Burn Injury Student

Chapter 28
CARE OF PATIENTS WITH

BURNS
Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.
Burns
Occur when there is injury to tissues of the
body caused by heat, chemicals, electrical

current, or radiation
Should be viewed as preventable
Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Dry heat
Moist heat
Contact
Chemical
Electrical burns

Electrical Burns
Severity of injury depends on
Amount of voltage
Tissue resistance
Current pathways
Surface area
Duration of the flow


Electrical Burns
Current that passes through vital organs will produce
more life-threatening sequelae than current that

passes through other tissue
Electrical sparks may ignite patients clothing,
causing a combination of thermal flash injury


Electrical Burns
Severity of injury can be difficult to assess, as most
damage occurs beneath skin
Iceberg effect
Electrical current may cause muscle spasms strong
enough to fracture bones

Classification of Burn Injury

Severity of injury is determined by
Depth of burn
Extent of burn in percent of TBSA
Location of burn
Patient risk factors

Identify the Burn Depth

Extent of Burn
Two commonly used guides for determining the total
body surface area
Lund-Browder chart
Considered more accurate
Rule of Nines
Used for initial assessment

Rule of Nines Chart


Smoke Inhalation Injuries
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


Location of Burn
Severity of burn injury is determined by location of
burn wound
Face, neck, chest respiratory obstruction

Hands, feet, joints, eyes self-care
Ears, nose, buttocks, perineum infection


Location of Burn
Circumferential burns of extremities can cause
circulation problems distal to burn

Patients may also develop compartment syndrome


Patient Risk Factors
Pre-existing cardiovascular, respiratory, and renal
diseases contribute to poorer prognosis

Diabetes mellitus and peripheral vascular disease
contribute to poor healing and gangrene


Patient Risk Factors
Physical debilitation renders patient less able to
recover
Alcoholism
Drug abuse
Malnutrition
Concurrent fractures, head injuries, or other trauma
leads to a more difficult time recovering

Resuscitation/Early Phase of Burn Injury

Continues for about 24 to 48 hours
Goals of management?
Application of Parkland Formula

A Patient weighing 154 lbs has a burn with a TBSA of
50%. The patient was found at home at 8am and

arrived to the hospital at 10am.
How much fluid should be administer in the first 8 hours?

Calculate the rate.
Facial Edema Before and After Fluid Resuscitation

Surgical Management of Burns

Escharotomy
Fasciotomy
Acute Phase of Burn Injury

Begins about 36 to 48 hr after injury; lasts until
wound closure is completed

Goals of management?
Rehabilitative Phase of
Burn Injury
Begins with wound closure, ends when patient
returns to highest possible level of functioning

Emphasis on psychosocial adjustment,
prevention of scars and contractures,
resumption of preburn activity
Rehabilitative Phase of Burn Injury

(contd)
This phase may last years or even a lifetime if
patient needs to adjust to permanent limitations
A patient arrives to the ED with superficial facial

burns from an explosion in his apartment
building. He has productive carbonaceous sputum
with labored respirations and singed hair.
Based on these findings what is the highest
priority of care for this patient?
(contd)
Which symptoms may indicate a pulmonary

injury from the inhalation? (Select all that apply.)
A. Development of a brassy cough
B. Drooling
C. Clear speech
D. Audible wheeze
E. Clear breath sounds
(contd)
Twenty minutes later, assessment of the patient reveals

loud wheezing on exhalation. What is the nurses best
action at this time?
A. Check the patients SaO2 with pulse oximetry.
B. Apply oxygen and call the Rapid Response Team.
C. Call a CODE and bring the crash cart to the room.
D. Call respiratory therapy for a treatment with a
bronchodilator.
Chapter 28
AUDIENCE RESPONSE
SYSTEM QUESTIONS
28
Question 1
A patient is admitted to the ED with burns to his lower
legs and hands after a gas can exploded. What is the
initial nursing priority on admission?
A.
B.
C.
D.
Assess and treat his pain.

Use the rule of nines to estimate his percent of body
surface area burned.
Evaluate his airway and circulation.
Place two IV catheters and initiate fluid
resuscitation.
Question 2
It has been 12 hours since a patient has been admitted
for burns to his face and neck and for inhalation
injuries. He had been wheezing audibly, but at this time
the nurse notes that his wheezing has stopped. What
should the nurse do?
A.
B.
C.
D.
Document this improvement in the patients

condition.
Re-assess his breathing in an hour.
Check the patients SPO2 level.
Notify the physician immediately.
Question 3
A patient has been receiving dressing changes with
silver sulfadiazine (Silvadene) for burn injuries over
both lower arms. The nurse notices that the patients
white blood cell count has dropped significantly over the
past 4 days. What may this change indicate?
A.
B.
C.
D.
The patients infection is improving.

The patient is having an allergic reaction to the silver
sulfadiazine.
The patient has kidney disease.
The patient has an electrolyte imbalance.

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Chapter 28

CARE OF PATIENTS WITH

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

body caused by heat, chemicals, electrical

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Types of Burn Injury

Severity of injury depends on

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Current that passes through vital organs will produce

more life-threatening sequelae than current that

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

Severity of injury can be difficult to assess, as most

damage occurs beneath skin

Electrical current may cause muscle spasms strong

enough to fracture bones

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Identify the Burn Depth

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Classification of Burn Injury

Two commonly used guides for determining the total

body surface area

Considered more accurate

Used for initial assessment

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Rule of Nines Chart

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Types of Burn Injury

From inhalation of hot air or noxious chemicals

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Severity of burn injury is determined by location of

Face, neck, chest respiratory obstruction

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Circumferential burns of extremities can cause

circulation problems distal to burn

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Pre-existing cardiovascular, respiratory, and renal

diseases contribute to poorer prognosis

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Classification of Burn Injury

Physical debilitation renders patient less able to

Concurrent fractures, head injuries, or other trauma

leads to a more difficult time recovering

Copyright 2014 by Mosby, an imprint of Elsevier Inc.

Resuscitation/Early Phase of Burn Injury

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Application of Parkland Formula

50%. The patient was found at home at 8am and

How much fluid should be administer in the first 8 hours?

Copyright 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc.

Facial Edema Before and After Fluid Resuscitation

Copyright 2014 by Mosby, an imprint of Elsevier Inc.