Module 5 - Burns Flashcards
Burns result in
cute inflammatory response & release chemicals with in the body
As severity of burns increase tissue and underlying organs have an increased risk at being …
destroyed
thermal burns
result from direct contact with a heat source (fire, sun, water)
nonthermal burns
result from exposure to an electric or chemical source, radiation, light, or friction (fug burns, radiation therapy, etc)
Pediatric and geriatric burns are more concerning because
their skin is thinner and more susceptible to heat
Burns are classified based on
Burns are classified based on depth and how much surface area the burn effects on the body
Partial thickness
(first degree) - affects the epidermis and part of the dermis - often with no scarring
Deep partial thickness
(second degree) - that destroy the epididymis and parts of the dermis - area is red, swollen, blistered, and cause a lot of pain
Full thickness burns
(Third degree)- destroys all skin layers and underlying tissue - wound appears hard and dry and charred (eschar)
Blisters
Frequently seen in deep partial thickness burns
Surrounding skin may be red
Area is often hypersensitive and painful
Edema
Seen in deep partial thickness and full thickness burns
Results from fluids shifting
Dead skin slowly sloughs off with healing occurring when cells along the edges regenerate
Dark coloring
Seen in full thickness burns; often painless initially, but pain increases as inflammation continues
As eschar shrinks, pressure is placed on tissues beneath, which could further compromise circulation
If on a limb, escharotomy (surgical cuts through the charred area) may be required to ease pressure and restore circulation
Requires skin graft for healing
Hypovolemic shock
Chemical mediators release and cause fluid shifts when the inflammatory response is invokes, meaning that if a burn is larger the shift can cause too much water, protein, and electrolytes to move into the surrounding tissues leading to edema, decreased blood pressure, and hypovolemic shock
Hematocrit increases due to the concentration of RBCs in circulating fluid in a decreasing circulating fluid volume deficit (FVD), or hemoconcentration
Albumin also moves out of the capillaries lowering osmotic pressure, making it difficult to correct and maintain circulating blood volume until the inflammation subsides
Inflammation process and healing of burns
Burns cause coagulation necrosis (an alteration in cell proteins).
Neutrophils and monocytes collect along the injury to destroy and remove microorganisms and destroy foreign material.
Fibroblasts and new collagen fibrils appear and start wound repair within 6-12 hours of the initial injury.
Immunologic Changes Resulting from a Burn Injury
Burns destroy the body’s first layer of defense—the skin barrier.
The bone marrow function becomes suppressed leading to a decrease in the amount of immunoglobulins circulating in the blood.
As the bone marrow function is suppressed, the white blood cells (WBCs), which are formed in the bone marrow, do not function adequately.
The inflammatory process affects the functioning of lymphocytes, monocytes, and neutrophils, placing the patient at an increased risk for infection.
Non-stick Dressing
This is used for small areas or superficial burns
skin graft
Grafts are used for larger burns since few cells are available to regenerate new skin.
They may be stretched to cover a greater area.
Temporary skin coverings (pig/xenograft or cadaver/allograft) may be used but are temporary because they will be rejected in time.
Cultured epithelial autograft (grown from the patient’s own skin cells) may be an option.
Biosynthetic skin substitutes are used when severely burned patients have little skin to use for grafts. These are strong and elastic and allow for the use of a thin skin graft. These skin substitutes reduce the number of surgeries required, decreasing scarring, and improving healing. Examples include Biobrane; Integra, or Matriderm (from cows); AlloDerm (from donated human skin); OrCel or Apligraf (donated neonatal foreskin)
Elastic Pressure Sleeve
This is used to control scarring, which may impact function and appearance.
Long-term use is often required.
burn complications - shock
explanation -
Fluid shift leading to edema and a loss of circulating intravascular fluid volume and eventually hypovolemic shock
May result in renal failure and organ damage
Hypotension
Tachycardia
Decreased urinary output (<30 mL/hr)
treatment -
Infusions of fluids
Electrolytes
Plasma expanders
burn complications - respiratory
Explanation-
Immediate inhalation of toxic fumes or gasses (carbon monoxide/cyanide), leading to respiratory damage
Fatal if inhaled in an enclosed space
Mucosal damage when hot air, steam, or chemicals are inhaled
Leads to damage to the lining of the trachea and bronchi
Airway obstruction
Inflammation within the lungs leading to pneumonia
treatment-
Requires administration of high levels of oxygen
Close observation of the patient for respiratory difficulties
burn complications - pain
Explanation-
Extremely painful throughout the healing process
Results from the actual injury, movement, and skin grafting procedures
treatment-
Administration of analgesics
burn complications - infection
Explanation-
Infection can extend into the burn from partial thickness to full thickness
Destruction of the skin barrier leads to an easy entry point for bacterial infection from normal microbes on the skin as well as opportunistic bacteria
Common bacteria in burn infections include Pseudomonas aeruginosa, Staphylococcus aureus, Klebsiella, and Candida
treatment-
Prescription of antimicrobial drugs
Proper use of appropriate therapy to decrease likelihood of the development of drug-resistant organisms
serious infection
Explanation-
Serious infections result in septic shock and organ failure
treatment-
Rapid removal of the infected tissue
Administration of antimicrobial drugs
Replacement with skin grafts
burn complications - pediatric-specific complication
Explanation-
Growth is affected during recovery
Metabolic needs are not met
Huge stress is placed on child
treatment-
Additional surgeries may be needed in the future to allow for growth and decrease the effects of scarring
