Comprehensive Care for Burn Patients

Aug 7, 2024

Nursing Care of Burn Patients

Lecture Overview

  • Presenter: Kathy, Level Up RN
  • Topics Covered: Nursing care of burn patients, phases of burn care, emergent phase focus, acute phase focus
  • Tools: Level Up RN medical surgical nursing flashcards (focus on bold red text)
  • Quiz at the end to test knowledge

Phases of Burn Care

  1. Emergent Phase

    • Timeframe: From injury to 24-48 hours after
    • Goals: Maintain airway, fluid resuscitation, preserve organ function

  2. Acute Phase

    • Timeframe: After fluid resuscitation to wound closure
    • Goals: Infection control, wound healing, nutrition, mobility

  3. Rehabilitative Phase

    • Timeframe: From wound closure to maximal function
    • Goals: Psychosocial adjustment, prevention of contractures, reconstructive procedures

Emergent Phase Details

  • Stop Burning Process
  • Maintain Airway: Administer oxygen, assess for inhalation injury (singed eyebrows, nasal hair, sooty sputum)
  • Fluid Resuscitation: IV fluids with large bore catheter to prevent hypovolemia
  • Pain Management: IV opioid analgesics
  • Other Interventions: Keep patient warm, NPO status, insert NG tube, insert Foley catheter, administer tetanus vaccine if needed
  • Assessment Tools: Rule of nines for adults, Lund-Browder chart for pediatrics

Rule of Nines (BSA Percentages)

  • Head: 9%
  • Trunk: 36% (18% anterior, 18% posterior)
  • Upper extremity: 9% each (4.5% anterior, 4.5% posterior)
  • Lower extremity: 18% each (9% anterior, 9% posterior)
  • Perineum: 1%

Depth of Burn Injury

  1. Superficial (1st Degree)
    • Damage: Epidermis
    • Characteristics: Pink/red skin, mild edema, no blisters (e.g., sunburn)
  2. Superficial Partial Thickness (2nd Degree)
    • Damage: Upper dermis
    • Characteristics: Red/pink skin, mild-moderate edema, blisters
  3. Deep Partial Thickness (2nd Degree)
    • Damage: Deep into dermis
    • Characteristics: Red/white skin, moderate edema, soft dry eschar
  4. Full Thickness (3rd Degree)
    • Damage: Into subcutaneous tissue
    • Characteristics: Severe edema, no blisters, hard inelastic eschar, no pain (nerve endings destroyed)
  5. Deep Full Thickness (4th Degree)
    • Damage: Beyond subcutaneous tissue to muscle, tendon, bone
    • Characteristics: Black skin, hard inelastic eschar, no edema/blisters, no pain (nerve endings destroyed)

Fluid Resuscitation

  • Goal: Maintain urine output of 0.5 mL/kg/hr for adults
  • Parkland Formula
    • Formula: 4 mL LR x patient weight (kg) x % BSA burned
    • Example: 60 kg patient with 36% BSA burn = 4 x 60 x 36 = 8,640 mL in 24 hours
    • Administration: Half in first 8 hours, remaining in next 16 hours

Acute Phase Details

  • Wound Care: Debridement, possible skin grafts, elevate/immobilize post-surgery, monitor for infection
  • Topical Antibiotics: Silver sulfadiazine (cannot penetrate eschar, risk of transient neutropenia), mafenide acetate (penetrates eschar, risk of metabolic acidosis)
  • Infection Prevention: Administer antibiotics, aseptic technique, restrict visitors, no fresh plants/flowers
  • Contracture Prevention: Assist with passive/active ROM exercises
  • Nutrition: Additional protein and calories, possible TPN

Quiz Questions

  1. Sign of Inhalation Injury: Singed eyebrows and sooty sputum
  2. Emergent Phase Vaccination: Tetanus vaccine
  3. Parkland Formula Calculation: 100 kg patient, 18% BSA burn = 7,200 mL in 24 hours (4 x 100 x 18)

Conclusion

  • Encourage use of Level Up RN resources
  • Prompt to subscribe, like, and comment on the video