wounds/invasive lines • Elevate burned upper/lower extremities • Large bore IV catheters/ foley catheter • Monitor fluid intake, I/O, v/s, • Burgundy – colored urine • Neurologic asessement
ACUTE PHASE • Begins with the mobilization of fluid & diuresis & ends when the burns are completely closed • Prevent complication • Nutritional support • Burn wound care • Pain management • May take weeks /months.
PATHOPHYSIOLOGY • Mobilization of fluid begins • Bowel sounds return • Healing begins • Partial-thickness burn wound heal from the edges • Full thickness-burn wound must be covered by skin grafts • Pt. becomes aware of the situation
LABORATORY VALUES • Body is attempting to reestablish homeostasis. • Decreased hematocrit • Increase u/o • Sodium (Na) deficit • Potassium (K+) deficit
ACUTE/INTERMEDIATE PHASE • Topical antibacterial therapy • Wound debridement * natural, mechanical, chemical, surgical • Wound grafting * autograft, homograft, heterograft * CEA – cultured epithelial graft
NURSING MANAGEMENT • Restore fluid balance • Prevent infection • Adequate nutrition • Promote skin integrity • Pain management • Physical mobility
POTENTIAL COMPLICTIONS • Heart failure • Sepsis • Acute respiratory failure • Visceral damage
REHABILITATION PHASE • Begins immediately after the burn has occurred and may extend for years after the injury. • Wounds have healed and the patient is able to resume a level of self-care activity. • Goal : return of ADL’s, self-care, scar management, return to work
REHABILTATION PHASE • Abnormal wound healing hypertropic scars keloid • Treatment of scars
Nursing intervention • Mental health • Burn skin precautions • Nutrition • Pain management • Thermoregulation
FYI • Cleansing wounds avoid cross-contamination of the patient’s wound • Move patients slowly and carefully across bed sheets to prevent shearing or dislodgement of new skin grafts • Narcotics are always administered intravenously due to decreased circulation