Module 9: Burns

Where do most burns occur?

at home

What 2 groups are at highest risk for burns?

• young children

• older adult

What are the 5 types of burns?

• thermal

• chemical

• electrical

• radiation

• extreme cold

What are the 4 classifications of burns?

• first degree

• second degree (partial thickness)

• third degree (full thickness)

• fourth degree (full thickness plus)

What layer do first degree burns affect?

epidermis

What is an example of a first degree burn?

sunburn

What color is a first degree burn?

• red

• reddish brown (darker skin tones)

Describe what a first degree burn feels like

• peeling

• itchy

What relieves a first degree burn?

cooling

T/F: first degree burns are blanchable

T; white & then turns red again

What layer do second degree (partial thickness) burns affect?

epidermis

What is an example of a second degree burn?

scalding water

What does a second degree burn look like?

• blisters

• edema

What layer do third degree (full thickness) burns affect?

epidermis, dermis, underlying tissue

What are examples of a third degree burn?

• chemical burns

• fires

What does skin look like in third degree burns?

• skin dry

• leathery

T/F: edema is present in third degree burns

T

What color are third degree burns?

white/pale

What do people lack in third degree burns?

lack of sensation

What is needed for third degree burns?

grafting

What layers do fourth degree burns (full thickness plus) affect?

deep tissue, muscle & bone

What are examples of fourth degree burns?

• high voltage shock

• prolonged burns

What color are fourth degree burns?

black or charred

What action may be needed in fourth degree burns?

amputation

What is the rule of 9s used for?

common way to estimate extent of burns

What percentage does the head & neck cover?

9%

What percentage does each arm cover?

9%

What percentage does the anterior portion of the upper body cover?

18%

What percentage does the posterior portion of the upper body cover?

18%

What percentage does gentalia cover?

1%

What percentage does each leg cover?

18%

Burns more than __% TBSA are major burns

20%

What are major burn cues?

• hypovolemia

• fluid shifts

• edema

• hypovolemic shock

• tissue & organ hypoperfusion

What happens to cardiac output in major burns?

decreases

What happens to BP in major burns?

decreases

What happens to HR in major burns?

increases

What does hypovolemic shock cause?

organ hypoperfusion

Are capillaries vasoconstricted or vasodilated?

vasoconstricted

What happens to capillaries in burns?

• vasoconstrict

• lose seal

  • leak fluid

What are 3 phases of burn care?

1. emergent/resuscitative

2. acute/intermediate

3. rehab

What happens in the emergent/resuscitative phase?

• injury

• completion of fluid resuscitation

What happens in the acute/intermediate phase?

beginning of diuresis (increased urine output)

• aids with wound healing

What happens in rehab phase?

wound closure

What are the 2 priorities during the emergent/resuscitative phase?

• stop the burn

• ABCDE

What is D is ABCDE?

disability (neuro)

What causes a neuro disability in burns?

decreased perfusion to brain causes confusion

What is E in ABCDE?

expose/examine extent of injuries

• rule of 9s

What are actions to take in the emergent phase?

• frequent assessment

• o2 supplementation

• foley insertion

• monitor labs

• place NGT

• IV

• IV analgesia

How often should vitals be taken in the emergent phase?

q1h

What happens if body T drops below 95º?

vasoconstriction leading to necrosis

In what situation is a patient given fluids? What kind of fluids are given?

major burns; lactated ringers

The most fluid is lost in the first _ to _ hours post burn

24-36 hours

What 3 electrolyte imbalances occur in the emergent phase?

• decreased Na

• decreased K (initially)

• decreased Mg

What lab is initially elevated in the emergent phase?

Hct

What lab is decreased in the emergent phase?

clotting

Where are upper airway burns?

above glottis

What causes upper airway burns?

inhalation of thermal/chemical irritants

What cue is present in upper airway burns?

edema

Where are lower airway burns located?

below glottis

What causes lower airway burns?

inhalation

What are pulmonary burn cues?

• facial erythema & edema

• tachypnea

• dyspnea

• brassy cough

• stridor

What ABGs are monitored?

• PaCO2

• PaO2

What value of PaCO2 shows need for patient to be intubated?

increased

hat value of PaO2 shows need for patient to be intubated?

decreased

What are 2 actions for pulmonary burns

• intubated

• given O2

When does the acute/intermediate phase begin?

48-72 hours post burn

What are the priorities during the acute phase?

• infection prevention

• pain management

• wound care

• monitor vitals

• ABCs

What happens to kidney function in the acute phase?

decreased

• increased BUN & creatinine

Describe fluid & electrolyte shifts in the acute phase

fluid re-enters vascular phase

hemodilution

Does urinary output increase or decrease in the acute phase

increase to promote wound healing

What lab decreases in the acute phase?

Na

What are 6 burn complications?

• AKI

• infection

• shock

• respiratory failure (s/t edema)

• compartment syndrome

• ileus

What are possible nursing dx for burns?

• pain

• risk for infection

• imbalanced nutrition

• fatigue

• impaired physical mobility

What are the 3 parts to burn wound care?

• wound cleaning

• topical antibacterial therapy

• wound dressing

What is used for wound cleaning?

non-scented soap & water

Describe wound dressing for wound care

• dry dressing

• remove dressing with sterile saline

What is wound debridement?

removing devitalized tissue so healthy tissue can grow

What are 4 types of wound debridement?

• surgical

• natural

• mechanical

• chemical

Describe natural wound debridement

tissue separates spontaneously

Describe mechanical wound debridement

tools are used to separate eschar

Describe chemical wound debridement

topical agent applied

Describe surgical wound debridement

• done early

• monitor for complications

• wound bed must be moist

What are 4 benefits of skin grafts?

• decreased infection

• decreased contractures

• decreased loss of fluid & electrolytes

• decreased loss of heat

What are 3 types of grafts?

• autografts

• hemografts

• xenografts

What is the preferred skin graft method?

autografts

What skin do autographs use?

own skin

What skin do hemografts use?

non-living donor

What skin do xenografts use?

animal (pig)

T/F: hemografts & zenografts are temporary

T

What are 4 ways to care for skin grafts?

• avoid positioning on graft

• dressing change 3-5 days pots op

• immobilize skin

What 3 types of analgesics can be given for pain management in burns?

• NSAIDs

• opioids

• benzos

Describe 2 components of rehabilitation phase

• provide psychological support

• d/c planning

What are 5 rehab phase complications?

• nerve entrapment

• pressure ulcers

• hypertrophic scarring

• contractures

• pain

What are actions to take for frostbite?

• remove from cold

• administer pan meds

• immerse in warm water

• apply dressing