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BurnsBurnsBurnsBurns Injury to tissue caused by heat,

chemicals, electric current, orradiation.

500,000 in US every year are treatedfor burn injury

40,000 will require hospitalization

Most burns can be prevented

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GerontologicGerontologic

considerationsconsiderationso risk because of reduced mobility,

changes in vision, q sensation in hands

& feet, thinning of skin

Major burn is considered >25% TBSA

burned

Minor burn

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Types of Burn injuryTypes of Burn injuryTypes of Burn injuryTypes of Burn injury Thermal

Most common type of burn injury Caused by:

flame, flash, scald, or contact with hot

objects

Cold thermal

frostbite

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Types of Burn injuryTypes of Burn injuryTypes of Burn injuryTypes of Burn injury Chemical

Most commonly caused by acids

Alkali burns more difficult to treat

Remove the patient from the burning agent

Remove clothing containing the chemical Lavage with copious amounts of water

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Types of Burn injuryTypes of Burn injuryTypes of Burn injuryTypes of Burn injury Electrical

Can cause cardiac arrest

Initiate CPR

Metabolic acidosis develops within minutes

Administer sodium bicarb based on ABGs Myoglobin can cause ATN

Infuse Ringers Lactate and osmotic diuretic

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Type of Burn InjuryType of Burn Injury

Radiation Burn

Exposure to radioactive source

Nuclear radiation accidents Ionizing radiation in industry

Therapeutic irradiation

Sunburn

Amt of radioactive energy received is r/t time,

distance, shielding, strength of radiation source,

and duration of exposure

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Types of Burn injuryTypes of Burn injuryTypes of Burn injuryTypes of Burn injury Inhalation injury

Carbon monoxide poisoning

Treat with 100% humidified oxygen

Assess for facial burns, singed nasal hair,hoarseness, painful swallowing, &

darkened oral & nasal membranesmanifestations may be delayed

respiratory distress syndrome

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Risk FactorsRisk Factors

Males 20-40 years of age

Fire/flame account for 60% of burns

Carelessness with Cigarettes r/talcohol/drug use

30% of burn related deaths attributed to

structural fires Toddlers 2-4 years of age have higher

incidence of scald injury

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PreventionP

revention

See Box: 50-1 on p. 1241Teach Home Safety measures

Smoke detectors!!!!!

Fire extinguishers that work!!!!

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PathophysiologyP

athophysiology Injury to Skin

Fluid Shifts

Pulmonary System

Myocardial Depression

Altered Skin Integrity Immunosuppression

Psychological Response

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Classification of Burn InjuryClassification of Burn InjuryClassification of Burn InjuryClassification of Burn Injury

Depth

Partial thickness (1)

Hyperemia, intact tactile & pain sensation

Partial thickness (2nd)

Wet, Red, shiny vesicles, edema, severe pain

Full thickness (3rd)

Dry, pale, waxy, leathery skin, thrombosedvessels, insensitivity to pain, eschar

Full thickness (4th)

Skin charred, or completely burned away

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Clinical ManifestationsC

linical Manifestations Hypothermia

Fluid & electrolyte Imbalances

Alterations in Respiration

Decreased CO

Pain responses Altered Level of Consciousness

Psychological Alterations

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Classification of Burn InjuryClassification of Burn Injury Assess burn severity

Extent

Rule of Nines for initial assessment

Lund & Browder chart

Palm method

Burn diagram (Berkow formula)

Location direct relationship to severity

Patient riskFactors

Older adult heals/obese pts more slowly and

has more co-morbidities than younger patients

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Rule of Nines

Rule of Nines

Rule of Nines

Rule of Nines

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Phases of Burn InjuryP

hases of Burn InjuryP

hases of Burn InjuryP

hases of Burn Injury Resuscitative Phase

Usually lasts 36-48 hours after injury

Begins with fluid loss and edema Hypovolemic shock a threat because of

intravascular depletion***

Second and Third spacing occur

Increased insensible losses

RBCs hemolyzed & capillaries thrombose

Sodium & Potassium shifts

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Clinical ManifestationsC

linical ManifestationsC

linical ManifestationsC

linical Manifestations Pain if partial thickness

Hypovolemia and dehydration

Shivering

Blister formation

Altered mental status Decreased blood pressure

Increased pulse

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ComplicationsC

omplicationsC

omplicationsC

omplicationsCardiovascular system

Arrhythmias & cardiogenic shock

Ischemia necrosis gangreneRespiratory system

Edema & inhalation injury

Renal system

qblood flow to the kidneys ATN

Occlusion of renal tubules from myoglobin

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Nursing Care:Nursing Care: ResucitativeResucitative

PhasePhase

Nursing Care:Nursing Care: ResucitativeResucitative

PhasePhase Airway!!!!!

Non- rebreather face mask

Naso or endotracheal intubation

High fowlers

Central line for IV fluid

Hyperbaric oxygen Indwelling catheter

MonitorECG

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Nursing Care: ResuscitativeNursing Care: Resuscitative

PhasePhase NPO initially to prevent aspiration

Fluids

E

stablished IV access: lactated Ringers Replace to produce 30-50ml u/o per hour

Parkland formula: 4ml/kg per % ofTBSA burned =total fluid replace for 1st 24 after burn injury

given infirst 8 hours

given in second 8 hours

given in third 8 hours

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Fluid resuscitationFluid resuscitation

question?question?

Calculate the 24 hour IV fluid intake for a

70 kg. male who has sustained burns on

50% of his body?

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Nursing Care: ResuscitativeNursing Care: Resuscitative

PhasePhase

Nursing Care: ResuscitativeNursing Care: Resuscitative

PhasePhase Drug therapy

Analgesics: Morphine drug of choice

Sedatives: Haldol

Tetanus

GI support: Zantac, Tagamet, Nystatin Nutrition

Hypermetabolic state

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Nursing diagnoses:Nursing diagnoses:

Resuscitative PhaseResuscitative Phase Impaired gas exchange

Deficient fluid volume

Ineffective tissue perfusion: renal

Ineffective tissue perfusion: peripheral

Acute pain

Anxiety

Impaired Physical mobility

Disabled family coping

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Acute

Phase of Burn Injury

Acute

Phase of Burn Injury

Acute Phase

Fluids mobilize

Diuresis occurs

Edema subsides

Bowel sounds return

Epithelialization begins Partial thickness heal from edges & below

Full thickness require skin grafting

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Complications during AcuteComplications during Acute

PhasePhase

Complications during AcuteComplications during Acute

PhasePhase Infection * Culture

CV & Respiratory

Neurologic

Musculoskeletal

Gastrointestinal: Curlings ulcer

Endocrine

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Wound CareWound CareWound CareWound Care

Remove burned clothing

Cover with dry sheet and blanket

Infection a threat

Wound cleansing : hydrotherapy

Debridemet = Removal of loose necrotic skin

Mechanical wet to drySurgical: tangential or fascia

Enzymatic

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Wound

Care

Wound

Care

Antimicrobials: Silvadene, Sulfamylon,

Bactroban, Neomycin, Bacitracin

Wound treatment: open or multiple dsg

Other eye care with warm saline

artificial tears. o hands and arms

Early ROM can be done during

hydrotherapy

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Nursing Management inNursing Management in

Acute PhaseAcute Phase

Nursing Management inNursing Management in

Acute PhaseAcute PhaseWound Care

Enzymatic debridement

Collagenase,E

lase, Accuzyme Excision and grafting: Autograft , Homograft, Heterograft

Cultured Epithelial Autographs

Artificial Skin: Integra and Alloderm

Pain Management

Physical and Occupational therapy

Nutritional therapy

Psychosocial Care

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Nursing Diagnoses during AcuteNursing Diagnoses during Acute

PhasePhase

Impaired gas exchange

Ineffective airway clearance

Hypothermia

Risk for infection

Risk for stress ulceration

Imbalanced nutrition: less than body requirements

Acute pain

Impaired physical mobility

Disturbed personal identity

Disabled family coping

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Rehabilitative Phase of BurnRehabilitative Phase of Burn

InjuryInjuryWounds are covered with skin or healed

Goal is to assist pt. to resume functional

roleWounds heal by primary intention or

grafting

Flat & pink raised & hyperemic 4-6weeks later

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BurnsBurnsBurnsBurns

Emotional needs of:

PatientFamily

Staff