Burns Flashcards
Explain the causes of burn injuries and prevention strategies.
caused by contact with dry heat (fire), moist heat (steam or hot liquid), corrosive chemicals, electric current, or radiation.
influenced by:
-temperature of burning agent
Duration of contact time
Type of tissue that has been injured
common: Flame, Scalding, Contact with hot objects
Chemical burns:
-Contact, concentration, volume and type are significant factors.
-Acids-Hydrochloric acid binds with calcium in the tissues
Acids can be neutralized by tissue fluids
-Alkaline ex. Drain-O. Harder to tx because alkaline substances cannot be neutralized by tissue fluids
-Organic- in disinfectants
- Smoke and Inhalation injury
3 types:
1)Carbon monoxide poisoning and asphyxiation
-Carbon monoxide poisoning- looks Cherry red. Carbon monoxide replaces O2 on hemoglobin = hypoxia
headache, dizziness, weakness, upset stomach, vomiting, chest pain, and confusion(flu like). No O2 sat indication
2) Inhalation injury above the glottis
-edema, blistering or redness of the oropharynx and larynx. Mechanical obstruction of inhalation can occur quickly.
-Early indicators- facial burns, singe nasal hair, voice hoarseness, painful swallowing, darkened oral and nasal membranes, carbonaceous sputum (thick black sputum), hx of being burned in enclosed space, clothing burns around chest and neck
3) Inhalation injury below the glottis
With tissue injury to the lower respiratory tract, clinical manifestations may not happen until 12-24 hrs after injury.
-chemically produced due to the duration of exposure to toxic fumes that is in the fine particulate matter causing inflammation and toxic effects. Manifestations occur 24 hrs after exposure; look like acute respiratory distress
ALWAYS worried about A-airway obstruction from swelling/edema
Tx: high flow 100% o2 in non-rebreather mask for at least 80 min
Electrical Burns
-lightening or contact with high voltage wire produces heat as electricity moves through the body.
-Extent of damage can be difficult to determine since damage is mostly below the skin (iceberg effect)
-Influenced by:
Duration of contact
Intensity of current (voltage)
Type of current (direct or alternating)
Pathway of current
Resistance of tissues as it passes through the body
-Remember they may have _fallen____ and the cause of immediate death is _cardiac failure_______.
-High voltage/lightening can throw a body and cause heart rhythm irregularities/arrest or vfib arrest which is shockable
-There is usually an entrance and exit as heat moves thru the body (grounded)
- Contact with electrical currents can cause muscle contractions strong enough to fracture the long bones and vertebrae.
-Current that passes through vital organs will produce more sequelae than current that passes through other tissues.
-Risk for myoglobineima – from muscle damage (protein breakdown) =protein ‘myoglobin’ release= myoglobins which are large proteins-> kidney obstruction -> acute kidney injury or acute tubular necrosis
Radiation Burns
Source: significant sunburn leading to carrcinogenisis of skin cells, From cancer radiation too
-Localized response: skin erythema, edema, pain
-Influenced by:
Distance from radiation
Strength of radiation source
Duration of exposure
Extent of body surface area exposed
Amount of shielding between person and source
Indications for tranfer to burn unit:
-burn in around face
-upper/lower airway burn
25% surface area burned
Location of the Burn
Face: mechanical obstruction rt edema or leathery eschar tissue might inhibit respiratory function.
Hands: inhibits self care
Ears/nose- risk of infection because of no blood supply + exposure to bone.
Buttocks/perineum- risk of infection because close to urine and feces
Extremities- cause circ impairment distal to the burn and then neurologic impairment. At risk for compartment syndrome and edema
Other concerns:
pt w/ HF, COPD, heartdisease:
Fluid overload causing HF and pulm edema
Pneumonia /Resp disease have poor prognosis of recovery because of higher demands on body with injury and healing
T2DM and PVD high risk of poor healing dt lack of circulation
Alcoholics have more compliations and longer hosp stays due to liver damage and malnutrition
Mortaliy rates highest in children because they lose fluid and elec balance gets so bad so hard to maintain cardiovasuler status
MOI(cause/hx of burn) is important. Where there fine particular matter => chemical burn
Differentiate between partial and full-thickness burns.
Classification of burn injury
Severity of the injury is determined by:
1) burn depth
2) extent of burn
3)location of burn
4) pt risk factors
Tx of burns is related to the severity of the injury.
3 layers.
Epidermis –nonvascular, nonliving epithelial cells. Barrier, hold in fluids and elec, regulate temp keep harmful agents out
Dermis- thicker than epidermis. Blood vessels and connective tissue, follicles, sweat glands, subaceous glands, nerve endings
Subcutaneous tissue – major vascular networks, fat, nerves, lymphatics. Heat insulator for muscles, tendons, bones, organs
DEPTH OF BURN INJURY
-Partial-thickness burns involve injury to epidermis and dermis.
First-degree burn- superficial
-epidermis
-painful, appear red, with no blistering initially (after 24h, skin may blister and peel).
Second-degree partial-thickness burns
-epidermis and dermis
-appear wet or blistered and are extremely painful but can heal on their own if area small and there is no infection.
-Painful because nerve endings
-Polysporin and occlusive bandaid
Full thickness burns
Third-degree full thickness burn
-damage throughout dermis into subcutaneous tissue
-unless area small and no infection, grafting is necessary.
-Dense white waxy or chared dry appearance,
-sensory nerves are destroyed so pinprick is lost
-the coagulated dead skin is called eschar. Burned skin is painless but it is the surrounding skin that is painful. Needs sx
Fourth-degree full-thickness burn
-involves skin, fat, muscle and sometimes bone.
-charred and needs sx debridement, grafting, sometimes amputation
Learn how to use the Rule of 9’s or the Lund Brower chart to determine severity of burns.
Burn size expressed as a percentage of total body surface area (TBSA) using the:
Lund Brower Chart
“Rule of 9’s”
rule of 9’s
anterior/posterior
head: 4.5/4.5
arms (4.5/4.5)x2
legs (9/9)x2
trunk 18/18
groin 1
total 50.5/49.5 =100%
Explain the etiology, pathophysiology, clinical manifestations, complications, collaborative care and nursing management of burn patients throughout the three burn phases.
Immediately following burn:
-vasoactive substances are released from injured tissue (These substances initiate changes in capillary integrity and allow plasma to seep into surrounding tissue) = will cause fluid shift with increase cap permeability, proteins leak outside of vessels and then intravascular oncotic pressure is low = fluid follows proteins into surrounding tissues
-Direct damage to vessels from heat further compromises vascular integrity and sodium-potassium pump fails = cellular edema.
-If the tissue is not cooled but continues to heat up cell necrosis occurs.
Phases of Burn Management:
1. Pre-hospital care
2. Emergent (resuscitative)
3. Acute (wound healing)
4. Rehabilitative (restorative)
- Pre-hospital care
Unresponsive patients with >10% TBSA burns, electrical or inhalation injury: CAB
Responsive patients: ABC
A-Stabilize the Cspine
AB-Intubation and ventilation is usually needed in inhalation burns. When intubation is not needed, 100% humidified O2
-Stop the _burning –cool burn in sterile water
-submerge small flame/scald burns in cold water until burning sensation stops. Major burns are not submerged for more than 10 min due to major loss of heat (risk of hypothermia). Never cover with ice
-Remove dried chemical from the skin
-Remove _clothing and accessories, and wrap pt in_dry drsg/clean sheets to prevent heat loss +infection
-Establish _x2 large bore IV’s if burn is > 15% to start fluid resusitation
-Insert urinary catheter if burn is > 15% to monitor output and end-organ perfusion
-Elevate burned limbs above heart level to decrease edema
- Emergent phase (resuscitative)
Priorities: #1 airway, #2 fluids, #3 wound care
Primary nursing concerns during the emergent phase are:
Monitoring for hypovolemic shock
Monitoring for edema formation
Lasts up to 72h from time of injury
-the period of time required to resolve immediate, life-threatening problems resulting from the burn injury
-Primary concerns are:
Onset of hypovolemic shock
Formation of edema
Sepsis
Fluid and electrolyte shifts
-Colloidal osmotic pressure decreases = fluid shifting out of the vascular space into the interstitial spaces
-Fluid accumulation in interstism = 2nd spacing
-3rd spacing- exudate, blister formation and edema in non-burned areas
-Hypovolemic shock caused by…massive fluid shifts out of blood vessles as a result of cap permeability. —-Water, Na, and later protein will leak into interstitial spaces
Signs of shock are:
-low BP
-increased HR
-increased RR
RBC’s are hemolyzed and thrombosis in the capillaries cause an additional loss of RBC’s. Elevation of the hematocrit occurs due to intravascular fluid loss = blood is viscous.
Injured cells and hemolyzed RBC release _K+__________ into circulation
K is largest intracellular cation. Cells destroyed= K released = hyperkalemia
Immune response is suppressed following burns, causing widespread impairment of the immune system
- 1- skin barrier is destroyed
2- bone marrow suppression occurs
3- circulating levels of immunoglobulins decrease
4-func of WBC becomes defective
5- the inflammatory cascade triggers by tissue damage impairs the function of lymphocytes/monocytes/neutrophils
*Significant risk of infection and sepsis with extensive burns.
Clinical manifestations of burns:
Areas of full thickness and deep partial thickness burns are initially anesthetic because the nerve endings are destroyed.
Blisters filled with fluid may form in partial thickness burns
Large burn may have signs of an adynamic ileus such as absent/deceased bowel sounds as the body’s response to trauma and K shifts
Shivering may occur as a result of chilling from heat loss, anxiety, pain
-Usually burn pts are conscious, if thy are not or have altered LOC, it is dt hypoxia from smoke inhalation. —May not show up on Sat probe because hemoglobin will be attatched to carbon monoxide not O2/head trauma/substance use/sedation from meds in pre-hospital phase
Complications of the Three Major Organ Systems:
*ALL body systems are affected by > 25% TBSA burn.
CVS Complications:
-Dysthymias and hypovolemic shock which may progress to irreversible shock.
-Impaired circulation to extremities
-Tissue ischemia
-Necrosis
-Impaired microcirculation and ↑ viscosity → sludging
Respiratory Complications:
Upper airway injuries cause edema formation and upper airway obstruction
-look for singed facial/nasal hair, lip swelling, neck eschar
-look inside mouth
-anticipate early intubation because swelling is massive and onset sudden
Lower airway injury
-take longer to react to injury 12-24 hrs
-caused by inhalation of smoke/toxic chemicals
-intersital edema that prevents diffusion of O2 from alveoli to circ system
-signs of impending resp distress:
-increased agitation, restlessness, change in rate/character of resps
Genitourinary system complications
-Acute kidney tubular necrosis due to hypovolemia/lack of circulating volume
-With full thickness and electrical burns:
-release of myoglobin from muscle cell breakdown and hemoglobin from RBC breakdown into blood stream and occlude renal tubules
Nurse priorities:
1. airway management
2. fluid therapy
3. wound care for reduce infection risk
AIRWAY MANAGEMENT
1. Early endotracheal intubation – if evidence of upper airway involvement
-Preferrable oral tracheal (Eliminates need for emergency trach after resp problems become apparent)
-Major burns to face/neck need intubation within 1-2 hrs after injury
-After intubation, pt is placed on ventilation and the O2 concentration is determined by ABG values
-Extubation when edema resolved (3-6 days after injury) unless severe inhalation into lower airways
- Escharotomies of the chest wall – so intercostal muscles can flex and expand to help with oxygenation and prevent complications
-Rt circumfrential full thickness burns of the neck and trunk - Fibreoptic bronchoscopy – camera in upper airways to look for early inhalation injuries – is it black and sutty –to anticipate lower airway complications
-done 6-12 hrs after smoke injury is suspected
-Mucosal edema, hemorrhage, ulceration, carbonaceous material - Humidified air and 100% oxygen – when not intubated, and high fowlers position. DB+C q1h.
Fluid therapy
-At least two large-bore IV lines for >15% TBSA
-Central line for >30% TBSA
-Type of fluid replacement based on size/depth of burn, age, and individual considerations
-Parkland (Baxter) formula for fluid replacement
Colloidal solutions- is with albumin
-Wait util after 12-24 hrs post burn when cap permeability returns to near normal/reverse so it pulls volume back into vascular space. If given too early, will pull more fluid out of vessels = worse 2nd spacing
Crystaloids - Ringers
How do we know fluid replacement is adequate?
-urine output 0.5-1ml/kg/hr (increases to 75-100ml/hr for electrical burns and evidence of hemoglobin uria and myoglobin uria
- Cardiac factors.
MAP>65mmHg
SBP >90mmHg,
HR <120 bpm
Wound care
-Should be delayed until a patent airway, adequate circulation, and adequate fluid replacement have been established.
-Cleansing
Can be done in a cart shower, shower, or bed
-Debridement
May need to be done in the OR
Loose necrotic skin is removed.
*Careful not to make pt hypothermic.
Warm NOT hot water
DRSGS:
Do not want to disturb wound bed
Taking off the top layer of new skin every time you take drsg off = less we do the better
Antimicrobial drsgs can be left on 3-14 days – decrease drsg changes = promote cellular replication
Source of infection is from pt’s own skin
(common) Closed drsg- sterile gauze dressings are impregnated with or laid over topical antimicrobial.
Open- patient’s burn is covered with a topical antimicrobial and has no dressing over the wound.
-Sterile gloves are used when applying ointments and sterile dressings.
-When open wound are exposed nurses must wear PPE.
-The room must be kept warm -hypothermia
-Shivering increases O2 consumption and caloric demand.
Partial thickness:
Pink-cherry red
Wet/shiny
Serous exudate
+/- intact Blisters
Full thickness:
Dry, waxy white-dark brown/black
Minor localize sensations because nerve endings are destroyed
Burned hands and arms should be extended and elevated to relieve edema
PAIN MANAGEMENT:
Types of pain:
-Background- at rest, repositioning = continuous.
Tx with long-acting pain med
-Procedural – acute pain and high intensity
Tx with breakthrough or PCA
-Hyperalgesia – pain when something touching them
– don’t have pillows touching them ect
-Itchiness when burn is healing
MEDICATIONS:
-Analgesia should be via IV opioids
ex hydromorphone, morphine
-IM meds are not absorbed adequately in burn tissue + pools = overdose
-onset of action is fastest for IV
- GI func is slower due to shock or paralytic ileus
Systematic antibiotics aren’t often used – no blood flow to burn eschar
other meds:
-sedatives
-antidepressants,
-tetnus immunization
-topical antimicrobials
-DVT – low molecular wight heparin
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Nutritional therapy:
-Hypermetabolic state proportional to the size of the wound.
-Fluid replacement takes priority over nutritional needs.
-Early and aggressive nutritional support within hours of burn injury
decreases mortality and complications.
optimizes wound healing.
Early enteral feeding preserves GI function and prevents complications like curlings ulcer.
-Less blood to intestines = less O2 and nutrients to intestinal wall cells = cells die = ulcer
Curling’s ulcers (stress ulcers) affect the duodenum (first segment in small int)
-Intubated pts need enteral feeding with NG or placed Gtube
> 20% TBSA can get a paralytic ileus within hours as a result of response to trauma (blood shunting)
-Large NG tube inserted and check Gastric residuals should be checked to rule out gastric emptying
Tx with metoclopramide which increases GI motility
Assess bowel sounds q8h
Explain the risks of carbon monoxide poisoning. What are relevant nursing assessments, diagnostics, and interventions associated with it?
Compare fluid and electrolyte shifts during the emergent and acute burn phases.
Differentiate the nutritional needs of the patient with a burn injury throughout the three burn phases.
Learn the burn wound care recommendations and surgical options for partial- and full-thickness burns.
Prioritize nursing interventions in the management of the physiological and psychological needs of patients through the three burn phases.
- Acute phase
recap of 2. Emergent phase
Emergent phase: first 12-72 hours. Fluid shifts. Loss of proteins, fluid follows. Risk of hypovolemic shock ++
Edema. Management of AIRWAY IMPORTANT
Esp upper airway burns – singed hair on face
C: give fluids large bore IV. Not sure about cap permeability, don’t give collids in fluid because will take fluid with it. Start with isotonic fluids.
Catherterize pt to monitor output and end-organ perfusion
Acute phase begins when cap permeability stops, mobilization of extracellular fluid, and diuresis is a significant jump in urine output.
-bowel sounds return after state of stress which reduces blood flow and movement
-necrotic tissue begins to slough
-The client may now become aware of the enormity of the situation and may benefit from additional psychosocial support.
-Main risk: infection, sepsis
SO we want full thick burns debrided early
Because necrotic tissue is breeding ground for bacteria
-Granulation tissue forms.
-A partial-thickness burn wound heals from the edges.
-Full-thickness burns must be covered by skin grafts
Partial-thickness wounds form eschar, which begins separating fairly soon after injury. Once the eschar is removed, re-epithelialization begins at the wound margins and appears as red or pink scar tissue.
-Epithelial buds from the dermal bed eventually close in the wound, which then heals spontaneously without surgical intervention, usually within 10–21 days.
-Margins of full-thickness eschar take longer to separate. As a result, full-thickness wounds require surgical debridement and skin grafting for healing.
-Debridement occurs in the OR – because of sterility, pt need to be under anesthesia. Esp in full-thickness burns.
-wounds need to be grafted or covered with dressing
Drsg; antimicrobial with silver in them which prevents things from growing (not antibacterial). Clean with sterile water, not saline. Layer of intercite gel
Hyponatremia can develop from
-excessive GI suction.
-diarrhea.
Manifestations of hyponatremia include weakness, dizziness, muscle cramps, fatigue, headache, tachycardia, and confusion.
Water intoxication
-The burn client may also develop a dilutional hyponatremia called water intoxication. To avoid this condition, the client should drink fluids other than water, such as juice, soft drinks, or nutritional supplements.
With any shift in fluids, will expect elec change
Don’t give hypertonic solutions because risk of hypernatremia
Hypernatremia may develop following:
Successful fluid replacement
Improper tube feedings
Inappropriate fluid administration
Hypernatremia may be seen following successful fluid resuscitation if copious amounts of hypertonic solutions were required.
K
Hyperkalemia noted if client has:
renal failure.
adrenocortical insufficiency.
massive deep muscle injury
Hyperkalemia can cause
cardiac dysrhythmias and ventricular failure.
muscle weakness.
ECG changes
Depending on how thick burn and cellular destruction because K will be released = hyper
Hypokalemia can be caused by:
lengthy IV therapy without potassium.
vomiting, diarrhea.
prolonged gastrointestinal suction.
Suctioning dt illeus = hypokalemia
Acute PhaseComplications
Infection
-Partial-thickness burns can become full-thickness wounds in the presence of infection.
-Burn wound infection may progress to transient bacteremia and sepsis as a result of burn wound manipulation (e.g., after showering and debridement)
-Manifestations of sepsis include hypothermia or hyperthermia, increased heart and respiratory rate, decreased BP, and decreased urine output. Mild confusion, chills, malaise, and loss of appetite may be observed. The WBC count will usually be between 10 000/μL (10 × 109/L) and 20 000/μL (20 × 109/L). Functional defects in the WBCs are noted, and the client remains immuno-suppressed for a period after the burn injury.
-The causative organisms of sepsis are usually gram-negative bacteria (e.g., Pseudomonas, Proteus organisms), putting the client at further risk for septic shock.
-When sepsis is suspected, cultures are immediately obtained from all possible sources, including the burn wound, blood, urine, sputum, oropharynx and perineal regions, and IV site.
However, treatment should not be delayed pending results of the culture and sensitivity studies. Therapy will begin with antibiotics appropriate for the usual residual flora of the particular burn unit. The topical antibiotic in use may be continued or may be changed to another agent.
At this stage, the client’s condition is critical, requiring close monitoring of vital signs. Collaboration with the Infectious Disease service is important to ensure appropriate antibiotic coverage.
Musculo-skeletal system
-Decreased ROM
-As the burns begin to heal and scar tissue forms, the skin is less supple and pliant.
ROM may be limited, and contractures can occur.
-Because of pain, the client will prefer to assume a flexed position for comfort. The nurse should encourage the client to stretch and move the burned body parts as much as possible. Splinting can be beneficial to prevent/reduce contracture formation
–burns on joints is ROM exercises during acute phase to ensure max func
-Contractures
Gastrointestinal system
-Paralytic ileus
-Diarrhea
-Diarrhea may be caused by the use of enteral feedings or antibiotics.
-Constipation
-Constipation can occur as an adverse effect of opioid analgesics, decreased mobility, and a low-fibre diet.
-Curling’s ulcer
Curling’s ulcer- spinal cord injury which dev in states of stress in duodenum = give PPI
-This condition is due to decreased blood flow to the GI tract during the emergent phase.
-The best measure for preventing Curling’s ulcer is feeding the client as soon as possible. Antacids, H2-histamine blockers (e.g., ranitidine [Zantac]), and proton pump inhibitors (e.g., esomeprazole [Nexium]) are used prophylactically to neutralize stomach acids and inhibit histamine and the stimulation of hydrochloric acid (HCl acid) secretion.
Clients with major burns may also have occult blood in their stools during the acute phase.
Endocrine system
-↑ Blood glucose levels
-↑ Insulin production
-Hyperglycemia
-dt stress response, cortisol = sliding scale
-can be caused by the increased caloric intake necessary to meet some clients’ metabolic requirements. When this occurs, the treatment is supplemental IV insulin, not decreased feeding. Serum glucose levels are checked frequently, and an appropriate amount of insulin is given if hyperglycemia is present. Glucometers may be used to assess blood glucose at the bedside; serum glucose samples are more accurate than capillary blood analysis by glucometer.
————
The predominant therapeutic interventions in the acute phase are
(1) wound care,
(2) excision and grafting,
(3) pain management,
(4) physical and occupational therapy,
(5) nutritional therapy, and
(6) psychosocial care.
wound care;
-daily observation, assessment, cleansing, debridement, and dressing reapplication.
-Nonsurgical debridement, dressing changes, topical antimicrobial therapy, graft care, and donor site care are performed as often as necessary, depending upon the topical cream or dressing ordered.
-The goals of wound care are to (1) prevent infection by cleansing and debriding the area of necrotic tissue that would promote bacterial growth, and (2) promote wound re-epithelialization and/or successful skin grafting.
Enzymatic debridement
Speeds up removal of dead tissue from healthy wound bed
Wounds are cleansed with soap and water or normal saline-moistened gauze to gently remove the old antimicrobial agent and any loose necrotic tissue, scabs, or dried blood. During the debridement phase, the wound is covered with topical antimicrobial creams (e.g., silver sulphadiazine, silver-impregnated dressings).
–debride with forceps and scissors, then sometimes need enzymatic debridement which breas down dead tussue chemically. Ex. Misalt which is hypertonic that pulls fluid and lifts slough
Pain management
-Continuous background pain
-tx:Morphine with haloperidol
a continuous IV infusion of an opioid
-Around-the-clock oral analgesics can also be used. Breakthrough doses of pain medication need to be available, regardless of the regimen selected. Anxiolytics, which frequently potentiate analgesics, are also indicated and include lorazepam (Ativan) or midazolam
-Treatment-induced pain
-Treatment-induced pain managed with potent, short-acting analgesic
-, premedication with an analgesic and an anxiolytic is required via the IV or oral route. For clients with an IV infusion, a potent, short-acting analgesic, such as fentanyl is useful. During treatment/activity, small doses should be given to keep the client as comfortable as possible.
Physical and occupational therapy
Good time for exercise is during wound cleaning.
Passive and active ROM
Splints should be custom-fitted.
Nutritional therapy
Meeting daily caloric requirements is crucial.
Caloric needs should be calculated by dietitian.
High-protein, high-carbohydrate foods
Favorite foods from home
Clients should be weighed weekly.
-burn pts are in hypermetabolic state for a long period of time
-the hyper met state is for weeks, nut requirements need to be assessed. High protein, high carb. Weekly weights. VS spinal – inn catabolic state. Both have high neds but diff reasons
-If the client is on a mechanical ventilator or is unable to consume adequate calories by mouth, a small-bore feeding tube is placed and enteral feedings are initiated. When the client is extubated, a swallowing assessment should be performed by a speech pathologist before the oral feeding is commenced.
-The alert client should be encouraged to eat high-protein, high-carbohydrate foods to meet increased caloric needs.
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Psychosocial care:
Social worker
Nursing staff
Pastoral care
- Rehabilitation Phase
The rehabilitation phase begins when
burn wounds are healed.
client is able to resume a level of self-care activity.
as early as 2 weeks or as long as 7–8 months after the burn injury.
Goals for this period are to:
(1) assist the client in resuming a functional role in society
(2) rehabilitate from functional and cosmetic reconstructive surgery. Rehabilitation-focused activities that have been taking place during the earlier emergent and acute phases now begin in earnest once the client’s wounds have healed.
-Burn wound heals either by primary intention or by grafting.
-Layers of epithelialization begin to rebuild the tissue structure.
-Collagen fibres add strength to weakened areas.
-In approximately 4–6 weeks, the area becomes raised and hyperemic.
-Mature healing is reached in about 12 months.
-Skin never completely regains its original colour.
The new skin appears flat and pink.
-hyperemic- skin becomes irregular. Can apply pressure to flatten out with compression sleeves/stockings
Newly healed areas can be hypersensitive or hyposensitive to cold, heat, and touch.
Healed areas must be protected from direct sunlight for 3–6 months.
Skin and joint contractures
-Most common complications during rehab phase
-Positioning, splinting, and exercise should be used to minimize contracture.
Nursing role:
-If needed, home care nursing services should be arranged to assist with care for the first few weeks postdischarge.
-An emollient water-based cream (e.g., Vaseline Intensive Care Extra Strength) that penetrates into the dermis should be used routinely on healed areas to keep the skin supple and well moisturized, which will decrease itching and flaking.
-Oral antihistamines may be used if itching persists.
-Postburn reconstructive surgery is frequently required following a major burn. It is important for the client to understand the need for or possibility of further surgery before leaving the hospital.
-Role of exercise cannot be overemphasized.
-Constant encouragement and reassurance
-Address spiritual and cultural needs.
