Nursing 211 BURNS Gail L Lupica Ph D

» Nursing 211 BURNS Gail L Lupica Ph. D, RN, CNE

» Burns are classified according to their mechanism of injury. . » Thermal- How are they caused? » Chemical- Causes? How do you treat them? » Electric- How do they cause injury to their victim? Burns? ? ? classified? ? ?

Electric burn

Burns-electrical A. Entry site b. exit site

» Carbon Monoxide Poisoning? Why is the pt at risk for death? What is the treatment? BURNS

» » » How are 1 2 3 4 …. degree burns classified? What do they look like? Painful? Blister? Scar? Burns

Categories- Burns

Superficial partial thickness

Deep partial thickness

Full and deep full thickness

» Immediate- at the scene » Emergent- (first 36 -48 hours) until capillaries heal and fluid resuscitation is complete » Acute- (48 -72 hours) diuresis occurs » Rehab phase – grafting… PT/OT BURNS - Phases

» Pathophysiology of BURN SHOCK. » What’s happening at the capillary level? » Why does vasodilation of vascular space (and capillaries) occur? » Why are ADH and Aldosterone released? Why is there < CO and blood volume? Why does tissue hypoxia occur? Burns- Emergent phase

Capillary leak syndrome---

» » » » » Let’s look at their labs…. . K+? ______high? Low? Hct______high? Low? BUN/CR ___ high? Low? ABG_____imbalance? How about HR…. BP…. CVP…. Burns- labs, VS, …

sympathetic nervous system compensatory responses to burn injury (early phase).

» What are your top three priorities in the immediate and Emergent phase of Burn care? » 1 » 2 » 3 Immediate/Emerg ent

» Under what circumstances that you obtained from the history of the burn incident would you suspect that inhalation of superheated (direct heat injury) air occurred? Is looking for evidence of this considered a priority? WHY? ? ? ? BURNS- inhalation of superheated air

» Describe what someone would look like with possible evidence of superheated air… » What interventions would be appropriate if they began to manifest dyspnea, and use their accessory muscles? » What other S&S would you look for? Burns- smoke inhalation? ?

Rule of 9 s

» Let’s say your pt’s head, front torso, and front of one leg is burned. . » What is his TBSA burned? 9 s example

» Let’s look at the rule of nine’s for determining the body surface area burned. Rule of 9 s

Burns-smoke inhalation

» What is tetanus toxoid and why is it used? ? ? » Why is colloid administration contraindicated in the first 24 hours post burn? What happens after that …that changes the way we manage the patient? Burns -emergent

» The Parkland formula is a way to calculate fluid needs in the first 24 hours after burn injury. (WEIGHT) x (%TBSA burned) x (24 ml) = Give ½ in the first 8 hours and the last half in the next 16. (After that it’s based on the pt’s responses to F & E treatment. Burns- emergent

» We need to give fluid in the first 24 hours to a 70 kg man who has 40% of his TBSA burned. We’ll use 2 ml. He was burned at 12 noon. It’s now 8 pm. How much should we have given him by now? » What fluid should we use and why? Parklandexample

» Management of Burns also includes escharotomies. What are they and how are they performed? Burns- mgmt

A. Tight circumferential eschar B. An escharotomy incision C. An anterior axillary incision

» The acute phase --24 -72 hours post burn injury. » What occurs during this period? » What clinical manifestations will you see? » Will fluid replacement needs increase or decrease? » Is colloid administration appropriate now? » What route is appropriate for administering pain medicine? Burns –Acute phase