Care of Patients with Burns

Skin Function

• Largest organ of the body
• Serves protective, excretory, sensory, and thermoregulatory roles

Pathophysiology of Burns

• Histamines are released initially after burn injury
• Increased capillary permeability leads to fluid loss and sodium depletion
• Vasodilation occurs in blood vessels

Immune Response

• Protects body against disease
• Identifies foreign materials
• Maintains hemostasis with a systemic response

Burn Classifications

• First-degree burns: Affect only the outer layer (epidermis)
• Second-degree burns: Superficial partial thickness and deep partial thickness with blisters and deeper tissue damage

Determining Severity of Burns

• Severity assessed by size (surface area), depth, age, health prior to injury, location, and associated injury severity

Rules of Nine

• Method to assess burn size in adults using body regions as a percentage

Types of Burns

• Electrical, thermal, chemical, and radioactive

First Degree Burn

• Affects only the epidermis

Second Degree Burn

• Superficial partial thickness: Blisters form, damage extends through the dermis

Third Degree Burn

• Full-thickness burn, involves entire epidermis, dermis, and underlying tissue; sensation may be reduced

Fourth Degree Burn

• Medical emergency involving skin, tendons, nerves, and possibly muscle; potential for permanent damage or amputation

Escharotomy and Fasciotomy

• Procedures to relieve pressure in compartment syndrome, indicated by the 6 P's: Pain, Parathesia, Pallor, Paralysis, Pulselessness, Poikilothermia

Metabolic Response to Burns

• Release of catecholamines, cortisone, ADH, aldosterone, and glucagon
• Hypermetabolic state requires increased nutrition and oxygen
• High evaporative water loss from burn wounds (up to 300 cc/m²/hr)

Resuscitative/Emergent Phase

• Priority actions include securing the airway, fluid replacement, pain control, and prevention of sepsis

Hypovolemic State (48 Hours Post-Injury)

• Rapid fluid shifts and increased capillary permeability
• Fluid loss deep into wounds contributing to metabolic acidosis (loss of bicarbonate)

Diuretic Phase (48-720 Hours Post-Injury)

• Potential for fluid overload due to increased intravascular volume
• Continued metabolic acidosis and heightened renal blood flow leading to diuresis

Adequacy of Fluid Resuscitation

• Assess through mental status, blood pressure, heart rate, capillary refill, arterial blood gases (ABGs), and urinary output

Cardiovascular Assessment

• Signs of hypovolemic shock include tachycardia, decreased blood pressure, weak peripheral pulses, and ECG changes

This quiz focuses on the care and management of patients with burn injuries. It explores skin function, the pathophysiology of burns, and the body's immune response to such injuries. Perfect for nursing students and healthcare professionals seeking to enhance their understanding of burn care.