ACTIVE LEARNING TEMPLATE: System Disorder

STUDENT NAME______________________________________
Burns: Prioritizing Care
DISORDER/DISEASE PROCESS___________________________________________________________ REVIEW MODULE CHAPTER__57
__________

Alterations in Pathophysiology Related Health Promotion and

Health (Diagnosis) to Client Problem Disease Prevention
Dry heat, moist heat, direct contact w/hot surfaces,
Burns chemicals, electricity & ionizing raditation causes burns. Fire extinguishers
Which results in cellular destruction of skin layers & Family exit/meeting plan
underlying tissue. Type & severity of burn affect treatment Stop, drop, & roll to extinguish clothes
plan
that area on fire

ASSESSMENT SAFETY
CONSIDERATIONS
Risk Factors Expected Findings 3 phases:
Inhalation syndrome Report of burn agents
Ventilatory system Duration of contact 1. emergent: injury
Body area of the burn
Physical & mental illnesses Demographic data: age, wt, ht
to 24-48 hrs
Advanced age and children Health hx, pre-existing illness
2. acute: @ 36-48
hrs
Laboratory Tests Diagnostic Procedures 3. rehabilitative:
SPECIFIC TO RESUSCITATION PHASE: Renal scans begins when most
Initial fluid shift occurs in 1st 12 hrs & CT scan
continues for 24-36 hrs, CBC /c diff, glucose,
of the burn area
U/S
bun, H/H, Na, K+, Carboxyhemoglobin more
Bronchoscopy
has healed
than 10% indicates smoke inhalation
MRI
Infection
prevention

PATIENT-CENTERED CARE Complications

Nursing Care Medications Client Education Airway injury
Replace fluids Silver nitrate 0.5% Gently clean burned area daily w/mild
Pain management soap & water, pat dry Fluid & electrolyte
Do not break closed blisters imbalances
Tx hypothermia/hyperthermia Silver Sulfadiazine Apply cream or ointment to burn
Infection prevention 1% w/cotton swab
Nutritional support Cover with nonstick bandage
Family/pt psychological support Wrap w/gauze around bandage
Wound infections
Mafenide acetate

Polymyxin
Muscle & joint
mobility
Therapeutic Procedures B-bacitracin Interprofessional Care
Escharaotomy Gentamicin topical Dietitian
Social worker
Fasciotomy Psychological counselor
Wound care PT & OT
Skin coverings Respiratory
Case Manager
Home Health

ACTIVE LEARNING TEMPLATES Therapeutic Procedure  A11