Phases of Burn Care

Emergent Phase Begins with the burn injury, assessing severity, initial care and ends when the patient is stable and begins to diurese and no longer requires fluid therapy. Acute Phase Return of fluid from the cells (intracellular fluid) and between the cells (interstitial fluid) to the intravascular space and continuous care of the wounds to promote grafting, prevent infections, and promote healing. (Weeks to months). Rehabilitation Phase Helping the patient return to previous or optiminal level of functioning. Many aspects of rehabilitation begins at the time of emergent care and continue through the phases.

Emergent Phase
Stop the burn: Flames: stop, drop and roll Chemical: remove contaminated clothing if not adhering to skin, rinse with cool water *remove all jewelry *use cool water not ice or cold water * do not apply any ointments, etc.

Acute Phase
Wound healing: 2 weeks to 18 months Complications: Infection Scarring Contractures Topical antimicrobials: Mafenide acetate (Sulfamylon acetate)-helps prevent common infections seen with burns Staph, hemolytic strept, pseudomonas Silver nitrate:bacteriostatic and infection preventing Properties Povidone-iodine ointment: broad spectrum of microbicidal action Silver sulfadiazine 1%: (Silvadene) bactericidal can help inhibit Candida and Pseudomonas organisms

ABCs

Estimate burn size: 1. Rule of nines(quick, use for ages 12 and older) 2.Lund-Browder classification(good for all ages, more accurate) Brief history: from patient/family (pre-existing conditions, allergies, tetanus vaccination date, details of

Can be lengthy and include further pain, cosmetic grafting, and reconstruction. Long-term physical, social, and psychologic therapy and financial planning must be carefully coordinated. Discharge planning needs: Emotional-adjustment Dressings/wound procedures Jobst garments Exercise, splinting, ADLs Medications Return visits and phone numbers if problems occur Home care or community agency f/u

Rehabilitation Phase/Period

accident, Head-to-toe assessment) Assessment & Intervention: Pay special attention to possible inhalation injuries (burns on face and around neck, singed nasal hairs, white oral mucous membrane tissue, sooty looking sputum, hoarseness, etc.) Fluid Shift to Tissues (EDEMA): *damage to capillary system occurs in the burn area as well as damage to body cells causing shifts in water & electrolytes from the plasma to the interstitial fluid causing edema Burn Shock: High risk if 15% burn for adults and 10% burn in children Due to fluid shifts causing decreased circulating oxygenated blood to body tissues S&S: increased pulse initially, then falling BP, increased respirations, scant urine output *Fluid resuscitation must be imitated immediately or damage can occur to the kidneys and other major life sustaining organs Fluid resuscitation: Many different criteria can be used as well as many different fluids (examples: crystalloids, colloids, glucose) A Foley catheter is anchored NPO status maintained Monitor for fluid shifts to

Surgical Management: 1. Debridement 2. Autograft-from victim 3. Homograft-(allograft)another person, cadaver or skin growth from a culture 4. Heterograft(xenograft)- another animal species (pig) 5. Synthetic grafts

Pressure garments Nursing Management

I&O Weight Positioning Prevention of infections Relief Diet Supportive care Emotional care

return to normal with marked increase in urinary output or diuresis ~24-48 hours Diuresis: Signals end of the emergent stage IV fluids are still indicated Monitor VS, I&O, weight, H&H levels GI support: NG tube is often inserted due to peristalsis is slowed or stopped due to the bodys normal response to stress Wound Care: Initially cleansed with antiseptics and NS (warmed), sterile technique, analgesics for pain (morphine sulfate), avoid IMs due to poor absorption in burned tissue, tetanus toxoid (prophylaxis), antibiotics Transfer: Most emergent care takes place in the ER, after initial care patients will be sent to burn units if indicated , need to be placed in reverse isolation (private room)