NCM 112 Client Care and Burn Injuries

Course Information

• Course: NCM 112: Care of Clients with Problems in Fluids and Electrolytes
• Developer: Prof. Merlie Q. Espiritu, RN, MAN
• Email: [email protected]/[email protected]

Course Description

• Covers concepts, principles, theories, and techniques for nursing care management of at-risk and sick adult clients.
• Focuses on alterations in oxygenation, fluid, electrolytes, infectious diseases, inflammatory responses, immunologic responses, and cellular disorders (acute and chronic).
• Learners are expected to develop nursing care plans.

Course Outline

• Week 10 & 12: Unit II: Fluid and Electrolyte Imbalances in Renal Disorders
• Week 13 & 14: Unit III: Fluid and Electrolyte Imbalances of Patient with Burn Injury
• Week 15 & 17: Unit IV: Fluid and Electrolyte Imbalances of Patient with Neurogenic Disorders
• Week 18: Final Examination

Rationale (Management of Patient with Burn Injury)

• Module aims to teach students about concepts, theories, and principles of fluid and electrolyte imbalances in burn injury patients.
• Module enables students to formulate comprehensive care plans for these patients.

Instructions for Users

• Students will complete preparatory activities to assess understanding of the topics.
• Developmental activities involve application, discussion, and analysis of patient cases from burns.

Burn Incidences

• Estimated 180,000 burn-related deaths annually, largely in low- and middle-income countries.
• Significant morbidity, including prolonged hospitalizations, disfigurement, and disability (DALYs).
• Rates of child deaths from burns are higher in low- and middle-income countries.

WHO (World Health Organization) 2023 Recommendations

• Enclose fires, use safer cook stoves, and use less hazardous fuels.
• Promote safer cook stoves, particularly those designed with stability, and prevent access by children.
• Promote fire safety education and the use of fire safety equipment (e.g., detectors, sprinklers).
• Promote using fire-retardant fabrics for children's sleepwear.

First Aid: What to do and What not to do

• What to Do: Remove clothing, extinguish flames, use cool water, apply a blanket, or use other fire extinguishing liquids, use cool running water, remove or dilute chemicals.
• What not to do: Do not use paste, oil, haldi (turmeric), or raw cotton; do not apply ice; do not leave uncovered; do not apply other materials directly to the wound.

Overview of Burn

• Involves destruction of skin layers, potentially life-threatening.
• Associated imbalances arise from alterations in skin and internal body membranes, and the effect of heat on body water and solutes.

Causes of Burns

• Thermal Burns: Dry or moist heat (e.g., flames, steam, hot liquids, frostbite).
• Mechanical Burns: Caused by friction or abrasion (e.g., rubbing against surfaces).
• Electrical Burns: Due to faulty wiring, high voltage lines, lightning, or immersion in electrically charged water.
• Chemical Burns: Result from direct contact, ingestion, inhalation, or injection.
• Radiation Burns: Typically associated with sunburn or radiation therapy.

Burn Severity Determination

• Factors include age, depth of burn, percentage of body surface area burned, presence of inhalation injury, other injuries, and location (face, perineum, hands, feet).
• A TBSA of more than 40% is a high-risk condition for mortality and morbidity.

Burn Depth Types (Superficial, Partial Thickness, Deep Partial Thickness, Full Thickness).

• Superficial: Dry, red, easily blanching, sometimes painful.
• Superficial Partial Thickness: Moist, red, blanching, blisters, very painful.
• Deep Partial Thickness: Drier, more pale, less blanching, less pain.
• Full Thickness: Dry, leathery texture, variable color (white, brown, black), loss of pin prick sensation.

Extent of Body Surface Area (TBSA)

• Rule of Nines: A common method to estimate the extent of burns.
• Lund and Browder Method: A more detailed method, which considers the patient's age
• Palmer Method: Used for scattered or extensive burns.

Burn Center Referral Criteria

• Partial-thickness burns exceeding 10% TBSA.
• Burns involving face, hands, feet, genitalia, or perineum.
• Third-degree (full-thickness) burns.
• Electrical burns.
• Chemical burns
• Inhalation injury
• Patients with existing medical problems or those with concomitant trauma
• Children with burn injuries in facilities that lack pediatric care expertise.

Pathophysiology of Burn Injury

• Chemical or heat injury at one site causes the damage to spread to other tissues.
• Involves coagulation, protein denaturation, or ionization.

Zones of Burn Injury (Coagulation, Stasis, Hyperemia)

• Coagulation: Central area of necrosis.
• Stasis: Surrounding area of decreased blood flow.
• Hyperemia: Outermost zone with minimal injury, potentially recovering.

Management

• Fluid resuscitation calculations based on TBSA.
• Serum creatinine kinase levels indicate muscle injury.
• IV fluids titrated to maintain urine output.
• Monitor myoglobin levels in urine.
• Sequential surgical debridement.

Cardiovascular Alterations

• Initial decrease in cardiac output.
• Vasoconstriction and increased workload of the heart.
• Hypovolemia due to blood loss and capillary leakage.

Respiratory Alterations

• Obstruction from edema (upper airway injury).
• Damage to lower airways from smoke inhalation.
• Causes inflammation, mucous production, atelectasis, and hypoxia.

Gastrointestinal Alterations

• Impaired motility and absorption.
• Possible nausea, vomiting, and paralytic ileus
• Increased risk of ulcers (Curling's ulcers).

Quality and Safety Nursing Alert

• Maintain a patent airway.
• Provide humidified oxygen.
• Administer appropriate fluids based on appropriate parameters.
• Monitor hydration and electrolyte balance.
• Early excision and care of the burn wounds.

Infection Prevention/Control

• Wound care and cleaning are crucial to prevent wound deterioration and infection.
• Use of barrier techniques, environmental procedures, appropriate topical antimicrobials, and close monitoring of signs of infection.

Wound Cleaning

• Gentle cleaning with mild soap and water.
• Short hair and shaven hairs around the burn area.
• Avoidance of ointments and creams unless in specific cases.

Topical Antibacterial Therapy

• Effective against gram-positive and gram-negative organisms and fungi.
• Penetrates eschar but is not systemically toxic
• Cost-effective and available to patients.

Wound Debridement

• Removal of nonviable tissue and foreign bodies to support healing and to prevent infections.
• Removal of devitalized tissue through techniques such as chemical or surgical methods, and natural débridement.

Autografts

• Preferred autologous method of definitive burn wound closure.
• Donor site healing involves a range of processes, and minimizing healing time is important.

Care of the Graft Site/Donor Site

• Protection and immobilization of the graft from injury.
• Maintenance of a humid environment and cleaning.

Pain Management

• Assess pain frequently and provide appropriate pain management strategies.
• Provide pain management and analgesic/anxiolytic medications.
• Use other methods like positioning, relaxation to ease painful situations.

Rehabilitation Phase

• Burn rehabilitation is a multifaceted effort.
• Rehabilitation strategies address psychological recovery.
• Patients' outlook, motivation, and support system are crucial.

Critical Thinking Activities (Questions Included)

• Includes prompts to discuss possible complications and interventions for patients with smoke inhalation injuries and burns.