Care of the Patients with Burns

Burns I Burns II Burns III

Burns IV Burns V

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This type of burn results from exposure to dry heat (flames) or

moist heat (steam and hot liquids). It is the most common

burn injury that most often occur in children and older adults.

Thermal BurnsThermal burn results from exposure to dry heat (flames) or

moist heat (steam and hot liquids).Chemical burns occur as a result of accidents in homes or

industry when chemicals come in direct contact with the skin and epithelial tissues or are ingested.

Electrical burns occur when an electrical current enters the body.

Radiation burns are usually associated with sunburn or radiation treatment for cancer.

Inhalation injury is a frequent and often lethal complication of burns that can range from mild respiratory inflammation to

massive

Carbon monoxide has ___ times greater affinity for hemoglobin

than does oxygen.

200

Carbon monoxide, a common asphyxiant, is a colorless, tasteless, odorless gas that has a 200 times

greater affinity for hemoglobin than does oxygen. It displaces oxygen to bind with hemoglobin. Thus, it

impairs both oxygen delivery and cellular oxygen use resulting to tissue hypoxia.

This type of burn only involves the skin’s epidermal layer. It usually

results from damage from sunburn, ultraviolet light, minor flash injury

(from a sudden ignition or explosion), or mild radiation burn associated with cancer treatment. What type of burn

is this?

Superficial thickness burnSuperficial burn only involves the skin’s

epidermal layer. The skin color ranges from pink to bright red, and there may be slight

edema over the burned area. It usually heals in 3-6 days, with dryness and peeling of the

outer layer of the skin, and with no scar formation.

It is the most rapid method for calculating the size of a burn injury in adult patients

whose weights are in normal proportion to their heights wherein the body is divided

into areas that are multiples of9%. What method is this?

Rule of ninesRule of nines is a quick and common method of estimating the total

body surface area of the burn wound during the prehospital and emergency care phases.

Other methods:Lund and Browder method is a more accurate method for estimating

the extent of the burn injury used on the the patient’s admission hospital, critical care area, or burn center.

The "rule of palm" or palm method is another way to estimate the size of a burn. The size of the patient’s palm not including the surface

area of the digits is approximately 1 % of the TBSA.

It is a type of burn that occurs with destruction of the entire

epidermis and dermis, leaving no skin cells to repopulate. What type of burn is this?

Full- Thickness Burn

Full-thickness burn occurs with destruction of the entire epidermis and dermis, leaving no

skin cells to repopulate. The burn wound may extend into the subcutaneous fat, connective tissue, muscle, and bone. It has a hard, dry, leathery eschar that forms from coagulated

particles of destroyed dermis.

This type of burn involves the entire dermis and papillae of the dermis. The wounds are

red and moist and blanch when pressure is applied.

Blister formation also occurs. What type of burn is this?

Superficial Partial-thickness Burn

This may be caused by injuries as a brief exposure to flash flame or dilute chemical agents, or contact with a hot surface. In this type of burn, the wounds are red and moist and blanch when pressure is applied. Blister forms due to the leakage of

large amounts of plasma from the damaged small blood vessels. Touch and pain sensation remain intact. Pain in

response to temperature and air is usually severe. This type of injury may heal within 21 days with minimal or no scarring,

but pigment changes are common.

This phase of burn management lasts from the

onset of injury through successful fluid resuscitation.

What phase is this?

Emergent PhaseThe emergent/ resuscitative stage lasts

from the onset of injury through successful fluid resuscitation. During

this stage, healthcare workers estimate the extent of burn injury, institute first-

aid measures, and implement fluid resuscitation therapies.

What is performed to examine the vocal cords and airways of

burned patients at risk for obstruction?

Bronchoscopy

A bronchoscopy is performed to examine the vocal cords and airways of patients at risk for obstruction. Patients with severe smoke inhalation or poisoning

may require a bronchoscopy on admission and routinely thereafter for examination of the respiratory

tract, deep suctioning of the lungs, and removal of sloughing necrotic tissue.

What are 2 types of wound treatment used to control

infection?

Open method and the use of multiple dressing changes

 In the open method the patient’s burn is covered with a topical antimicrobial and has no dressing over the wound. In the multiple

dressing change method, sterile gauze dressings are impregnated with or laid over a

topical antimicrobial.

What is given routinely to all burned patients because of the likelihood of anaerobic

burn wound contamination?

Tetanus toxoid The current protocol for tetanus immunization in clients

with any burn injury is the same with other types of trauma. Clients who have not received immunization

against tetanus within the past 5 years should receive a tetanus toxoid booster. For clients who have not

been immunized, tetanus immunoglobulin, a passive immunizing agent, and the first of a series of immunizations with tetanus toxoid should be

administered.

The acute phase begins at approximately how many hours after the time of injury?

48-72 hours

The acute phase of recovery following a major burn begins when the patient is

hemodynamically stable, capillary integrity is restored, and diuresis has begun. This time-point begins at approximately 48-72 hours

after the time of injury

This is a type of gastroduodenal ulcer that possibly occurs with

burn patients.

Curling’s ulcerCurling’s ulcer, a type of gastroduodenal ulcer characterized

by diffuse superficial lesions, is caused by a generalized stress response resulting in decreased production of mucus and increased gastric acid secretion. Prevention is the best treatment to this condition, but prophylactic use of antacids and H2-histamine blockers like Ranitidine and proton-pump

inhibitors like Esomeprazole may be used to inhibit stimulation of hydrochloric acid secretion or reduce gastric

acid secretion.

It is the medical procedure of the removal of dead, damaged, or infected tissue to improve the

healing potential of the remaining healthy tissue.

DebridementDebridement involves the removal of eschar, exudate and

crusts. This promotes wound healing by preventing bacterial proliferation in and under the devitalized tissue. Debridement

of the burn wound is accomplished through mechanical, enzymatic, or surgical means.

This phase of burn managementbegins with wound closure and

ends when the patient returns to the highest level of health

restoration.

Rehabilitative stageThe rehabilitative stage begins with wound closure and ends

when the patient returns to the highest level of health restoration, which may take years. During this stage, the primary focus is the biopsychosocial adjustment of the

patient, specifically the prevention of contractures and scars and the patient’s successful resumption of work, family, and social roles through physical, vocational, occupational, and psychosocial rehabilitation. The patient is taught to perform

range-of-motion exercises to enhance mobility and to support injured joints.

A nurse sees a patient get struck by lightning during a thunder storm on a golf course. What should be the FIRST action

by the nurse?1. Check breathing and circulation.

2. Look for entrance and exit wounds.3. Cover the patient to prevent heat loss.

4. Move the patient indoors to a dry place.5. Get the patient up off the ground

1. Check breathing and circulation.

Cardiopulmonary arrest is the most common cause of death from lightening. Respiratory and cardiac status should be

assessed immediately to determine if CPR is necessary. All other actions are secondary.

A patient is brought to the emergency department with the

following burn injuries: a blistered and reddened anterior trunk,

reddened lower back, and pale, waxy anterior right arm. Calculate the extent of the burn injury (TBSA)

using the rule of nines.

22.5The anterior trunk has superficial partial-thickness burns and is calculated in TBSA as 18%. The arm has a deep partial-thickness burn and is calculated as 4.5%. The burn on the

lower back is superficial and is not calculated in TBSA.

A 70-year-old patient has experienced a sunburn over much of the body. What

self-care technique is MOST important to emphasize to an older adult in dealing

with the effects of the sunburn?1. increasing fluid intake2. applying mild lotions

3. taking mild analgesics4. maintaining warmth

5. using sunscreen

1. increasing fluid intakeOlder adults are especially prone to dehydration; therefore,

increasing fluid intake is especially important. Other manifestations could include nausea and vomiting. All the

measures help alleviate the manifestations of this minor burn which include pain, skin redness, chills, and headache. Use

of sunscreen is a preventative, not a treatment measure.

When evaluating the laboratory values of the burn-injured patient, which of the following can

be anticipated?1. decreased hemoglobin and elevated

hematocrit levels2. elevated hemoglobin and elevated hematocrit

levels3. elevated hemoglobin and decreased

hematocrit levels4. decreased hemoglobin and decreased

hematocrit levels5. hemoglobin and hematocrit levels within

normal ranges

1. decreased hemoglobin and elevated hematocrit levels

Hemoglobin levels are reduced in response to the hemolysis of red blood cells. Hematocrit levels are elevated secondary to hemoconcentration, and fluid shifts from the intravascular

compartment.

A patient is admitted to the emergency department with deep partial-thickness burns over 35 % of the body. What IV

solution will be started initially?1. warmed lactated Ringer's solution2. dextrose 5% with saline solution

3. dextrose 5% with water4. normal saline solution5. 0.45% saline solution

1. warmed lactated Ringer's solution

Warmed lactated Ringer's solution is the IV solution of choice because it most closely approximates the body's extracellular

fluid composition. It is warmed to prevent hypothermia.

Using the modified Brooke formula, calculate the amount of intravenous solution that will be administered in the first 8 hours for a patient with 40% TBSA and

weighs 52 kg.

2080 mLThe modified Brooke formula is 2 mL × total kg of body

weight × % TBSA. In this situation, 2 mL × 52 kg × 40 = 4160 mL. One-half is given over the first eight hours, or 2080 mL.