Transcript BURNS - Vincent's

BURNS
M.GARDNER
NUR-224
BURNS
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Occurs when there is injury to the tissues
of the body as a result of heat transfer
from one site to another.
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Injury from exposure to heat, chemicals,
radiation or electric current
BURNS
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Approximately 1.1 million people require medical
attention of burns every year, and about 4,500
persons die from burns and associated
inhalation injuries every year.
Most burns occur in the home.
Young children and the elderly are at high risk
for burn injuries.
BURNS
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Affect peoples of all age groups,
socioeconomic groups
Males have greater then twice the chance
of burn injury than women
Age group – 20-40 years of age
5th most common cause of death from
unintentional injury
TYPES OF BURNS
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Thermal
Chemical
Smoke & Inhalation injury
Electrical
Cold Thermal injury
THERMAL BURNS
Caused by flames, flash,
scald or contact with hot
objects.
 Most common type of burn
 Occur most often in
children/older adults
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CHEMICAL BURNS
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Caused by direct skin contact, from acids,
& organic compounds
Found in many household cleaners, lab
chemicals
Remove the client from the burning agent
& quickly remove the chemical from the
skin
CHEMICAL BURNS
SMOKE & INHALATION
INJURY
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Result from the inhalation of hot
air/noxious chemicals damage to tissue
of the respiratory tract.
Client’s with smoke inhalation injuries
must be observed for signs of respiratory
distress.
ELECTRIC BURNS
Cause tissue damage & result from heat
generated by the flow of electric current
through the body.
 Only one with an exit wound
 Damage cannot be judged
from the size/depth of the
wound
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COLD THERMAL INJURY
SEVERITY BURN INJURY
1.
2.
3.
4.
5.
6.
Age of the patient
The nature of the burning agent
Depth of the burn
Extent of the burn calculated by (TBSA)
Location of the burn
Presence of inhalation of injury
DEPTH OF BURNS
Categorized according to depth of skin
destruction:
1. Superficial Partial -Thickness
2. Partial –Thickness Skin
3. Full –Thickness Skin
SUPERFICIAL PARTIALTHICKNESS SKIN
Superficial (first-degree)
a. Least severe
b. Limited to the first 2/3 layers of the
epidermis
c. Redness, mild swelling & pain , minor
pigment changes
d. Sunburn is considered 1st degree burn
DEEP PARTIAL -THICKNESS
SKIN
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a.
b.
c.
d.
Deep (second degree)
Usually involve the entire epidermis and
upper dermis
Blisters, edema
Severe pain  nerve injury
Will heal within 2-4 weeks with minimal
scarring
FULL-THICKNESS SKIN
Third/Fourth Degree Burns
a. Destruction of skin through all layers of
epidermis & dermis
b. Hard, leathery, eschar (burn scabs)
c. Edema is present
d. Sensation is minimal or absent/pain free
e. Possible involve of muscles, tendons &
bones.
EXTENT OF BURN INJURY
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1.
2.
Two commonly used guidelines to
determine the total body surface area
affected to the extent of the burn wound
are:
Lund-Browder chart
Rule of nines
RULE OF NINES
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Easy to remember
Estimated % of total body surface area
(TBSA )in the adult is arrived by sectioning
the body surface areas with numerical
value related to nine.
Considered adequate for initial
assessment of an adult burn patient.
RULE OF NINE’S
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Head & Neck -- 9%
Right arm – 9%
Left arm - 9%
Trunk - 36%
Left leg -18%
Right leg -18%
Perineum -1%
LUND-BROWDER CHART
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More accurate pt.’s
age, in proportion to
relative body-area
size , is taken into
account.
PATHOPHYSIOLOGY
Hemodynamic instability
 loss of capillary integrity
 shift of fluid -- sodium, proteins from
intravascular space  interstitial space.
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ALTERATIONS
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Cardiovascular
Fluid/electrolyte
Pulmonary
Immunologic
Renal
Thermoregulatory
Gastrointestinal
ON THE SCENE CARE
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Remove the person from the source of the
burn & the burning process
Prevent further injury
Maintain V/S, initiate CPR(if necessary)
Rescuers must protect themselves from
the burning process
ON THE SCENE CARE
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adhered clothing leave in place
wrap the client in a clean sheet/blanket
no food/fld. by mouth
place in position to prevent aspiration
PHASES OF BURN
MANAGEMENT
Emergent phase (resuscitative)
 Acute phase (wound healing)
 Rehabilitative phase (restorative)
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EMERGENT PHASE
Onset of injury to completion of fluid
resuscitation
Patient is transported to emergency department
Fluid resuscitation is begun
Foley catheter is inserted
Patient with burns exceeding 20–25% should
have an NGT inserted and placed to suction
Rule of Nine’s
Focus on onset of hypovolemic shock & edema
formation
EMERGENT PHASE
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Patient is stabilized and condition is continually
monitored
Patients with electrical burns should have ECG
Address pain; only IV medication should be
administered
Psychosocial consideration and emotional
support should be given to patient and family
NURSING MANAGEMENT
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Aseptic management – wounds/invasive
lines
Elevate burned upper/lower extremities
Large bore IV catheters/ foley catheter
Monitor fluid intake, I/O, v/s,
Burgundy – colored urine
Neurologic asessement
ACUTE PHASE
Begins with the mobilization of fluid &
diuresis & ends when the burns are
completely closed
Prevent complication
Nutritional support
Burn wound care
Pain management
May take weeks /months.
PATHOPHYSIOLOGY
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Mobilization of fluid begins
Bowel sounds return
Healing begins
Partial-thickness burn wound  heal from the
edges
Full thickness-burn wound  must be covered
by skin grafts
Pt. becomes aware of the situation
LABORATORY VALUES
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Body is attempting to reestablish
homeostasis.
Decreased hematocrit
Increase u/o
Sodium (Na) deficit
Potassium (K+) deficit
ACUTE/INTERMEDIATE PHASE
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Topical antibacterial therapy
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Wound debridement
* natural, mechanical, chemical, surgical
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Wound grafting
* autograft, homograft, heterograft
* CEA – cultured epithelial graft
NURSING MANAGEMENT
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Restore fluid balance
Prevent infection
Adequate nutrition
Promote skin integrity
Pain management
Physical mobility
POTENTIAL COMPLICTIONS
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Heart failure
Sepsis
Acute respiratory failure
Visceral damage
REHABILITATION PHASE
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Begins immediately after the burn has
occurred and may extend for years after
the injury.
Wounds have healed and the patient is
able to resume a level of self-care activity.
Goal : return of ADL’s, self-care, scar
management, return to work
REHABILTATION PHASE
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Abnormal wound healing
hypertropic scars
keloid
Treatment of scars
Nursing intervention
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Mental health
Burn skin precautions
Nutrition
Pain management
Thermoregulation
FYI
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Cleansing wounds  avoid crosscontamination of the patient’s wound
Move patients slowly and carefully across
bed sheets to prevent shearing or
dislodgement of new skin grafts
Narcotics are always administered
intravenously due to decreased
circulation