Chapter 024

Chapter 24
Burns
Copyright © 2020 by Elsevier, Inc. All rights reserved.

Burns
 Occur when there is injury to the skin or other
tissues of the body caused by heat, chemicals,
electrical current, or radiation
 The patient with a burn injury may have a
multitude of problems
 Most burn accidents are preventable
Copyright © 2020 by Elsevier, Inc. All rights reserved. 2

Types of Burn Injury
 Thermal burns
 Chemical burns
 Smoke inhalation injury
 Electrical burns
 Cold thermal injury

Thermal Burns
 Caused by flame, flash, scald, or contact with hot
objects
 Most common type of burn injury
 Severity of injury depends on
 Temperature of burning agent
 Duration of contact time

Partial-Thickness Burn to Hand
Fig. 24-1

Full-Thickness Flame Burn
Fig. 24-1
Chemical Burns
 Result of contact with acids, alkalis, and organic
compounds
 Alkali burns can be more difficult to manage
because they cause protein hydrolysis and melting
 Alkalis found in cement, oven and drain cleaners,
heavy metal cleaners
 Organic compounds include phenols and petroleum
products

Smoke Inhalation Injuries (1 of 7)
 From breathing noxious chemicals or hot air
 Cause damage to respiratory tract
 Major predictor of mortality in burn victims
 Rapid initial and ongoing assessment is critical
 Airway compromise and pulmonary edema can
quickly develop

 Three types
 Upper airway injury
 Lower airway injury
 Metabolic asphyxiation

 Metabolic asphyxiation
 Carbon monoxide (CO) and hydrogen cyanide inhaled
 Impairs oxygen delivery to tissues, resulting in
• Hypoxia
• Elevated carboxyhemoglobin levels
• Death when levels reach greater than 20%
 May occur in absence of burn injury

 Upper airway injury
 Injury to mouth, oropharynx, and/or larynx
 Thermal burns
 Inhalation of hot air, steam, or smoke
 Mucosal burns of oropharynx and larynx manifested
by
• Redness
• Blistering
• edema

 Upper airway injury
 Swelling may be massive and onset rapid
• Eschar and edema may compromise breathing
• Edema from facial and neck burns can be lethal
• Internal pressure from edema may narrow airway
 Obstruction can occur quickly, presenting airway
emergency

 Lower airway injury
 Injury to trachea, bronchioles, and alveoli
 Tissue damage is related to duration of exposure to
toxic fumes or smoke
 Pulmonary edema may not appear until 12 to 48
hours after burn
• May manifest as acute respiratory distress syndrome
(ARDS)

 Lower airway injury
 Assess for
• Facial burns
• Singed nasal hair
• Hoarseness
• Painful swallowing
• Darkened oral and nasal membranes
• Carbonaceous sputum
• History of being burned in enclosed space
• Clothing burns around neck and chest

Electrical Burns (1 of 5)
 Result from intense heat generated from an
electric current
 May result in direct damage to nerves and
vessels, causing tissue anoxia and death

Electrical Burn: Back
Fig. 24-2

Electrical Burn: Leg
Fig. 24-2
 Severity of injury depends on
 Amount of voltage
 Tissue resistance
 Current pathways
 Surface area
 Length of time current flow was sustained

 Current that passes through vital organs
produces more life-threatening sequelae than
current that passes through other tissues
 Electric sparks may also ignite patient’s clothing,
causing a thermal flash injury

 Severity of injury can be difficult to determine
since most damage occurs below the skin
 Electrical current can cause muscle spasms
strong enough to fracture long bones and
vertebrae

 Patients at risk for dysrhythmias or cardiac arrest,
severe metabolic acidosis, and myoglobinuria
 Myoglobin from injured muscle and hemoglobin from
damaged RBCs travel to kidneys
 Acute tubular necrosis (ATN)
 Acute kidney injury

Case Study (1 of 13)
 M.K., a 25-year-old male, fell from a ladder while
repairing the roof and struck a hot charcoal grill.
 He is a cigarette smoker and drinks beer three
times a week.
 He works as a carpenter.
 He lacerated his left leg and his clothes caught
fire.

Classification of Burn Injury
 Severity of injury is determined by
 Depth of burn
 Extent of burn in percent of TBSA
 Location of burn
 Age of patient, pre-burn medical history, and
circumstances or complicating factors

Cross Section of Skin
Fig. 24-3
 M.K. was brought to the ED.
 His burns were estimated to be partial and full

thickness over his face, neck, trunk, right upper
arm, and left leg.

Depth of Burn (1 of 2)
 Burns are defined by degrees (first, second, third,
and fourth)
 ABA classifies burns according to depth of skin
destruction
 Partial-thickness burn
 Full-thickness burn

Depth of Burn (2 of 2)
 Superficial partial-thickness burn
 Involves epidermis
 First degree
 Deep partial-thickness burn
 Involves dermis
 Second degree
 Full-thickness burn
 Involves all skin elements, nerve endings, fat, muscle,
bone
 Thirds and fourth degree

Extent of Burn
 Two common tools for determining the total body
surface area
 Lund-Browder chart
• Considered more accurate
 Rule of Nines
• Used for initial assessment
 Sage Burn Diagram (www.sagediagram.com)

Lund-Browder Chart
Fig. 24-4
Rule of Nines Chart
Fig. 24-4
Location of Burn (1 of 2)
 Severity of burn injury is determined by location of
burn wound
 Face, neck, chest
• Respiratory obstruction from edema, eschar
 Hands, feet, joints, eyes
• Self-care difficult
 Ears, nose, buttocks, perineum
• High risk for infection

Location of Burn (2 of 2)
 Circumferential burns of extremities can cause
circulation problems distal to burn
 Possible nerve damage to affected extremity
 Patients may also develop compartment syndrome

Patient Risk Factors (1 of 2)
 Preexisting heart, lung, or kidney disease
contribute to poorer prognosis
 Diabetes and peripheral vascular disease put
patient at high risk for delayed healing

Patient Risk Factors (2 of 2)
 Physical weakness make it challenging for patient to
recover
 Alcohol or drug use
 Malnutrition
 Concurrent fractures, head injuries, or other trauma
leads to a more difficult time recovering

 What actual and potential risk factors might
affect M.K. and his recovery?

Prehospital Care (1 of 3)
 Remove person from source of burn and stop
burning process
 Rescuer must protect themselves from being
injured
 Electrical and chemical injuries
 Remove patient from contact with source

 Small thermal burns
 Cover with clean, cool, tap water-dampened towel
 Cooling within 1 minute helps minimize depth of injury
 Large thermal burns
 If unresponsive—circulation, airway, breathing
 If responsive—Airway, breathing, circulation

 Large thermal burns
 Cool burns for no more than 10 minutes
 Do not immerse in cool water or cover with ice
 Remove burned clothing
 Wrap in dry, clean sheet or blanket

Prehospital Phase
 Chemical burns
 Remove chemical particles or powder
 Flush area with water
 Inhalation injury
 Watch for signs of respiratory distress
 Treat quickly and efficiently
 100% humidified oxygen if CO poisoning is suspected

Phases of Burn Management
 Emergent (resuscitative)
 Acute (wound healing)
 Rehabilitative (restorative)

 Two large-bore IVs are started.
 An indwelling urinary catheter is inserted into the
bladder.
 By using the Lund-Browder chart, M.K.’s total
body surface area affected is 46%.

Emergent Phase
 Emergent (resuscitative) phase is time required to
resolve immediate problems resulting from injury
 Up to 72 hours
 Main concerns
 Hypovolemic shock
 Edema
 Ends when fluid mobilization and diuresis begins

Emergent Phase
Pathophysiology
 Fluid and electrolyte shifts
 Greatest threat is hypovolemic shock
• Caused by a massive shift of fluids out of blood vessels
because of increased capillary permeability
• Can begin as early as 20 minutes postburn

Conditions Leading to Burn Shock
Fig. 24-5
Emergent Phase
Pathophysiology
 Colloidal osmotic pressure decreases
 More fluid shifting out of vascular space into interstitial
spaces
 Third spacing
• Exudate and blisters
• Edema in unburned areas

Facial Edema Before and After
Fluid Resuscitation
Fig. 24-6
Emergent Phase
Pathophysiology (1 of 3)
 Normal insensible loss: 30 to 50 mL/hr
 Increased insensible losses in the severely burned
patient
 Net result of fluid shift is intravascular volume
depletion
• Edema
• Decreased blood pressure
• Increased pulse

Emergent Phase
 RBCs are hemolyzed by circulating factors released
at time of burn, as well as direct result of insult of burn
injury
 Thrombosis in capillaries of burned tissue
 High hematocrit caused by hemoconcentration

Emergent Phase
 K+ shift develops first because injured cells and
hemolyzed RBCs release K+ into circulation
 Na+ rapidly moves to interstitial spaces and stays
there until edema formation ends

Effects of Burn Shock
Fig. 24-7
Audience Response Question (1 of
2)
A patient who is admitted to a burn unit is hypovolemic. A new
nurse asks an experienced nurse about the patient’s condition.
Which response if made by the experienced nurse is most
appropriate?
a. “Blood loss from burned tissue is the most likely cause of
hypovolemia.”
b. “Third spacing of fluid into fluid-filled vesicles is usually the
cause of hypovolemia.”
c. “The usual cause of hypovolemia is evaporation of fluid from
denuded body surfaces.”
d. “Increased capillary permeability causes fluid shifts out of
blood vessels and results in hypovolemia.”

2)
Answer: D
“Increased capillary permeability causes fluid shifts
out of blood vessels and results in hypovolemia.”

Emergent Phase
 Inflammation and healing
 Neutrophils and monocytes accumulate at site of
injury
 Fibroblasts and newly formed collagen fibrils begin
wound repair within first 6 to 12 hours after injury

Emergent Phase
 Immunologic changes
 Immune system is challenged when burn injury
occurs
• Skin barrier is destroyed
• Bone marrow depression occurs
• Circulating levels of immune globulins are decreased
• Defects occur in function of WBCs
 Patient at greater risk for infection

Emergent Phase
Clinical Manifestations
 Shock from hypovolemia
 Pain
 Blisters
 Paralytic ileus
 Shivering
 Altered mental status

Emergent Phase
Complications (1 of 6)
 Cardiovascular system
 Dysrhythmias and hypovolemic shock
 Impaired circulation to extremities with circumferential
burns- if untreated can lead to
• Tissue ischemia
• Paresthesia
• Necrosis

Escharotomies of Chest and Arm
Fig. 24-8
Emergent Phase
 Cardiovascular system
 Impaired microcirculation and
increased viscosity results in sludging
• Corrected by adequate fluid replacement
 Venous thromboembolism (VTE)
• Prophylaxis with anticoagulants

Emergent Phase
 Respiratory system
 Upper airway burns
• May occur with or without smoke inhalation
 Lower airway injury

Emergent Phase
 Respiratory system
 Need fiberoptic bronchoscopy and
carboxyhemoglobin blood levels
 Watch for signs of respiratory distress Chest x-ray
may appear normal on admission; changes can occur
over next 24 to 48 hours
 ABGs may be within normal range on admission and
change over time

 What places M.K. at risk for an inhalation injury?
 What are your nursing goals for his care?

Emergent Phase
 Other cardiopulmonary problems
 Patients with preexisting heart or lung disease are at
increased risk
• Heart failure
• Pulmonary edema
• Pneumonia

Emergent Phase
 Urinary system
 Acute tubular necrosis (ATN)
 Decreases blood flow to kidneys causes renal
ischemia

Emergent Phase (1 of 19)
Nursing/Interprofessional
Management
 Airway management
 Early endotracheal intubation
 Escharotomies of the chest
 Fiberoptic bronchoscopy
 Humidified air and 100% oxygen
 High fowler’s position
 Suctioning, chest PT
 Bronchodilators

Management
 Fluid therapy
 2 large-bore IV lines for greater than 15% TBSA
 For burns greater than 20% TBSA central line may be
considered
 Arterial line placed if frequent ABGs or invasive BP
monitoring needed
 Parkland (Baxter) formula for fluid replacement

Management
 Wound care
 Cleansing and gentle debridement
• Can be done on a shower cart, in a shower, or on a bed
or stretcher
 Surgical debridement
• May need to be done in the OR
• Necrotic skin is removed
• Releasing escharotomies and fasciotomies may be
done

Hydrotherapy Cart Shower
Fig. 24-9
Debriding Full–Thickness Burn
Fig. 24-10
 M.K.’s breathing is stable on 100% humidified
oxygen.
 He is taken to OR for debridement of burns of

his trunk and arm.

Management
 Wound care
 Shower
• Once-daily shower
• Dressing change in morning and evening
 Newer antimicrobial dressings can be left in place
from 3 to 14 days

Management
 Wound care
 Infection can cause further tissue injury and possible
sepsis
• Source of infection is patient’s own flora
• Skin, respiratory, GI

Management
 Wound care
 Open method
• Burn is covered with topical antimicrobial
• No dressing over wound
• Usually limited to the care of facial burns

Management
 Wound care
 Multiple dressing changes or closed method
• Sterile gauze dressings are laid over topical
antimicrobial
• Dressings may be changed from every 12 hours to
once every 14 days

Application of Silver Sulfadiazine to
Moistened Gauze
Fig. 24-11
Management
 Wound care
 When open burns wounds are exposed, staff should
wear PPE
• Disposable hats
• Masks
• Gowns
• Gloves
 Use sterile gloves to apply antimicrobial ointment and
sterile dressings

Management
 Wound care
 Allograft
 Homograft skin
• From skin donor cadavers
• Used with newer biosynthetic options

Emergent Phase (10 0f 19)
Management
 Other care measures
 Facial care
• Covered with ointment and gauze
• Not wrapped to limit pressure
 Eye care for corneal burns
• Antibiotic ointment is used
• Artificial tears for moisture, comfort
• Periorbital edema may frighten patient

Management
 Keep ears free of pressure
• No use of pillows
• Raise patient’s head with rolled towel
 Hands and arms should be extended and elevated on
pillows or foam wedges
• Splints may be used on hands and feet
• Wraps may reduce edema

Management
 Keep patient’s perineum clean and dry as possible
• Indwelling catheter
• Perineal care
• Fecal diversion device if loose stools
 Laboratory tests to monitor fluids and electrolytes
 ABGs to assess oxygenation
 PT for ROM exercises

Management
 Drug therapy
 Analgesics and sedatives
• Morphine
• Hydromorphone (Dilaudid)
• Haloperidol (Haldol)
• Lorazepam (Ativan)
• Midazolam
 IV pain medication for fastest onset of action

 M.K. reports severe pain (9 on a 0-to-10 scale)
over his face and leg.
 He appears very anxious and expresses fear

regarding his healing and future.

Management
 Drug therapy
 Tetanus immunization
• Given routinely to all burn patients

Management
 Drug therapy
 Antimicrobial agents
• Topical agents
 Silver sulfadiazine
 Mafenide acetate
• Systemic antibiotics are not usually used in controlling
burn wound flora
 Started when diagnosis of sepsis is made

Management
 Drug therapy
 VTE prophylaxis
• Low-molecular-weight heparin or low-dose
unfractionated heparin is started
• Those with high bleeding risk, VTE prophylaxis with
intermittent pneumatic compression devices, or
graduated compression stockings recommended

Management
 Nutritional therapy
 Nutrition takes priority once fluid replacement needs
addressed
 Early and aggressive nutritional support within hours
of burn injury
• Decreases complications and mortality
• Optimizes burn wound healing
• Minimizes negative effects of hypermetabolism and
catabolism

 M.K. reports slight difficulty swallowing and his
voice is hoarse.
 He is able to swallow ice chips without difficulty.

Management
 Hypermetabolic state
• Resting metabolic expenditure may be increased by
50% to 100% above normal
• Core temperature is increased
• Catecholamines increased, stimulate catabolism

Management
 Hypermetabolic state
• Early, continuous enteral feeding promotes optimal
conditions for wound healing
• Adequate calories and protein needed
• Supplemental vitamins and iron may be given

2)
When monitoring initial fluid replacement for the
patient with 40% TBSA deep partial-thickness and
full-thickness burns, which finding is of most
concern to the nurse?
a. Serum K+ of 4.5 mEq/L
b. Urine output of 35 mL/hr
c. Decreased bowel sounds
d. Blood pressure of 86/72 mm Hg

2)
Answer: D
Blood pressure of 86/72 mm Hg

2)
During the emergent phase of burn injury, the nurse
assesses for the presence of hypovolemia. In burn
patients, hypovolemia occurs primarily as a result of
a. Blood loss from injured tissue.
b. Third spacing of fluid into fluid-filled vesicles.
c. Evaporation of fluid from denuded body surfaces.
d. Capillary permeability with fluid shift to the interstitium.

2)
Answer: D
Capillary permeability with fluid shift to the
interstitium.

Acute Phase
 Begins with mobilization of extracellular fluid and
subsequent diuresis
 Ends when
 Partial thickness wounds are healed or
 Full thickness burns are covered by skin grafts

Acute Phase
 Diuresis from fluid mobilization occurs, and
patient is less edematous
 Bowel sounds return
 Healing begins as WBCs surround burn wound
and phagocytosis occurs

Acute Phase
 Necrotic tissue begins to slough
 Granulation tissue forms
 Partial-thickness burns heal from wound edges
and dermal bed
 Full-thickness burns must have eschar removed
and skin grafts applied

Acute Phase
Clinical Manifestations
 Partial-thickness wounds form eschar
 Once eschar is removed,
re-epithelialization begins
 Full-thickness burn wounds require
 Surgical debridement
 Skin grafting

 M.K. begins to diurese and his facial and body
edema subside.
 He is taken to OR again for further debridement

and skin grafting.

Acute Phase
Laboratory Values (1 of 4)
 Sodium
 Hyponatremia can develop from
• Excessive GI suction
• Diarrhea
 Water intoxication
• From excess water intake
• Offer juices, nutritional supplements

Acute Phase
 Sodium
 Hypernatremia may occur after
• Successful fluid resuscitation
• Improper tube feedings
• Inappropriate fluid administration
 Restrict sodium in IVs, enteral or oral feedings

Acute Phase
 Potassium
 Hyperkalemia may occur if patient has
• Renal failure
• Adrenocortical insufficiency
• Massive deep muscle injury
 Large amounts of potassium are released from
damaged cells
 Assess for manifestations of hyperkalemia

Acute Phase
 Potassium
 Hypokalemia occurs with
• Vomiting, diarrhea
• Prolonged GI suction
• IV therapy without potassium supplementation
• Through burn wounds
 Assess for manifestations of hypokalemia

Acute Phase
 Infection
 Burn wound colonized by patient’s own flora
 WBCs have functional deficit and patient is
immunosuppressed
 Partial-thickness burns can convert to full-thickness
wounds in the presence of infection

Acute Phase
 Infection
 Watch for signs and symptoms
• Hypothermia or hyperthermia
• Increased heart and respiratory rate
• Decreased BP
• Decreased urine output
 Causative organism of sepsis usually gram-negative
bacteria
• Obtain cultures
• Lactate level

 At week 4, M.K. develops a temperature of 102°
F, pulse is 98, and respirations are 22.
 He has increased redness over his neck region
burns and some puslike drainage.
 He is started on a broad-spectrum antibiotic IV.

Acute Phase
 Cardiovascular and respiratory systems
 Same complications can be present in emergent
phase and may continue into acute phase
 In addition, new problems might arise, requiring timely
intervention

Acute Phase
 Neurologic system
 No physical symptoms unless severe hypoxia from
respiratory injuries or complications from electrical
injuries occur
 Disorientation
 Combative
 Hallucinations
 Frequent nightmare-like episodes

Acute Phase
 Neurologic system
 Delirium
• More acute at night
• Occurs more often in older adults
• Usually transient
• Complications and sequelae can last for years

Acute Phase
 Musculoskeletal system
 Limited ROM
 Skin and joint contractures
 Gastrointestinal system
 Paralytic ileus
 Diarrhea
 Constipation
 Curling’s ulcer

Acute Phase
 Endocrine system
 Increased blood glucose levels
• Increased mobilization of glycogen stores
• gluconeogenesis
 Increased insulin production
• Insulin effectiveness decreased due to insulin
insensitivity
 Hyperglycemia may also be caused by high caloric
intake needed

Acute Phase (1 of 12)
Management
 Wound care
 Excision and grafting
 Pain management
 Physical and occupational therapy

Management
 Wound care
 Ongoing observation
 Assessment
 Cleansing
 Debridement
 Dressing reapplication

Nursing/Interprofessional Management
 Wound care
 Enzymatic debridement
• Speeds up removal of dead tissue from healthy wound
bed
 Cleanse with soap and water or normal saline
 Cover with antimicrobial creams
 When fully debrided, cover with protective, greasy-
based gauze

Management
 Wound care
 Appropriate coverage of graft
• Greasy gauze next to graft followed by saline
moistened middle and dry outer dressings
• Unmeshed sheet graft used for facial grafts
 Grafts are left open
 Complication: Blebs

Management

 Eschar is excised down to subcutaneous tissue or
fascia
 Hemostasis is achieved
 Autograft is placed on clean, viable tissue
 Donor skin is taken with a dermatome
 Choice of dressings varies

Management
 Grafts are attached with
• Fibrin sealant
• Sutures or staples
• Negative pressure wound therapy
 With early excision, function is restored, scar tissue
minimized

Split-Thickness Sheet Skin Graft to
Hand
Fig. 24-12 Copyright © 2020 by Elsevier, Inc. All rights reserved. 116
Donor Site Being Harvested
Fig. 24-12

Covering Donor Site With
Hydrophilic Foam Dressing
Fig. 24-12
Healed Donor Site
Fig. 24-12
Management

 Cultured epithelial autographs (CEAs)
• Grown from biopsies obtained from the patient’s unburned
skin
• Used in patients with a large body surface burn area or those
with limited skin for harvesting

Application of
Cultured Epithelial Autograft
Fig. 24-13
Healed Cultured
Epithelial Autograft
Fig. 24-13
2)
A patient is to undergo skin grafting with the use of cultured
epithelial autografts for full-thickness burns. The nurse explains
to the patient that this treatment involves
a. Shaving a split-thickness layer of the patient’s skin to cover
the burn wound.
b. Using epidermal growth factor to cultivate cadaver skin for
temporary wound coverage.
c. Growing small specimens of the patient’s skin into sheets to
use as permanent skin coverage.
d. Exposing animal skin to growth factors to decrease
antigenicity so it can be used for permanent wound
coverage.

2)
Answer: C
Growing small specimens of the patient’s skin into
sheets to use as permanent skin coverage.

Management
 Dermal substitutes
• Life-threatening full-thickness or deep partial-thickness
wounds where conventional autograft is not available or
advisable
• Consists of both dermal and synthetic elements

Management
 Pain management
 Patients experience two kinds of pain
• Continuous background pain
 IV administration of an opioid
 Or slow-release, twice-a-day oral opioid
 Patient-controlled analgesia
 Anxiolytics and adjuvant analgesics
• Treatment-induced pain
 Pre-medicate with analgesic and anxiolytic
 Nondrug strategies may also be used

Management
 Pain management
 Nondrug strategies
• Relaxation breathing
• Visualization, guided imagery
• Hypnosis
• Biofeedback
• Music therapy

 M.K.’s skin grafts are healing well.
 His pain is now well controlled with oral
morphine.
 M.K. begins a regular schedule of physical and
occupational therapy.

Management
 Physical and occupational therapy

 Good time for exercise is during dressing changes
 Passive and active ROM
 Splints should be custom-fitted

Management
 Caloric needs should be calculated by dietitian
 High-protein, high-carbohydrate foods
 Antioxidant protocol may be beneficial
 Monitor laboratory values
 Weigh weekly

Rehabilitation Phase
 The rehabilitation phase begins when
 Wounds have nearly healed
 Patient is engaging in some level of self-care

Pathophysiologic Changes (1 of 3)
 Burn wounds heal either by spontaneous re-
epithelialization or by skin grafting
 Layers of keratinocytes begin rebuilding the
tissue structure
 Collagen fibers add strength to weakened areas

 In about 4 to 6 weeks, area becomes raised and
hyperemic
 Mature healing is reached about
12 months
 Often skin does not regain its original color

 Discoloration of scar fades somewhat with time
 Scar contour elevates and enlarges
 Newly healed areas can be hypersensitive or
hyposensitive to cold, heat, and touch

 M.K. progresses in his healing and is transferred
to a rehabilitation facility.
 His parents have been very involved in his
hospital care and are now ready to help him in
this phase.

Complications
 Skin and joint contractures
 Most common complications during rehab phase
 Develops because of shortening of scar tissue in
flexor tissues of joint
 Proper positioning, splinting, and exercise should be
used to minimize contracture.

Contracture of the Neck
Fig. 24-14
Rehabilitation Phase (1 of 2)
Management
 Encourage both patient and caregiver to take part in

care
 Skills for wound care
 Dressing changes
 Scar management, moisturizing, sun protection
 Reconstructive surgery is often done after a major
burn

Rehabilitation Phase (2 of 2)
Management
 Ongoing pain management

 Nutritional needs
 PT and OT routines
 Encouragement and reassurance

Gerontologic Considerations
 Normal aging process puts the patient at risk for
injury because of
 Unsteady gait
 Limited eyesight
 Decreased hearing
 Skin drier and more wrinkled
 Thinner dermis, reduced blood flow

Emotional Needs of the
Patient and Caregivers
 Many emotional and psychologic needs
 Assess circumstances of burn injury
 Burn survivors often have guilt, fear of dying,
and frustrations
 New fears may occur during recovery

 M.K. has been expressing some concern about
his ability to return to work.
 He also states that he has trouble looking in the
mirror and has been avoiding his girlfriend’s
phone calls.

Emotional Needs of
Patient and Family
 Self-esteem may be adversely affected
 Address spiritual and cultural needs
 Issue of sexuality must be met with honesty
 Caregiver and patient support groups

Special Needs of Nursing Staff
 You may find it difficult to cope with deformities
of burn injury
 Know you provide care that makes a critical
difference
 Ongoing support services or debriefings may be
helpful
 Practice good self-care

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Chapter 24

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 His burns were estimated to be partial and full

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 What are your nursing goals for his care?

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 He is taken to OR for debridement of burns of

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