Burns

Question 1

Patho of Burns

Answer 1

Fluid shifts from intravascular into interstitial space (3rd Spacing) due to increased permeability

Edema and low blood flow
INCREASED HCT - increased viscosity - hypovolemia shock

Question 2

Classification of Burn

Answer 2

Depth
Extent of burn calculated in % TBSA
Location
Age, pre-burn medical hx and circumstances/complicating factors

Question 3

Superficial Partial Thickness (first degree)

Answer 3

Affect Epidermis
Destruction of skin
Tactile/Sensation intact
Pain and mild swelling (no vesicles)
Erythema (blanchable)

Question 4

Deep Partial Thickness (second degree)

Answer 4

Affects Epidermis and Dermis
Nerves damaged - severe pain
Vesicles = red, shiny, & wet
Rupture – blisters and scarring
Mild/Moderate Edema

Question 5

Full Thickness (3rd and 4th degree)

Answer 5

Affects all skin elements and nerve endings
Lack of pain - nerve destruction
Dry, waxy, white, leathery/hard skin
See muscles, bone, tendons
Coagulation necrosis
Eschar
Fluid loss & infection concerns

Question 6

Phases of Management

Answer 6

Emergent (Resuscitative) Phase
Acute Phase
Rehabilitation Phase

Question 7

Emergent Phase

Answer 7

Major Concerns = hypovolemic shock (organs not perfused related to sudden fluid shifts) and edema formation

Patho
Massive F&E shifts r/t massive increase in capillary permeability

Clinical Manifestations
Anxious, painful, blisters form, shock s/s

End = fluid mobilization & diuresis begins

Question 8

Emergent Phase Complications

Answer 8

CV = shock + increased viscosity + VTE
Circumferential Burns & edema impair circulation even more – ischemia/necrosis/paresthesia
Tx= escharotomy (cut through necrotic tissue to improve circulation)

PULMONARY
Upper = Severe edema
Lower = atelectasis & pneumonia

URINARY = Acute renal failure r/t decrease blood flow to kidneys (w/ shock) and excessive myoglobin (muscle breakdown) and hgb release block tubules

Question 9

Nursing/ Interprofessional Management

Answer 9

1. AIRWAY MANAGEMENT
   patent airway
   O2 sat. - Supp. if needed + 100% humidification
2. FLUID THERAPY
   Aggressive via 2 large bore IVs/CVAD
   Crystalloids (LR), Colloids (albumin) - increase intravascular volume and increase CO
   Monitor resp., UOP (0.5- 1 mL/kg/hr), BP, HR, fluid resuscitation (FVE)
3. WOUND CARE
   Necrotic tissue removed during debridement - allow new skin to generate, give pain meds before and after
   Escharotomies and Fasciotomies to promote circulation - Pain meds and remove dead tissue/swollen connective tissue
   Sterile gloves, PPE, keep room warm (lose heat through wounds and prevent shivering)

Question 10

Emergent Phase Meds

Answer 10

Opioid analgesics and sedatives
Tetanus immunization
Topical antimicrobial (sliver sulfadiazine)
VTE prophylaxis - increased viscosity of blood
Nutritional Therapy - eternal feedings due to hypermetabolic state (wound healing)

Question 11

Acute Phase

Answer 11

Continued assessment and maintenance of resp., circulatory status, F&E balance, GI function
Fluid Intake, I&O’s, Pain management, emotional support
Watch lab values - F&E
high/low sodium and high/low sodium
PT/OT – regain and maintain muscle strength
Skin graft for full-thickness burns

Complications = infection, CV, and rep. compromise, limited ROM, skin and joint contractures, GI issues, increased glucose levels

HIGH protein, carbs, and calorie diet

Question 12

Rehabilitation Phase

Answer 12

GOALS = Resume a functional role in society and rehabilitate from reconstructive surgery

Avoid contractures and hypertrophic scarring - schedule ROM and consider pressure garments (keep scars flat)

Emotional/Psychological Needs
Anxiety & Anger
Depression & Fear
Guilt & hopelessness