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BURNS

BURNS. BURNS . Burn injury and the number of deaths - dropped in the past 10 years -decrease is from: -use of smoke detectors -creation of regional burn centers -national focus on safety -occupational safety mandates. Causes.

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BURNS

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  1. BURNS

  2. BURNS • Burn injury and the number of deaths • - dropped in the past 10 years • -decrease is from: • -use of smoke detectors • -creation of regional burn centers • -national focus on safety • -occupational safety mandates

  3. Causes • -Thermal or nonthermal causes. • -Thermal burns • -most common type of burn injury • -caused from heat • -flames, scalds, thermal energy • -Nonthermal burns • -electricity, chemicals, and radiation.

  4. Causes • Skin destruction • -depends on the burning agent • -condition of the skin before injury • -duration of the person’s contact with the agent

  5. Severity of burns • The factors that determine the severity of a burn are: -Percentage of the body surface area burned. - Age -Specific location of the burn. -Cause -Other diseases -Depth of the burn. -Injuries

  6. THERMAL BURNS

  7. NONTHERMAL BURNS

  8. Depth of burns/Classification • Superficial thickness injuries • Partial-thickness injuries • Full-thickness injuries • - graphically describe the burn • -depth and severity of the tissue injury See AHN p. 95, Table 3-3 for descriptions of the burn classifications. -If you use only the visual characteristics of the burn wound, it would not provide an accurate assessment of how much damage might have been caused.

  9. First Degree Burns

  10. Second Degree Burns

  11. Third Degree Burns

  12. Percentage Estimates • The RULE OF NINES • - determines the total body surface area (BSA) burned. See p. 106, FIGURE 3-22. • The “rule of nines” divides the body into multiples of nine. -Head to neck 18% -Arm (shoulder to fingertips) 9% each -Anterior trunk 18% -Posterior trunk 18% -Leg (groin to toe) 14% each

  13. Age considerations • Percentage of body area burned in infants and children -the surface area of the child’s head is larger • Increased risk to develop circulatory • -adults with cardiac disease • -the very old • -the very young overload.

  14. Burns • Dramatic changes • -first few minutes to the first 12-24 hours

  15. Extent of the burns? • -greater the 20% • -cause massive evaporative of water • -fluid losses into the interstitial space • -capillaries dilate (hypermeablitiy) for 24 hours • -fluid shifts from the capillaries to the • interstitial spaces • -causes edema and blistering (third spacing) • -cells become dehydrated • -hypovolemic shock starts • - hypotension and decreased renal flow

  16. Three stages of medical treatment • 1. Emergent Phase (Stage 1) • Decreased volume and shock • -occur up to 48 hours after being burned.

  17. Three stages of medical treatment • 2. Acute Phase (Stage 2) • -48-72 hours after a burn • -circulatory overload • - secondary to fluid shifting back from the interstitial • spaces to the capillaries • - increased urine output • -“diuretic stage”

  18. 3. Rehabilitation Phase (Stage 3) • -wound treatment begins • -slowly returns to as normal status as • possible

  19. Complications • Carbon Monoxide (CO) poisoning • -Person in an enclosed area during a fire • -CO displaces O2 from hemoglobin • -Don’t’ rely on oximeters • - can’t distinguish from oxyhemoglobin and • carboxyhemoglobin • -Early signs- • -headache • -nausea • -vomiting • - unsteady gait • -Treatment- 100% oxygen

  20. Smoke Inhalation • Inhaling chemicals produced by the fire • Damages- • -celia and mucous membranes of the respiratory • tract • Symptoms- • -several hours after the initial burn • High risk for patients • -upper chest, neck and face burns

  21. Smoke Inhalation • -hoarse voice -gutteral breath sounds • -productive cough -redness/swelling • -sooty sputum -nasal or oral pharynx • -singed nasal hairs • -agitation • -tachypnea • -flaring nostrils • -intercostal retractions • - grunting

  22. Smoke Inhalation • Treatment • -establish airway • -initiate oxygen • -may need intubation

  23. Shock • Emergent phase • -fluid shifting from the capillaries to the interstitial • spaces. • Requires fluid resuscitation (IV fluids) • -Adults-greater then 20% of their body surface • -Children-10 % • -Older then 55 • -Younger then 14 years • -Cardiac, pulmonary disease or diabetic • -Electric burns

  24. IV fluid therapy • -central line of Lactate Ringers • -amount of fluid given • -body weight • -percentage of body surface burned. • Foley catheter • -monitors urine output. • -30-50 cc/hour urine output • -maintain adequate renal function • Airway • -continue to maintain • -vital signs monitored

  25. Infection • Most common cause of death in the first 72 hours in burn victims • Nursing implications • -erythema, odor, green or yellow exudate • -wound culture and sensitivity • -topical bacteriostatics -capillaries are coagulated by the burns

  26. Protective Isolation • -gown, mask, cap and glove • -dressing changes require strict surgical aseptic • techniques.

  27. Immediate Medical Management • 1. Establish an airway • -Oxygen -intubated to ensure a patent airway • 2. Initiate fluid therapy • -Insert a central IV line • -Ringers Lactate IV immediately • -the amount depends on: • -body weight and the • -percentage of the body surface area burned

  28. 3. Renal function and urine output -insert a foley catheter -maintain a 30-50cc/hour urine output to perfuse the kidneys -adjust the IV fluid to maintain adequate urine output • 4. Pain control -Morphine IV -small doses given frequently

  29. -3-5mg IV every 5-10 minutes until pain relived • -Children- 0.1-0.2 mg/kg every 2-4 hours PRN • -Hypovolemic -effects of analgesic may increase • -Monitor for respiratory depression • -Fentanyl may be an alternative if the client is • allergic to Morphine

  30. 6. Body temperature -chilling -secondary to the skin being left open to the air for wound healing. -keep room at 85 degrees and humidity at 40-50% -light and heat lamps (use caution) • 7. Infection control -Tetanus immunization if client is not up to date, -Wound infections-topical bacteriostatics -Systematic infections (pneumonia) -IV antibiotics.

  31. Recovery Phase • - 10 days to several months depending on severity of the burns • -72 hours after a burn injury • -increased metabolism • -decreased urine output • -decreased edema • -Goals • -treat burn wounds • -prevent and manage complications

  32. Prevent Complications • -Infections • -heart failure • -renal failure • -extremity contractures • -paralytic ileus • -Curling’s ulcer

  33. Wound Debridement • Debridement • -removes the damaged tissue/debris from a • wound or burned tissue • -prevents infection • -promotes healing • Partial thickness wounds • -debrided twice a day • -topical antibiotic • -dressing applied

  34. Eschar removal • Black leathery crust -forms over burned tissue -holds in micro-organisms -causes infection • Escharectomy- -cutting down to the healthy tissue -chest expansion is restricted -burns around the chest, arms or legs

  35. Debridement • -Helps with regeneration of the tissues • -Enzymes • -applied topically • -chemically debride the eschar • -Hydrotherapy • -softens the eschar with water • -makes debridement less painful • -promotes range of motion the extremities • - preventing contractures

  36. Debridement • Failure to debride • -increased the chance for infection • -delays healing • -increases scarring

  37. WOUND CARE • -Severity of the burn • -Open (exposure) method -burns of the face, neck, ears, and perineum -cleaned and exposed to air -hard crust forms -regeneration of tissue occurs -advantages : -wound can be observed -body part is not restricted -circulation is not compromised -exercises can be performed more easily

  38. Pain Control • Changing the dressing will be PAINFUL!!!!! • -Analgesics-given at least 30 minutes before dressing changes • -IV Morphine • -Remove dressings after hydrotherapy

  39. Rehabilitation • -Less the 20% BSA remains burned -Physical and Occupational Therapy work -improve endurance, strengthening and independence in ADLs • Nursing Implications • -realistic short term goals-keep the client motivated -encourage to verbalize feelings about his changed body image

  40. Surgical Options • Skin Grafts- • -Prevents the scar tissue • -disfigurement • -and loss of mobility • -Required for burns • -disrupted the epidermis • -most of the dermis

  41. Surgical Options • -Promotes healing • -Prevents infection • -First 3 weeks after a burn • -4 types of grafts -auto graft -homograft -heterograft -synthetic graft

  42. Auto graft • Surgical transplantation of tissue from one part of the body from the same person

  43. Homograft • Surgical transfer of tissue from two genetically different individuals of the same species • -a temporary graft can be from a cadaver

  44. Heterograft • Tissue from another species • -Temporary graft

  45. Synthetic Graft Made from a variety of materials such as neonatal human fibroblast cells TransCyte developed in 1997 -applied only once -temporary covering -protect against fluid loss -decreases the chance of infection

  46. Methods of application of grafts • Pedicule method -partially attached to the donor site and the other portion is attached to the burn site • Free standing method -tissue is completely removed from the donor site and attached to the burn site

  47. Client education • 1. Do not to remove the dressing until the physician orders the removal. • 2. Report bruising or fluid collection under the graft to the physician. • 3. Protect the skin graft from sunlight/use sunscreen to the graft site for 6 months after the surgery. • 4. Use lotion to the skin graft site for 6-12 months. • 5. Wear elastic stocking when having skin grafts to the lower extremities for 4-6 months

  48. Pharmacology Anti-Infectives, Antiseptics and Germicides- • -Topical medications -prevent wound infections • Types- • Sulfamylon Silvadene • Silver Nitrate Furacin • Gentamycin Neomycin

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