Clinical care
THERMAL INJURIES RENAL DISORDERS
[MOLLEY UNIVERSITY]
EXAM 3 NOTES
ASSESSMENT
,Thermal Injuries
Overview of Burn Injury
- When talking about burn patients, you must manage:
- Pain
- Hydration (replace volume they lost through the burn) - difficult because a lot of
the patients are elderly and have comorbidities
- Make sure you don’t give the volume replacement too quickly\
- Infection (skin is the largest organ/barrier and now it is damaged)
- One of the serious indication of how a patient will do if they are involved in a serious
burn, is if there is lung involvement
- If there is lung involvement, there is a good possibility they can develop ARDS
- A complication is contraction formation, especially if it is over a joint
- Incidence of burn injury in the United States
- During a lifetime everyone can expect to have some sort of burn injury
- Approximately 450,000 people are treated annually (10% are hospitalized)
- Prolonged hospitalizations
- Surgical intervention
- Grafts
- Escharotomy
- Fasciotomy
- Surgeries to prevent contraction formation
- Surgeries to prevent pressure buildup in the musculature
- Pain control meds - mostly opioids
- Immobilization and rehabilitation
- Often associated with long term disability
- Intravenous antibiotics and fluid resuscitation
- Fluid resuscitation begins after the airway is secured
- Wound management
- Smoke inhalation injuries/ electrical injuries
- Men are about twice as likely than females experience a burn
- Adults between 20 and 30 have a high incidence
- Burns affect all ages, ethnicities, and all socioeconomic groups evenly
- For pain, whirlpool treatment is often used
The significance of the burn determines the outcome
- Total body surface area burned
- The depth/stage of the burn
- The presence of an inhalation injury
- Advanced age and comorbidities (60 and above)
- Most common complication is pneumonia
, - The major cause of death: sepsis and MODS (multiple organ dysfunction syndrome)
- Burns that involve more than 20% of the total body surface area are classified as severe
and produce local and systemic responses
Sources of burn injury
- Scald injury particularly involving children
- Heat injury - from direct flame
- Contact injury - touching something that is extremely hot
- Chemical, electrical, moist heat, radiation
- Radiation has a thermal effect and has damage to the DNA - can be localized or
affect the whole body
- Fire
- Grease, tar
- Inhalation injury
- Home lighting
Prevention of burns in the elderly population
- Providing education
- Do not smoke around/on oxygen
- Do not smoke in bed
- Smoking and being bed bound is not good
- Nurses need to accurately determine a patient's ADL ability
- The role of alcohol and cigarettes
- Smoke detectors, carbon monoxide alarms, safer appliances
- Child resistant lighters and sprinkler systems
Severity of a burn is based on…
- Age
- When children are burned, if they need reconstructive surgery they may need it
multiple times in their life because they are growing
- Depth
- 1st degree burn: involves the epidermis, superficial injury, usually recovery within
a few days
- Sunburn
- 2nd degree burn: partial thickness involving the epidermis and a portion of the
dermis, can take 2-3 weeks to heal, very painful
- Patients can be sensitive to the air currents blowing across their skin -
make sure they are covered
- 3rd degree burn: involving the epidermis, dermis, and subcutaneous tissue, might
involve tissue and muscle, they don’t feel pain until they start to heal
- No pain because the nerve endings are destroyed
, - 4th degree burn: include fat, fascia muscle, and/or bone, likely to end up with
amputation if it is an extremity
- BSA
- Inhalation
- Location: face, hands, feet, perineum
- PMHx
Methods to determine BSA #1 Rule of nines
- Most common method used
- Allows for quick body surface area affected
Two other methods used of determining BSA burns
- Lund and Brower Method - used with children
- More precise
- Divides the body into very smaller areas
- Relates burned areas to the age of the patient
- Palmer method
- Useful with scattered burns, possibly chemical burns
- The size of the patients hands and fingers are used (approximately 1%)
Pathophysiology: Three Zones of Injury
- Zone of Coagulation - necrosis cells, they will not get better and they need to be removed
- Zone of Stasis - injured cells that are viable but with persistent ischemia, will undergo
necrosis within 24-48 hours if not treated
- Zone of hyperemia - area of injury that is minimally damaged, outermost layer
Local and systemic responses
- Burns that exceed one third of BSA are major burns
- Major burns produce local and systemic responses
- Major burns are characterized
THERMAL INJURIES RENAL DISORDERS
[MOLLEY UNIVERSITY]
EXAM 3 NOTES
ASSESSMENT
,Thermal Injuries
Overview of Burn Injury
- When talking about burn patients, you must manage:
- Pain
- Hydration (replace volume they lost through the burn) - difficult because a lot of
the patients are elderly and have comorbidities
- Make sure you don’t give the volume replacement too quickly\
- Infection (skin is the largest organ/barrier and now it is damaged)
- One of the serious indication of how a patient will do if they are involved in a serious
burn, is if there is lung involvement
- If there is lung involvement, there is a good possibility they can develop ARDS
- A complication is contraction formation, especially if it is over a joint
- Incidence of burn injury in the United States
- During a lifetime everyone can expect to have some sort of burn injury
- Approximately 450,000 people are treated annually (10% are hospitalized)
- Prolonged hospitalizations
- Surgical intervention
- Grafts
- Escharotomy
- Fasciotomy
- Surgeries to prevent contraction formation
- Surgeries to prevent pressure buildup in the musculature
- Pain control meds - mostly opioids
- Immobilization and rehabilitation
- Often associated with long term disability
- Intravenous antibiotics and fluid resuscitation
- Fluid resuscitation begins after the airway is secured
- Wound management
- Smoke inhalation injuries/ electrical injuries
- Men are about twice as likely than females experience a burn
- Adults between 20 and 30 have a high incidence
- Burns affect all ages, ethnicities, and all socioeconomic groups evenly
- For pain, whirlpool treatment is often used
The significance of the burn determines the outcome
- Total body surface area burned
- The depth/stage of the burn
- The presence of an inhalation injury
- Advanced age and comorbidities (60 and above)
- Most common complication is pneumonia
, - The major cause of death: sepsis and MODS (multiple organ dysfunction syndrome)
- Burns that involve more than 20% of the total body surface area are classified as severe
and produce local and systemic responses
Sources of burn injury
- Scald injury particularly involving children
- Heat injury - from direct flame
- Contact injury - touching something that is extremely hot
- Chemical, electrical, moist heat, radiation
- Radiation has a thermal effect and has damage to the DNA - can be localized or
affect the whole body
- Fire
- Grease, tar
- Inhalation injury
- Home lighting
Prevention of burns in the elderly population
- Providing education
- Do not smoke around/on oxygen
- Do not smoke in bed
- Smoking and being bed bound is not good
- Nurses need to accurately determine a patient's ADL ability
- The role of alcohol and cigarettes
- Smoke detectors, carbon monoxide alarms, safer appliances
- Child resistant lighters and sprinkler systems
Severity of a burn is based on…
- Age
- When children are burned, if they need reconstructive surgery they may need it
multiple times in their life because they are growing
- Depth
- 1st degree burn: involves the epidermis, superficial injury, usually recovery within
a few days
- Sunburn
- 2nd degree burn: partial thickness involving the epidermis and a portion of the
dermis, can take 2-3 weeks to heal, very painful
- Patients can be sensitive to the air currents blowing across their skin -
make sure they are covered
- 3rd degree burn: involving the epidermis, dermis, and subcutaneous tissue, might
involve tissue and muscle, they don’t feel pain until they start to heal
- No pain because the nerve endings are destroyed
, - 4th degree burn: include fat, fascia muscle, and/or bone, likely to end up with
amputation if it is an extremity
- BSA
- Inhalation
- Location: face, hands, feet, perineum
- PMHx
Methods to determine BSA #1 Rule of nines
- Most common method used
- Allows for quick body surface area affected
Two other methods used of determining BSA burns
- Lund and Brower Method - used with children
- More precise
- Divides the body into very smaller areas
- Relates burned areas to the age of the patient
- Palmer method
- Useful with scattered burns, possibly chemical burns
- The size of the patients hands and fingers are used (approximately 1%)
Pathophysiology: Three Zones of Injury
- Zone of Coagulation - necrosis cells, they will not get better and they need to be removed
- Zone of Stasis - injured cells that are viable but with persistent ischemia, will undergo
necrosis within 24-48 hours if not treated
- Zone of hyperemia - area of injury that is minimally damaged, outermost layer
Local and systemic responses
- Burns that exceed one third of BSA are major burns
- Major burns produce local and systemic responses
- Major burns are characterized
