Interventions for ClientsInterventions for Clients

with with BurnsBurns

Burn Injury 10,000 deaths/year

More common in men

Death rates high in kids and older adults

Most deaths happen in home

High incidence in low-income households

Major Sources of Burns Interaction between energy (thermal, chemical, electrical, or

radiation) and biological matterThermal burns

Most common type Flames, scalds, or contact with hot substances Frostbite is a type of thermal injury

Chemical burns Substances that produce chemical changes in skin with or

without heat productionElectrical injuries

Lightning injuries Direct contact with electrical current Arcing of electricity between two contact points near skin Flash burns if fuel source is ignited

Anatomy of the Skin

Skin is the largest organ in the body. The skin consists of three layers:

Epidermis Consists of five layers (stratum)

Tough non-vascular protective barrier Dermis

Consists of two layers Nerve endings, blood vessels,

hair follicles, sebaceous and sweat glands & sensory fibers

Subcutaneous Tissue Adipose tissue, major blood vessels and nerves

Abuse & Burn Injuries

Abuse & Burn Injuries Can occur in any age group; children highest incidence Burn injuries accounts for 10% of all child abuse cases

Suspect Abuse When: Burn distribution inconsistent with reported incident Delay in seeking medical attention History of family instability Inability to cope with stress in time of crisis

Laws Related to Suspicion of Abuse Must report suspected abuse cases !!

Zones of Burn Injury

Zone of Coagulation Inner Zone Area of cellular death (necrosis)

Zone of Stasis Area surrounding zone of coagulation Cellular injury: decreased blood flow & inflammation Potentially salvable; susceptible to additional injury

Zone of Hyperemia Peripheral area of burn Area of least cellular injury & increased blood flow Complete recovery of this tissue likely.

Figure 21-1

Local Response to Burn Injury

Zone of hyperemia (A) Zone of stasis (B) Zone of coagulation (C)

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Causes of Burn Injuries

Thermal

Electrical

Chemical

Radiation

Cold Injuries

Inhalation

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Figure 21-2

First‑Degree Burn

Painful, red, dry, blanch with pressure

Superficial layer of epidermal cells is destroyed

Heals in 2-3 days

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Figure 21-3

Second-Degree Burn Superficial partial-

thickness Blisters

Injury extends through epidermis to dermis If no infection, generally

heals without scarring

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Figure 21-4

Deep Partial-Thickness Burn

Figure 21-5

Third-Degree Burn Full-thickness burn

Epidermis and dermis destroyed Eschar present Sensation and capillary

refill absent Skin grafts needed for

timely and proper healing

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Fourth-Degree Burn

Included in some burn classifications

Full-thickness injury that penetrates Subcutaneous tissue Muscle Fascia Periosteum Bone

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

Superficial Partial-Thickness Burn

Deep Partial-Thickness Burn

Full-Thickness Burn

Deep Full-Thickness Burn

Compensatory Responses to Burn Injury

Inflammatory compensation can trigger healing.

Sympathetic nervous system compensation occurs when any physical or psychological stressors are present.

Physiologic Compensatory Response to Burn Injury

Classification of Burn Injuries Cont.,

Size of a Burn Injury Total Body Surface Area (TBSA) Burned

Palmar Method A quick method to evaluate scattered or localized burns Client’s palm = 1 % TBSA

Rule of Nines A quick method to evaluate the extent of burns Major body surface areas divided into multiples of nine

Modified version for children and infants Lund-Browder Method

Most Accurate; based on age (growth) Can be used for the adult, children & infants

The Rule of Nines

Figure 21-7

Lund and Browder Chart

Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

American Burn Association Categorization

Classifies burns as major, moderate, and minor

Considers: Patient's age Medical or surgical problems Burns of:

Face and neck Hands and feet Genitalia

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Summary of Emergent Phase:

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Nursing Care During Acute Phase

Skin/systemic infection r/t Loss of normal skin Formation of eschar Suppression of immune system Metabolic/hormonal alterations

Operative Debridement

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Acute Phase

GRAFTING

Acute Phase

GRAFTING

Meshed Autograft

Dermatome-harvesting donor skin from thigh

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Acute Phase (cont)

Self-care Deficit r/t restricted movement/contractures/muscle atrophy

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Interventions

Assist with positioning ROM exercises Support O.T. & P.T. efforts Always maintain eye contact

with client

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Rehabilitation Phase

Instruct client to wear JoBST pressure garment up to 1 year

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Rehabilitation Phase

Instruct client on skin care: Need to wear Jobst to prevent keloid

formation

BURNS !!

B Breathing & Body Image

U Urinary output

R Rule of Nines & Resuscitation with fluid

N Nutrition

S Shock & Silvadene