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11/15/2011
BURNS
HCC Nursing N241
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Contents
Structure of skin Types of burn (cause, depth, area, phase) Symptoms and complications Interventions (urgent and long-term) Nursing diagnoses
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Burns
Occur when there is injury to the tissues
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chemicals Major predictor of mortality in burn victims Need to be treated quickly: who (area of burn) are at risk? Types Carbon monoxide poisoning above the glottis vs. below the glottis
Electrical BurnHand
Fig. 25-2 A
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Electrical BurnBack
Fig. 25-2 B
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Severity of injury is determined by Depth of burn Extent of burn Location of burn Patient risk factors
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Involves the epidermis Pink-bright red, mild edema, mild pain Deep partial-thickness burn Involves the dermis Bright red, blister, moist glistening appearance Severe pain, graft may be needed Full-thickness burn Involves fat, muscle, bone Pale, waxy, charred, or nonblanching red No pain, graft required
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Hyperbaric Chamber
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infection, fluid and electrolyte imbalances, and hypothermia Cardiac dysrhythmias and circulatory failure Profound catabolic state Alteration in gastrointestinal motility Dehydration
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resuscitation Acute (wound healing) From the start of diuresis to the closure of the wound, either by natural healing or by using skin grafts Rehabilitative (restorative) Starts wound closure and ends when client returns to highest level of health restoration, which may take years
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Pre-hospital Care
Remove the person from the source of
the burn, Rescuer must be protected ABC Irriga on cover IV Foley ABG
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Parkland Formula
4ml of LR x Kg x %TBSA in first 8hr The rest in the remaining 16 hours
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Hypovolemic shock * second spacing * insensible loss of fluid Electrolytes imbalances Wounds infections, pain
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Acute Phase
begins with the mobilization of
extracellular fluid and subsequent diuresis concluded when the burned area is completely covered by skin grafts or when the wounds are healed
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Drugs
Analgesics and sedatives
Morphine, Hydromorphone (Dilaudid)
Haloperidol (Haldol) Lorazepam (Ativan), Midazolam (Versed) Tetanus immunization Antimicrobial agents
Topical agents: Silver sulfadiazine (Silvadene)
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Wound Care
Infection/ sepsis prevention Sheet skin grafts must be kept free of blebs Prevent contracture Nutritional support
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Anasarca
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Escharotomy
Fig. 25-9
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Fig. 25-10
Fig. 25-11 B
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Fig. 25-12 A
Fig. 25-13
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custom-made elastic pressure garments such as a Jobst garment for 6 months to a year postgraft.
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charcoal grill. He lacerated his left leg, and his clothes caught fire. Once brought to ED, his burns were estimated to be partial and full thickness over his face, neck, trunk, right upper arm, and left leg. He is alert, and his voice is slightly hoarse. His left leg is splinted, and the lacerated wound is cleaned and debrided. IV is started, and urinary catheter is inserted. Using the Lund-Browder chart, his TBSA is 46%.
In what phase of burning injuries would he be
classified?
What are the priorities of care for him? What places him at risk for an inhalation injury? What are your nursing goals for his long-term care?
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