Care of the Patients with

Burns

Burns I

Burns II

Burns
III

Burns
IV

Burns V

100

100

100

100

100

200

200

200

200

200

300

300

300

300

300

400

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400

400

400

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 Burns
Thermal 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

skins 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 burn

Superficial burn only involves the skins
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 of
9%. What method is this?

Rule of nines
Rule 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 patients 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 patients 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 Phase
The 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 firstaid 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 patients 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 timepoint begins at approximately 48-72 hours
after the time of injury

This is a type of gastroduodenal

ulcer that possibly occurs with
burn patients.

Curlings ulcer
Curlings 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.

Debridement
Debridement 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 management

begins with wound closure and
ends when the patient returns to
the highest level of health
restoration.

Rehabilitative stage
The 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 patients 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.

22.5
The anterior trunk has superficial partial-thickness burns and
is calculated in TBSA as 18%. The arm has a deep partialthickness 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 intake
2. applying mild lotions
3. taking mild analgesics
4. maintaining warmth
5. using sunscreen

1. increasing fluid intake

Older 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 levels
2. elevated hemoglobin and elevated
hematocrit levels
3. elevated hemoglobin and decreased
hematocrit levels
4. decreased hemoglobin and decreased
hematocrit levels
5. 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 solution
2. dextrose 5% with saline solution
3. dextrose 5% with water
4. normal saline solution
5. 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 mL
The 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.