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Burns Presentation

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by

Ryan Lim

on 11 December 2012

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Transcript of Burns Presentation

Pathophysiology Burns are an injury to the body that may be caused by things like electricity, chemical heat, light radiation and even friction.

Burn injuries are local or systemic inflammatory responses depending on the severity of the burns.

This systemic response causes shift in fluid and hypovolemia, which affects most systems of the body adversely like cardiocirculatory, immunologic, respiratory, metabolic and renal.

Burns affect the lung through smoke inhalation and venous affluent returning from circulation through the burned skin. There is always a release of catecholamine from the burnt skin, accompanied by hypovolemia from fluid loss which leads to an increase heart rate and peripheral vascular resistance. Burns
3rd Degree By: Ryan Lim, Kenisha Cyrus, Hilda Chi, Emmanuel Chi, Basudeva Aryal, Dorathy Rajamonickam, Susan Lee, Rachidetou Njoya, Nneka Offiah Third Degree Burns Cont. Third Degree Burns Case Study Mrs. Perez is an 82 year old female present at the emergency department with burn injuries sustained at her home. Patient says she was in the process of preparing dinner and forgot the pot on the fire until “it caught flames”. Mrs. Perez further stated that in her attempts to “out the fire” her clothes began to burn.

She is coughing with high mucous production, and complains of difficulty breathing and a sore throat.

The patient had a medic alert bracelet on the right hand which was removed due to excessive swelling. Burn Classifications A third-degree burn is referred to as a full thickness burn. This type of burn destroys the outer layer of skin (epidermis) and the entire layer beneath (or dermis Assessment Findings The burned covers about 50 percent of the Body Service Area (BSA) the patient denies pain in affected areas that appear red and swollen and does not blanch when touched. The appearance of the skin is dry and leathery. In addition, coagulated blood vessels are visible below the burned skin surface Plan of Care DIAGNOSIS
Impaired gas exchange related to smoke inhalation as evidence by the presence of excessive carbon monoxide in lungs.

Impaired skin integrity related to burn injury as evidence by skin tissue damage

Risk for fluid electrolyte imbalance related to water loss

Risk for nutritional imbalance less than body requirements related to increased metabolic needs following burn injury

Risk for infection related to exposed skin tissue Goal The goal is to maintain the patients physiologic stability, repair skin integrity, prevent infection, reduce pain, and promote maximal functioning and psychosocial health Interventions Cont. Implement infection control and standard precaution (especially hand washing)

Clean burn wound with normal saline, apply topical medication and dressing as ordered

Closely monitor the burn wound for signs of infection (i.e. foul smelling drainage, green or purulent drainage) during dressing change

In graft wounds, monitor to ensure that the graft is not sloughing and pulling away from the wound bed.

Position burn patient appropriately to minimize deformity

Administer antibiotic medication (topical ointment, cream, IV, or oral) as prescribed to prevent infection and promote healing. Assessment Assess CABs (circulation, airway, and breathing)

Perform a head to toe assessment, look for other serious injuries such as lacerations, fractures, blunt trauma, head contusion, and spinal cord injury.

Assess nasal cavity for signs of inhalation injury
Perform Neurological assessment (Level of consciousness)

Medical History Interventions Monitor respiratory status, administer humidified oxygen as need

Monitor blood gasses (carbon monoxide should be <10)
Continuous assessment of the injury for evidence of adequate tissue perfusion, edema, and depth

Check pulses and capillary refill every hour

Provide pain medication and prescribed

Administer IV fluid (lactated ringers) containing electrolytes to prevent electrolyte imbalance Burn Debridement Autolytic - uses the body's enzymes to re-hydrate, soften and liquefy hard eschar and slough

Enzymatic - Using chemical enzymes to free dead tissue

Mechanical - Removing dead tissue through the use of hydrotherapy and now super-oxidized technology.

Surgical - Using sharp instruments or lasers for debridement Cleaning and Dressing Medications Hydrocortisone Cream 1%

Triple Antibiotic Ointment

Antiseptic Wipes

Burn Cream with Lidocaine
Corticosteroids, antihistamines
and interferons help reduce scar formation

IV Therapy (Lactated Ringers and electrolytes) Positioning Skin Grafting and Grafting Sites Collaborative Care Patient and Family: Patient and family are important in collaborative care. Family must be encouraged to participate and asked questions.

Respiratory Therapist: respiratory therapist administers oxygen, breathing treatments or other assistance for patients in respiratory distress from inhalation of noxious agents

Dietician: Consult with registered dietician to assess nutritional status as soon as possible, develop nutritional goals and nutritional plan

Physical and Occupational Therapist: Consult with physical therapist or occupational therapist as needed to assist patient with or to facilitate mobility and activates of daily living.

Wound specialist: Consult wound care specialist to assist with wound care Teaching Encourage patient and family members to participate in burn care and discuss any thought of concerns with the health care team

Educate patient and family members on wound management and pain control

Encourage patient to follow medication/exercise regimen

Teach family members how to provide care and support

Encourage patient to join support group (burn survivor)

Encourage patient to eat a balance diet and increase protein intake Patient Response DORATHY WILL REWORD THIS
Breathing: The patient will maintain a patent airway and establish an effective breathing pattern

Cardiac Output: The patient is expected to have her cardiac output restored to normal

Risk for Infection: The patient is expected to remain free of any infections

Wound Care: The patient’s wound decreases in size, granulation takes place and no new wounds occur

Nutrition: The patient will have adequate nutritional intake needed for her body restoration

Mobility: The patient is expected to perform range of motion exercises to prevent contractures Continuum of Care Continued... Discharge planning starts at the time of admission to the hospital.

Psychosocial preparation

Home care management (Daily wound care, physical therapy, nutrition support, drug therapy)

Health teaching

Health resources

Expected outcomes Consumer Resources Each year 1.25 million patients are treated for burns. Usually a patient that suffers third degree burns will have a shorter time to live. According to this study approximately 20,000 dollars has been used to treat patients with burns. Consumer Resources Cont. Whenever taking care of a burn patient the nurse needs to be aware of risk factors and the United States spends about 2 billion dollars a year on burn care therefore it is important to assess the length of stay for the patient so hospitals will not consume too much money in burn patients. References Continuum of Care SUSAN NEEDS TO REWORD THIS

Secure the airway

Support circulation by fluid replacement

Keep the patient comfortable with analgesics

Prevent infection through careful wound care

Maintain body temperature

Provide emotional support Diagnostic Testing Daily expected stay for a burns patient is an average of 28 days.

Costs for patients bed is to be assessed at least 1300 Euros

Physical therapy for the patient cost 243 Euros per day

Cost of burn management is expected to be 15 million euros

On average, 890.85 Euros are used for nutritional products for burn patients a week
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