Burn Injury Severity and Nursing Care

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

Which age groups are at increased risk for morbidity and mortality from burn injuries?

Young children and older adults (correct)

Infants and teenagers

Middle-aged adults and elderly

All age groups equally

What is the primary factor that determines the severity of a burn injury?

The availability of healthcare

Depth of the burn (correct)

Circumstances under which the burn occurred

The presence of burns on the face

Which method is commonly used to assess the extent of the body surface area injured by burns?

Braden scale

APGAR score

Glasgow Coma Scale

Lund & Browder method (correct)

What characterizes the zone of coagulation in burn injuries?

Coagulation necrosis of cells occurs Signup and view all the answers

What happens to fluid and proteins after a major burn injury?

They are lost from the intravascular space Signup and view all the answers

What is a common physiological response to burn injuries that exceed one third of the total body surface area?

Hypovolemic shock Signup and view all the answers

Which zone of a burn injury may fully recover spontaneously over time?

Zone of hyperemia Signup and view all the answers

What is the initial systemic event following a major burn injury?

Hemodynamic instability Signup and view all the answers

What is the initial cardiovascular alteration that occurs immediately after a burn injury?

Decreased cardiac output Signup and view all the answers

What is a common treatment for edema following a burn injury?

Elevation of the extremity Signup and view all the answers

Which procedure is performed to relieve constricted muscle due to edema formation?

Fasciotomy Signup and view all the answers

What occurs as a compensatory response to intravascular fluid loss?

Increased heart workload Signup and view all the answers

What type of shock is burn shock initially classified as?

Hypovolemic shock Signup and view all the answers

Which electrolyte imbalance may occur immediately following a burn injury?

Hyperkalemia Signup and view all the answers

When does reabsorption of edema typically begin after a burn injury?

4 hours post injury Signup and view all the answers

What long-term effect can fluid shifts have in a burn patient?

Hypokalemia or potassium depletion Signup and view all the answers

What is the primary goal of nursing interventions for impaired gas exchange related to CO poisoning?

Maintenance of adequate tissue oxygenation Signup and view all the answers

Which intervention is crucial for maintaining a patent airway in patients exposed to smoke?

Maintaining proper patient positioning Signup and view all the answers

What should be monitored to manage hypovolaemia in burn patients?

Vital signs and urine output Signup and view all the answers

What is a nursing intervention to prevent hypothermia in burn patients?

Monitor core body temperature frequently Signup and view all the answers

How should pain be assessed in patients with acute pain from injury?

Using a numeric pain intensity scale Signup and view all the answers

What should be checked when monitoring for fluid and electrolyte balance in burn patients?

Symptoms of deficiency or excess of specific serum electrolytes Signup and view all the answers

What is an important intervention when exposing burn wounds?

Work quickly to minimize heat loss Signup and view all the answers

In the acute phase after a burn injury, what is a primary goal of nursing interventions?

Control of pain using pharmacological measures Signup and view all the answers

Which symptom is indicative of gastric bleeding due to stress?

Occult blood in the stool Signup and view all the answers

What is the primary method to manage a burn victim at the site of injury?

Establish an airway Signup and view all the answers

What immediate healthcare intervention is indicated for patients with burns greater than 20% TBSA?

Fluid resuscitation Signup and view all the answers

When should an indwelling urinary catheter be inserted in a burn patient?

For accurate monitoring of urine output Signup and view all the answers

In patients with extensive burns, what complication can arise from fluid resuscitation?

Abdominal compartment syndrome Signup and view all the answers

What should be done to treat hypothermia in burn victims during fluid resuscitation?

Perform warming techniques Signup and view all the answers

What is the primary goal of initial medical management in the emergency department for burn patients?

Stabilizing airway, breathing, and circulation Signup and view all the answers

During the management of burn injuries, what is the recommended fluid resuscitation for electrical burns?

4 ml of RL * wt * % TBSA Signup and view all the answers

What is a possible cause of hyponatremia in patients during the acute phase?

Loss of plasma or water shifts Signup and view all the answers

Which of the following is NOT a commonly observed indicator of inhalation injury?

Burns of the extremities Signup and view all the answers

How does inadequate blood flow through the kidneys affect renal function?

It causes acute tubular necrosis Signup and view all the answers

What hematologic abnormality is commonly present following burns?

Thrombocytopenia Signup and view all the answers

Which alteration often leads to increased mortality and infection rates in burn patients?

Hypothermia on admission Signup and view all the answers

What is a primary gastrointestinal alteration in patients with burns?

Paralytic ileus Signup and view all the answers

What is one of the immunologic alterations noted in burn patients?

Increased risk for sepsis Signup and view all the answers

Which laboratory finding signifies destruction of red blood cells in burn patients?

Elevated hematocrit Signup and view all the answers

What is a key component of medical management for burn injuries?

Pain management Signup and view all the answers

Which of the following is a priority in the acute/intermediate stage of recovery for burn patients?

Early positioning/mobility Signup and view all the answers

What is the primary purpose of debridement in burn care?

To remove devitalized tissue Signup and view all the answers

Which of the following complications can arise during the rehabilitation phase of burn recovery?

Hypertrophic scarring Signup and view all the answers

What approach is crucial in optimizing recovery following a burn injury?

Multidisciplinary care Signup and view all the answers

During rehabilitation, which of the following should be monitored to prevent complications?

Nutritional intake Signup and view all the answers

Which dietary requirement is emphasized in managing burn injury recovery?

High calorie, high protein diet Signup and view all the answers

What is one of the main goals during the rehabilitation phase of burn recovery?

Returning patients to the highest level of function Signup and view all the answers

Study Notes

Learning Objectives

Learners will be able to identify the incidence and factors affecting burn injury severity in the US.
Learners will be able to describe the local and systemic effects of major burn injuries.
Learners will use the nursing process to provide care for burn patients during emergent/resuscitative, acute/intermediate, and rehabilitative phases.
Learners will compare priorities of care, including fluid replacement, wound management, and other concerns.

Introduction

All adults experience burn injury at some point.
Burn injuries are painful, costly, disfiguring, and require extensive rehabilitation.
Large burns have high morbidity and mortality.
Burn injuries can affect people of all ages and socioeconomic backgrounds.
Burn patients have longer hospital stays.
Men experience burn injuries more than women.
Overall mortality from burns is 2.9%.

Incidence

Flame burns contribute to 41% of burn cases.
Scald burns make up 35% of burn cases.
Direct contact accounts for 10%.
Electrical burns account for 3%.
Chemical burns account for 3%.
Inhalation burns account for 3%.
Other causes account for 5%.

Gerontologic Considerations

Mortality from burns is higher in older adults.
Older adult skin is thinner and less elastic, impacting injury depth and healing.
Older burn patients have a higher risk of complications including pneumonia, respiratory failure, septicemia, cellulitis, wound infections, kidney injury, arrhythmias, and other hospital-acquired infections.

Prevention

Most burn injuries are preventable.

Outlook for Survival and Recovery

Age, depth, extent of body burned, inhalation injury presence, other injuries, and comorbid conditions influence burn injury severity.
Young children and older adults have higher morbidity and mortality rates when compared to other age ranges.
Burn depth is determined by the degree of tissue destruction.

Characteristics of Burns According to Depth

First-degree (superficial): Includes sunburn, characterized by redness, blanching with pressure, minimal edema. Healing is complete in a few days.
Second-degree (partial thickness): Includes scalds and flash flame. Characterized by blisters, mottled red base, and edema. Healing takes 2-3 weeks. Scarring and discoloration are possible.
Third-degree (full thickness): Characterized by dryness, pale white or charred appearance. Shows coagulated vessels. Requires grafting to heal.
Fourth-degree (full thickness deep tissue): Involves fat, fascia, muscle, or bone. Requires grafting and amputations, if possible, are likely. Healing is more challenging and is not easily achievable without further intervention.

Outlook for Survival and Recovery (continued)

Extent of body surface area injured is measured using methods like the Rule of Nines, Lund and Browder method, and the Palmer method.

Pathophysiology

Burn injury results from chemical or heat transfer causing tissue damage.
The depth of the injury depends on burn agent temperature and contact time.
The zones of burn injury include coagulation, stasis, and hyperemia.
Burns exceeding one-third TBSA result in major injuries accompanied by local and systemic inflammatory responses.
Initial systemic events after major burn injuries include hemodynamic instability caused by capillary leakage and fluid shifts.
This can progress into hypovolemic shock.

Pathophysiologic Changes with Severe Burns (Table 57-2)

Cardiovascular alterations: Cardiac depression, edema, hypovolemia.
Pulmonary alterations: Vasoconstriction, edema.
Gastrointestinal alterations: Impaired motility, absorption, vasoconstriction, and mucosal barrier function loss.
Kidney alterations: Vasoconstriction, altered thermoregulation, and increased metabolic demand.
Immunologic alterations: Increased susceptibility to infection.
Thermoregulatory alterations: Hypothermia common in early phase.
Gastrointestinal alterations: Often include paralytic ileus (absence of intestinal peristalsis), Curling's ulcer, and bacterial translocation.

Pathophysiology (continued)

Cardiovascular alterations: initial decrease in cardiac output, compensation via vasoconstriction and increased heart rate, hypovolemia due to loss of plasma volume.
Fluid and electrolyte alterations: Edema formation, often within 4 hours of superficial burns, with deeper burns having up to 18 hours. Edema can necessitate escharotomy and/or fasciotomy; reabsorption occurs approximately 4 days post-burn.
Pulmonary alterations: Inhalation of smoke or other thermal agents can lead to injury. Signs and symptoms: Singed nasal hair as indicator, hoarseness, stridor, dyspnea, and others.
Kidney alterations: Muscle damage, particularly by electrical burns, can release myoglobin, which may cause acute tubular necrosis and kidney failure if kidneys can't process and eliminate.
Immunological alterations: increased risk of sepsis.
Thermoregulatory alterations: Hypothermia.

Management of Burn Injury–On the Scene

Remove patient from source of injury.
Stop burning process, protecting rescuer.
Establish airway, deliver 100% oxygen.
Insert IV catheter.
Cover wound with clean, dry gauze.
Administer ABCDE (airway, breathing, circulation, disability, and exposure) care.

Management of Burn Injury–Medical

Transport patient to nearest ER.
Prioritize airway, breathing, and circulation.
Administer fluid resuscitation for burns exceeding 20% TBSA using lactated Ringer's solution (RL) calculated based on body surface area burned.
Obtain peripheral IV access.
Consider escharotomies or fasciotomies as needed.

Nursing Management (Emergent/Resuscitative Phase)

Establish airway, breathing, circulation, and maintain adequate ventilation.
Manage fluid and electrolyte imbalances.
Monitor and maintain body temperature.
Monitor for and prevent infection.
Assess, monitor, and support the patient's emotional, psychological, psychological, and spiritual wellbeing.
Provide adequate pain relief and manage discomfort.
Prevent complications as identified.

Nursing Management (Acute/Intermediate Phase)

Prevention of infection.
Wound cleaning, wound dressings, and wound debridement.
Remove devitalized tissue and any contamination from damaged tissue to facilitate wound healing.
Wound grafting as needed.
Manage pain, including use of pain scales, medications, and other interventions as required.

Nursing Management (Rehabilitative Phase)

Activity intolerance management in relation to pain.
Disturbed body image.
Impaired mobility, due to contractures or hypertrophic scarring.
Lack of knowledge regarding post-discharge home care and recovery needs.

Monitoring and Managing Potential Complications

Acute respiratory failure.
Acute respiratory distress syndrome.
Heart failure.
Pulmonary edema.
Sepsis.
Delirium

Rehabilitation Phase

Rehabilitation starts promptly after burns.
It's a multidisciplinary process focused on physical and psychosocial recovery to return patient to highest possible functional level.
Rehabilitation phase complications include neuropathic pain, nerve entrapment, wound breakdown, hypertrophic scarring, contractures and impaired joint mobility.

Studying That Suits You

Use AI to generate personalized quizzes and flashcards to suit your learning preferences.

Description

This quiz covers key aspects of burn injuries, including incidence rates, influencing factors on injury severity, and the local and systemic effects of burns. It also addresses nursing processes critical for the emergent and rehabilitative care of burn patients. Understanding these elements is essential for effective patient management and improving outcomes.