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Adult Health 2

Why do people die from burns?

Shock, dehydr­ation, sepsis
If pt survives first 72 hours infe­ction

Universal Trauma Model

American Burn Associ­ation (ABA)
- Develops strate­gies, preven­tion, research
PRIMARY GOAL IS PREV­ENT­ION!
Burn: alteration in skin integrity resulting in tissue loss/d­amage

4 Major Types/­Causes of Burns

Thermal
Chemical
Electrical
Radiation

Thermal Burns

MOST COMMON
Due to exposure to dry heat (flames) or moist heat (steam, hot liquids)
Direct exposure to heat = cell destru­ction
Includes inhalation injuries r/t gases (CO) & particles

Chemical Burns

Direct skin contact w/ acidic or basic agents
- Treating acidic easier than basic (caustic)
May cause local tissue damage, system tox.
Damage can continue until traces disappear
Includes powders & gases
Treat quick to flush pH & lessen damage

Electrical Burns

Higher mortality than thermal burns
- Can generate a lot of damage, subdermal - high resistance off of tissues
Destru­ctive process of electrical burns persists for weeks beyond the insult
Has an "exit wound"
Affects...
- Muscles & bones
- Heart (dysrh­yth­mias)
- Rhabdo AKI, acute tubular necrosis

Electrical Burns - Electrical Current

Radiation Burns

Caused by solar or radioa­ctive agents
- UV burns, thermal radiation, ionizing radiation (x-rays)
Also may include friction burns r/t trauma

Inhalation Injuries

Result of resp. tract exposure to direct heat, chemicals, or carbon monoxide poisoning
CO poisoning: CO takes over RBC's AMS, HA, dizzy 100% NRB

Cross Section of the Skin

 

Burn Severity Affected By...

Length of exposure
Mechanism of injury
Depth of burn
Location on body
TBSA %
Age - children, older
PMH - DM, CHF
Entire leg risk of compar­tment syndrome
Perineum risk of infection

Functions of the Skin

Protective barrier
Assists w/ fluid & elect. balance
Thermo­reg­ulation
Excretion
Sensory organ
Epid­erm­is: basic protection
Derm­is: blood vessels, nerves, sweat glands
SQ: fatty tissue; can have veins, arteries, & nerves

Burn Injuries

1st degree
(Super­ficial wounds)
2nd degree
(Partial thickness)
3rd degree
(Full thickness)
4th degree?
(Bone?)

First Degree Burn

Painful r/t damaged nerves
Warm, blanching effect

Superf­icial Partial Thickness Burn (Second Degree)

May be shiny, pink, red - blanching?
Scar formation

Deep Partial Thickness Burn (Second Degree)

MORE SEVERE, skin grafts may be necessary

Third Degree Burn

May be black, some redness, yellow
Skin grafts (doesn't heal on own)
Eschar needs to be removed
Breathing issues if front &/or back of chest
Cartil­aginous areas may not heal as well (r/t dec. blood supply)
May have some disability

3 Zones of Injury

Zone of coag.: injury site, tissue necrosis
Zone of stasis: infla­mmatory response = vasoco­nst­riction = tissue may be salvaged
Zone of hypere­mia: inc. inflam­mation = vasodi­lation = inc. blood flow

Degrees of Burns

 

Systemic Response to Burns

All systems are affected
Extent of dysfun­ction depends on the TBSA involved
Early: hypo­fun­ction hyperf­unc­tion
- Occurs rapidly
- Inc. permea­bility plasma leaks to inters­titial spaces dec. CO r/t dec. fluid volume (dec. BP) hyperf­unction (compe­nsatory mechan­isms)
Maximal edema occurs in 8-48 hours

Major Burn Event

R/t systemic inflam­mation
Concerns:
Shock:
- Fluid & electr­olyte imbalance
- Temp. regulation
- Pain control (IV)
Infe­cti­on:
- Reverse isolation (no plants, fresh fruits­/ve­ggies, current immuni­zat­ions)
- Temp. regulation (room ~80oF)

Rule of 9's

Lund & Browder Classi­fic­ation

* More accurate than the Rule of 9's

Burn Survival & Burn Size

Suvival rate decreases = TBSA increa­ses

Burn Shock

Leading cause of mortal­ity
Leads to...
- Hypo­ten­sion
- Tissue hypoxia
- Acute renal failure
It's critical to accurately estimate fluid losses in order to determine replac­ement!
- Replace using Parkland Formula

Parkland Formula of Fluid Rescus­cit­ation

Lactated Ringer's - corrects Na deficits
Should be started ASAP!
2 PIV's if no central line
Give albumin for edema
Monitor urine output

Priorities w/ Burn Patients

1. Stop the burning process
2. Airway - ensure patent
3. C-spine stabil­iza­tion
4. Brea­thing - give 100% O2 or ventilate
5. Circ­ula­tion - assess pulses or CPR

Stages of Burn Assess­men­t/Care

1. Emerge­nt/­Res­usc­itative Phase
2. Acute Phase
3. Rehabi­lit­ative Phase

1. Emerge­nt/­Res­usc­itative Phase

24-48 hours
Point of injury
Fluid resusc­itation
Big risk of...
- Hypo­volemic shock
- Resp. problems
- Compar­tment syndrome

Acute Phase

48-72 hours/­wound starts to heal
Starts w/ diuresis - Ends w/ closure of burn wound
Interv­ent­ions:
- Reassess ABC's
- Fluid resusc­itation
- Urine output (myogl­obi­nuria)
- Circul­ation (escha­rotomy)
- Pain control
- Nutrit­ional support
- Focus on wound care
- Prevent infection

Assessment (Immediate Resusc­itative Phase)

A
Airway intubated prophy­lac­tically
B
Breathing & ventil­ation
C
Circul­ation
D
Deficits (neuro)
Deform­ities
Disability
E
Exposure

Rehabi­lit­ative Phase

May be years
Begins w/ wound closure - Ends w/ pt at highest level of functi­oning
Finger injury may not heal correctly webbing
Psycho­social therapy
Multid­isc­ipl­inary care - respir­atory therapy, PT/OT, speech therapy, plastic surgery

Wound Care

Debr­ide­ment
- Surgical, enzymatic
- May be painful ALWAYS pre-me­dicate
- Prepare for graft
Dres­sings
- Gauze
- Biologic (skin, membrane)
- Synthetic
- Biosyn­thetic
Skin grafts
- Skin won't heal on its own (full thickness)
- Concerns: circul­ation, mobili­zat­ion­/ROM, pressure on injury
Pressure garments
Hydr­oth­erapy (cleaning)
Homo-­/al­log­rafts = humans
Heter­o-/­xen­ografts = animals

Protective Barriers

Minor
Solosite (gel)
Opsite (clear Tegaderm)
Supe­rfi­cial
Allevyn
Acticoat (anti­mic­rob­ial)
Mepillex
Silvad­ene­/Ba­cit­racin (part­/full thickn­ess)
Mid to Deep
Acticoat
Scar Manage­ment
Cica Care (silicone gel sheeting)
Jobskin
Jobs­kin: worn to prevent contra­ctures, hypotr­ophic scar formation
- Worn 23 hours/day
- Inhibits pooling, venous stasis

Nursing Diagnoses

Risk for infection
Fluid volume deficit
Alteration in...
- Skin integrity
- Tissue perfusion
- Resp. status
Imbalanced nutrition (weight loss r/t inc. metabolic rate)
Impaired mobility
Decreased self-e­steem
               
 

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  • Published: 10th December, 2018
  • Rated: 5 stars based on 1 ratings

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Comments

Really informative!

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