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Burns Case Study. The pathophysiology involves both local and systemic responses which Klein et al. (2009) explains affects skin or other tissue and is dependent on the cause of the injury and extent.

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BURNS SPC BELL, ALEXANDRA BURNS Christenson and Kockrow (2011) states that a burn can be defined as an injury to the tissue which results from thermal, chemical, radiation, or electrical. Thermal burns are caused by a flame, hot fluids or gases, friction, or exposure to extremely cold objects. Flame burns are most often associated with smoke or inhalation injury. Chemical burns occur when there is contact with a caustic substance. This substance can be acidic or alkaline. The degree of injury is relative to the type and content as well as the concentration and temperature of the injuring agent. Electrical burn is when a current travels through the body along the pathway of least resistance. This pathway often includes nerves, as they offer the least resistance, while the greater resistance is through bones. The resistance from bones can generate heat. The amount of injury is dependent on the type and voltage of current. Electrical burns often have underlying injury which is sometimes more severe than the observable injury. Doenges, Moorhouse, and Murr (2010) explains that radiation burns result from an exposure to an ionizing radiation, most commonly is an overexposure to ultraviolet rays from the sun, sunlamp, tanning booths, or high exposure to x-rays. Doenges et al. (2010) suggests that there are several risk factors predispose a person to burns including substance abuse, careless smoking, cultural practices, overcrowded living conditions, lack of parental supervision of children, insufficient safety precautions and violence, including child abuse and neglect. The pathophysiology involves both local and systemic responses which Klein et al. (2009) explains affects skin or other tissue and is dependent on the cause of the injury and extent. In local response Klein et al. (2009) explains that there are three stages. The first stage is coagulation which occurs at the point of maximum damage, causing irreversible tissue loss due to coagulation of the constituent proteins. ...read more.


There are three collaborative parts to the care of a burn patient, Klein et al. (2009) describes them as resuscitative, acute, and rehabilitive. The resuscitative stage also called the emergency phase starts when the injury takes place and lasts until forty eight hours when the shift of fluids and proteins has subsided. Typically the first health care professionals to encounter the patient are emergency medical technicians, but occasionally the first care received may be at the emergency department. Klein et al. (2009) states that the first priority is to stop the burning process as quickly as possible. If the burn was caused by cement, tar, or scalding, clothing should be removed by using water. Ice should never be used as it can cause vasoconstriction and lead to further tissue damage. Once the burning process has stopped the patient may be transferred to a specialty burn center as the care for a severe burn is complex. Klein et al. (2009) states that once the resuscitative phase is complete the acute phase begins. The airway should be assessed first. If an inhalation injury is suspected intubation may be necessary to prevent airway closure from tracheal edema. If the patient is not intubated the nurse should constantly be monitoring for hoarseness, stridor, or wheezing, as these signs can indicate ineffective airway clearance. The patients' breathing should also be assessed if carbon monoxide poisoning is established. Humidified one hundred percent oxygen therapy should be administered by endotracheal tube or face mask to decrease the work of breathing and help facilitate oxygen saturation until COHgb levels have returned to normal. When treating a burn patient fluid resuscitation plays a vital role in burn management and recovery. There are many methods in calculating burn resuscitation fluids, but in the end the overall goal is to maintain tissue perfusion and the organs function without fluid therapy deficit or overload. Klein et al. ...read more.


The nurse can suction, if necessary, with extreme care, while maintaining sterile technique. This helps maintain clear airway, but should be done cautiously because of mucosal edema and inflammation. Risk for infection related to burn trauma. Implement appropriate isolation techniques, as ordered. To achieve an infection free patient isolation precautions should be in place, dependent on type and extent of wounds. Isolation precautions reduce the risk of cross contamination and exposure to bacteria from other patients. The nurse should also emphasize and implement good hand washing technique for all individuals coming in contact with the patient. This prevents cross contamination and reduces the risk of acquired infections. The nurse should also monitor vital signs for fever and increased respiratory rate and depth, presence of diarrhea, decreased platelet count, and increased white blood cell count. As these are all indicators of sepsis, often occurring with full thickness burns which require prompt evaluation and intervention. Acute pain related to burn trauma. Nursing interventions include covering the wounds as soon as possible unless open air exposure burn care method required. This reduces temperature changes and air movement that can cause great pain to exposed nerve endings. The nurse should also administer analgesics opioid and non opioids as ordered. The patient may require around the clock medication and dose titration. IV method is often used initially to maximize drug effect. If the doctor orders patient controlled analgesia may be used, and the nurse should provide and instruct in use of a PCA. A PCA provides for timely drug administration, preventing fluctuations in intensity of pain, often at lower total dosage while allowing the patient to have control over the situation. The care of a burn patient is both complex and meticulous. There are many facilities across the nation, which offer burn centers, housed with specialized nurses and doctors to treat patients with burns. The treatment plan varies from each facility to another, so it is important for the nurse to understand their facilities policies regarding the care of a burn patient. ...read more.

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