MedSurg II Chapter 23

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Med-Surg IIChapter 23

• Caring For Clients With Burns

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Causes

• Heat
• Chemical
• Electricity
• Severity related to
• temperature
• duration of exposure
• thickness of tissue exposed to heat source
• location of burn
• peri area prone to infection
• face, neck or chest can impair ventilation
• those involving hand or major joints can
  affect dexterity

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Effects of Burns

• Inflammatory processes begin which affect bodys
  stress response
• Electrolyte loss due to loss of fluids from open
  areas
• Fluid shifts from others areas to burned area
  causing edema
• Loss of extracellular components such as albumin
  affect fluid electrolyte balances
• Decreased volume cause hypotension which can lead
  to shock

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DEPTH OF BURN INJURY

• SUPERFICIAL
• PARTIAL THICKNESS
• FULL THICKNESS
• SEE FIGURE 23-2, 23-3, TABLE 23-1

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ZONES OF BURN INJURY-fig 23-4

• ZONE OF COAGULATION center, area of worst,
  deepest injury
• ZONE OF STASIS-intermediate area
• ZONE OF HYPEREMIA-area of least injury

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EXTENT OF BURN INJURY

• Assessing the of body surface area burned fig
  23-6
• Rule of Nines fig 23-5
• Estimating total body surface area burned (TBSA)
  compare the clients palm with size of the burn
  wound palm is approximately 1 of TBSA

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Assessment

• Skin color
• ranges from light pink to black
• Presence of edema or blistering
• Pain
• all burns except full-thickness will have pain
• S/S of hypovolemic shock
• Respiratory effort, box 23-1
• If electrical burns may have entrance exit
  wounds

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MEDICAL MANAGEMENT

• Initial First Aid
• prevent further injury
• observe for signs of respiratory distress
• transport to hospital
• O2, IVF established

• ACUTE CARE
• assess extent of burns other injuries
• respiratory mgmt
• blood specimens
• fluid resusitation
• pain mgmt
• foley
• Tetanus, antibiotics

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WOUND MANAGEMENT

• Open Method
• Expose burned area
• Not used much
• Only used for areas such as face perineum where
  it is difficult to apply dressings

• Closed Method
• Most common method
• Dressings applied
• Topical antimicrobials applied, silvadene,
  sulfamylon, silver nitrate

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SURGICAL MANAGEMENT

• DEBRIDEMENT
• Methods
• Naturally
• Mechanically
• Enzymatically
• Surgically

• SKIN GRAFTING
• Purposes
• Sources
• autografts pts own skin fig 23-7
• allografts cadaver
• heterografts animal used, mostly pigs

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SURGICAL MANAGEMENT

• SKIN SUBSTITUTES
• Biobrane-fig 23-9
• Integra
• TranCyte
• CULTURED SKIN
• cultures the clients skin in a lab
• used with very large burns

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NURSING MANAGEMENT

• assessment
• fluid replacement
• pain management
• dressings
• see nursing care plan 23-1

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General Nutritional Considerations

• Extensive burns is one of the most severe forms
  of stress that a person can experience
• Proper nutritional support is very important to
  lessen chances of weight loss malnutrition that
  can compromise the healing process
• Protein needs increase as much as 2-4 times
  calorie needs may be as high as 4000 to 5000/day