Archer Integumentary System Burns

1st degree burn

most superficial burn

skin remains intact, no break in integrity of epidermis

redness

no blisters

can be painful to the touch

ex sunburn

2nd degree

partial thickness burn

blisters form

affects the epidermis and dermis

skin moist and red

burns are very painful

3rd degree burn

full thickness burn

penetrate all the way from the epidermis to the dermis and down into the subcutaneous tissue

destroy nerve endings so are not as painful as 2nd degree burns

appear red, tan, or black

dry and leathery

areas of eschar

require skin grafting

4th degree burn

full thickness, plus involvement of bone and muscle underneath

these burns are dry and dull

exposed tissue may include bones and muscles as well as ligaments and tendons

emergent phase of burn management

first 24-48 hours

large shift in capillary membrane permeability (capillary membrane becomes more permeable, fluid shifts from the intravascular space into the interstitial space )

high risk for hypovolemia shock, electrolyte imbalances, and renal failure

fluids is priority intervention (parkland burn formula) (un;ess airway is compromised)

acute phases of burn management

48-72 hours after injury until the would heal

capillary membrane permeability is stabilized

focus on healing (prevent infection, alleviating pain, nutrition, would care)

rehabilitative

burn is now healed

focus is on regaining function (psychosocial care, ADL assistance, physio/occupational theraoy, cosmetic correction)

rule of 9

head -9%(4/5% anterior and 4.5% posterior)

torso -chest 9%, back 9%

abdomen- 9% front, 9% back

arms - front 4. 5% back 4.5%

genital -1%

leg- 9% front, 9% back

when is a burn critical

greater than 15 percent

complications of burn injury

hypovolemic shock

renal failure

hyperkalemia

hyponatremia

hypovolemic shock

increase in capiallary permeability

third spacing occurs (plasma moves from the intravascular space, to the interstitial space, sodium, albumin)

decreased intravascular volume = decreased BP =hypovolemia

cardiovascular system recognizes hypovolemia -increases HR to compensate (increased HR, Decreased CO, decreased BP)

hypovolemic shock leads to decreased perfusion of kidneys and renal damage

renal failure

decreased perfusion to the kidneys

insufficient UOP <30ml/hr

increased BUN and Cr

monitor UOP closely - foley, fluid adjustments as needed

hyperkalemia in relation to burns

most K stored in the cells

injury causes lysis of cells, which then release K into bloodstream

muscle weakness

cramps

nausea

chest pain

arrythmias

tall peaked T waves

hyponatremia

water follows sodium

sodium leaving the intravascular space and going to the interstitial space

due to increaaed capillary membrane permeability

water follows this sodium and the patietn becomes hyponatremia

headache

confusion

restlessness

irritability

seizures

coma

fluid replacement

crucial in first 24 hours

due to increase in capilarry permeability, this is when the patient is losing large volumes of fluid and is at risk for hypovolemic shock

LR- expands intravascular volume

colliods - albumin- helps pull fluids back into the intravascular

monitor UOP

fluid are titrated to ensure adequate UOP 33cc/hr

correction of imbalances

parkland burn formula

volume of Lr

4ML x TBSA of Burn (%) xBody weight (kg)

First half of the solution over the first 8hrs

second half of the solution of the next 16 hours

fluids used in burns

lactated ringer's

colloids - albumin to pull fluids back