interventions for clients with burns. burn injury 10,000 deaths/year more common in men death rates...
TRANSCRIPT
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