Burn Injuries

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NCM102 - Fluids and Electrolytes

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Burn Injuries

  1. 1. Fluids and Electrolytes NCM102 by: ispongklong
  2. 2. Burns
  3. 3. Burns <ul><li>Types </li></ul><ul><ul><li>Chemical </li></ul></ul><ul><ul><li>Electric </li></ul></ul><ul><ul><li>Thermal </li></ul></ul><ul><ul><li>Inhalation </li></ul></ul>
  4. 4. Burns <ul><li>Fluid considerations </li></ul><ul><ul><li>Fluid shift and edema formation occur within 24-48 hours after burn injury. Fluid mobilization occurs within approximately 18-36 hours after burn injury. </li></ul></ul><ul><ul><li>Serum K levels ↑ and Hct levels ↑ because of hemoconcentration </li></ul></ul><ul><ul><li>The ↑ capillary permeability and the histamine released from the injured cells precipitate a ↓ in fluid volume </li></ul></ul>
  5. 5. Burns <ul><li>NURSING PRIORITY: </li></ul><ul><li>The client with burn injury is often awake, mentally alert, and cooperative at first. The level of consciousness may change as respiratory status change or as the fluid shift occurs, precipitating hypovolemia. If the client is unconscious or confused, assess him or her for the possibility of a head injury. </li></ul>
  6. 6. Burns <ul><li>Assess for </li></ul><ul><ul><li>Patent airway </li></ul></ul><ul><ul><li>Presence of adequate breath sounds </li></ul></ul><ul><ul><li>Symptoms of hypoxia </li></ul></ul><ul><ul><li>Pulmonary damage </li></ul></ul><ul><ul><ul><li>Burns around the face, neck, mouth or in the oral mucosal area </li></ul></ul></ul><ul><ul><li>Circulatory status </li></ul></ul><ul><ul><ul><li>Tachycardia and hypotension occur early </li></ul></ul></ul><ul><ul><ul><li>Elevate UO </li></ul></ul></ul>
  7. 7. Burns <ul><li>Assess for </li></ul><ul><ul><li>GI function – check last time client ate </li></ul></ul><ul><ul><li>Fluid status </li></ul></ul><ul><ul><ul><li>UO (30 ml/hr) </li></ul></ul></ul><ul><ul><ul><li>Hypotension (< 90/60) </li></ul></ul></ul><ul><ul><ul><li>Confusion / disorientation </li></ul></ul></ul><ul><ul><li>Circulatory status of the extremities </li></ul></ul>
  8. 8. <ul><li>Determine the severity of burns </li></ul><ul><ul><li>Rule of nines (adult) </li></ul></ul><ul><ul><li>Pediatric burn calculation </li></ul></ul>Burns
  9. 9. Burns DEPTH OF BURNS <ul><li>Superficial or first-degree burn: Area is reddened and blanches with pressures; no edema present; area is generally painful to touch </li></ul><ul><li>Partial thickness or second-degree burn: Dermis and epidermis are affected; formation of large, thick-walled blisters; underlying skin is erythematous </li></ul><ul><li>Full-thickness or third-degree burn: all of the skin is destroyed; may have damage to the subcutaneous tissue and muscle; usually has a dry appearance, may be white or charred; will require skin grafting to cover area </li></ul><ul><li>Fourth-degree burn: full-thickness burn in which underlying structures (fascia, tendons, and bones) are severely damaged, usually blackened </li></ul>
  10. 10. Burns <ul><li>Severity according to age </li></ul><ul><ul><li>Infants have an immature immune system and poor body defense </li></ul></ul><ul><ul><li>Elderly clients heal more slowly and are more likely to have wound infection problems and pulmonary complications </li></ul></ul>
  11. 11. Burns <ul><li>Treatment </li></ul><ul><ul><li>Respiratory status takes priority over the treatment of the burn injury </li></ul></ul><ul><ul><li>If burn area is small  cold compress or immerse in cool water ( not ice ) to ↓ heat </li></ul></ul><ul><ul><li>No ointment on the burn area </li></ul></ul><ul><ul><li>Analgesics IV, IM, SQ. oral forms may not be absorbed effectively </li></ul></ul>
  12. 12. Burns <ul><li>Nursing intervention </li></ul><ul><ul><li>Maintain patent airway; prevent hypoxia </li></ul></ul><ul><ul><li>Evaluate fluid status; determine circulatory status </li></ul></ul><ul><ul><li>Prevent of decrease infection </li></ul></ul><ul><ul><li>Maintain nutrition </li></ul></ul><ul><ul><li>Prevent contractures and scarring </li></ul></ul><ul><ul><li>Promote acceptance and adaptation to alterations in body image </li></ul></ul>
  13. 13. Burns First 24 hours Formula name Electrolyte- Containing solution Colloid-Containing Solution Dextrose in Water Evans NSS 1 ml/kg/%burn NSS 1 ml/kg/%burn 2000 ml Brooke LR 1.5 ml/kg/%burn 0.5 ml/kg/%burn 2000 ml Modified Brooke LR 2 ml/kg/%burn None None Parkland LR 4 ml/kg/%burn None None Hypertonic Saline Fluid containing 250 mEq of Na/L to maintain hourly urine output of 70 ml in adults None None
  14. 14. Burns Second 24 hours Formula name Electrolyte- Containing solution Colloid-Containing Solution Dextrose in Water Evans ½ of first 24-hr requirement ½ of first 24-hr requirement 2000 ml Brooke ½ - ¾ of first 24-hr requirement ½ - ¾ of first 24-hr requirement 2000 ml Modified Brooke None 0.3-0.5 ml/kg/%burn Titrate to maintain urine output Parkland None 0.3-0.5 ml/kg/%burn Titrate to maintain urine output Hypertonic Saline Same solution to maintain hourly urine output of 30 ml in adults None None

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