Patho of Burns
Fluid shifts from intravascular into interstitial space (3rd Spacing) due to increased permeability
Edema and low blood flow
INCREASED HCT - increased viscosity - hypovolemia shock
Classification of Burn
Depth
Extent of burn calculated in % TBSA
Location
Age, pre-burn medical hx and circumstances/complicating factors
Superficial Partial Thickness (first degree)
Affect Epidermis
Destruction of skin
Tactile/Sensation intact
Pain and mild swelling (no vesicles)
Erythema (blanchable)
Deep Partial Thickness (second degree)
Affects Epidermis and Dermis
Nerves damaged - severe pain
Vesicles = red, shiny, & wet
Rupture – blisters and scarring
Mild/Moderate Edema
Full Thickness (3rd and 4th degree)
Affects all skin elements and nerve endings
Lack of pain - nerve destruction
Dry, waxy, white, leathery/hard skin
See muscles, bone, tendons
Coagulation necrosis
Eschar
Fluid loss & infection concerns
Phases of Management
Emergent (Resuscitative) Phase
Acute Phase
Rehabilitation Phase
Emergent Phase
Major Concerns = hypovolemic shock (organs not perfused related to sudden fluid shifts) and edema formation
Patho
Massive F&E shifts r/t massive increase in capillary permeability
Clinical Manifestations
Anxious, painful, blisters form, shock s/s
End = fluid mobilization & diuresis begins
Emergent Phase Complications
CV = shock + increased viscosity + VTE
Circumferential Burns & edema impair circulation even more – ischemia/necrosis/paresthesia
Tx= escharotomy (cut through necrotic tissue to improve circulation)
PULMONARY
Upper = Severe edema
Lower = atelectasis & pneumonia
URINARY = Acute renal failure r/t decrease blood flow to kidneys (w/ shock) and excessive myoglobin (muscle breakdown) and hgb release block tubules
Nursing/ Interprofessional Management
- AIRWAY MANAGEMENT
patent airway
O2 sat. - Supp. if needed + 100% humidification - FLUID THERAPY
Aggressive via 2 large bore IVs/CVAD
Crystalloids (LR), Colloids (albumin) - increase intravascular volume and increase CO
Monitor resp., UOP (0.5- 1 mL/kg/hr), BP, HR, fluid resuscitation (FVE) - WOUND CARE
Necrotic tissue removed during debridement - allow new skin to generate, give pain meds before and after
Escharotomies and Fasciotomies to promote circulation - Pain meds and remove dead tissue/swollen connective tissue
Sterile gloves, PPE, keep room warm (lose heat through wounds and prevent shivering)
Emergent Phase Meds
Opioid analgesics and sedatives
Tetanus immunization
Topical antimicrobial (sliver sulfadiazine)
VTE prophylaxis - increased viscosity of blood
Nutritional Therapy - eternal feedings due to hypermetabolic state (wound healing)
Acute Phase
Continued assessment and maintenance of resp., circulatory status, F&E balance, GI function
Fluid Intake, I&O’s, Pain management, emotional support
Watch lab values - F&E
high/low sodium and high/low sodium
PT/OT – regain and maintain muscle strength
Skin graft for full-thickness burns
Complications = infection, CV, and rep. compromise, limited ROM, skin and joint contractures, GI issues, increased glucose levels
HIGH protein, carbs, and calorie diet
Rehabilitation Phase
GOALS = Resume a functional role in society and rehabilitate from reconstructive surgery
Avoid contractures and hypertrophic scarring - schedule ROM and consider pressure garments (keep scars flat)
Emotional/Psychological Needs
Anxiety & Anger
Depression & Fear
Guilt & hopelessness
