Care of Patient with BurnsSV.pdf

Care of Patients with Burns By Dr. Angela Banks, RN, PhD Skin Function The largest organ of the body Protection Excretory Sensory perception Heat regulation  Pathophysiology of Burns Burn injury occurs Initial release of...

Care of Patients with Burns By Dr. Angela Banks, RN, PhD Skin Function The largest organ of the body Protection Excretory Sensory perception Heat regulation  Pathophysiology of Burns Burn injury occurs Initial release of histamines Increased capillary permeability with 3rd spacing Fluid loss and sodium depletion Vasodilation of the blood vessels Pathophysiology of Burns Injury Immune Response Protects the body from disease Recognizes foreign material Defenses to maintain hemostasis Response is systemic Burn Classifications First-degree burns Superficial partial thickness; 2nd degree Deep partial- thickness: 2nd degree Determining Severity of the Burn Size (surface area) Depth Age Prior status of health of victim Location of burn Severity of associated injury Rules of Nine 4 Types of Burns Electrical Thermal Chemical Radioactive First Degree Burn Second Degree Burn Superficial partial thickness burns Blisters Injury extends from the epidermis through the dermis Third Degree Burn Full thickness burn Involves the entire epidermis, dermis and underlying subcutaneous tissue Reduced sensation Fourth Degree Burn Medical emergency Involves skin, tendons nerves and possibly muscles May cause permanent damage to the affected area and lead to amputation Escharotomy and Fasciotomy 6 P’s of Compartmental Syndrome Pain- Early Parathesia- Numbness and Tingling Pallor- Pale Paralysis- Inability to move Pulselessness- No pulse Poikilothermia-Inability to regulate core body temperature  Metabolic Response to Burns Body secretions of catecholamine Cortisone, ADH, and aldosterone and glucagon Profound hypermetabolic state that requires Excess nutrients and oxygen Evaporative water loss from burn wounds May reach 300 cc/m2/hr (normal = 15) Heat loss is extensive since protective barrier (skin) is lost  Resuscitative/Emergent Phase Secure the airway Fluid Replacement Control pain and stress Prevent sepsis  Hypovolemic State - 48 Hours Rapid fluid shifts Capillary permeability with Burns increases with Vasodilation Fluid loss deep in wounds Metabolic acidosis (Loss of bicarbonate) Diuretic Phase 48-720 after Injury Fluid overload can occur due to increased intravascular volume Metabolic acidosis - HCO3 loss in urine, increase in fat metabolism Increase in renal blood Flow - Results in diuresis Adequacy of Fluid Resuscitation Mental status Blood pressure Heart Rate Capillary refill ABGs Urinary output Cardiovascular Assessment Hypovolemic shock Tachycardia Decreased BP Decreased peripheral pulses ECG changes a. ST depression b. ST elevation Respiratory Dysfunction Result of obstruction Edema of upper airway Smoke and fume inhalation  GI Assessment GI tract not directly injured except in a chemical burn Changes in function with all burn patients Decreased blood flow Histamine Blockers Famotidine (Pepcid) Cimetidine (Tagamet) Renal/Urinary Assessment  Topical Antibiotics for Burns Bacitracin - minor burns 25% TBSA Silver Nitrate >25% TBSA - fungal infections, use for patients with sulfur allergy Mafenide Acetate (Sulfamylon) - Electrical injury and wounds resistant to other topical agents Burn Surgery Treatment  Nutritional Support Positive Nitrogen Balance Early nutrition Maintenance of body protein Maintenance of daily caloric intake