Slides presentation for Burns lecture for ADN Nursing at Kaua`i Community College

2. ● Injury resulting from exposure to heat,
chemicals, radiation, or electrical
● Over 1 million per year in US, mostly thermal
burns
● Risk factors:
●age
●smoking
●alcohol/drugs
●cognitive and physical disability

3. Types of Burns
● Thermal (hot or
cold)/Scald
● Chemical
● Smoke inhalation
injury
● Electrical
● Radiation

4. Electrical Burn

5. Radiation Burn

6. Full-Thickness Thermal Burn
Fig. 25-1. Types of burn injury. A, Full-thickness thermal burn.

7. Full-Thickness Thermal Burn
Fig. 25-1. Types of burn injury. A, Full-thickness thermal burn.

8. Partial-Thickness Burn to the Hand
Fig. 25-1. Types of burn injury. B, Partial-thickness thermal burn.

9. Partial-Thickness Burns Due to
Immersion in Hot Water
Fig. 25-1. Types of burn injury. C, Full-thickness scald burn secondary to immersion in hot water.

10. ● Result from tissue injury and
destruction from acids, alkalis, and
organic compounds
● Alkali burns are hard to manage because
they cause protein hydrolysis and
liquefaction.
●Damage continues after alkali is
neutralized.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.
Etiology

11. ●Results in injuries to:
● Skin
● Eyes
● Respiratory system
● Liver and kidney
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

12. ● Chemical should be quickly removed from the
skin.
● Clothing containing the chemical should be
removed.
● Tissue destruction may continue up to 72 hours
after a chemical injury.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.
Treatment

13. ● Result from inhalation of hot air or
noxious chemicals
● Cause damage to respiratory tract
● Major predictor of mortality in burn
victims
● Need to be treated quickly
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

14. ●Three types:
● Carbon monoxide poisoning
● Upper airway (above the glottis)
● Lower airway (below the glottis)
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

15. ● Carbon monoxide (CO) poisoning
● CO is produced by the incomplete
combustion of burning materials.
● Inhaled CO displaces oxygen.
● Hypoxia
● Carboxyhemoglobinemia
● Death
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

16. ● Carbon monoxide (CO) poisoning
● Treat with 100% humidified oxygen.
● CO poisoning may occur in the
absence of burn injury to the skin.
● Skin color may be described as
“cherry red” in appearance.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

17. ● Inhalation injury above the glottis
● Thermally produced
● Hot air, steam, or smoke
● Mucosal burns of oropharynx and
larynx
● Mechanical obstruction can occur
quickly
● True medical emergency (airway)
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

18. ● Inhalation injury above the glottis
● Reliable clues to this injury:
● Presence of facial burns
● Singed nasal hair
● Hoarseness, painful swallowing
● Darkened oral and nasal membranes
● Carbonaceous sputum
● History of being burned in enclosed space
● Clothing burns around chest and neck
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

19. ● Inhalation injury below the glottis
● Injury is related to the length of
exposure to smoke or toxic fumes.
● Pulmonary edema may not appear
until 12 to 24 hours after the burn.
● Manifests as acute respiratory distress
syndrome (ARDS)
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

20. Types of Burn Injury
Electrical Burns
● Result from coagulation necrosis caused by
intense heat generated from an electric
current
● May result from direct damage to nerves and
vessels, causing tissue anoxia and death
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

21. Electrical Burn: Back
Fig. 25-2. Electrical injury produces heat coagulation of blood supply and contact area as electric current
passes through the skin. A, Back and buttock.

22. Electrical Burn: Leg
Fig. 25-2. Electrical injury produces heat coagulation of blood supply and contact area as electric current
passes through the skin. B, Leg.

23. Severity of Burns
● Source of burn
● Body regions burned
● Age
● General health
● Time
● Depth/Severity
● Extent

24. Classification of Burn Injuries
● Depth
● Superficial (First degree)
● Partial thickness (Second degree)
● Full thickness (Third degree)
● Severity
● Minor
● Moderate
● Major

25. Classification of Burn Injury
Depth of Burn
● Superficial partial-thickness burn
● Involves the epidermis
● Deep partial-thickness burn
● Involves the dermis
● Full-thickness burn
● Involves fat, muscle, bone
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

27. Lund-Browder Chart
Fig. 25-4. A, Lund-Browder chart. By convention, areas of partial-thickness injury are colored in blue and areas
of full-thickness injury in red. Superficial partial-thickness burns are not calculated.

28. Fig. 25-4. B, Rule of nines chart.

29. A client received deep partial
thickness burns to the
● anterior trunk
● perineum
● left arm anterior and posterior.
Using the rule of nines, what is the percent
of total body surface area (TBSA) that was
burned?
28%

30. Fluid Resuscitation
● Parkland Formula: warmed Lactated Ringer’s
● 4ml x kg x % TBSA (from rule of nines) over 24
hours
●Give ½ of the total amount over the first 8 hours,
●½ of the total amount over next 16 hours
4ml x 75 kg x .28 tbsa /24 hours

31. 4ml x 75kg x 28%tbsa = total ml over 24 hours
kg 1 100% tbsa
Fluid Resuscitation
● Give ½ of the total amount over the first 8 hours,
●½ of the total amount over next 16 hours
1. What is the hourly rate for the first 8 hours?
4ml x 75 x .28 / 8 hours = ml /hour
2
2. What is the rate for the next 16 hours?
4ml x 75 kg x .28 tbsa /24 hours

32. Facial Edema Before and After
Fluid Resuscitation
Fig. 25-6. A, Facial edema before fluid resuscitation. B, Facial edema after 24 hours.

33. Fluid Resuscitation
●Urine output is used as indicator of
effectiveness
● 30-50 ml/hr
●adult thermal burns

34. Classification of Burn Injury
Location of Burn
●Location of the burn is related to
the severity of the injury
● Face, neck, chest → respiratory
obstruction
● Hands, feet, joints, eyes → self-care
● Ears, nose, buttocks, perineum →
infection
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

35. Classification of Burn Injury
Location of Burn
●Circumferential burns of the
extremities can cause circulatory
compromise.
●Patients may also develop
compartment syndrome.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

36. ●Electrical injuries
● Remove patient from contact
with source.
●Chemical injuries
● Brush solid particles off the
skin.
● Use water lavage.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

37. ●Small thermal burns
● Cover with clean, cool, tap
water– dampened towel.
●Large thermal burns
● Airway, breathing, and
circulation
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

38. Burn Stages
● Prehospital Care
● Emergent/Resuscitative Phase
● Acute Phase
● Rehabilitation Phase

40. Assessment and Intervention:
● Ensure patent airway
● Assess effectiveness of respiratory function
● Signs of respiratory burns
● Prepare for early intubation
● Provide high flow O2
● Initiate fluid resuscitation
● Indwelling urinary catheterization

41. Emergent Phase
Pathophysiology
● Fluid and electrolyte shifts (cont’d)
● Normal insensible (evaporative) loss: 30 to 50
mL/hr
● Severely burned patient: 200 to
400 mL/hr
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

42. Emergent Phase
Complications
● Cardiovascular system
● Dysrhythmias and hypovolemic shock
● Impaired circulation to extremities
● Tissue ischemia
● Necrosis
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

43. Nursing Care
● Assessment – continuous
● Time of Injury
● Cause of Injury
● First aid treatment - what was done
● Past medical history
● Age
● Medications
● Body weight

44. Nursing Diagnoses
● Impaired gas exchange – resp compromise
● Acute Pain – IV MS, propofal, wound coverage
● Deficient fluid volume – IVF’s, Parkland
formula
● Impaired skin integrity *Hypothermia
● Risk for infection – wound management
● Impaired physical mobility
● Imbalanced nutrition: less than body req.
● Grieving, Powerlessness, Fear

45. Burn Assessment & Intervention
● Naso-gastric intubation
● Infection prevention-protective isol.
● Pain management
● Tetanus administration
● Monitor ABGs-serum lab work
● Monitor peripheral pulses
● Prevent hypothermia

46. Wound Management
Pain Control
Antimicrobial Agents
Tetanus Prophylaxis
Surgery
Escharotomy
Surgical debridement
Autografting

47. Wound Management
● Purpose
● Prevent sepsis
● Prevent conversion of partial thickness to full
● Reduce pain from exposed nerve endings
● Prepare for coverage
● Dressings
● Antimicrobials – Sivadene, Sulfamylon, Silver
nitrate, Systemic antibiotics

48. Emergent Phase
Nursing and Collaborative Management
● Drug therapy (cont’d)
● Antimicrobial agents
● Topical agents
● Silver sulfadiazine (Silvadene)
● Mafenide acetate (Sulfamylon)
● Systemic agents are not usually used in controlling
burn flora.
● Initiated when diagnosis of invasive burn wound
sepsis is made
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

49. Emergent Phase
Nursing and Collaborative Management
● Nutritional therapy (cont’d)
● Hypermetabolic state
● Resting metabolic expenditure may be increased by
50% to 100% above normal.
● Core temperature is elevated.
● Caloric needs are about 5000 kcal/day.
Copyright © 2011, 2007 by Mosby, Inc., an affiliate
of Elsevier Inc.

50. Wound Management
● Pain control
● Nutrition
● Positioning, splints, exercise
● Pressure garments
● Appearance, scarring, future surgeries
Disturbing picture alert

52. Psychologic Concerns
● Body image
● Fear
● Anxiety
● Ineffective Coping
● Interrupted family processes
● Ineffective role performance
● Grieving
● Powerlessness

53. psycho-socialaspectsofburncare