Burns NCLEX Review Summary

What are Burns?

• Burns cause damage to skin integrity.
• Skin layers affected:
  • Epidermis
  • Dermis
  • Subcutaneous tissue
  • Muscle and Bone (in severe cases)

Types of Burns

1. Heat (Thermal) Burns

   • Most common.
   • Caused by hot liquids, steam, fire.
   • Risk of inhalation injury in enclosed spaces.

2. Electrical Burns

   • Caused by electrical current.
   • Affects deeper structures (muscles, bones).
   • Iceberg effect: more damage under skin than appears.
   • Risks: dysrhythmias, bone fractures, acute tubular necrosis due to myoglobin/hemoglobin in blood.

3. Chemical Burns

   • Caused by toxic substances (powders, gases, foods).
   • Can be acidic or alkali; alkali are harder to treat.

4. Cold Burns

   • Caused by frostbite.

5. Radiation Burns

   • Sunburns or from cancer treatments.

6. Friction Burns

   • Caused by abrasion (e.g., road rash).

Factors Determining Burn Severity

• Burn Depth: Ranges from first to fourth degree.
• Total Body Surface Area: Assessed by rule of nines.
• Age: Higher risk in children and the elderly.
• Medical History: Conditions like diabetes or heart failure increase risk.
• Location of Burn:
  • Face, neck, torso affect respiratory function.
  • Perineum increases infection risk.

Skin Layers and Burn Injury Depth

• Epidermis: outer layer.
• Dermis: contains blood vessels, glands.
• Subcutaneous Tissue (Hypodermis): contains fat, veins, nerves.

Degrees of Burns

1. First-Degree (Superficial)

   • Affects only epidermis.
   • Red, painful, no blisters.

2. Second-Degree (Partial Thickness)

   • Affects epidermis and dermis.
   • Painful, moist, blisters.

3. Third-Degree (Full Thickness)

   • Extends to subcutaneous tissue.
   • Not painful due to nerve damage.
   • Requires skin grafting.

4. Fourth-Degree (Deep Full Thickness)

   • Extends to muscle and bone.
   • Black, charred appearance.
   • Requires extensive treatment.

Burn Location and Considerations

• Respiratory Issues: Burns on face, neck, chest.
• Healing Issues: Ears, nose have poor blood supply.
• Disability Risk: Eyes, hands, feet.
• Infection Risk: Perineum.

Inhalation Injury

• Damage to respiratory system by inhaling harmful substances.
• Common in enclosed fires.
• Carbon monoxide poisoning risks.

Phases of Burn Management

1. Emergent Phase

   • Onset to capillary permeability restoration.
   • Risks: hypovolemic shock, respiratory distress.

2. Acute Phase

   • Stabilization to wound closure.
   • Focus: infection prevention, pain management, wound care.

3. Rehabilitative Phase

   • Wound closure to return to function.
   • Focus: psychosocial health, ADLs, rehabilitation.

Burn Physiology and Nursing Interventions

• Capillary Permeability: Increased initially causing fluid shift.
• Fluid Replacement: Critical in emergent phase.
• Renal System: Monitor for urine output and myoglobinuria.
• GI System: Risk for ulcers and ileus.
• Respiratory System: Monitor for inhalation injury, airway management.
• Immune System: High risk of infection due to skin loss.

Nursing Care

• Fluid Therapy: Parkland formula for fluid resuscitation.
• Infection Control: Protective isolation, sterile techniques.
• Pain Management: Prefer IV route.
• Wound Care: Pre-medicate before procedures, clean wounds.
• Temperature Regulation: Ensure warm environment to prevent hypothermia.
• Nutrition: High calorie, protein, and carb diet for healing.

This concludes an overview of burns in the NCLEX review series, focusing on understanding burns, their types, severity factors, body response, and nursing interventions.