11/15/2011

11/15/2011

BURNS
HCC Nursing N241

11/15/2011

Contents
Structure of skin Types of burn (cause, depth, area, phase) Symptoms and complications Interventions (urgent and long-term) Nursing diagnoses

11/15/2011

Burns
Occur when there is injury to the tissues

of the body caused by heat, chemicals, electrical current, or radiation

11/15/2011

11/15/2011

Types of Burn Injury

Thermal burns: most common Chemical burns Smoke inhalation injuries Electrical burns: Radiation burns Cold thermal injuries

11/15/2011

Smoke Inhalation Injuries

from inhalation of hot air or noxious

chemicals Major predictor of mortality in burn victims Need to be treated quickly: who (area of burn) are at risk? Types Carbon monoxide poisoning above the glottis vs. below the glottis

Electrical BurnHand

Fig. 25-2 A

11/15/2011

Electrical BurnBack

Fig. 25-2 B

11/15/2011

Severity of injury is determined by Depth of burn Extent of burn Location of burn Patient risk factors

11/15/2011

Classication of burns by depth of injury

11/15/2011

11/15/2011

10

Classication of burns by depth of injury

Superficial partial-thickness burn

Involves the epidermis Pink-bright red, mild edema, mild pain Deep partial-thickness burn Involves the dermis Bright red, blister, moist glistening appearance Severe pain, graft may be needed Full-thickness burn Involves fat, muscle, bone Pale, waxy, charred, or nonblanching red No pain, graft required

11/15/2011

11

11/15/2011

12

Superficial (First-Degree) Burn

11/15/2011

11/15/2011

13

Partial-Thickness (Second-Degree) Burns

11/15/2011

14

Full-Thickness (Third-Degree) Burn

11/15/2011

15

Hyperbaric Chamber

11/15/2011

11/15/2011

16

The Extent of Burns

Lund-Browder chart Rule of nines

11/15/2011

17

11/15/2011

18

11/15/2011

11/15/2011

19

Classification of Burn Injuries

Minor Burn Injuries o Partial thickness burn < 15% of TBSA o Full thickness burn < 2% of TBSA Moderate Burn Injuries o Partial thickness burns of 15-25% of TBSA o Full thickness burns < 10% of TBSA Major Burn Injuries o all burns of the hands, face, eyes, ears, feet, and perineum, all electrical injuries, multiple traumas, all clients at high risk o PTB of > 25% of TBSA, FTB of 10% or > of TBSA

11/15/2011

20

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 Alteration in gastrointestinal motility Dehydration

11/15/2011

21

11/15/2011

11/15/2011

22

Phases of Burn Management

Pre-hospital care/ Emergent (resuscitative) From onset of injury to successful fluid

resuscitation Acute (wound healing) From the start of diuresis to the closure of the wound, either by natural healing or by using skin grafts Rehabilitative (restorative) Starts wound closure and ends when client returns to highest level of health restoration, which may take years

11/15/2011

23

Pre-hospital Care
Remove the person from the source of

the burn, Rescuer must be protected ABC Irriga on cover IV Foley ABG

11/15/2011

24

Parkland Formula
4ml of LR x Kg x %TBSA in first 8hr The rest in the remaining 16 hours

11/15/2011

11/15/2011

25

Emergent (resuscitative) Phase

The first 24-48 hours

Hypovolemic shock * second spacing * insensible loss of fluid Electrolytes imbalances Wounds infections, pain

11/15/2011

26

Management during emergency phase

Case A * 39 YO male truck driver admitted to ER following MVC/ fire * At ED, diagnosed with 1st, 2nd,and 3rd degree burn at ant. Chest, arms, hands VS: 96.2, 140, 40, 98/60 ABG: 7.49, PaO2 60, PaCO2 32, HCO3 22 A &O, Pain What to do?

11/15/2011

27

Acute Phase
begins with the mobilization of

extracellular fluid and subsequent diuresis concluded when the burned area is completely covered by skin grafts or when the wounds are healed

11/15/2011

11/15/2011

28

Drugs
Analgesics and sedatives
Morphine, Hydromorphone (Dilaudid)

Haloperidol (Haldol) Lorazepam (Ativan), Midazolam (Versed) Tetanus immunization Antimicrobial agents
Topical agents: Silver sulfadiazine (Silvadene)

Systemic agents: sepsis

11/15/2011

29

Wound Care
Infection/ sepsis prevention Sheet skin grafts must be kept free of blebs Prevent contracture Nutritional support

High-protein, high-carbohydrate Diet supplements Rehabilitation Cosmetic Functional

11/15/2011

30

Anasarca

10

11/15/2011

11/15/2011

31

Hydrotherapy Cart Shower

11/15/2011

32

Escharotomy

Debriding FullThickness Burn

Fig. 25-9

11

11/15/2011

Application of Silver Sulfadiazene to Moistened Gauze

Fig. 25-10

Surgeon Harvesting Skin

Fig. 25-11 A Fig. 25-11 A

Donor Site After Harvesting

Fig. 25-11 B

12

11/15/2011

Cultured Epithelial Autograft

Fig. 25-12 A

Contracture of the Axilla

Fig. 25-13

11/15/2011

39

Closed method of dressing a burn

13

11/15/2011

11/15/2011

40

custom-made elastic pressure garments such as a Jobst garment for 6 months to a year postgraft.

11/15/2011

41

11/15/2011

42

25-year-old male fell out of a tree and struck a hot

charcoal grill. He lacerated his left leg, and his clothes caught fire. Once brought to ED, his burns were estimated to be partial and full thickness over his face, neck, trunk, right upper arm, and left leg. He is alert, and his voice is slightly hoarse. His left leg is splinted, and the lacerated wound is cleaned and debrided. IV is started, and urinary catheter is inserted. Using the Lund-Browder chart, his TBSA is 46%.
In what phase of burning injuries would he be

classified?
What are the priorities of care for him? What places him at risk for an inhalation injury? What are your nursing goals for his long-term care?

14

11/15/2011

Classication of burns by depth of injury

11/15/2011

17

11/15/2011

18

11/15/2011

21

11/15/2011

41