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It is important to obtain and review medical records from the ambulance crew and emergency department in burn cases. The first responders will obtain information about the details of the fire, injuries and medical history. This information is needed for management of the injuries. Demographic data such as height, weight and age are important. The pre-burn weight is used to calculate fluid and medication doses. It may be documented in the medical record as “dry weight.” A detailed description of how and when the burn occurred and medical history should be documented. This information may be obtained from family members or witnesses if the client is unable to speak or is confused. Treatment in the first hours after a burn injury can mean the difference between life and death. It may be surprising to learn that treatment of the burns is not the first priority of care. Immediate care begins with the maintenance of respiratory function. In our case study, Mr. Smith was at risk for inhalation injury because the fire occurred indoors. Carbon monoxide is released in the process of combustion and leads to decreased oxygenation. If the neck or chest area is burned it can restrict the movement needed for breathing. Burns of the head, face and neck are high risk injuries. Sometimes soot can be visualized in the oral/nasal passages or the client may be hoarse, indicating respiratory injury. Most clients are heavily sedated and intubated quickly when an inhalation injury is suspected before airway obstruction can occur. They are then connected to a mechanical ventilator and the oxygen level is monitored carefully. At this point, the client will be unable to speak and provide information. Restoring fluid balance is the second priority of care because there is a massive capillary leak that occurs after major burns. This is sometimes referred to as “burn shock.” The rapid infusion of IV fluids is referred to as “fluid resuscitation.” The emergency personnel will try to establish IV access as quickly as possible. A urinary catheter is also placed to monitor urine output. The amount of fluid infused is calculated using a formula based on the client’s weight and percentage of body surface area burned. Baseline lab values will also be obtained in the initial stage of burn treatment and will be monitored throughout hospitalization. Nurses can help to interpret lab values and explain them to attorneys. Pain management is the next priority of care if there is no blood loss. The pain experienced by burn clients is managed with medication, often narcotics initially. Wound care is not the first priority but wounds are cleansed and covered to prevent infection until the patient is assessed by a specialist in burn care. In cases of extensive and severe burns, the patient will be transported to an American Burn Association Verified Burn Center. The treatment of burns will be discussed in the following section. This month we are discussing Burn Injuries. The blog topics for this month are:
Note: To see all posts in this topic, click here Learn about the nursing care management of patients with burn injury in this nursing study guide.
What is Burn Injury?A nurse who cares for a patient with burn injury should be knowledgeable about the physiologic changes that occur after a burn, as well as astute assessment skills to detect subtle changes in the patient’s condition.
ClassificationBurns are classified according to the depth of tissue destruction as superficial partial-thickness injuries, deep partial-thickness injuries, or full-thickness injuries.
PathophysiologyTissue destruction results from coagulation, protein denaturation, or ionization of cellular components.
Statistics and EpidemiologyA burn injury can affect people of all age groups, in all socioeconomic groups.
Clinical ManifestationsThe changes that occur in burns include the following:
PreventionTo promote safety and avoid burns, the following must be done to prevent burns:
ComplicationsThere are a lot of consequences involved in burn injuries that may progress without treatment.
Assessment and Diagnostic FindingsVarious methods are used to determine the TBSA affected by burns.
Medical ManagementBurn care is a delicate task any nurse can have and being knowledgeable in the proper sequencing of the interventions is very essential.
Nursing ManagementNursing management in burn care requires specific knowledge on burns so that there could be a provision of appropriate and effective interventions. Nursing AssessmentThe nursing assessment focuses on the major priorities for any trauma patient; the burn wound is a secondary consideration.
Acute Phase The acute or intermediate phase begins 48 to 72 hours after the burn injury. Burn wound care and pain control are priorities at this stage.
Rehabilitation Phase Rehabilitation should begin immediately after the burn has occurred. Wound healing, psychosocial support, and restoring maximum functional activity remain priorities. Maintaining fluid and electrolyte balance and improving nutrition status continue to be important.
DiagnosisNursing diagnoses for burn injuries include:
Planning & GoalsMain Article: 11 Burn Injury Nursing Care Plans To implement the plan of care for a burn injury patient effectively, there should be goals that should be set:
Nursing Priorities
Nursing InterventionsNursing care of a patient with burn injury needs to be precise and effective. Promoting Gas Exchange and Airway Clearance
Restoring fluid and Electrolyte Balance
Maintaining Normal Body Temperature
Minimizing Pain and Anxiety
Monitoring and Managing Potential Complications
Restoring Normal fluid Balance
Preventing Infection
Monitor culture results and white blood cell counts.
Maintaining Adequate Nutrition
Promoting Skin Integrity
Relieving Pain and Discomfort
Encourage the patient to use analgesic medications before painful procedures.
Promoting Physical Mobility
Strengthening Coping Strategies
Supporting Patient and Family Processes
Monitoring and Managing Potential Complications
Promoting Activity Tolerance
Improving Body Image and Self-Concept
Teaching Self-care
EvaluationIn a patient with burn injury, the expected outcomes are:
Gerontologic ConsiderationsThe following are interventions you must consider when caring elderly people with burn injury.
Discharge and Home Care GuidelinesThe focus of rehabilitative interventions is directed towards outpatient care, home care, or care in a rehabilitation center.
Documentation GuidelinesThe nurse should document the following data to ensure that each care documented is a care that is done.
Practice Quiz: Burn InjuryLet’s reinforce what you’ve learned with this 5-item NCLEX practice quiz about burn injury. Please visit our nursing test bank for more NCLEX practice questions. 1. A full-thickness burn is: A. Classified by the appearance of blisters. 2. Fluids shifts during the first week of the acute phase of a burn injury that cause massive cell destruction result in: A. Hypernatremia 3. As the first priority of care, a patient with burn injury will initially need: A. A patent airway established. 4. During the acute phase of burn injury, the nurse knows to assess for signs of potassium shifting: A. Within 24 hours 5. The leading cause of death in fire victims is believed to be: A. Cardiac arrest Answers and Rationale 1. Answer: B. Identified by the destruction of the dermis and epidermis.
2. Answer: C. Hyperkalemia
3. Answer: A. A patent airway established.
4. Answer: A. Within 24 hours
5. Answer: B. Carbon monoxide intoxication
See AlsoPosts related to Burn Injury:
[sc name=”Affiliate_MedicalSurgical”] What is the first priority in the treatment of burns?The highest priority (after airway, breathing, and intravenous access) in the setting of combined burn/trauma is the assessment and treatment of immediately life-threatening injuries, whether penetrating or blunt, then the management of the burn [46].
Which are the priorities of care for a patient with a burn injury during the emergent phase?During the emergent phase, the priority of client care involves maintaining an adequate airway and treating the client for burn shock. The eyes should be irrigated with water immediately if a chemical burn occurs.
What are initial steps for burn management?To treat minor burns, follow these steps:. Cool the burn. Hold the burned area under cool (not cold) running water or apply a cool, wet compress until the pain eases. ... . Remove rings or other tight items. ... . Don't break blisters. ... . Apply lotion. ... . Bandage the burn. ... . Take a pain reliever. ... . Consider a tetanus shot.. |