burns Flashcards
6 types of burns
- thermal
- chemical
- inhalation
- electrical
- radiation
- extreme temperature burns
thermal burns
caused by flame, flash, scald or contact with hot objects
chemical burns
exposure to acid, alkaline, or chemicals
inhalation burns
causes oral/nasal, esophageal & direct parenchymal lung injury
(alveoli = functional part of lung)
electrical burns
results from conversion of electrical energy into heat
radiation burns
transfer of radiant energy to the body
ex: radiation therapy for cancer
extreme temperature burns and who is at risk?
frostbite
children & older adults increased risk d/t reduced ability to generate heat
what is the most common type of burn
thermal burn
severity of a burn is determined by…
- depth
- extent of burn calculated in % of total body surface area (TBSA)
- location
- age of pt, pre-burn medical hx & circumstances or complicating factors
1st degree burn
superficial partial thickness
*epidermis
2nd degree burn
deep partial thickness
*dermis
3rd & 4th degree burn
full thickness
*fat, muscle and bone
rule of nines
used for initial assessment to measure the extent of burns
primary goal in emergency
-stop the burning by removing the source
-ABC’s
-assess burns
-transfer to burn center, as needed
-stabilization
3 phases of burn management
- emergent (resuscitative) phase
- acute phase
- rehabilitation phase
emergent (resuscitative) phase
*time needed to resolve the immediate, life-threatening problems from burn injury
*massive F&E shifts r/t massive increase in capillary permeability
~ lasts up to 72 hours from time burn occurred
~ ends when fluid mobilization and diuresis begins
main concerns of emergent phase
hypovolemic shock PRIMARY CONCERN
edema formation
clinical manifestations of emergent phase
hypovolemic shock (decrease BP)
blisters
if partial/full thickness –> nerve endings are damaged, so painless at first, then very painful
how is the CV system susceptible to complications in the emergent phase?
shock, increased blood viscosity, VTE
circumferential burns & edema impairs circulation more
*escharotomy: treatment where scalpel opens and allows perfusion to area swelling - slice top of skin to allow for decreased circulation
how is the respiratory system susceptible to complications in the emergent phase?
concern for injury of the upper and lower airway
how is the urinary system susceptible to complications in the emergent phase?
acute renal failure d/t decreased blood flow to kidneys (w/ shock) and excessive myoglobin and hemoglobin released can block renal tubules (pt will experience renal shutdown)
nursing management in the emergent phase
airway management
fluid therapy
-aggressive resuscitation with 2 large bore IV’s or CVAD and fluid resuscitation
-crystalloids (LR), colloids (albumin) or combo of the 2
-amt/formula determined by location + extent of burn
wound care during emergent phase
-debridement: necrotic tissue is removed
-escharotomies & fasciotomies
-physically and mentally demanding for patient (excruciating pain)
-permanent skin coverage is primary goal
when wounds are exposed…
PPE (hats, masks, gloves, gowns)
sterile gloves to apply ointments/dressings
keep room warm - >85 (bc pt have no skin barrier)
drug therapy during the emergent phase
opioid analgesics & sedatives - ATC & IV route
tetanus immunization (if not had in the last 10 years)
VTE prophylaxis
topical antimicrobial agents
-silver sulfadiazine
-systemic only if concerns regarding sepsis (Abx)
nutritional therapy during emergent phase
enteral feedings to treat extreme hyper metabolic state
acute phase
~ begins with mobilization of ECF and subsequent diuresis
~ ends when partial-thickness wounds are healed and full-thickness burns are covered by skin grafts
takes weeks to months
watch labs closely –> F&E influx
physical therapy and occupational therapy
partial thickness vs full thickness wound in acute phase
partial: eschar formation = removed & re-epithelialization occurs
full: eschar takes longer to separate; surgical debridement & skin grafting is common
