Critical Care and Emergency Nursing:

Integumentary System

BURNS
Levi A. Santana, R.N.
Bulacan State University
College of Nursing
Apalit Doctors Hospital Inc.
Nursing Service Department
A lesion caused by heat or any cauterizing
agent, including friction, caustic agents,
electricity, or electromagnetic energy.
Types of burns resulting from different
agents are relatively specific and diagnostic.

Burns can be categorize into three

clasification (superficial, partial thickness,
and full thickness)
Burns
Types Assessment:

Flash Medical History

Scald Size and depth of

Flame burn
Age
Chemical
Body part involved
Electrical
Mechanism of injury
Burns
Burns
Superficial Partial
Thickness Burns
Dry, no blisters
Increased redness
Painful
No scarring
Burns Deep Partial Thickness
Burns
Moist with blister
formation
Mottled appearance
Very painful
Takes weeks to heal
Burns
Full Thickness
Burns
Dry with lathery
eschar
Color varies
Not painful
No healing
potential
Burns
Burns
Major Moderate Minor
•FT>10% of BSA •FT-2-10% of •FT< 2% of
•PT>25% of BSA BSA BSA
•Burns on hands, face, •PT-15-25% of •PT<15% of
feet and genitalia BSA BSA
•Complicated by
fractures or
respiratory damage
•Electrical burns
•Burns in poor-risk
patients
Burns
RBC mass metabolic rate

Anemia gluconeogenesis, glycogenolysis

Aldosterone . adrenal secretion MAJOR BURN Myocardial depressant factor

Catecholamine release H2O loss myocardial insufficiency

Na retention vasoconstriction hypovolemia CO

K loss
RBF Liver failure Tissue perfusion

metabolic acidosis
Burns
2 Stages
1. Hypovolemic Stage
 Hemoconcentration
 Hyponatremia
 Hyperkalemia
 Metabolic acidosis

2. Diuretic Stage
 Fluid overload
 Hyponatremia
 hypokalemia
Local and Systemic Responses to Burns

Hypovolemia leading to burn shock

Fluid shift leading to burn edema
Hyponatremia and hyperkalemia
Inhalation injury and carboxyhemoglobin
Renal function alterations
Local and Systemic Responses to Burns

Immunologic defenses
Body temperature changes
Paralytic ileus and Curling’s ulcer
Management of the Patient With a Burn Injury

 Emergent/Resuscitative Phase
◦ ABC
◦ Fluid and electrolyte replacement
 Acute or Intermediate Phase
◦ Infection control and wound cleaning
◦ Grafts and pain control
Management of the Patient With a Burn Injury

Rehabilitation Phase
◦ Prevention of scarring
◦ Improving body image and self-
concept
Burns
PHASES OF TREATMENT
I. Emergent Phase
A. Thermal Burns
1. Remove victim from source of burn.
2. Remove tight fitting clothing and jewelry
3. AIRWAY/BREATHING
 Assess for inhalational injury. Give oxygen if
available.
 Escharotomy for circumferential burns
4. CIRCULATION.
 Provide fluid resuscitation (use of Parkland
formula).
 Check peripheral pulses to assess circulatory status.
Burns
Escharotomy
Burns
5. THERMOREGULATION
6. INFECTION CONTROL
7. PAIN CONTROL

B. Chemical burn
 Carefully remove clothing and flush wound with
large amounts of water.

C. Electrical Burns
1. AIRWAY/BREATHING
2. CIRCULATION
 Check for presence of arrythmias.
 Check for presence of fractures
Burns
II. Acute Phase
A. Preventing Infection
 All persons approaching the patient should
wear gowns, caps, masks and gloves.
 Patients with URTI are not permitted near the
patient.
 Maintain aseptic technique when doing
procedures.
 Thorough wound dressing is necessary
Burns
B. Promoting Skin Integrity
Assess severity of burn wounds regularly.
Remove eschars.
Apply hydrotherapy.
Use sterile technique when dressing the wound.
Evacuate blisters and remove devitalized tissues.
Monitor donor and recipient sites regularly.
Offer high-protein, high carbohydrate diet.
Burns
C. Relief of anxiety
Administer and evaluate effectiveness of pain
medication before intervention.
Encourage family visits and participation of care.
Be open to patient’s expression of feelings.
Provide information or explanation as assessment
indicates.
Burns
III. Rehabilitation Phase
 Gradually increase mobility of patient.
 Encourage patient to do active ROM exercises.
 Provide splints to prevent/correct contractures
 Encourage patient to do ADLs indepoendently.
 Encourage patient to talk about concerns and fears.
 Provide discharge teaching regarding care of the
burn wounds
Burns
Medical Management:
1. Topical agents
2. Grafts
 Autografts
 Homografts
 Heterografts
Burns

Drugs Advantage Disadvantage

Silver •(-) electrolyte •Produces foul-smell
sulfadiazine imbalances
•painless
Silver •Reduces water loss •Stains skin
Nitrate •Decrease pain and •Electrolyte
odor imbalances
Mafenide •Penetrates eschar •Metabolic acidosis
(sulfamylon •allergy
)
Burns
Complications of Burns
1. Infection
2. Contractures
3. Gastrointestinal System
 Ileus
 Diarrhea
 Curling’s ulcer

4. Stress Diabetes
Summary
B Breathing
Body Image

U Urine output

R Rule of nines
Resuscitation

N Nutrition

S Shock
Silvadene