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Integumentary: Burns

Integumentary: Burns. Marnie Quick, RN, MSN, CNRN. Skin layers, hair follicle, nerves, sweat glands. Types of burns. Thermal Chemical Smoke and inhalation Electrical Radiation. Thermal burn.

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Integumentary: Burns

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  1. Integumentary: Burns Marnie Quick, RN, MSN, CNRN

  2. Skin layers, hair follicle, nerves, sweat glands

  3. Types of burns • Thermal • Chemical • Smoke and inhalation • Electrical • Radiation

  4. Thermal burn

  5. Cool burn with cold water until pain is relieved- Do not apply to more than 20% body surface- hypothermia may occur

  6. Chemical burn from sulfuric acid

  7. Smoke & Inhalation: Which is this?- CO; injury above glottis; below glottis

  8. Electrical burns

  9. Depth of Burn

  10. Depth of burn: Superficial partial (old 1st) Deep partial-thickness (old 2nd) Full-thickness (old 3/4th)

  11. Deep partial-thickness burn- note blisters

  12. Partial-thickness (Second degree burn)

  13. Full-thickness

  14. Extent of Burn: *calculate total burn with rule of 9’s-- ½of ant trunk=9% and ¼ of arm=3% **TOTAL area burn=12% Rule of Nines Lund & Browder- age

  15. Location of Burn • Location of the burn is related to the severity of the injury: • Face, neck, chest → respiratory obstruction • Hands, feet, joints, eyes → self-care • Ears, nose → infection • Circumferential burns of the extremities can cause circulatory compromise • Patients may also develop compartment syndrome

  16. Phases of Burn Management • Prehospital care • Emergent (resuscitative- fluid) • Acute (wound healing) • Rehabilitative (restorative)

  17. Emergent/resuscitative • Onset injury to successful fluid resuscitation • Major concern- Fluid Resuscitation- prevent hypovolemic shock • 2 large bore IV’s in unburned area to restore bl vol due to inc capillary permeability> 3rd spacing • Guidelines burns >20% TBSA- Parkland formula or Modified Brooke formula • Need Weight and % TBSA burned to calculate

  18. Lactated Ringers solution 1st 24 hrs then add 5% Dextrose to crystalloid fluid • 50% of formula volume in first 8 hrs; rest over next 16 hrs; then maintain urinary output • Hourly output 30-50 cc/hr (foley); heart rate less than 120/min; SBP> 90;hemodynamic monitoring • Elevate edematous part; escharotomy

  19. Effects of Burn Shock

  20. Third spacing

  21. Burn with escarotomy

  22. Escarotomy

  23. Elevate arms to decrease swelling also note escarotomy of arms and chest- assess CMS (circulation/motor/sensory)

  24. Before the escharotomy, how would this eschar affected his respirations?

  25. What are the Priorities in this patient??? Meet criteria for Burn Unit Referral?

  26. What do you assess for here???

  27. Complications in emergent phase • Cardiovascular • Respiratory • Upper/inhalation/lower • Urinary • Renal blood flow/GFR decrease causing release ADH • Myoglobinurea- dark urine may block renal tubules

  28. Summary:

  29. Acute Phase • Start of diuresis and ends with closure of burn • Major concern in this stage- infection • Most common cause infection- pts own GI track • Wound management- • hydrotherapy, debridement of eschar • topical antimicrobial creams (open/closed method) • splints/exercise prevent contractures; • Excision/grafting of 3rd degree (temporary cover 2nd )

  30. Decreasing of third spacing- Note edema of the face decreasing

  31. Hydrotherapy: Hubbard Tank

  32. Clean/debridement Rt tank or Lt surgery

  33. Topical broad spectrum antimicrobials Open method

  34. Separate skin; use of splints Closed method

  35. Skin will grow together if not separated

  36. Several patients utilizing closed method Who is that nurse with white stockings& cap?

  37. Removal of necrotic tissueEschar removed until viable tissue

  38. Donor sites:after harvesting healed donor site

  39. Grafting (Lewis 484 Table 25-13) • Permanent- if no infection • Autograft • CEA • Integra/AlloDerm • Temporary grafts • Homograft- cadaver • Heterograft- animal • Synthetic

  40. Grafting

  41. Application of Cultured Epithelial Autograft • Cultured epithelial autografts • Grown from biopsies obtained from the patient’s own skin • Used in patients with a large body surface burn area or those with limited skin for harvesting

  42. Pressure garments

  43. What are your assessment findings?

  44. What are your nursing priorities for this patient?

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