Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Timby/Smith: Introductory Medical- Surgical Nursing, 10/e 01/25 PG 1054 Chapter 66: Caring for Clients with Burns By: P.K. Williams, RN

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 05 Objectives : 02/25 Pg 1053 On completion of this chapter, you will be able to: 1. Explain how the depth and percentage of burns are determined. 2. Name three life-threatening complications of serious burns. 3. Differentiate between open and closed methods of wound care for burns. 4. Name three sources of skin grafts. 5. Describe nursing management for the client with a burn injury.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins 15 Words to Know 03/25 Pg 1053 AllograftAutograftClosed method DebridementEpithelializationEschar EscharotomyHeterograftOpen method Full-thickness-graftHyperbaric oxygen treatment Slit graftSplit-thickness-graft StridorTachypnea

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injuries*** 04/25 Pg 1053 Pathophysiology, Etiology: Heat; Chemicals; Electricity –Heat: Cell damage; Protein coagulation Severity: Temperature of heat source; Duration of contact; Thickness of tissue exposed; Burn location –Chemicals: Liquefy tissue; Loosen cell attachment*** –Electrical: Cardiac dysrhythmias; Central nervous system complications***

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 05/25 Pg 1053 Is the following statement true or false? A burn’s severity is affected by the temperature of the heat source.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 06/25 Pg 1053 True. A burn’s severity is affected by the temperature of the heat source. Additional factors, which affect a burn’s severity include duration of contact, thickness of tissue exposed to the heat, and the location of the burn.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injuries*** 07/25 Pg 1053 Pathophysiology –Effect of inflammatory process –Neuroendocrine changes; Edema –Fluid, electrolyte status alteration –Anemia; Hemoconcentration –Factors affecting mortality

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Depth of Burn Injury*** 08/25 Pg 1053 Color Skin Characteristics Sensation in Burn Area Classification Superficial 1 st Drg Partial thickness 2 nd Drg Full thickness 3 rd Dr Through adipose tissue 4rth Drg

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Depth of Burn Injury 04/25 Pg 1053 Figure 66-2 Left: Deep partial-thickness burn Right: Superficial partial-thickness burn

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 10/25 Pg 1053 Is the following statement true or false? Burns can affect fluid balance.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 11/25 Pg 1053 True. As a response to the trauma of a burn, fluid shifts, which results in edema. Not only does it result in edema, the fluid is trapped and unavailable to the rest of the body. Decreased blood pressure (due to decreased fluid volume) can result in irreversible shock.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Zones of Burn Injury 12/25 Pg 1054 Zone of Coagulation Zone of Stasis Zone of Hyperemia

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Extent Rule of Nines*** Percentage of TBSA Burned Client’s Palm: 1% of TBSA 13/25 Pg 1056

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injuries 14/25 Pg 1053 Assessment Findings: Signs and Symptoms –Light pink to black skin color; Edema; Blistering; Pain; Compromised breathing; Symptoms of hypovolemic shock; Entrance, exit wounds Diagnostic Findings: Physical inspection; Radiographs Medical Management: Potential life-threatening complications: Inhalation injury; Hypovolemic shock; Infection –Major burns: Transport to regional burn center

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Question 15/25 Pg 1056 Is the following statement true or false? An infection within a burn wound can be life- threatening.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer 16/25 Pg 1056 True. An infection within a burn wound can be life- threatening. Outcome of a burn injury depends on the initial first aid and subsequent acute treatment. Three complications of burns can be life-threatening: inhalation injury, hypovolemic shock, and infection.

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Medical Management 17/25 Pg 1056 Initial First Aid: First priority: Prevent further injury; Observe for respiratory difficulty Acute Care: Assess extent of burn injury, additional trauma –Interventions: Ventilation; Fluid resuscitation Endotracheal tube; Bronchoscopy Mechanical ventilation; Tracheostomy; Hyperbaric oxygen treatment IV analgesics; Tetanus immunization

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Wound Management 18/25 Pg 1058 Infection prevention measures; Debris Removal Open Method: Exposes burned areas to air;*** Used only for areas where it is difficult to apply dressings (face, perineum) –Isolation; Sterile environment; Escharotomy Closed Method: Current, preferred method*** –Use of dressings: Nonadherent; Absorbent; Occlusive, semiocclusive; Dressing changes Antimicrobial Therapy: Silver sulfadiazine; Mafenide; Silver nitrate; Acticoat

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Surgical Management 19/25 Pg 1059 Surgical Management: Debridement –Removal of necrotic tissue –Four ways: Naturally; Mechanically; Enzymes; Surgery –Disadvantage: Bleeding –Covering of healthy tissue: Skin graft; Temporary skin substitute; Cultured skin

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Surgical Management: Skin Grafting 20/25 Pg 1053 Purpose: Lessen infection; Minimize fluid loss; Hasten recovery; Reduce scarring; Prevent loss of function Keratinocytes regenerate epidermis Used for deep partial-thickness and full- thickness burns Unassisted Healing: Granulation tissue; Contractures; Chronic open wounds

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Surgical Management: Skin Grafting 21/25 Pg 1059 Sources for Skin Grafts –Autograft: Client’s own skin –Allograft: Human skin from cadaver –Heterograft: Animal skin Types of Autografts –Split-thickness; Full-thickness; Slit –Disadvantages; Pressure garments; Sunscreen

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Surgical Management: Skin Grafting 22/25 Pg 1053 Skin Substitutes –Cover wound; Promote healing –Direct interaction with body tissues –Applied soon after skin is healed and débrided Cultured Skin –Culture client’s skin; Collagen –Disadvantage: Pigmentation mismatch

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Wound Management 23/25 Pg 1062 Figure 66-9 Biobrane dressing applied to lower extremity partial-thickness burn

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins Burn Injury Nursing Management 24/25 Pg 1053 Assessment –Wound; Client’s status –Calculation and infusion—fluid replacement requirements –Treatment of shock; Pain relief Wound care: Antimicrobials; Dressings; Monitoring for infection; Emotional support –Client teaching: Exercise; Pressure garments; Skin care measures

Copyright © 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins End of Presentation & BEGIN NCLEX By: P.K Williams, RN 25/25 Pg 1053