Ch51 Burns (1)

Chapter 51: Dr. Killough's Coordinating Care for Patients With Burns

Introduction

• Overview of burn injuries and their complexities in medical-surgical nursing.

• Relevant for nursing professionals involved in caring for burn patients.

Epidemiology of Burns

• In 2017, the U.S. recorded 1,319,500 fires.

• Casualties included:

  • 3,400 civilian deaths

  • 14,670 civilian injuries

• Common etiologies for burn injuries:

  • Fire/flame: 43%

  • Scalds: 34%

  • Contact: 9%

  • Electrical: 4%

  • Chemical: 3%

  • Other causes: 7%

Pathophysiology of Burns

Classifications of Burns

• Thermal Burns: Caused by heat sources like flames, scalds, and hot objects.

  • Factors determining depth: temperature and duration of contact.

• Electrical Burns: Effects range from mild to lethal, extensive internal damage may not be visible.

• Chemical Burns: Categorized into three subclasses: acids, alkalines, and organic compounds.

• Radiation Burns: Severity linked to type, dose, and exposure duration.

Depth of Burns

• Superficial Burns:

  • Affects only the epidermis.

  • Mild erythema, hypersensitivity.

  • Usually resolves within 24-72 hours.

  • Example: Sunburn.

• Superficial Partial-Thickness Burns:

  • Involves epidermis and superficial dermis.

  • Characterized by painful, wet blisters that heal in 1-2 weeks with minimal scarring.

• Deep Partial-Thickness Burns:

  • Extends further into the dermis.

  • Presentation includes waxy appearance; patient may have decreased sensation.

• Full Thickness Burns:

  • Destroys epidermis, dermis, and parts of subcutaneous tissue.

  • Insensate, does not heal quickly; presents dry and leathery.

Total Body Surface Area (TBSA)

Estimation Methods

• Rule of Palm: Patient's hand represents approximately 1% TBSA, useful for small burns.

• Rule of Nines:

  • Divides the body into percentages for quick assessment in adults; adjusted for children.

• Lund and Browder Classification: More accurate in hospital settings, considers age-related body proportions.

Burn Injury Severity

• Factors determining severity include:

  • Presence of inhalation injury

  • Patient age

  • Past medical history

  • Concomitant injuries

  • Anatomical location of injury.

Systemic Effects of Major Burn Injuries

Key Systems Affected

• Respiratory System:

  • Recognizing inhalation injuries is crucial; complications can lead to pneumonia or hypoxemia.

• Cardiovascular:

  • Burn shock manifests due to fluid shifts.

  • Risk of decreased cardiac output and elevated hematocrit.

• Fluid and Electrolytes:

  • Monitor potassium and sodium levels; burns can lead to significant losses.

• Renal:

  • Decreased perfusion and potential acute tubular necrosis due to myoglobin release.

• Gastrointestinal:

  • Risks of decreased nutrient absorption and abdominal compartment syndrome.

• Metabolic and Immunological:

  • Increased metabolic rate; need for nutritional support.

  • High infection risk and potential for systemic inflammatory response syndrome (SIRS).

Management of Burn Injuries

Emergent Phase

• Focused on initial management, including airway maintenance, fluid resuscitation, and pain management.

Intermediate Phase

• Involves wound healing, closure, nutritional support, and infection prevention.

Rehabilitative Phase

• Extended care focusing on rehabilitation and psychological support.

  • Monitor for complications like contractures and scarring.

Special Considerations

• Inhalation injury: Identifiable regardless of TBSA burned, increases mortality.

• Electrical injuries: Tissue damage may not be obvious, requires careful monitoring.

• Chemical injuries: Immediate irrigation essential for alkaline burns.

Nursing Management

Nursing Diagnoses

• Focus on airway clearance, gas exchange, fluid volume deficit, and risk for infection.

• Emphasis on holistic care, including mental health support and educational interventions.