BURN INJURYS (Burns are one of the most devastating injuries an individual can

experience. Burns can be painful & disfiguring & require long

hospitalizations. Severe burns can be life threatening or fatal). *Most
Burns Occur in the home & can be prevented. *70% burn clients are
men, according to ABA.
Major Causes *Two most common causes are fire/flame & Scalds.
Majority burns occur in the home. Burn injuries to ADULTS are often
r/t cig smoking or cooking. ELDERLY are prone to spilling hot liquid
on themselves or catch their clothes on fire while cooking or smoking.
YOUNG children are prone to spilling scalding liquids on them &
playing with matches. Contact burns can happen when a person makes
skin-skin contact with a hot object.
INDUSTRIAL Injuries account for a significant number of burn injuries
in YOUNG ADULTS; this burn is a result of a chemical, electrical,
radiation, or heat injury in the work place.
** Another source of burns for ALL ages is overexposure to SUNLIGHT.
Need SPF of at least 15 on exposed skin. Tanning devices can cause
sunburns & should be used cautiously.
Severity *FIRST & SECOND DEGREE burns are partial thickness. THIRD &
FOURTH Degree burns are full thickness.
FIRST DEGREE: ONLY EPIDERMIS, skin is red hot and painful,
maybe swollen. Ex. Sunburn. Heal in about a week without
scarring.
SECOND DEGREE: DAMAGES DERMIS & EPIDERMIS. Red-hot
painful skin blisters. Skin may be glossy from leaking fluid. Ex.
Spilling boiling water on skin. Heals in about two weeks with
no scarring. However that depends on how deep the dermis
was burned, it could scar and take longer to heal.
THIRD DEGREE: ALL DERMIS STRUCTURES ARE DESTROYED
& CANNOT BE REGENERATED. SUB Q can also be damaged.
White, Tan, brown, black charred or bright red in color.
FOURTH DEGREE: EXTEND TO MUSCLE & BONES, appear
white to black charred. This results from fires, explosives &
nuclear radiation.
****First & Second degree burns are painful Third & Fourth
are not because the nerve endings are destroyed.
** Most Frequent Burn Related problem is inhalation injury, &
this has the most significant effect on patients survival.

Complications Smoke inhalation & carbon monoxide poisoning, shock, & infection.
MOST Life threatening; Respiratory failure & massive fluid loss.
ESCHAROTOMY: surgical incision into eschar to relieve pressure &
constriction of burned tissue.
Smoke Inhalation & Carbon Monoxide Poisoning: Symptoms:
Confusion, facial burns, singed nasal hair, changes in voice,
difficulty breathing, wheezing, coughing, and carbon-tinged
sputum. (Carboxyhemoglobin- carbon monoxide attaches to the
hemoglobin, giving a false high reading of O2). Keep airway
open, administer 100% humidified O2, intubation might be
necessary. Hyperbaric Oxygen therapy can reduce amount of
Carbon monoxide in clients blood.
SHOCK: Hypovolemic shock or neurogenic shock. Fluid &
electrolytes are lost threw burns.
Infection: Staph. Aureus is common cause for infections. MRSA
is also an infection that can occur, treated with vancomycin. All
persons that come in contact with burn patient must wear
GOWN, GLOVES, MASKS, & CAPS to help prevent organisms
from getting into burn wound, Sterile Tech. for wound care &
dressing changes.
Med Surge Management MEDICAL CARE:
IMMEDIATE CARE: Keep airway open, maintain O2, Replace
body fluids & electrolytes. Monitor kidney function, control
pain, and protect burns with sterile dressings. Minimize loss of
body temp and risk for infection. FOLEY, CHEST XRAY,
ENDOTRACH TUBE, MULTI PORT VENOUS CATH. Pain
controlled with morphine, patient given tetanus toxoid
immunization.
STABLIZED CARE: promote healing, preventing complications,
controlling pain, & restoring function. Antibiotics ordered. **
Dead tissue from full thickness burns form dry dark leathery
eschar within 48-72 hours (Infection can occur under the
eschar causes tissue sloughing). Excisional debridement of
wound may be ordered. ** Must be free of infection & necrotic
tissue to be covered with a skin graft. Limiting movement &
maintain body alignment with use of splints can also help with
discomfort.

SURGICAL:
Autograft: Patients own skin, removed from unburned
area and applied to wound.
Homograft: Skin from another person, usually a cadaver
(within 6-24 hours after death)
Heterograft: Skin from an animal, pig.
Artificial Skin: Biomaterial from non-living substance
with two layers like skin. Surgeon cover wound with this
after debriding and removing burned tissue.

Pharmacological:
IV narcotics, usually morphine q10-15 mins before
procedure, Psy drugs to decrease anxiety & fear, topical
agents to decrease infection and promote healing
(Silvadene) may cause skin rash. Apply topical agents in
a thin layer with sterile gloves.

Diet & Activity:
High Calorie, High Protein. Possible TPN. *Food or fluids
cannot be given orally or by tube until peristalsis is
restored (bowel sounds). Prevent contractures by
positioning, splinting, exercising, and ambulating.
Immobilize joints following skin graft.

Nursing Management LR IV therapy, Foley to monitor I & O (should be 30-50ml/hr), pain
med IV, Monitor vitals and respirations, SpO2, LOC, Lab results. Follow
standard precautions, monitor wounds for infection, monitor mental
status. Explain healing process to family & patient.


*** Rules of 9:
-Head 9% (4.5 anterior, 4.5 posterior)
-Each Arm 9% (4.5 anterior, 4.5 posterior)
-Anterior Trunk 18%
-Posterior Trunk 18%
-Each Leg 18% (9 anterior, 9 posterior)
-Genital 1%


*** Parklands Formula: 4mL of LR x Body weight (kg) x %TBSA