8/3/2019 1 2 2012Med Surg Burns

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Jocef Ian D. Rama January 3, 2012

NCM 40 Medical-Surgical Nursing Mrs. Jenny Balo

Types of burn injury

1.  Th

ermal burn2.  Electrical burn

3.  Chemical burn

4.  Radiation burn

Pathophysiology of burns

Heat changes the molecular structure of tissue thus denaturing of proteins. Extent of burn

damage depends on temperature of agent, concentration of heat, duration of contact.

Clinical manifestations of burn injuries

Pain

Pain is immediate, acute and intense with superficial burns. It is likely to persist until strong

analgesia is administered. With deep burns there may be surprisingly little pain.

Acute anxiety

The patient is often severely distressed at the time of injury. It is frequent for patients to run

about in pain or in an attempt to escape, and secondary injury may result.

Fluid loss and dehydration

Fluid loss commences immediately and, if replacement is delayed or inadequate, the patient

may be clinically dehydrated. There may initially be tachycardia from anxiety and later a

tachycardia from fluid loss.

Local tissue edema 

Superficial burns will blister and deeper burns develop oedema in the subcutaneous spaces.

This may be marked in the head and neck, with severe swelling which may obstruct the airway.

Limb oedema may compromise the circulation.

Special sites

Burns of the eyes are uncommon in house fires as the eyes are tightly shut and relatively

protected. The eyes, however, may be involved in explosion injuries or chemical burns. Burns of the nasal airways, the mouth and upper airway may occur in inhalation injuries.

Coma 

Following house fires, the patient may be unconscious and the reason for this must be

ascertained. Asphyxiation or head injury must be excluded. Burning furniture is particularly

toxic and the patient may suffer from carbon monoxide or cyanide poisoning

Medical and Nursing management of burn injuries

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- Begins 48 72 hrs after injury

- Monitor respiratory status

- Airway obstruction related to edema can take 48 hrs to develop

- Monitor Cardiac status

- capillaries regain integrity after 48 hrs fluid moves into intravascular compartment diuresis begins

- If cardiac or renal function is inadequate fluid overload symptoms of CHF ( treat with 

vasoactive drugs, diuretics, fluid restriction)

- Maintain body temperature at 37.2 38.3 Cent.

- Fever is common (treat with Tylenol, hypothermic blankets to reduce metabolic stress)

Source: http://www.nursing-lectures.com/2011/02/burn-injuries-nursing-role-and.html

Management of Burn Injury The phases in the management of a burn injury are the following:

  Emergent phase 

This phase begins immediately at the time of injury and ends with the restoration of capillary

permeability. The main goal of this phase is to prevent hypovolemic shock and preserve vital

organ functioning. Methods used during this time are prehospital care and emergency room

care.

  Resuscitative Phase 

The management involving resuscitation begins when the fluid replacement are initiated or

started and ends when the capillary integrity returns to the near normal levels and when the

large fluid shifts have decreased. The amount of fluid administered to the patient is based on

the clients weight and extent of injury. Usually, fluid replacement formulas are calculated from

the time of injury not on the arrival on the hospital. The main goal of the resuscitative phase is

to prevent shock through the initiation of fluids to maintain adequate circulating blood volume

and maintain vital organ perfusion.

  Acute Phase 

When the client is hemodynamically stable, has restored capillary permeability and has been

showing signs of dieresis, acute phase took place. During this time, the emphasis is palced on

restoration of the patients capillary permeability and the phase continues until the wound is

totally closed. Main goal of the acute phase is focused on prevention of infection, wound care,

optimum nutrition and physical therapy.

  Rehabilitative Phase Rehabilitative phase is the final phase of managing a burn injury. Most frequently, it overlaps

the acute phase and it goes on after hospitalization. Main goals during this phase are helping

the client gain independence and achieve maximal function.

Source: http://nursingcrib.com/nursing-notes-reviewer/medical-surgical-nursing/phases-of-

burn-therapy/