Lecture on Burns: NCLEX Review

Introduction

• Instructor: Sarah, RegisteredNurseRN.com
• Part of NCLEX review series.
• Definition of Burns: Damage to skin integrity, involving layers from epidermis to bones/muscles.

Types of Burns

• Heat/Thermal Burns:
  • Common sources: hot liquid, steam, fire.
  • Concerns: Airway management due to inhalation injuries.
• Electrical Burns:
  • Affect skin and underlying tissues (muscle, bone).
  • Risks: Dysrhythmias, bone fractures, acute kidney injury due to myoglobin.
• Chemical Burns:
  • Sources: Powders, gases, certain foods.
  • Treatment challenges: Alkali (more challenging) vs. acidic burns.
• Cold Burns:
  • Example: Frostbite.
• Radiation Burns:
  • Source: Sunburns, cancer treatments.
• Friction Burns:
  • Causes: Accidents resulting in abrasion (e.g., road rash).

Burn Severity Factors

• Burn Depth:
  • Ranges from 1st (epidermis) to 4th (muscle/bone).
• Total Surface Area:
  • Rule of Nines for assessment
• Age:
  • Children and elderly are at higher risk.
• Medical History:
  • Pre-existing conditions affect healing.
• Location:
  • Severity affected by respiratory involvement, potential for infection.

Skin Layers and Burn Depth

• Epidermis: Top layer, thin, infection prevention.
• Dermis: Thicker, contains blood vessels, nerve endings.
• Subcutaneous (Hypodermis): Fatty tissue, insulates organs.

Degrees of Burns

• First Degree:
  • Limited to epidermis, red/pink, painful, no blisters.
• Second Degree:
  • Affects epidermis and dermis, painful, blisters present.
• Third Degree:
  • Extends into hypodermis, destroys nerve endings, requires grafts.
• Fourth Degree:
  • Extends to muscles/bones, black/charred appearance.

Assessment and Treatment

• Circumferential Burns:
  • Risk of restricting breathing/circulation.
• Inhalation Injury:
  • Assess facial, neck, and torso burns for respiratory involvement.

Phases of Burn Management

• Emergent Phase:
  • Onset to restoration of capillary permeability.
• Acute Phase:
  • Capillary permeability stabilization to wound closure.
• Rehabilitative Phase:
  • From wound closure to resumption of normal activities.

Nursing Considerations

• Fluid Replacement:
  • Use Parkland formula for fluid resuscitation.
• Respiratory Monitoring:
  • Watch for inhalation injuries, assess airway regularly.
• Infection Prevention:
  • Protective isolation, monitor for signs of infection.
• Pain Management:
  • Prioritize IV route for medication.
• Nutritional Needs:
  • High-calorie, high-protein diet necessary for healing.

Complications

• Renal Issues:
  • Monitor for acute tubular necrosis, diuresis during acute phase.
• GI Problems:
  • Risk of ulcers and ileus due to stress and decreased perfusion.
• Immune System Impact:
  • Loss of skin barrier increases infection risk.

Conclusion

• Emphasis on understanding burn types, severity factors, and management phases.
• Importance of adequate fluid replacement, infection prevention, and pain management.

• Next Steps: Take the free quiz provided to test comprehension on burns.