BURNS
Definition
A burn is a tissue damaged cause by heat, chemicals, electricity, Sunlight or nuclear radiation. Burns are define by how des they are and how large an area they cover.
Classification of Burns
- Burns are classified into first, second, third and fourth degree depending on how deeply and severely they penetrate the skin’s surface.
- First -Degree (Superficial) Burns: first degree Burns affects only the outer layer of the skin, the epidermis. The burn site is red, painful, and dry with no blisters.
- Second- Degree (partial thickness) Burns: second- degree burn involve the epidermis, and part of the lower layer of the skin, the dermis. The burn site looks red, blistered and may be swollen and painful.
- Third-Degree (full thickness) Burns: The epidermis and the dermis is destroy. They may go into the innermost layer of the skin, the subcutaneous tissue. The burn site may look white or blackened and charred.
- Fourth-Degree Bien: Fourth degree Burns go through both lauers of the skin and underlying tissue as well as deeper tissue possibly involving muscle and Bone. There is no feeling in the area since the nerve endings are destroyed.
Signs and Symptoms of Burns
- Redness and pain
- swelling
- Blisters
- Numbness
- Black, Brown or white skin area
Complications
- Bacterial infections which may lead to bloodstream infections.
- Fluid loss including low blood volume (hypovolemia)
- Dangerously low body temperature (hypothermia)
- Scare or ridged areas causes by over growth of the scar tissue.
- Respiratory failure.
Nursing intervention/Care
- Promoting gas exchange and airway clearance
- Restoring fluid and electrolyte balance
- Maintaining normal body temperature
- Minimizing pain and anxiety
- Monitoring and managing potential complications
- Restoring normal fluid balance
- Prevent infections
- monitor culture results and white blood cell counts
- Maintaining adequate nutrition
- Promoting skin integrity
- Relieving pain and discomfort
- Promoting physical mobility
- Supporting patient and family processes
- Teaching self -care
Medical Care
Medical Care may include medications and products that are intended to encourage healing.
- Water-basedtreatment such as ultrasound mist therapy to clean and stimulate the wound tissue.
- Fluid to prevent dehydration: intravenous (IV) fluidto prevent dehydration and organ failure.
- Pain and anxiety medications: Healing Burns Can be incredibly painful. Morphine and anti-anxiety medications can be used particularly for dressing changes.
- Burn creams and ointments: topical products for wound healing such as bacitracin and silver sulfadiazine help prevent infection and prepare the wound to close.
- Drugs that fight infection: Intravenous antibiotics are administered to fight infection.
- Tetanus shot:To fight tetanus toxin that may invade and infect the burn area.
Emergency Management of Burns
*Remove any source of heat
- Remove any clothing that may be burned, covered with chemicals.
- Cover the patient with a clean dry sheet to prevent hypothermia
- Use of burn shield is a very effective means of cooling and dressing the injury for the first 24 hours.
*Assess Airway /Breathing
- Careful Airway assessment must be done where there are flame or scald Burns of the face and neck.
- All patients with major Burns must receive high-flow oxygen for 24 hours
- Stop any external bleeding
- Identify potential sources of internal bleeding
*Ongoing Losses (once the patient has been stabilized)
- Patient with <10% Burns Can be resuscitated orally (unless the patient has an electrical injury).
- In the case of patients with burns 10-40% secure a large-bore Intravenous Line
- Assess urine output (this is the best guide to resuscitation)
- Observe urine for burgundy colour
- Insert a nasogastric tube in patient with Burns >30% or who are unresponsive, shocked.
- Give tetanus immunization
- After fluid resuscitation has been started, pain medication may be titrated in small Intravenous doses.
Laboratory Care of patient with Burns
A variety of laboratory test will be needed within the first 24 hours of patient’s admission. Every patient will have complete blood count, electrolytes, blood urea nitrogen, creatinine, and glucose levels drawn. These all gives a clear result about the patient situation and help to prompt for Care.
Collaborative Care of Patient’s with Burns
Burn patients are unique, representing the most severe model of trauma and hence this necessitates treatment in the best facilities available for that endeavor. The management of burn injury may well represented the surgical specialty with the greatest integration of health professionals, seeing the most benefit from the influence of truly multi-disciplinary Care.
- The Burn Surgeons:The ultimate responsibility and overall control for the Care of a severely burned patient lies with the admitting burn surgeon.
- Burn Nurses: They are responsible for implementing the daily continuous Care of the burn patient, bring physical as well as emotional support to the patient and their families. They also managed patient on critical mechanical ventilation and renal support carry out sophisticated wound dressing.
- The Burn-team anesthesiologist: They have the Knowledge and expertise to deal with the challenges presented by the pathophysiological changes related to Burn injury.
- Respiratory therapist:provide a range of skills to evaluate pulmonary mechanics, enhance patient ventilation and reduce the risks of complications.
- Psychosocial Experts: Burn injury can have a devastating impact on the emotional and psychological well-being of a patient and their families. Psychologist help patient and their families to cope with the effects of the injury and manage the transition to come to terms with the grief and consequences of the injury.
- Nutritionist: patients with major Burns require intense nutritional support to address massively elevated energy and protein demands. The nutritionist on the burn team monitors the dietary needs of the patient and provides the nutritional recommendations and feeding regimen to meet changing demands.
