class 14 burn's Flashcards
role of epidermis
barrier
role of dermis
dense connective tissue
role of subcutaneous tissue
regulation of body temp
what are the functions of the skin
-protection against infection
-prevention of fluid loss
-temperature maintenance
-sensory organ(touch, heat, cold, pain)
-can be eliminated partially or totally depending on burn
infants and burns
-thinner, more permeable skin, less subcut fat
-greater potential for fluid loss, less effective temperature regulation
-can be damaged at a lower temp/less duration than adults
-larger body surface area= greater loss of fluid, have to have inc calories & protein
older adults and burns
-skin becomes thin with a decrease in strength, moisture, and elasticity
-decrease in lean muscle mass and subcut fat, diminished sensation of pain
-slower wound healing
moralitiy with thermal injuries
-fire/smoke inhalation= most common
-death rates 11x higher in low/middle income countries
-infants, elderlt at greatest risk
morbiditiy with thermal injuries
-most pediatric burns are d/t scalds
-most are in the home
nursing care for burns patients
-knowledgable about physiology changes
-good wound care
-good assessment skills
what is a thermal burn
-majority
-exposure/contact to something hot (fire, steam, stove etc)
what is an electrical burn
-very common in children/teen(risk behaviour)
-occurs when in contact with electricity (socket, lighting, live wire)
what is a chemical burn
-burns that occur when in contact with a harsh substance such as acid
-can have mucus membrane bruns from drinking
-i.e bleach, drain cleaner, paint thinner
what are radiation burns
damage to the tissue as a result from radiation
treatment of burn
-determined by percentage of burn and depth
-is on face/nares, airway is priority
what is the rule of nines
each part of the body represents 9% (chest, each leg, abdomen, both arms)
-used for ages 10+ (in kids head is 18%)
-compartment syndrome can occur is the circumference of the body part is burned
what is a superficial injury
-1st degree
-epidermis only, appearance of skin is red, blanches easily, painful
i.e.sunburn
-place in cold water & take tylenol
what is a partial thickness injury
epidermis and part of dermis
-burns look wet, moist, blistered, red, painful
-pending on how much of the dermis is involved can be broken down further to deep partial thickness
what is a deep partial thickness injury
involves more of the dermal
-skin appears mottled, pink, red, even waxy white areas, edema, and blisters
what is a full thickness injury (3rd degree)
-subdermal involves entire epidermis, dermis, and its structure (some muscle, nerve endings, sweat glands, hair follicles destroyed)
-skin looks tough, leathery, black, dry
-does not blanch, is painless to touch
-grafting is required
what is a full thickness injury (4th degree)
-all skin and nerve endings destroyed and includes muscle and bone
-blood vessels and bone may be visible
necrosis occurs, amputation common, grafting is required
what percent is considered a minor burn
<10% TBSA in adults or <5% in young or old
<2% full-thickness burn
what percentage is considered a moderate burn
10-20% in TBSA
-5-10% TBSA kids or old
2-5% full thickness burn
what percentage is considered a major burn
> 20% TBSA in adult
10% TBSA young or old
5% full-thickness burn
what is an inhalation injury
-burns in the airways
-look for signs of thermal injury to upper airway
-crackles in lungs/wheezing
local physiologic responses to burn
-tissue damage, erythema, edema, infection (bacteria colonizes on burn)
-burns that do not exceed over 10% do not have a local response
systemic physiologic response to burn
-capillary permeability
-hypovolemia
-anemia
-decreased blood flow to GI tract
-increased metabolism
post burn physiologic response to burn
temp will be 38 (less indicated sepsis)
-if fluid resus doesn’t work->albumin and fresh frozen plasma
-shunt of blood to brain/heart/kidneys
-decreased BF to GI can lead to inc risk for aspiration (NG on low continuous)
management of minor burns
-cool
-cleanse
-manage blisters (do not pop unless chemical)
-apply topical medication + dressing
-analgesia for comfort
-possible tetanus shot
management of major burns
-airway, 100% o2 (ET if airway burn)
-v/s, nv assess
-IV (large bore)
-NGT, foley
-IV pain management
-EKG, cardiac monitor for electrical burns
-baseline labs
-tetanus
-room temp 28-32 to prevent hypothermia
fluid resus in burns
-gauged by physiologic response
-determined by output, BP, AR, COC, cap refill
-IV fluids given if >10% burned (RL)
nutriton and burns
first 2-3 days: hypometabolic phase
5-9 days: hypermetabolic
-erosion of lean body mass, muscle weakness, immunosuppression, poor wound healing
-high protein, high calorie
-vitamins A, C, Zinc
-supplement feedings in burns 25% or greater
wound care for burns
-primary excision
-debridement - hydrotherapy
-topical antimicrobials & dressings
-biological skin coverings
-permanent skin covering
rehab phase of burns
cont’d pain & puritis management
-scare management
-minimize functional loss/prevent contractures
-ongoing psychosocial support
