Welcome to Scribd. Sign in or start your free trial to enjoy unlimited e-books, audiobooks & documents.Find out more
Download
Standard view
Full view
of .
Look up keyword
Like this
14Activity
0 of .
Results for:
No results containing your search query
P. 1
Burn Lecture Notes

Burn Lecture Notes

Ratings:

4.67

(1)
|Views: 2,436|Likes:
Published by Marcus, RN
includes nursing management
includes nursing management

More info:

Published by: Marcus, RN on Sep 20, 2008
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOCX, PDF, TXT or read online from Scribd
See more
See less

09/06/2012

pdf

text

original

 
Burn Lecture Notes
BURNS:
A. CLASSIFICATION OF BURNS
Partial thickness -
characterized by varying depth from epidermis (outer layer of skin) to the dermis (middle layer of skin)
Superficial -
includes only the epidermis
Deep -
involve entire epidermis and part of the dermis
Full thickness -
includes destruction of the epidermis and the entire dermis as wellas possible damage to the SQ, muscle and bone
B. REVIEW OF SKIN FUNCTIONS
Functions of the skin
Protection -
intact skin is the first line of defense against bacterial andforeign-substance invasion
Heat regulation
Sensory preception
Excretion
Vitamin D production
Expression -
important with body image - fear of disfigurement
C. STAGES OF BURNS:
Hypovolemic state -
 begins at the onset of burn and lasts for the first 48 hours - 72hours
Rapid fluid shifts - from the vascular compartments into the interstitialspaces
Capillary permeability with burns increases with vasodilation
Fluid loss deep in wounds
Initially Sodium and H2O
Protein loss - hypoproteninemia
Hemoconcentration - Hct increases
Low blood volume, oliguria
Hyponatremia - loss of sodium with fluid
Hyperkalemia - damaged cells release K, oliguria
Metabolic acidosis
Diuretic Stage -
 begins 48 - 72 hours after burn injury:
Capillary membrane integrity returns
Edema fluid shifts back into vessels - blood volume increases
Increase in renal blood flow - result in diuresis (unless renal damage)
Hemodilution - low Hct, decreased potassium as it moves back into thecell or is excreted in urine with the diuresis
Fluid overload can occur due to increased intravascular volume
 
Metabolic acidosis - HCO3 loss in urine, increase in fat metabolismE. Fluid shifts resolving - pt still acutely ill2. malnutrition3. anemia - develops from the loss of RBC
Three periods of treatment -Emergent, Acute, Rehabilitation:I.EMERGENT 
(first 24-48 hrs)
immediate problems
Maintain airway, fluids, analgesia, temperature, wound
Assessment:
Objective
how burn occurred, when
duration
type of agent
Subjective:
 previous medical problems
size and depth of burn
age
 body part involved
mechanism of injury
Factors Determining Severity of Burns:
Size of Burn Depth of Burn
Age
Body part effected
Mechanism of Injury
History of cardiac, pulmonary, renal or hepatic diseases
Injuries sustained at time of burn
Duration of contact with burning agent
c.
Size & Depth of Burn
- "Rule of Nines"
Divide body surface into multiplesof nine
MAJOR BURN:
> 25% of BSA of a partial thickness> 10% of BSA of a full thickness
d. Age < 2 years old or > 60 years old, the mortality rates increases
e. Body part involved -
not all are equalCosmetic and functional concerns Face, eyes, ears, feet, hands, perineumLimbs, neck and chest - burns can produce a tourniquet effect
f. Mechanism of injury -
identify causative agent (Flame, contact, scalds, chemical,electrical)
g. Nursing diagnosis:
 
Airway clearance,
ineffective Fluid volume deficit Fluid volume excess
Hypothermia
Infection,
high risk for Pain (with partial thickness burns)
Skin integrity, impaired
Anxiety Knowledge
h. Interventions:
maintain a patent airway - watch for laryngeal edema,
100% FiO2 mask (increase in carboxyhemoglobin) intubation for inhalationmost often required
maintain circulation - fluid resuscitation - crystalloids and colloidsCrystalloids - may be isotonic or hypertonic
1.
Isotonic -
most common are lacted Ringers or NaCl (0.9%) - these donot generate a difference in osmotic pressure between the intravascular and interstitial spaces - subsequently LARGE amounts of fluid arerequired
2.
Hypertonic
salt solutions create an osmotic pull of fluid from theinterstitial space back to the depleted intravascular space (helpsdecrease the amount of fluid needed during resuscitation. decreases thedevelopment of burn tissue edema, pulmonary edema, and CHF)
Colloids - replacement begins during the second 24 hours following the burn toreplace intravascular volume ONCE CAPILLARY PERMEABILITYSIGNIFICANTLY DECREASES
General Indications for Fluid Resuscitation:
1.
Burns > 20% of BSA with adults
2.
Burns > 10% of BSA with children
3.
Age >65 or < 2
"Parkland Formula"
4ml of Lacted Ringers x weight (Kg) x %BSA burned = ml of Lacted Ringers to be given during the first 24 hour period following the burn first 8 hoursfollowing the burn are the most crucial - need to half of the total, the second 8 hrs give one-quarter or the remaining fluids, the last 8 hrs give the remaining one-quarter (with severe burn it is not uncommon to give greater than 20 thousand ml in a 24 hour period) colloid(protein) given after capillary integrity returns NPO - great thirst, ileus is common assessfor adequate fluid replacement - HR < 120, BP - systolic >100, UO > 30 cc/hr pH 7.35 -7.45, weight gain the first 72 hours during the diuretic phase UP is not a reliable indicator look at electrolytes analgesia - drug of choice is IV Morphine - NO IM or SQ wound caremaintain body temperature - need to keep environment WARM, no drafts, heat lamps,sterile sheets emotional support - fear of dying, disfigurement, trauma
SIGNS OF ADEQUATE FLUID RESUSCITATION:
Clear sensorium
Pulse < 120 beats per minute

Activity (14)

You've already reviewed this. Edit your review.
1 hundred reads
1 thousand reads
shenric16 liked this
jom006 liked this
julie liked this
Altayework liked this
plastic68 liked this
akosipaa liked this
annelovesjesus liked this

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->