Power Point Sir Def

7/31/2019 Power Point Sir Def

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Reporter:Ms. Reyna Marie P.

Labadan


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Epidemiology ofBurns

2 million people requiremedical attention eachyear

51,000 requireadmission

4,500 people dieannually

Most burns cover lessthan 5-10% of bodysurface area

Most injuries occur at


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Mortality fromBurns

Most deathsoccur at home

Causes of death

Smokeinhalation, sepsis,pneumonia,shock

the risk of deathincreasessignificantly if thepatient has

sutained bothcutaneous burn


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What areburns???


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PREDISPOSING

FACTORS all age groups at risk

Mortality increases withage

Males predominate

Young children and elderlypeople are at particularlyhigh risk for major burns

Occupation


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PRECIPITATINGFACTORS


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burns


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em c

al BB

UURR

NNss


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Electrical burns


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Radiation burns


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bb


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INTEGUMENTARY SYSTEM and

BURNS


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DEGREES OF BURNS


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First Degree


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Second Degree


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Third Degree


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PATHOPHYSIOLOGY


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Be familiar

Hyperkalemia Hyponatremia

Anemia

Acute tubularnecrosis

Laryngeal edema

Hypoxemia

ARDS

Respiratoryacidosis

Hemoconcentrati

Edema

Pain

Hypovolemicshock

Oliguria Ileus

Curlings ulcer

Altered LOC

Metabolic acidosis

Major organdamage

Renal failure

Respiratory


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DETERMINING EXTENT OFINJURY

E ti ti


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EstimatingBURNS in

AdULts

RULE OF9


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Estimating BURNS inChildren

LUND andBROWDER

METHOD

-

recognizes thatTBSA

especiall


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PALM METHOD

- Used inpatients with

scatteredburns

- Size of ptspalm is

approx. 1 %


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D

I

A

G

NO

S

T

I

S


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LABORATORYTESTS

SERUMELECTROLYTESa.Emergentphase:1st48hourshyperkalemia >5meq/Lhyponatrem

ia


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Bloodtest..

Elevated hematocrit (emergentphase)

Decreased RBC count (electricalburns)

Elevated glucose level

elevated BUNelevated creatinine (acute

tubular necrosis,

electrical burns)

UR


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Elevated specific gravity

Color: Dark amber

concentratedBurgundy-colored

presence of

myoglobin

Glucosuria

URINALYSIS


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Indicated if:

positive history of cardiacdisease

Electrical injury

Pulse is dysrhythmic orrate is abnormally slow or

rapid

ECGmonitoring


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ABG

analysisRespiratory acidosis

Metabolic acidosis

Not valid in carbon monoxidepoisoning

Usually normal

Hemoglobin is well saturated

Pulseoximetry


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Carbon monoxide level..

5-10%

11-20%

21-30%

31-40%

41-50%

>50%

Impaired visualacuity

Flushing, headache Nausea, impaired

dexterity

Vomiting, dizziness,syncope

Tachypnea,


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Management of the patient

with Burn injury

mergen


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mergenResuscitative

phase On-the-sceneCareExtinguish theflame


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Cool the burn


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remove restrictive objects

cover the wound

Chemical burns

irrigate

I iti l i iti i


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Initial priorities inthe E.R.

AirwayBreathing

Circulation

If edemadevelops,


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Large bore needle inserted

NGT if nauseated

Indwelling urinary catheter


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Acute or intermediatephase

Continued assessment

Maintenance of respiratory andcirculatory status

Fluid and electrolyte balance

infection prevention

Pain managementNutritional support

Burn wound care


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WOUNDCLEANING

Hydrotherap

y

Topical antibacterial


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Topical antibacterialtherapySilver sulfadiazine(silvadene)

Silver nitrate

Mafenide acetate(sulfamylon)


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Wounddebridement

to remove tissuecontaminated

by bacteria andforeign bodies

To removedevitalized tissue

or

burn eschar inpreparation for

raftin and


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i h i d h i


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Biosynthetic and syntheticdressings

Biobran

e

Dermal


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Dermalsubstitutes

Integr

a

Alloderm

A t ft


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Autografts


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Disorders

ofwound healing

Scars


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Keloids

Contractures

REHABILITAtION


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REHABILITAtIONPHASE

Wound healing, psychologicalsupport, and restoring maximal

functional activity remain priorities

Reconstructive surgery maybe needed


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urs ng


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urs ng

Management

EMERGENT PHASE


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EMERGENT PHASE

INTERVENTIONS RATIONALE

1. Provide humidified oxygen

2. Monitor for signs of hypoxia

and report to the physician

immediately

3. Place patient in semi fowlers

position4. Prepare to assist with

intubation and escharotomies

5. Monitor mechanically

ventilated patient closely

1. Humidified oxygen provides

moisture to injured tissues;

supplemental oxygen

increases alveolar oxygenation

2. To detect worsening of

condition

3. To promote lung expansion4. Intubation allows mechanical

ventilation. Escharotomy

enables chest excursion in

circumferential chest burns

5. It allows for early detection ofdecreasin res irator status

PROBLEM 1

Assessment: dyspnea, shortness of breath, irritability, tachypnea,

tachycardia, restlessness

Nursing diagnosis: Impaired gas exchange related to upper airway

obstruction secondary to smoke inhalation injury

Goal: Maintenance of adequate tissue oxygenation

Assessment: SOB, dyspnea, crackles,


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Assessment: SOB, dyspnea, crackles,tachycardia, tachypneaNursing diagnosis: Ineffective airway clearancerelated to edema and effects of

smoke inhalationGoal: Maintain patent airway and adequateairway clearanceINTERVENTIONS RATIONALE

1. Maintain patent airway

through proper patient

positioning

2. Suction secretions as

needed

3. Provide humidified oxygen

4. Encourage patient to turn,cough, and deep breathe

5. Encourage patient to use

incentive spirometry

1. A patent airway is crucial

to respiration

2. To remove accumulated

secretions if client is

unable to cough

effectively

3. Humidity liquefiessecretions and facilitates

expectoration

4. To mobilize secretions

5. To promote lung

expansion, mobilize

Assessment: tachycardia, weight loss, irritability,


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hypotension, tachypneaNursing Diagnosis: Fluid volume deficit related toincreased capillary permeability andevaporative losses from the burn wound

Goal: Restoration of optimal fluid and electrolytebalance and perfusion of vital organs


1. Observe vital signs and urine

output, and be alert for signs of

hypovolemia or fluid overload

2. Monitor urine output at least

hourly and weigh patient daily

3. Maintain IV lines and regulate

fluids at appropriate rates, as

prescribed

4. Elevate head of patients bed and

elevate burned extremities

5. Notify physician immediately of

decreased urine output, blood

pressure, or increased pulse rate

1. Hypovolemia is a major risk

immediately after the burn

injury. Overresuscitation might

cause fluid overload

2. Output and weight provide

information about renal

perfusion and fluid status

3. Adequate fluids are necessary to

maintain fluid and electrolyte

balance and perfusion of vital

organs

4. Elevation promotes venous

return

5. Because of the rapid fluid shifts

in burn shock, fluid deficit must

be detected early so that

ACUTE PHASE


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ACUTEPHASE


1. Monitor vital signs, intake

and output, weight. Assess

for edema, jugular veindistention (JVD), crackles,

increased arterial

pressures

2. Notify physician if urine

output


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Assessment: altered skin integrity, weakness, fullthickness burn injuryNursing diagnosis: Risk of infection related to loss ofskin barrier and impaired immune response

Goal: Absence of localized or systemic infectionINTERVENTIONS RATIONALE

1. Use asepsis in all aspects of

patient care:

a. Meticulous hand hygiene before

and after patient care

b. Use clean or sterile gloves forwound care

c. Wear isolation gown or protective

plastic apron for patient care

d. Wear mask and hair cover when

wounds are exposed and during

sterile procedurese. Change invasive lines and tubings

as recommended

2. Screen visitors for possible

infection

3. Exclude plants and flowers in water

from patients room

1. Aseptic techniques minimize risk

of cross contamination and spread

of bacterial contamination

2. Avoiding known infecting agents

prevents introduction of additionalmicroorganisms

3. Stagnant water is a potential

source of bacterial growth

4. Antibiotics reduce and kill bacteria

5. Increased WBC count indicates

infection. Culture and sensitivityindicate microorganisms present

and what appropriate antibiotics

to be used.

Health teachings


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Health teachings

instruct to wash burned areas

daily with mild soap and waterand to apply the prescribedtopical agent or dressing

Written and verbal instructionsshould be given about

prevention of complications,

pain management, and nutritionGive information about specificexercises to preventcomplications like DVT and


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TheEnd

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