HS 20
Mini Unit A: Integumentary System
Unit 2: Body Systems
Burn Injuries and Management
BURNS
Wounds caused by exposure to:
1. excessive heat
2. _________________________
3. fire/steam
4. radiation
5. electricity

Results in 10-20 thousand deaths annually

Survival best at ages 15-45
o

Children, elderly, and diabetics are most in danger
Survival best burns cover less than ____________ of TBA (total body area)
TYPES OF BURNS

____________________________ - exposure to flame or a hot object

Chemical - exposure to acid, alkali or organic substances

_____________________________________ - result from the conversion of electrical
energy into heat. Extent of injury depends on the type of current, the pathway of flow, local
tissue resistance, and duration of contact

Radiation - result from radiant energy being transferred to the body resulting in production of
cellular toxins
BURN WOUND ASSESSMENT

Classified according to ______________________ of
injury and extent of ___________________________
involved
HS 20

Mini Unit A: Integumentary System
Unit 2: Body Systems
Burn wounds differentiated depending on the level of
_____________________ and
___________________________________________
involved

1. superficial (first-degree)

2. deep (second-degree)

3. full thickness (third and fourth degree)
SUPERFICIAL BURNS (FIRST DEGREE)

___________________________________ tissue only
affected

Erythema (redness of skin), blanching on pressure, mild
swelling

No blister initially

Not serious unless large areas involved

i.e. ______________________________
DEEP (SECOND DEGREE)

Involves the epidermis and deep layer of the __________________________

Fluid-filled vesicles – red, shiny, wet, severe pain

Hospitalization required if over ________________ of body surface involved

i.e. ____________________________
FULL THICKNESS (THIRD/FOURTH DEGREE)

Destruction of _______________ skin layers

Requires __________________________ hospitalization

Dry, waxy white, leathery, or hard skin, no pain

Exposure to flames, electricity or chemicals can cause 3rd degree burns
HS 20
Mini Unit A: Integumentary System
Unit 2: Body Systems
Calculation of Burned Body Surface Area
TOTAL BODY SURFACE AREA (TBSA)

Superficial burns are not involved in the calculation

Lund and Browder Chart is the most accurate because it adjusts for age

Rule of _______________ divides the body – adequate for initial assessment for adult burns
RULES OF NINES

Head & Neck = _______%

Each upper extremity (Arms) = ______%

Each lower extremity (Legs) = _______%

Anterior trunk= __________%

Posterior trunk = _________%

Genitalia (perineum) = __________%
VASCULAR CHANGES RESULTING FROM BURN INJURIES

Circulatory________________________ occurs at the burn site immediately after a burn
injury

Blood flow ______________________ or _________________ due to occluded blood
vessels

Damaged macrophages within the tissues release chemicals that cause constriction of vessel
o
Macrophage: A type of white blood that ingests (takes in) foreign material. Macrophages
are key players in the immune response to foreign invaders such as infectious
microorganisms.

Blood vessel thrombosis (clotting) may occur causing necrosis
FLUID SHIFT
HS 20
Mini Unit A: Integumentary System
Unit 2: Body Systems

Occurs after initial vasoconstriction, then dilation

Blood vessels dilate and leak ____________________ into the interstitial space

Known as third spacing or ______________________________________________

Causes ______________________ blood volume and blood pressure

Occurs within the first ________ hours after the burn and can continue to up to 36 hours
FLUID IMBALANCES

Occur as a result of fluid shift and ____________________________________

___________________________ - decrease of volume of circulating blood

Metabolic acidosis - pH imbalance in the body

Hyperkalemia - increased potassium levels

Hyponatremia - low sodium levels

Hemoconcentration (elevated blood osmolarity, hematocrit/hemoglobin) due to dehydration
FLUID REMOBILIZATION

Occurs after 24 hours

Capillary leak _____________

See diuretic stage where edema fluid shifts from the interstitial spaces into the vascular space

Blood volume ____________________ leading to increased renal blood flow and diuresis

Body weight returns to normal
CURLING’S ULCER

Acute ulcerative gastro duodenal disease

Occur within 24 hours after burn

Due to reduced __________________________ and mucosal damage
PHASES OF BURN INJURIES

________________________ (24-48 hrs)
HS 20
Mini Unit A: Integumentary System

____________________________

____________________________
Unit 2: Body Systems
EMERGENT PHASE
*Immediate problem is fluid loss, edema, reduced blood flow (fluid and electrolyte shifts)
Goals:
1. secure _____________________
2. support circulation by fluid replacement
3. keep the client comfortable with analgesics (pain relievers)
4. prevent ______________________ through wound care
5. maintain __________________________________
6. provide emotional support
CLINICAL MANIFESTATIONS IN THE EMERGENT PHASE

Clients with major burn injuries and with inhalation injury are at risk for
____________________________ problems

____________________________ injuries are present in 20% to 50% of the clients admitted
to burn centers

Assess the respiratory system by inspecting the mouth, nose, and pharynx

Burns of the lips, face, ears, neck, eyelids, eyebrows, and eyelashes are strong indicators that
an inhalation injury may be present

Change in respiratory ______________________ may indicate a pulmonary injury.

The client may: become progressively hoarse, develop a brassy cough, drool or have
difficulty swallowing, produce expiratory sounds that include audible wheezes, and crowing

Cardiovascular problems will begin immediately which can include
____________________________________ (Shock is a common cause of death in the
emergent phase in clients with serious injuries)

Changes in renal function are related to decreased renal blood flow
HS 20

Mini Unit A: Integumentary System
Unit 2: Body Systems
Urine output is decreased during the first 24 hours of the emergent phase
SKIN ASSESSMENT

Assess the skin to determine the ________________ and ___________________ of burn
injury

The size of the injury is first estimated in comparison to the total
___________________________________ area (TBSA). For example, a burn that involves
40% of the TBSA is a 40% burn

Use the rule of nines for clients whose weights are in normal proportion to their heights
IV FLUID THERAPY

Clients with burns involving 15% to 20% of the TBSA require _______________________

Purpose is to _____________________ by maintaining adequate circulating blood fluid
volume

Severe burn requires large fluid loads in a short time to maintain blood flow to vital organs

Fluid replacement formulas are calculated from the time of injury and not from the time of
arrival at the hospital
ACUTE PHASE OF BURN INJURY
o
Lasts until wound ______________________e is complete
o
Care is directed toward continued assessment and maintenance of the cardiovascular and
respiratory system
o
_________________________________ is a concern which can result in respiratory failure
requiring mechanical ventilation
o
Weight daily without dressings or splints and compare to pre-burn weight
o
Monitor for signs of infection
HS 20
Mini Unit A: Integumentary System
Unit 2: Body Systems
DRESSING THE BURN WOUND

After burn wounds are cleaned and _____________________________, topical antibiotics
are reapplied to prevent infection

Standard wound dressings are multiple layers of gauze applied over the topical agents on the
burn wound
REHABILITATIVE PHASE OF BURN INJURY

Started at the time of _____________________________

Technically begins with wound closure and ends when the client returns to the highest
possible level of functioning

Provide psychosocial support

Assess home environment, financial resources, medical equipment, prosthetic rehab

Health __________________________ should include symptoms of infection, drugs
regimens, follow up appointments, comfort measures to reduce pruritus (severe itching of the
skin)
DIET

Initially nothing by mouth

Begin oral fluids after bowel sounds return

Do not give ice chips or free water lead to electrolyte imbalance

High protein, high calorie
DEBRIDEMENT

Done with forceps and curved scissor or through hydrotherapy (application of water for
treatment)

Only loose eschar removed

______________________________________ are left alone to serve as a protector
HS 20
Mini Unit A: Integumentary System
Unit 2: Body Systems
SKIN GRAFTS

Done during the ___________________________ phase

Used for full-thickness and deep partial-thickness wounds
POST CARE OF SKIN GRAFTS

Maintain dressing

Use aseptic technique

Graft should look __________________ if it has taken after 5 days

Skeletal traction may be used to prevent contractures

Elastic bandages may be applied for 6 mo to 1 year to prevent
_____________________________________ scarring (raised scarring)