1. Interventions for Clients with Burns

2. 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

3. Major Sources of Burns Interaction between energy (thermal, chemical, electrical, or radiation) and biological matter Thermal 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 production Electrical injuries Lightning injuries Direct contact with electrical current Arcing of electricity between two contact points near skin Flash burns if fuel source is ignited

4. 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

5. 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 !!

6. 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.

7. 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.

8. Causes of Burn Injuries Thermal Electrical Chemical Radiation Cold Injuries Inhalation

9. 9

10. 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.

11. 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.

12. Figure 21-4 Deep Partial-Thickness Burn

13. 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.

14. 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.

15. Superficial Partial-Thickness Burn

16. Deep Partial-Thickness Burn

17. Full-Thickness Burn

18. Deep Full-Thickness Burn

19. Compensatory Responses to Burn Injury Inflammatory compensation can trigger healing. Sympathetic nervous system compensation occurs when any physical or psychological stressors are present.

20. Physiologic Compensatory Response to Burn Injury

21. 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

22. The Rule of Nines

23. Figure 21-7 Lund and Browder Chart Copyright © 2007, 2006, 2001, 1994 by Mosby, Inc., an affiliate of Elsevier Inc.

24. 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

25. 25 Summary of Emergent Phase:

26. 12/3/201526 Nursing Care During Acute Phase Skin/systemic infection r/t Loss of normal skin Formation of eschar Suppression of immune system Metabolic/hormonal alterations

27. Operative Debridement 12/3/201527

28. Acute Phase GRAFTING

29. Acute Phase GRAFTING

30. Meshed Autograft

31. Dermatome-harvesting donor skin from thigh

33. 12/3/201533 Acute Phase (cont) Self-care Deficit r/t restricted movement/contractures/muscle atrophy

34. 12/3/201534 Interventions Assist with positioning ROM exercises Support O.T. & P.T. efforts Always maintain eye contact with client

35. 12/3/201535 Rehabilitation Phase Instruct client to wear JoBST pressure garment up to 1 year

36. 12/3/201536 Rehabilitation Phase Instruct client on skin care: Need to wear Jobst to prevent keloid formation

37. BURNS !! B Breathing & Body Image U Urinary output R Rule of Nines & Resuscitation with fluid N Nutrition S Shock & Silvadene