TimbySmith Introductory MedicalSurgical Nursing 11e Chapter 66 Caring

Depth of Burn Injuries • Superficial partial thickness • Deep partial thickness • Full

Extent of Burns • Quick initial method of estimating how much of the client’s skin surface is involved • Another quick assessment technique is to compare the client’s palm with the size of the burn wound. The palm is approximately 1% of a person’s total body surface area. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injuries • Pathophysiology and Etiology: heat, chemicals, electricity – Heat: cell damage, protein coagulation • Severity: temperature of heat source, duration of contact, thickness of tissue exposed, burn location – Chemicals: liquefy tissue, loosen cell attachment – Electrical: cardiac dysrhythmias, central nervous system complications Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? A burn’s severity is affected by

Answer True Rationale: A burn’s severity is affected by the temperature of the heat source. Additional factors, which affect a burn’s severity, include duration of contact, thickness of tissue exposed to the heat, and the location of the burn. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injuries—(cont. ) • Pathophysiology – Effect of inflammatory process – Neuroendocrine changes; edema – Fluid, electrolyte status alteration – Anemia; hemoconcentration – Factors affecting mortality Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Life-Threatening Complications • Inhalation injury • Hypovolemic shock • Infection Copyright © 2014 Wolters

Question Is the following statement true or false? Burns can affect fluid balance. Copyright

Answer True Rationale: As a response to the trauma of a burn, fluid shifts, which results in edema. Not only does it result in edema but the fluid is also trapped and unavailable to the rest of the body. Decreased blood pressure (due to decreased fluid volume) can result in irreversible shock. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injuries—(cont. ) • Assessment Findings: Signs and Symptoms – Light pink to black skin color; edema; blistering; pain; compromised breathing; symptoms of hypovolemic shock; entrance, exit wounds • Diagnostic Findings: physical inspection, radiographs • Medical Management: potential life-threatening complications: inhalation injury, hypovolemic shock, infection – Major burns: transport to regional burn center Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Question Is the following statement true or false? An infection within a burn wound

Answer True Rationale: An infection within a burn wound can be life-threatening. Outcome of a burn injury depends on the initial first aid and subsequent acute treatment. Three complications of burns can be life-threatening: inhalation injury, hypovolemic shock, and infection. Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injury Medical Management • Initial first aid: first priority: prevent further injury; observe for respiratory difficulty • Acute care: assess extent of burn injury, additional trauma – Interventions: ventilation, fluid resuscitation • Endotracheal tube, bronchoscopy • Mechanical ventilation, tracheostomy, hyperbaric oxygen treatment • IV analgesics, tetanus immunization Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injury Wound Management • Infection prevention measures; debris removal • Open Method: exposes burned areas to air; used only for areas where it is difficult to apply dressings (face, perineum) – Isolation, sterile environment, escharotomy • Closed Method: current, preferred method – Use of dressings: nonadherent; absorbent; occlusive, semiocclusive; dressing changes • Antimicrobial Therapy: silver sulfadiazine, mafenide, silver nitrate, Acticoat Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injury Surgical Management • Surgical Management: debridement – Removal of necrotic tissue – Four ways: naturally, mechanically, enzymes, surgery – Disadvantage: bleeding – Covering of healthy tissue: skin graft, temporary skin substitute, cultured skin Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Surgical Management: Skin Grafting • Purpose: lessen infection, minimize fluid loss, hasten recovery, reduce scarring, prevent loss of function • Keratinocytes regenerate epidermis. • Used for deep partial-thickness and full-thickness burns • Unassisted healing: granulation tissue, contractures, chronic open wounds Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Surgical Management: Skin Grafting— (cont. ) • Sources for Skin Grafts – Autograft: client’s own skin – Allograft: human skin from cadaver – Heterograft: animal skin • Types of Autografts – Split-thickness; full-thickness; slit – Disadvantages; pressure garments; sunscreen Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Surgical Management: Skin Grafting— (cont. ) • Skin Substitutes – Cover wound; promote healing – Direct interaction with body tissues – Applied soon after skin is healed and débrided • Cultured Skin – Culture client’s skin; collagen – Disadvantage: pigmentation mismatch Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins

Burn Injury Nursing Management • Assessment – Wound; client’s status – Calculation and infusion—fluid replacement requirements – Treatment of shock; pain relief • Wound care: antimicrobials, dressings, monitoring for infection, emotional support – Client teaching: exercise, pressure garments, skin care measures Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins