chapter 66 burns quiz 7

This chapter reviews types of burns, their physiologic consequences, essential assessments when caring for clients with burns, and the principles and techniques of burn management.

Gerontologic Considerations

  • Increased Risk for Older Adults:

    • Aging or disease may reduce sensory perceptions of touch, vision, smell, or hearing, increase risk for peripheral neuropathy, reduce mobility, or cause cognitive changes.

    • Assessment must evaluate:

    • Functional ability levels

    • Home maintenance and safety.

  • Risk-Reduction Teaching:

    • Water temperature settings should be no higher than 110°F.

    • Working smoke detectors with scheduled battery changes every 6 months (may sync with changing clocks for daylight savings time).

    • Accessible working fire extinguishers in the home.

  • Older adults may face serious complications due to diminished renal, cardiac, and respiratory functions.

  • Client teaching should focus on reducing the risk of flame and scald burns in home settings.

Burn Statistics

  • Approximately 1 million people in the United States seek treatment for burn injuries, most of which are minor (Rice & Orgill, 2021).

  • The incidence of burns is decreasing, but around 30,000 individuals with major burns require hospitalization (American Burn Association, 2024).

  • The mortality rate from burn injuries is increased by concurrent medical problems and the client's age.

  • The American Burn Association (2024) estimates that 3,800 people die annually from burns.

  • The risk of acquiring a burn injury peaks among children and adults over 60 years of age.

  • Common causes of thermal burns at home include:

    • Flames and scalding from steam or hot liquids, often secondary to smoking, alcohol ingestion, or flammable substances. (Schaefer & Tannan, 2020).

Burn Injuries

  • Definition:

    • A burn is a traumatic injury to the skin and underlying tissues caused by heat, chemicals, or electricity.

    • Electrical burns are often the most severe due to deep tissue damage caused by current flow through the body.

Pathophysiology and Etiology

  • Causes of Cell Damage:

    • The immediate cause is heat, with severity dependent on:

    1. Temperature of the heat source

    2. Duration of contact

    3. Thickness of the tissue exposed

    4. Location of the burn.

  • Burns in sensitive areas (e.g., perineal area) are at higher risk for infection, and facial, neck, or chest burns may compromise ventilation.

  • Burns affecting hands or joints can impact mobility and dexterity.

  • Effects of Burns:

    • Thermal injuries cause protein coagulation in cells.

    • Chemical burns result in liquefying tissue due to the reactions of strong acids, bases, or organic compounds with cells.

    • Electric burns create higher levels of heat at entry/exit points, complicating damage assessment.

Inflammatory Processes

  • Initial burn injuries extend further due to inflammatory responses affecting deeper tissue layers.

  • Protease enzymes and oxidants can cause additional injury, and neutrophils consume oxygen leading to tissue hypoxia.

  • Injured capillaries can thrombose, leading to ischemia and necrosis of tissues.

Neuroendocrine Changes

  • Serious burns induce neuroendocrine changes within the first 24 hours:

    • Hormonal Releases:

    • Adrenocorticotropic hormone and antidiuretic hormone are released in response to stress.

    • Glucocorticoids and aldosterone release lead to hyperglycemia and sodium retention, causing peripheral edema and oliguria.

  • Hypermetabolic State:

    • Increased oxygen and nutritional demands are crucial for recovery due to accelerated tissue catabolism.

Shifts in Fluids and Electrolytes

  • Fluid Dynamics:

    • Fluid shifts and electrolyte deficits occur post-burn, with fluid moving toward the burn area and causing edema.

    • Some fluids become trapped, leading to intravascular fluid deficits and decreased blood pressure.

    • If unmonitored, these changes can proceed to irreversible shock.

Cellular, Chemical, and Concurrent Injuries

  • Common Complications:

    • Anemia, hemoconcentration, and renal failure due to myoglobin and hemoglobin overload.

    • Increased gastric acidity and risks for gastric ulcers.

    • Inhalation injuries, concurrent medical problems, and advanced age can heighten mortality rates.

    • Cardiac dysrhythmias and CNS complications are frequent in electrical burn victims.

Burn Assessment

  • Assessment Components:

    • Determination of burn depth, zones of injury, and estimation of total body surface area (TBSA) burned.

Depth of Burn Injury

  • Classification of burn depth includes:

    • Superficial (First Degree):

    • Involves epidermis; red, painful, and heals < 5 days.

    • Superficial Partial Thickness (Second Degree):

    • Epidermis/demis, blistering, heals within 14 days.

    • Deep Partial Thickness (Second Degree):

    • Involves deeper dermis, takes > 3 weeks to heal, may require grafting.

    • Full Thickness (Third Degree):

    • Destroys all skin layers; may need skin graft.

    • Fourth Degree:

    • Extends to structures: fat, fascia, muscle, bone; painless and severely damaging.

Zones of Burn Injury

  • Zone of Coagulation:

    • Most severe injury, deepest area.

  • Zone of Stasis:

    • Intermediate burn area; potential for tissue survival.

  • Zone of Hyperemia:

    • Least injury, minimally affected epidermis and dermis.

Extent of Burn Injury

  • Rule of Nines:

    • Initial method for estimating TBSA involved with burns.

  • Lund and Browder Method:

    • More accurate than the rule of nines for TBSA calculations.

Medical Management

  • First Aid to Hospital Care:

    • The outcome relies heavily on the quality of initial first aid and later treatment at hospital or burn center.

    • Key complications: inhalation injury, hypovolemic shock, and infection.

  • Referral Criteria:

    • Partial/full thickness >10% TBSA

    • Burns involving face, hands, feet, genitalia, perineum, or major joints.

    • Chemical and electrical burns, as well as inhalation injuries and burns connected with other trauma.

Initial First Aid

  • Safety First:

    • Smother flames with a blanket if clothing is on fire and transport to a hospital.

  • Oxygen Administration and IV Fluids:

    • Administer oxygen and initiate IV therapy during transport.

Acute Care

  • Assessment upon Arrival:

    • Assess extent of injury and monitor for additional trauma (fractures, head injury, lacerations).

  • Ventilation Maintenance:

    • Initiate fluid resuscitation promptly.

  • Compromised ventilation can arise from various causes during first 12-24 hours post-burn (swelling, chemical inhalation, respiratory failure).

  • Administer humidified oxygen if airway edema or soot indicates potential injury.

Fluid Resuscitation

  • Goals:

    • Restore intravascular volume, prevent ischemia, and maintain organ function.

  • Calculate volume based on burn severity and initial interventions.

Wound Management

  • Examine Output and Infection:

    • Use personal protective equipment during wound care and monitor bacteria for infection.

  • **Cleansing and Antimicrobial Application: **

    • Use open vs. closed methods based on patient needs and severity of burns.

Antimicrobial Therapy

  • Common Antimicrobials and Their Uses:

    • Silver Sulfadiazine (Silvadene):

    • Broad-spectrum coverage for partial-thickness burns.

    • Mafenide Acetate (Sulfamylon):

    • Used for deep burns, penetrates eschar with potential metabolic side effects.

  • Skin Management:

    • Options include topical dressings, gauzes, and skin substitutes.

Surgical Management

  • Debridement Practices:

    • Remove necrotic tissue effectively while managing pain.

Skin Substitutes and Grafting

  • Techniques:

    • Autografts utilize the patient's skin; xenografts use animal skin while allografts use human donor sources.

Client Management and Education

  • Nutrition:

    • Clients may require increased calories (4,000-5,000/day) and protein support (2.0-2.5 g/kg).

  • Fluid Management:

    • Monitoring I&O is essential post-burn due to fluid loss.

Conclusion

  • Holistic Care Approach:

    • Incorporate physical, emotional, and nutritional support tailored to individual needs throughout recovery.