Download Severe Burn Injury

Severe Burn Injury
Principles of early care:
Early intubation for facial burn, smoke inhalation (s/s- burns to face, neck, upper chest, hoarseness,
carbonaceous sputum, soot around nares, darkened oral mucosa, difficulty swallowing)
IV access with a large bore needle and fluids
Small, frequent doses of IV morphine
Foley catheter, monitor hourly U/O
NG tube for gastric decompression
PMH, medications, allergies, last DT immunization
Accurate flow sheet of VS, including pulse ox; check frequently, cardiac monitor
Keep warm, dry, clean dressings
Elevate affected extremities; check distal pulses
Encourage C & DB, turn q 1- 2 hours, suction and chest physiotherapy
Monitor electrolytes, ABGs, and CBC
Pain Management:
Pain is usually absent initially in full-thickness and deep partial-thickness burns because the nerve
endings are destroyed. Superficial to moderate partial-thickness burns are painful. Medications used
include analgesic and sedative agents. Pain medications should be given by IV route. The drug of choice
for pain control is morphine, but hydromorphone and methadone may also be used.
Fluid Disturbance in Burn Injury:
Hypovolemia
 massive amounts of fluid shift out of blood vessels because of increased capillary permeability.
Continuing capillary permeability promotes movement of sodium and plasma proteins into the
interstitial spaces and other surrounding tissues, resulting in continuing loss of fluid from the
vascular space.
 Evaporation of fluid from denuded body surfaces also increases fluid loss.
 circulatory status is also impaired because of hemolysis of RBCs. The RBCs are hemolyzed by a
circulating factor released at the time of the burn as well as by the direct insult of the burn injury.
Thrombosis in the capillaries of burned tissue causes an additional loss of circulating RBCs.
Diagnostics/Lab values
Elevated hematocrit is commonly caused by hemoconcentration resulting from fluid loss. After the fluid
balance has been restored, lowered hematocrit levels are found secondary to dilution.
Electrolyte imbalances occur as sodium shifts to the interstitial spaces (hypo) and potassium(hypo) is
released from injured cells and hemolyzed red blood cells into the extracellular spaces. With adequate
fluid replacement, serum sodium (hyper) levels increase as sodium returns to the vascular space, and
potassium(hyper) levels may be markedly elevated as fluid mobilization brings potassium from the
interstitial spaces into the vascular spaces. Clinically, diuresis is noted with low urine specific gravities.
Psychosocial
Initially keep family informed of patient condition and the care being provided. Before the family sees the
patient, explain the reasons for his change in appearance and that the edema is temporary.
Ongoing, involve the family in patient care, treat them as team members. This helps family members
understand and appreciate the importance of reestablishing patient independence.
Changes in the various burn phases will require repeated explanations of what to expect, and it may be
helpful for some family members to view the burn wounds frequently so that they can see the progress of
healing.
The nurse should always be available to address the family’s concerns and questions.