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Burns - Lecture notes Topic 15
Adult Health Nursing II (NSG-430)
Grand Canyon University
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Types of Burn Injury Chemical Burns Immediate care Chemical should be quickly removed from the skin Clothing containing chemical should be removed Tissue destruction may continue up to 72 hours after chemical injury Tissue death instantaneous, it goes on in the body Electrical Burns Severity of injury depends on electrical factors Coagulation necrosis caused intense heat generated from an electric current May result from direct damage to nerves and vessels, causing tissue anoxia and death Vital organs produce more sequelae Difficult to assess, most damage occurs beneath Muscle spasms strong enough to fracture bone Patients are at risk for Dysrhythmias or cardiac VF, cardiac standstill Continued risk for 24 hours after injury Severe metabolic acidosis Myoglobinuria Myoglobin and hemoglobin from damaged RBCS travel to kidny AKI Atn Classification of burn injury Severity of injury is determined Depth of burn Burns in past defined degress (first, second third, and fourth) ABA advocates categorizing burn according to depth of skin destruction partial thickness burn or full thickness burn Superficial partial thickness burn Involves epidermis Deep partial thickness burn Involves Dermis Full thickness burn Involves all skin elements, nerve endings, fat muscle, bone Extent of burn in percent of TBSA Two commonly used guides for determining Location of burn Severity of burn injury is determined location of burn wound Face, neck, chest respiratory obstruction Hands, feet, joins, eyes self care Ears, nose, buttocks, perineum infection Circumferential burns of extremities can cause circulation problems distal to burn Patients may also develop compartment syndrome Patient risk factors Older, younger, risk Diabetes mellitus and peripheral vascular disease contribute to poor healing and gangrene Will take longer to heal Physical weakness Drugs Alcohol Smokers Prehospital Care Remove person from source of burn and stop burning process Rescuer must be protected from becoming part of incident Electrical injuries Remove patient from contact with source Chemical injuries Brush solid particles off skin Use Water lavage Tissue destruction may continue for up to 72 hours after rub them during wash, let water rinse them off. Rubbing can make it worse. Small thermal burns Cover with clean, cool, tap dampened towel Large thermal burns circulation , airway, breathing Cool burns Inhalation covered WBCs Clinical Manifestations Shock from hypovolemia Blisters Paralytic ileus Complications Cardiovascular system Dysrhythmias an dhypovolemica shock Impaired circulation to extremitiescircumferential Impaired microcirculation and increased viscosity sludging Venous thromboembolism Escharotomies of chest They do not feel pain Eschar does not bleed Keep cutting til we get viable tissue Respiratory Upper airway burns Edema forms Treatment Airway managment High if possible Early intubation Fluid therapy Two large IV lines for central line needed Type of fluid replacement Parkland formula Practice Step 1 BSA burned x 165 75 kg x 4 mL 24 hour volume Step 2 ½ over 8 hours ? mL ? x8 hours Step 3 ½ over Part 2 powerpoint Acute phase Complications Musculoskeletal Treatment Wound care Appropriate coverage of graft Gauze is Excision and grafting Eschar is removed down to subcutaneous tissue or fascia Graft is place on clean, viable tissue Wound is covered with autograft Donor Skin is takne with a dermatome Sheet skin Graft to hand Grafts are attached with Fibrin sealant Sutures or staples Negative pressure wound therapy With early excision, function is restored, scar tissue minimized Artificial skin Life Emotional therapy Pain management Patients experience two kinds of pain Continuous background pain IV infusion Physical and occupational therapy Good time for exercise is during wound cleaning Passive and active ROM Splint should be Nutrition Meeting daily caloric requirements is crucial Albumin, pre albumin Rehabilitation phase Patho Begins when Would healing Ajfkda
Burns - Lecture notes Topic 15
Course: Adult Health Nursing II (NSG-430)
University: Grand Canyon University
