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Nursing Care of the Burned Client

Nursing Care of the Burned Client

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Nursing Care of the Burned Client

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  1. Nursing Care of the Burned Client Joyce M. Black, PhD, RN

  2. A “minor” burn happens to someone else. Anonymous burn victim.

  3. How serious is the burn problem? • 1.4 million people seek care for burn injuries yearly • 54,000 hospitalizations • 5,000 deaths annually

  4. How do burn injuries occur? • Thermal Burns • flames, hot liquids, semi-liquids (steam), semi-solids (tar) or hot objects • the most common etiology

  5. How do burn injuries occur? • Chemical Burns • strong acids, alkali, or organic compounds • depth of injury determined by: - concentration - volume - duration of contact - type of chemical

  6. How do burn injuries occur? • Electrical Burns • lightning • faulty or exposed wiring - electrical wiring - high-voltage power lines

  7. How do burn injuries occur? • Radiation Burns • least common form of burns • exposure to radioactive source - nuclear radiation accidents - ionizing radiation exposure - prolonged exposure to ultraviolet light ( sunburn)

  8. Who is at risk of burn injury? • 75% due to action of the victim • Contact with scalding liquids • elderly with mental and /or physical limitations • reduce temperatures on water heaters • clothing ignition during meal prep • no flammability standards yet • cigarette-related mattress fires • playing with matches • need for operable smoke detectors

  9. What are the responses to burn injury? • If the burn is greater than 25% BSA: • Systemic and proportional response • If burn is less than 25% BSA: • Localized to injured area • Response characterized by early system hypofunction followed by hyperfunction

  10. Nervous System Response • Neurological problems uncommon unless injury was associated with: • A fall • An explosion • Impaired brain perfusion • Closed-space fire • Inhalation injury • Ingested drugs • Usually awake and alert on admission

  11. Fluid and Electrolyte Response • Vasoactive substances released from injured tissues increases capillary permeability • Direct heat injury to vessels further increases permeability • Fluids are shifted throughout entire body, not just in burned area • Leads to hypovolemic shock • Low B/P, high Hct,

  12. Cardiovascular Response • Catecholamine release and hypovolemia increases HR and peripheral vascular resistance (PVR) • Initial decrease in cardiac output • ? Myocardial depressant factor • May explain unresponsiveness to fluids in extensive burn injuries

  13. Pulmonary Response • Without inhalation injury, pulmonary response is minimal • Rise in minute rate and tidal volume • Slight increase in pulmonary resistance and a decrease in lung compliance

  14. Renal System Response • Blood shunted from kidneys: • If fluids not replaced, prerenal renal failure can develop • Hemoglobin and myoglobin can become trapped in nephron • Can lead to renal failure • Presents as hemoglobinuria/myoglobinuria • RX= fluids, tubular diuretics

  15. Gastrointestinal (GI) Response • Decreased blood flow initially: • Ileus • Risks of bleeding - Erosions lead to - Ulcerations (called Curlings ulcers in burn victims)

  16. Immune Response • Depressed immune function: • Decreased lymphocyte activity • Decreased immunoglobulin production • Suppression of complement • Altered neutrophil and phagocyte function • Increases risk of sepsis and infections

  17. Psychological Response • Influenced by: • Age • Personality • Cultural and ethnic background • Extent and location of injury • Impact on body image • Cause of injury (self-inflicted vs. victim of others)

  18. Four Stages of Psychosocial Response • Impact Stage • Shock, disbelief, feelings of being overwhelmed • Family and client need assurance, proximity to the client, information • Retreat Stage • repression, withdrawal, denial, suppression • Family needs to know that these responses are normal and self-protective

  19. Psychological Response Continued… • Acknowledgment Stage • Begins when client accepts the injury • Mourns actual or perceived losses • Family and client may benefit from meeting other burned clients • Reconstructive Phase • Accepts limitations imposed by injury • Begins to plan realistically for the future • May benefit from job retraining