Summary NUR 445 Critical Exam 4 Study Guide

Burns

 Anatomy and Functions of the Skin
o Integumentary system
 Largest organ
 Epidermis
 Outer protective barrier
 Five layers
 Dermis
 Sebaceous and sweat glands
 Blood vessels, nerves, etc
 Two layers
 Hypodermis
 Layer of insulation
 Pathophysiology and Etiology of Burn Injury
o Zones of Injury
 Depends on extreme/extent of injury
 Zone of coagulation
 Most of where obstruction will happen
 Most damaged skin death area
 Zone of stasis
 Depending on how quickly treatment is given depends on healing
 Zone of hyperemia
 Usually healed well
 Vasodilation; increases healing process
 Classification of Burn Injury
o Size of injury
 Rule of nines
 KNOW THIS
 Estimates extent of burn in adult pts
 Ex: front of torso + entire R arm = 27%
 Rule of palms
 From tip of finger to wrist is 1%
 Lund and Browder
 Most accurate; what is used in the hospital setting
o **identify pts age, weight; identifies prognosis of pt

,o Depth of Injury
 Superficial
 1st degree burns
 Erythema, mild pain, mild discomfort and itching
 Ex: sunburns
 Minor burns that do not penetrate skin
 Partial-thickness
 2nd degree burn
 A little deeper
 Can be severe sunburns that cause blistering
 Exposure burns to heat, friction
 These get past epidermal layer, BUT still superficial
 Healing in 7-21 days
 Causes increased permeability causing leakage of fluid (blisters)
 **LOSE a lot of fluid with these burns
 Deep partial-thickness burns
 Severe impairment of blood supply
 Painful
 Dry and white waxy layer
 Complete epidermal damage and now reached the dermis
 No fluid and drainage bc of poor blood supply
 Takes 6 weeks to recover

,  Can cause necrosis
 Tx: surgical incision and skin grafting
 Full thickness
 All three layers are destroyed
 VERY high risk for infection, fluid loss
 Pain is gone; nerves are burned away
 Skin CANNOT heal properly
 Autograft
 Int: for full thickness d/t improper healing
 Additional Considerations
 Frequent assessments d/t risk of infection; done for al burns except for
superficial to see how much fluid replacement is needed
o Types of Injury
 Thermal burns
 Exposure to heat
 Longer hot item is in contact with tissue = worse the injury
 Most of burns (most common)
 Fires, hot water, sun, hot oil
 Electrical burns
 CANNOT use rule of 9s bc these type of burns are internal
 Contact injury and exit injury
 Most of the damage is inside body
 Just assessing the surface is not enough
 Severe damage to muscles…WATCH for rhabdomyolysis
 Chemical burns
 Acidic or alkalitic agents (alkalitic are more severe)
 There is continuous damage if agent is not removed
 Int: irrigate and flush it, remove clothing that contains that agent; do
NOT neutralize pt
 Radiation burns
 Least likely to see
 Cancer pts with radiation exposure
o Location of Injury
 If burn is greater than 10-15% of body; get to a burn center or specialized tx
 If face, hands, feet, major joints, genetalia, perineum; get to a burn center!!
 Functionality will be affected otherwise
o Pt age and history
 Child and elder abuse
 Large percentage have burn injuries
 Int: watch for patterns that don’t fit the story
 Even if you suspect any type of abuse, REPORT IT
 High mortality; less than 2 or older than 60
 Initial Emergency Burn Management
o Resuscitation phase (emergent)