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Burn Injuries - Outline

Outline
Course

Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)

30 Documents
Students shared 30 documents in this course
Academic year: 2019/2020
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Temple University

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Burn Injuries:

Thermal Injury: - Flame, scald, flash, hot surface, tar, grease

Chemical Burn: - Tissue reaction to a noxious substance - 500,000 chemicals in use - 30,000 considered hazardous - 2-6% Burn Center admissions - Severity of tissue damage is determined by:

o Amount of chemical o Duration of exposure o Concentration of chemical o Extent of chemical penetration o Mechanism of action

  • Causes of Chemical Burns: o Work related o Household (cleaning) agent

o Accidental / intentional ingestion o Assaults

  • Types of Chemicals: o Acids o Alkalis

o Organic compounds

  • Protect yourself-wear gloves
  • Remove clothing don’t forget shoes / boots
  • Powdered chemical -brush off first then flush
  • Continuous flush 10-30 minutes
  • Eye burns- remove contacts, continuous flush from center outwards
  • Look for hidden burns
  • .. damage caused by a chemical will progress until the chemical has been removed or inactivated

Inhalation Injury: - Chemical injury, impaired ciliary action, mucous membrane ulcers, erythema, edema, hypersecretion, bronchial spasm - 20-50% Burn Unit admissions

  • 60-70% Burn Unit mortality

  • Above & below glottis

  • Rapid and continuous assessment

  • Carbon monoxide poisoning o Binds Hgb- CO has 200 times the affinity -robs blood of oxygen o 100% O2 ½ life of CO to 30-40 mins

  • Signs and Symptoms: o Singing o Soot o Burns - face, chest, head, neck o Cough o Wheeze (late sign) o Chest tightness

o Sooty sputum o Loss of voice o Airway edema o Blistering o Rapid respirations o Hypoxia / anxiousness o High CoHgb

  • Treatment: o Continuous observation / pulse ox o 100% humidified oxygen / face mask o Frequent cough / Incentive spirometer

o ETT o Suctioning with lavage / nebulization therapy o Broncoscopy (prior extubation)

Electrical Injury: - True: Current passes directly through body creating an entrance and exit wound - Severity: o Factors that determine the extent of tissue damage and the complications:  Type of current  Amperage

 Current pathway  Duration of contact

 Resistance

  • Resistance: o Electricity travels through areas of least resistance  nerves  blood vessels  muscles

 skin  bone

  • Arc: Current courses external to the body from the contact point to the ground
  • Flame: Low voltage, household appliances
  • Immediate Care: o At the Scene:  Determine power source  Turn power off  Assess for cardiac / respiratory arrest

 C-spine control  Assess LOC, other injuries, entrance - exit wounds  Keep patient warm

  • Hospital Care: o Possible intubation o Cardiac monitoring - 12 lead EKG o C-spine control o IV access/Fluid resuscitation o Foley catheter - keep urine output > 75-100cc/hr

o Labs, urine myoglobin o Assess pulses - all extremities o Xrays to assess C-spine and fractures o Reassure patient & family

Inhalation Injury: - Smoke & heat - upper airway - Steam - lower airway - Enclosed space - Explosions - Trapped inside, children hiding - Toxic gases - High incidence of ETOH - Singing - Soot - Burns - face, chest, head, neck - Cough

  • Wheeze
  • Chest tightness
  • Sooty sputum
  • Loss of voice
  • Airway edema
  • Blistering
  • Rapid respirations
  • Hypoxia / anxiousness
  • 20-50% Burn Unit admissions
  • 60-70% Burn Unit mortality
  • Above & below glottis
  • Carbon monoxide poisoning o Binds Hgb with 200 times the affinity of oxygen o 100% O2 ½ life of CO to 30-40 mins

Determination of Severity: - Depth - Extent - Location

  • Past Medical History
  • Trauma
  • Age

Structure of Skin: - Epidermis - Dermis

  • Subcutaneous Tissue
  • Underlying structures

First Degree/Partial Thickness: - Epidermis - Painful - Red

  • Dry
  • Heals 3-5 day
  • Moisturize

Pathophysiology of Burn Shock: - Increase capillary permeability - Loss of plasma, proteins, electrolytes - Increase interstitial fluid / decrease intravascular volume - Edema & hypovolemia - Decreasing B/P & shock

Burn Shock: - Fluids from unburned areas rush to burn areas to help the body compensate for the massive fluid loss - This fluid also leaks

Fluid Resuscitation: - Concensus Formula - 2-4cc LR x %TBSA x kg/wt = Amount of fluid needed in the first 24 hrs. - Give 1/2 the first 8 hrs, 1/4 next 8 hrs, and 1/4 the 3rd 8 hrs. - May need 4-5cc for inhalation or electrical

Treatment Parameters for Fluid Resuscitation: - Urine output >30-50cc/hr adults o Children <30 kg =1cc/kg/hr o Children >30kg = 30-50cc/hr

  • Blood pressure
  • Heart rate / pulses
  • Respiratory rate
  • Sensorium

Neurovascular Compromise: - Circumferential injury - Check pulses - Check chest expansion

  • Doppler
  • Remove occlusive jewelry or clothing

Fasciotomy: - Incision of investing muscle fascia beneath burned tissue (OR) - Used with electrical injuries to explore damaged muscle - Covered with a biological dressing

Communication: - Get history: time of burn, down time, cause - Number of people and relationships - Media frenzy

  • Calm and reassuring / orient
  • Bad news-confirm information-don’t assume patient knows or was told

American Burn Association Criteria for Burn Center Referral: - Second degree burn o Age: Any o BSA: 10%

  • Third degree burn o Age: Any o BSA: Any
  • Special areas o Electrical o Chemical o Inhalation o Associated injury

o Trauma o Special needs o Suspected abuse

Transport:

  • Be prepared

  • Keep warm, dry, & covered

  • Secure all lines & tubes

  • Note ETA

  • Communication

Acute Phase: - Prevent infection and sepsis - Environmental controls - Wound care - Need for surgery-STSG

  • Nutrition
  • Pain Management
  • Prevent wound contractures

Wound Care: - Clean daily - Topical antimicrobial or temporary cover - Assess need for skin graft

  • Maintain function
  • Adequate pain management

Prevention of Infection and Sepsis: - Handwashing - Universal precautions - Environmental cleanliness

  • Limit potential for cross contamination
  • Limit antibiotic use

Permanent Wound Coverings: - Autograft o Mesh o Sheet o Flap

o STSG vs FTSG

  • Cultured Epithelial Autograft (CEA)
  • Dermal Replacement o Integra

Donor Sites: - Promote healing o 2 weeks

  • Prevent infection
  • Manage pain
  • Possible scarring

Infection and Sepsis: - Signs of sepsis 3-5 days post injury - Increase blood sugar, glycosuria - Changes in platelets and WBC - Increase HR & RR

  • Changes in SVO
  • Edema, increase weight gain
  • Confusion
  • Ileus

Sepsis: - Imbalance of inflammatory and anti-inflammatory mediators in sepsis causes: o clotting to obstruct microvascular perfusion of tissue o tissue necrosis o organ failure

Pain Management: - Manage pain continuously not p.r. - Manage anxiety - Manage sleep

  • Intravenous
  • Individual dosing
  • Pain scales / 5th vital sign

Pain Variables: - Pain is variable in burn patients o Can’t give too much medication to interfere with function o Can’t give too little and not treat pain

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Burn Injuries - Outline

Course: Generalist Nursing Practice IV: Tertiary Care Across the Lifespan (NURS 4889)

30 Documents
Students shared 30 documents in this course

University: Temple University

Was this document helpful?
Burn Injuries:
Thermal Injury:
-Flame, scald, flash, hot surface, tar, grease
Chemical Burn:
-Tissue reaction to a noxious substance
-500,000 chemicals in use
-30,000 considered hazardous
-2-6% Burn Center admissions
-Severity of tissue damage is determined by:
oAmount of chemical
oDuration of exposure
oConcentration of chemical
oExtent of chemical penetration
oMechanism of action
- Causes of Chemical Burns:
oWork related
oHousehold (cleaning) agent
oAccidental / intentional ingestion
oAssaults
- Types of Chemicals:
oAcids
oAlkalis
oOrganic compounds
-Protect yourself-wear gloves
-Remove clothing don’t forget shoes / boots
-Powdered chemical -brush off first then flush
-Continuous flush 10-30 minutes
-Eye burns- remove contacts, continuous flush from center outwards
-Look for hidden burns
-...Tissue damage caused by a chemical will progress until the chemical has been removed or inactivated
Inhalation Injury:
-Chemical injury, impaired ciliary action,
mucous membrane ulcers, erythema,
edema, hypersecretion, bronchial spasm
-20-50% Burn Unit admissions
-60-70% Burn Unit mortality
-Above & below glottis
-Rapid and continuous assessment
-Carbon monoxide poisoning
oBinds Hgb- CO has 200 times the affinity -robs blood of oxygen
o100% O2 ½ life of CO to 30-40 mins
- Signs and Symptoms:
oSinging
oSoot
oBurns - face, chest, head, neck
oCough
oWheeze (late sign)
oChest tightness
oSooty sputum
oLoss of voice
oAirway edema
oBlistering
oRapid respirations
oHypoxia / anxiousness
oHigh CoHgb
- Treatment:
oContinuous observation / pulse ox
o100% humidified oxygen / face
mask
oFrequent cough / Incentive
spirometer
oETT
oSuctioning with lavage /
nebulization therapy
oBroncoscopy (prior extubation)
Electrical Injury:
-True: Current passes directly through body creating an entrance and exit wound
-Severity:
oFactors that determine the extent of tissue damage and the complications:
Type of current
Amperage
Current pathway
Duration of contact

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