BURNS NURSING MANAGEMENT

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Chapter 17 Nursing Care of Clients with Burns Dr. Marylynn Aguirre

Types and Causative Agents of Burns : 

Types and Causative Agents of Burns Thermal: open flame, steam, hot liquids Chemical: acids, strong alkalis, organic compounds Electrical: direct current, alternating current, lightening Radiation: solar, x-rays, radioactive agents

Factors Affecting Burn Classification : 

Factors Affecting Burn Classification Characteristics of Burns by Depth Superficial (epidermis): skin may pink to red and dry, painful Partial thickness (epidermis and dermis): skin bright pink and blisters, painful Full thickness (epidermis, dermis, underlying tissues): skin appears waxy, dry, leathery, charred, no pain

Classification by Burn Depth : 

Classification by Burn Depth

Zones of Injury : 

Zones of Injury

Extent of Burn - TBSA : 

Extent of Burn - TBSA

Lund & Browder Burn Chart : 

Lund & Browder Burn Chart

Minor Burns : 

Minor Burns Sunburn Exposure to ultraviolet light More commonly seen in light skinned clients Redness, pain, nausea/vomiting, chills Scald burn Exposure to moist heat Involves superficial and partial thickness Superficial burns less than 15% of TBSA

Classification – Minor Burns : 

Classification – Minor Burns Classification of Burn Injuries Minor Burn Injuries Excludes electrical, inhalation, and complicated injures such as trauma Partial thickness burn of less than 15% of total body surface area Full thickness burn of less than 2% of total body surface

Classification - Moderate : 

Classification - Moderate Moderate Burn Injuries Excludes electrical, inhalation, and complicated injures such as trauma Partial thickness burns of 15-25% of the total body surface Full thickness burns of less than 10% of total body surface

Partial Thickness Burn : 

Partial Thickness Burn

Major Burn Event : 

Major Burn Event

Cardiovascular System : 

Cardiovascular System Hypovolemic shock (Burn shock) – massive fluid shift from intracellular & intravascular into the interstitium 24 to 36 hours of injury Direct loss of cell wall integrity BP falls as cardiac output diminishes Proteins and sodium escape into interstitium Potassium increases then will decrease as burn shock resolves

Cardiovascular System : 

Cardiovascular System Myocardial dysfunction – ventricular fibrillation, cardiac arrest, & vascular compromise Peripheral vascular compromise – edema, compartment syndrome

Classification - Major : 

Classification - Major Major Burn Injuries Includes all burns of the hands, face, eyes, ears, feet, and perineum, all electrical injuries, multiple traumas, and all clients that are considered high risk Partial thickness burns of greater than 25% of the total body surface Full thickness burns of 10% or greater of the total body surface area

Burn Injuries : 

Burn Injuries

Pathophysiologic Effects of a Major Burn : 

Pathophysiologic Effects of a Major Burn Can involve all body systems Extensive loss of skin can result in massive infection, fluid and electrolyte imbalances, and hypothermia Cardiac dysrhythmias and circulatory failure Profound catabolic state & dehydration Alteration in gastrointestinal motility – Curling’s ulcer Overall body metabolism is profoundly altered

Pathophysiologic Effects of a Major Burn : 

Pathophysiologic Effects of a Major Burn Burn wound healing Inflammation, Proliferation, Remodeling Burn wound infection Increased sloughing of burn tissue Increased edema around wound edges Partial-thickness wound converting to full-thickness wound Black or brown areas of discoloration

Stages of Progression : 

Stages of Progression

Burn Stages : 

Burn Stages Emergent/Resuscitative Stage From onset of injury through successful fluid resuscitation Estimate extent of burn injury Institute first aid measures Client may be intubated Nursing diagnosis – Impaired Skin Integrity, Deficient Fluid Volume, Acute Pain, Powerlessness, Risk for Infection

Burn Stages : 

Burn Stages Acute Stage Begins with start of diuresis and ends with closure of the wound, either by natural healing or by using skin grafts Rehabilitative Stage Begins with wound closure and ends when client returns to highest level of health restoration, which may take years

Fluid Resuscition : 

Fluid Resuscition Necessary in all burns >20%TBSA Warmed Ringer’s lactate using Parkland formula 4mLxkgx&TBSA through two large bore (14 to 16 gauge) catheters for 1st 24 hours Hourly urine 30 to 50 mL/hr HR <120 beats/min Changed to 5% dextrose to maintain urine output

Respiratory Management : 

Respiratory Management Maintain head of bed 30 degrees TCDB every 2 hours Maintain adequate tissue oxygenation with least amount of inspired oxygen necessary Arterial line for continuous assessment of ABGS Pulmonary artery pressure catheter

Medications : 

Medications Morphine 3 to 5mg every 5 to 10 minutes Anxiolytic agents – midazolan (Versed)andlorazepan (Ativan) Antiulcer meds – dec.intestinal motility Topical antimicrobial therapy Mafenide acetate (Sulfamylon) cream – face and neck edema Silver nitrate 0.5% soaks – blackens skin Sulfadiazine(Silvadene) cream- leukopenia

Closed Dressing Method : 

Closed Dressing Method

Surgery : 

Surgery Escharotomy - prevent circumferential constriction, removal of eschar facilitates healing Surgical Debridement – remove burn wound to level of viable tissue, should bleed briskly before coagulation Autografting – permanent skin coverage Homograft/allograft – human skin Heterograft/xenograft – animal usually pig Biologic dressings – Biobrane, Intregra

Escharotomy : 

Escharotomy

Autograft : 

Autograft

Skin Grafting : 

Skin Grafting

Burn Contracture : 

Burn Contracture

Jobst Garment : 

Jobst Garment

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