Burns Nursing Care, Treatment, Degrees, Pathophysiology, Management, NCLEX Review

this is cereth registered nurse re and calm and in this video I want to be going over the burns and this video is part of an in clicks review series over burns and as always at the end of this video you can access the free quiz I will test you on this condition so let's get started water burns burns are where you have damage to the skin integrity so we're talking about those layers of skin we have the epidermis dermis subcutaneous tissue and then below that the muscle and the bone and depending on the severity of the burn you can have just the epidermis affected you could have the dermis or the subcutaneous tissue or even in worst cases the bone and the muscle can be involved in here a little bit later we're going to talk about those different degree of burns and these burns come from some type of energy source so you have various types and let's talk about those and I would remember these types for your exams okay the first type you can have is known as a heat burn or a thermal burn and this is the most common type of burn that you usually see in patients and it can come from various sources like a hot liquid getting on the skin can come from hot steam or a fire etc now whenever you have a patient who has been like in a fire like an enclosed structure or has like a steam type of injury what are you thinking about we're thinking about the airway you're thinking about an inhalation injury which we're going to talk about in depth a little bit later so these patients are at risk for the respiratory system being affected because with the fire the things that come off of the fire where the fires burning material carbon monoxide they can get poisoning steam can go in there affect those upper Airways burn the glottis and all those structures that are before the one so you want to watch that another type of burn is called an electrical burn and just like the name says it's from some type of electrical source so what's happened is that the patient has got around something that is going to generate electrical current it's wet and it's damaged the skin but the thing with electrical burns you have to remember is that it not only affects the skin but can affect the structures way under the skin and we're talking about muscle and bones because think about it depending on how strong of a current this person received it can generate a lot of damage so one thing you have to watch out for is even though you're looking at their skin it looks burned they go to electrical barn it looks bad there can be even more damage underneath that skin layer from where that electrical current traveled so this is what's called the iceberg effect so if you ever hear that term that's what that means the skin looks you know not very well but underneath the damage could be even worse from where that electrical current went now because we're talking about that let's take it a step further and think of some things that these patients can be at risk for with these electrical burns so we said are structures involved were muscle and bones okay say this person had a really bad electrical burn really strong electrical activity that they were saved well it's going to affect our muscles one muscle in particular is the heart how does our heart even pump well it has electrical activity that causes those ventricles and the atrium and all that to contract to pump the blood out of there well if you send in an 11 another electrical source in there can throw off that electrical rhythm so they're at risk for dysrhythmias also bone fractures if the current is strong enough it can tense up those muscles so much it can fracture bones and so we want to watch out for cervical spine injuries in these patients in addition think back to muscle when a muscle becomes damaged what can it release in the blood a substance called myoglobin we don't really want this in her blood and also from where those cells are gonna be damaged as well red blood cells can release hemoglobin so we got myoglobin and hemoglobin hanging out in the blood too much of it can clog up in there and as it travels to the kidneys that can collect in the kidneys and cause a condition called acute tubular necrosis where our tubules and our kidneys are becoming clogged kidney function it's not going to work they're going to enter into acute renal failure or acute kidney injury and experience those things who you want to be thinking about that if you see a scenario with a patient who has an electrical burn you're gonna watch their urine for that now another thing is that this myoglobin hemoglobin phenomenon can also happen with those full thickness burns as well because the muscle is going to be involved with those if the burn is really severe especially in those deep partial thickness third-degree burns or in the fourth degree burn the deep full thickness burns next time a burn is a chemical burn and this is where some type of toxic substance has come into contact with the skin and this can be from various sources again like powders gases even certain foods can burn the skin now whenever we're talking about that because say it's a powder it's got on their skin they can breathe that in so we have to watch out for inhalation injury as well with those patients so it's a risky type of burn as well and one thing let's talk about is we can have different type of chemical burns you can have sources that are from alkalized sources or acidic sources and which ones do you think would be easier to treat acidic because alkali the skin is going to have an issue neutralizing that so acidic burns are a little bit easier to treat than alkaline next our cold burns and this is where the skin has just been over exposed to cold leading to frostbite you can also have radiation burns which is from the Sun sunburns we see that a lot especially during the summer and from cancer treatments as well radiation therapy another type is a friction burn and this is abrasion to the skin patients can experience this and a lot of ways of some of the most common ways if you have a patient who's had a car accident and been thrown out of the car or a motorcycle accident when they slide across that pavement they can get road rash the skin can become burned now let's look at the factors that determine burn severity in your patient because depending on what's going on with your patient how severe the burn is can determine how many complications the patient's going to experience and watch and the patient's going to receive so burn severity depends on several things first the burn depth how deep did that burn go did it just affect the epidermis or did it go all the way down where it's affecting the bone and muscle we have partial thickness and full thickness burns ranging from first degree to fourth degree another thing that can affect burn severity is the percentage of the total surface body area that is burned and that's where that rule of nines comes into play so usually if a patient's had 15% to 25% or more of a body surface area that has been burned that's a really bad burn and they're gonna have a lot of complications because the capillary permeability is going to increase which we're going to dive in a little bit later into the path oba hind a burn another thing is aged patients who are really at risk are children of course because they are small they can't handle the damage that's went to their skin along with elderly patients because their skin integrity isn't what it used to be along with they have usually a lot of medical issues already and that ties into a medical history what's going on with your patient before they experienced the burn are they diabetic well they already have compromised circulation so really healing that tissue recovering from this burn is going to be a lot harder or heart failure where that heart muscle is weak so when we have all this shifting of fluid that's going to cause a lot of stress on the heart and the location this is huge this plays a big role in burn severity is there burn on their face their head in the neck what do you think is going to be an issue our respiratory system anytime you see a scenario saying a patient has a burn on their face neck and head think respiratory also their torso especially if they have it on the front in the back what can happen especially if it's a full thickness burn eschar can develop it can restrict breathing and they can have issues with that also the perineum think infection I'm gonna have issues keeping that wound free from infection and that really is our goal during that acute phase of burn management is for fanning infection and again did that patient suffer an inhalation injury that makes treatment even more complicated if they experience one of those as well so now let's switch gears and let's talk about the layers of the skin because what we're going to go into is we're gonna go to the different depths of damage that a patient can experience from a burn which we're talking about the degrees of burns so let's talk about skin layers okay so what's our top layer what's a called the epidermis and it's very thin compared to the dermis and it keeps us protected from environmental hazards and it's great in preventing infections so if we lose that layer at risk for infection now below that is the dermis which is thicker than the epidermis and it contains blood vessels along with nerve endings our sweat and oil glands and the cells that help create new skin cells which is why when patients have a really deep burn that is affecting this dermis where it's gone they're gonna have issues with remaking skin cells they're not gonna make them so they're gonna need skin grafts to help generate new skin and below the dermis is the subcutaneous tissue also called the hypodermis and this contains fatty tissue or veins arteries nerves and it helps insulate the muscles bones and organs so it's very vital in regulating our body temperature so whenever we're getting down into this layer with a burn the patient this is like a full-thickness the patient is going to have issues with regulating their body temperature so when we're providing care we need to make sure that room is warm at least 85 to 100 degrees now that's hot especially whenever you're putting on all that protective gear to provide care but that needs to be for the patient to keep them warm because I can't regulate their body temperature so now since we're familiar with the layers of the skin let's talk about burn injury death okay we're going to be talking about first-degree burns which are super Bern's we're also gonna be talking about second degree which are your partial thickness burns and this is where we're getting down into the dermis and you can have various depth in these second degree burns you can have superficial partial thickness or you can have deep partial thickness next we're gonna talk about third degree burns which is where we're getting into the full thickness burn so pretty severe burn and we're gonna be talking about fourth degree where this is deep full thickness so first let's talk about first degree burns and as you can see in this picture first degree burns is going to be limited to the epidermis so that top layer of skin and whenever you assess the patient what you're gonna see it's going to be very red or pink the patient is going to say it is painful and why is it painful well it's affecting just that top layer so that patient still has all those nerve endings there so they can feel sensation so they're gonna complain a pain compared to if you have a more severe burn it will be warm to the touch there's not going to be blisters or scars left behind because we're just dealing with that top layer and if you touch on it like for blanching purposes you will see a brisk capillary refill next type is our second-degree burn and this is going to extend down into the epidermis and the dermis and again severity can vary it can really go deep down into that dermis where it's almost going into the hypodermis which could easily make it turn into a third-degree burn but this again is going to be very painful to the patient and it can be shiny and moist as you can see in the picture also it's going to be red and pink and you're gonna see blisters present with this and scars can be left a lot behind especially if those skin cells are being affected and a lot of times if this is a deep partial thickness the patient will need a skin graft and blanching is usually still present next burns hype is third degree and this extent into the epidermis the dermis and the hypodermis so the subcutaneous tissue so with this your epidermis and your dermis are destroyed which is going to include those hair follicles sweat glands and nerves and because it's going all the way down into the hypodermis the subcutaneous tissue so it's a pretty severe burn and it's not going to be painful for the patient or the pain is going to be dramatically decreased and why is that because those layers that contain those nerves for sensation have been destroyed and with this because those skin cells that would help regenerate new skin have been destroyed the skin is not going to heal and the patient's going to need skin grafting with this now let's look at an assessment okay whenever you look at a burn that is a full thickness third-degree what's going to look like well can have various colors it can look black yellow red and it's going to be dry matte instead of being moist and shiny like in that second degree now there can also be some hard areas within that burn and these hard areas are called s scar now what is s car well it's developed due to severely burned tissue that is dead and whenever this tissue has become so burned it's not working anymore it can becomes really hard and leathery so let's think about this for a moment if we are given a scenario and it says this patient has full thickness circumferential burns on their torso so we have these full thickness wounds on the front in the back of the torso and it's really hard and leathery we have all the swelling going on what do you think's going to happen with breathing this patient's not going to be able to breathe because it's going to act like a tight band around the chest and this can also happen with your extremity so if it's a circumference you'll burn on let's say the right leg well that hard tissue is going to just squeeze or not allow circulation to go to that distal extremity so that right foot so you can issues with that we're gonna talk a little bit more about that with our complications so always know the location of that circum French will burn and if it's talking about full-thickness because that's where you get your s car and for treatment for this wound to be able to heal if s car is present it's going to have to be removed in order for it to heal now let's look at fourth degree okay this is the worst of them all and this is going to affect the epidermis the dermis the hypodermis the subcutaneous tissue all the way down to the muscle and the bone and the ligaments so all of it and it appears when you look at it it's going to appear black charred with s car and all sensation is totally gone and of course these patients are going to need skin grafting probably cosmetic surgery and a lot of things like that now let's talk about burn location because that's another big thing that determines our burn severity and on your exams in nursing school they love to throw out scenarios about patient has a burn on the face the neck what are you going to be looking for as the nurse what are you going to assess what's your priority so let's quickly go over these different locations and hit the highlights and things you should be thinking about if you're giving those scenarios okay talk about respiratory what areas if burned on the body are you probably going to have some respiratory issues with well burn on the face because this is where breathing starts we inhale and this is where breathing really stops because we exhale through it if we can't get air in or out through this area because it's burned and all that swelling that's going on we're gonna have respiratory issues so especially those burns on the nose and the mouth also on the neck because again we help airflow up and down that but if we have swelling it's gonna close all of our windpipe to allow us to breathe and of course the torso and that's where I was talking about those circumference will burns with those full thickness burns like a band around that chest impeding the patient's respiratory effort to breathe in and out so if you see that be thinking that along with if your patient has a burn on face the nose you're really going to be thinking about inhalation injury as well which we're gonna go over here in a moment next trouble healing what areas on the body of burn do you think are gonna have really a big issue with healing because they have a poor blood supply to them well any structure that's really made out of cartilage they don't have a lot of blood flow to them naturally so we're talking about our ears and our nose which is going to put them at risk for disfigurement because it's not going to heal very well because it doesn't have a nice blood supply going and we're talking about infection definitely at risk for infection especially those ears and we're gonna talk about our nursing interventions it's going to be careful positioning a patient's head when their ears are burned disability what area on the body if it's burned really bad that the patient once they heal there's really going to be disabled and it's going to affect their life compared to if they just have a burn on the thigh or something like that the eyes vision will be gone or the hands and the feet because these structures are very delicate and when a patient has a burn on the hands or the feet very severe burns this they're really hard to heal and they can have a lot of complications like contractions things like that so the patient's going to need a lot of physical therapy in compartment syndrome we talked a little bit about that earlier what areas are gonna be at risk for compartment syndrome our extremities who have experienced full thickness circumferential burns where that tight band of s cars or some pedan circulation so you have a scenario it says that your patient has that be checking those pulses in the feet what does the color of the foot look like and so forth and also if you have it on the torso you want to be thinking about that as well with the respiratory an infection what areas are going to be really prone to infection the perineum the bottom because though those are just natural routes where elimination happens and if we're trying to keep a wound clean because they're already a huge risk for infection it's just going to double down on a huge risk for infection sepsis and things like that now we talked about total body surface area being affected that that determines burn severity if we have really high percentage anywhere from 15 25 or higher percent that's gonna change our capillary permeability in the body which leads to all this fluid shifting and problems so to determine that we like to use the rule of nines and I've come and I've made a whole video on the rule of nines that you can access has a quiz that's going to test you give you some sample problems that you can work and get practice with that because if you're going over burns in nursing school it's a very high probability that you're going to have a question on your exam about the rule of nine so be sure to check out that video another thing that determines burn severity is did that person suffer an inhalation injury now what is this exactly well it is where there is damage to the respiratory system due to that person breathing in some type of substance that shouldn't be there that's damaged or upper or lower Airways and these substances can vary like smoke carbon monoxide and carbon monoxide poisoning it's colorless and odorless it's really hard to detect also from thermal type burn from the heat like a hot liquid or steam or a chemical like those powders and gases and usually this is a high cause of death in fires the inhalation injury and your upper and lower Airways can be involved typically the upper airway is the biggest area that's involved because rather than the lower because the lower is really protected by the glottis and the vocal cord structures so really the upper airway is what happens and then it causes a mechanical obstruction where air cannot go down into the lower Airways so let's talk about carbon monoxide poisoning okay what's happening what's going on well like I said you can't really detect it the patient doesn't know that they're breathing in carbon monoxide and what happens is they breathe this em and let's talk about the red blood cell because this is who's really begin affected with this okay a red blood cell one of its things that it does is it transports oxygen throughout the body so our organs and tissues can be replenished well what on that red blood cell helps to do that hemoglobin okay normally hemoglobin will carry the oxygen throughout the body and they have a really strong connection to each other but once you introduce a lot of carbon monoxide the red blood cell that hemoglobin starts to prefer carbon monoxide so carbon monoxide takes over on this red blood cell and there's no more oxygen left well that's a huge problem because instead of transporting oxygen throughout the body to replenish our tissues and organs it's going to transport carbon monoxide and our body doesn't like that and it will kill us if it's hot and how do we measure that well they will draw labs and they'll check what's called a carboxy hemoglobin level and if carbon monoxide poisoning is in the patient's system it'll be greater than 15% so what can you see in these patients you're going to see neuro status changes or don't give them as much oxygen as they need so they can even go into coma they'll be confused they'll be drowsy headache nausea dizziness and they can have some patience if it's really severe they can have this bright cherry color to their skin or to their lips and what's treatment for this from nursing standpoint I would remember this treatment is a hundred percent oxygen on a non-rebreather mask to help replenish that oxygen in the body because the patient needs it now let's talk about why are some signs and symptoms that would tip you off that a patient may have suffered an inhalation injury what could you expect to see or find in your patient well first of all you need to investigate where this patient suffered this burn was it in an enclosed structure that means not ventilated very well they can be at risk for inhaling smoke and other substances also where the burns located are they on the face the nose the mouth be thinking possible inhalation injury also is the patient having sputum that looks a little abnormal called carbonaceous sputum and this is where the spit literally looks like it has blacks in it does the patient have hair Singhji on the head or the nose hairs think inhalation injury or is there black soot around their nose or their mouth and of course are you seeing the bright red lips the cherry red skin think carbon monoxide poisoning is the patient having trouble talking to you is their voice hoarse where those upper Airways have been affected those vocal cords and are they confused are they having anxiety from where that respiratory system is being compromised or not getting the oxygen transferred throughout the body so it's causing mental status changes or do they have an increased heart rate which goes along with the decreased oxygen the heart's trying to compensate for that by increasing its output now let's switch gears and let's talk about the phases of burn management this is going to help us whenever we're talking about the physiology of burns because physiology of burns and nursing interventions really go hand-in-hand and we're gonna cover that next but I want you to be familiar with the phases so if I refer to them you'll know what I'm talking about okay and to remember the phases whenever you put the beginning of the words together it forms an easy word in its ear so remember the word ear and that'll help you remember the way that the stages fall okay the first phase is called emergent also called resuscitative and this is where you have the onset of the burn injury and it ends with the restoration of capillary permeability in this phase lasts about 24 to 48 hours depending on how severe the burn is now during this phase the patient is at risk for some things because we have an increase in capillary permeability you're gonna learn about here in a moment and this can lead to hypovolemic shock also respiratory distress due to all the swelling and again that determines where the burns actually located and of course compartment syndrome and that goes again where the burn is located as well then we have the next phase which is the acute phase and this starts when capillary permeability has stabilized so it's corrected itself which is going to turn into diuresis because we had all this fluids shift outward and now it's coming back into the intravascular system and it ends to the closure of the wound the burn and it typically starts at 48 to 72 hours and ends when that wound hills and our focus during this phase is preventing infection alleviating pain ensuring proper nutrition and providing wound care and the last phase is known as the rehabilitative phase and this is where the burns healed so it starts with that to the patient being able to function again and this would include mentally and physically so the focus during this would be psychosocial activities of daily living physical therapy occupational therapy and cosmetic correction if needed now let's talk about burn physiology what's going on in the body and the nursing interventions and what I'm going to do is I'm going to mesh the two together because it makes so much more sense while we were doing this nursing intervention based on what phases patients in and what's actually going on during this phase I hope you remember it better okay what we're talking about whenever we have a big change going on in the body and as you're gonna see with burns it literally affects everything that's why patients can die from this what we're talking about if a severe burn like one of those full thickness burns or we're talking about where they've had all those risk factors for burn severity and they had a high percentage of their body burn they're gonna go through this they're not gonna go through this if it's like a really minor minor burn so keep that in mind okay so we have a really bad severe burn the patient is burned like 40 percent all over their ball we're going to have a major change in capillary permeability and this is going to happen fast about 20-30 minutes after burn this can happen and what happens is that we have our intravascular space so be thinking that that's where we are right now and within that what's in that space we have our blood which is plasma and suspended in the plasma or red blood cells white blood cells all of the substances in our body that we need to survive well that capillary that's really holding that changes its permeability and in a sense what happens is that plasma starts spilling out of that intravascular bed and it leaves the intravascular system and goes into the interstitial tissue so it's leaving there and what's going to follow that plasma as it's leaving the interstitial tissue sodium so our sodium level is going to drop it's going into the interstitial space so the patient can have hyponatremia also albumin can follow as well and move outward now we've talked a lot about albumin what does albumin do it regulates oncotic pressure which helps in a sense in a nutshell regulate the water within the intravascular system and if you lose it out of the intravascular system the water the fluid is going to space other places other than there so we're gonna have problems with edema even more now because we have depleted our intravascular system that plasma has left that nice capillary area what do you think is going to be happening to all the other substances that are left in there has no fluid left to suspend it it's going to become really concentrated specifically the hematocrit so you can see an increase in the hematocrit level and then whenever the patient is replaced with fluids the capillary permeability stabilizes and the acute phase you're going to actually see a decrease in it so remember that and another thing is that the blood is going to become very thick because the plasma is gone and this is going to affect micro circulation as well because it's just really thick inside those little areas of micro circulation potassium what do you thinks gonna happen to potassium we have a injury to the burn the cell is affected it's messed up and what's nice inside of herself potassium well whenever that cell breaks open from the damage it's gonna leak potassium into whatever's left into that intravascular system so we're gonna have hyperkalemia potassium levels will increase white blood cells they're gonna go down they were there as well they've been injured with this injury also those immunoglobulin those proteins that help us find infection as well so from a nursing standpoint we got to watch for infection we've got to do things to prevent infection because they don't really have a system to help fight infection plus they just lost the layers of their skin that help protect us from infection as well we're gonna watch for signs of hyperkalemia and hyponatremia so we've established that that intravascular system has no fluid in it which isn't good because that fluid plays a huge role in allowing our heart to pump all the blood to our vital organs so if you don't have a lot of fluid for the heart to pump what's the hard one to do it's gonna try to increase itself to pump harder it's like if I can work harder I can pump more blood so you're gonna have an increased heart rate but there's nothing really to pump so cardiac output is going to go down and blood pressure is going to go down well our vital organs suffer from that and they don't like that and they can die especially our kidneys and our GI tract and all that's going to be effective and the patient can enter into hypovolemic shock and that's the big thing we're trying to prevent in this emergent phase is hypovolemic shock and that's why we're throwing all these fluids in on this patient to prevent this from happening because we want to maintain the function of those organs so now let's talk about those organs that are being affected first the renal system the kidneys okay initially our pay is going to be ugly Erick because of what is going on and the fluid volume deficit because all that fluids moving out and one thing remember I told you to remember about the full thickness and the electrical burns because muscles can be involved with those as the nurse you're gonna be monitoring that urine for myoglobin and hemoglobin because if those collect in those tubules it can cause acute tubular necrosis in the in Lita renal failure so you'll be monitoring that now these processes switch though patients in emergent phase over here then they go into the acute phase within about 48 to 72 hours and what's going to happen during that is that all that fluid outside that capillary bed which is in the interstitial tissue is gonna move back into the intravascular system whenever that happens kidneys are gonna have to get rid of all that fluid so you're gonna see diuresis tearing that so those processes really switched and as the nurse patients going to have a Foley and the best indicator of our fluid of our patients fluid status is their urinary output so you're going to be watching that very closely and you want it at least thirty CCS or thirty milliliters per hour now let's go and talk about fluid replacement because during the emergent phase this is the most important thing that we're trying to do along with preserving the respiratory status if they have respiratory problems but we're also looking at that circulation status so crucial crucial fluid replacement over those next 24 hours and a lot of times they use what's called the Parkland burn formula this is a formula used it's based on how much the patient weighs their total body surface area that has been burned based on amount of lactated ringers that they're gonna give over the next 24 hours and I have a whole video that you can watch where I work a problem and there's a quiz along with it and you can work some sample problems to help prepare you for your exam so check out that video now nursing wise you want to make sure that your patient has IV access because fluids are crucial so you need at least two IV accesses or central-line that can handle all the fluid resuscitation fluid wives a lot of times lactated ringers are given LR and what they do is they expand the intravascular compartment which is what we need and what's going on with this situation also colloid solutions like albumin will be given and we talked about why that was over there because the albumin left and went into the interstitial tissue we need to replace it so we can help get that fluid back into that intravascular system because that's what albumin does it attracts water and we give that to them and it'll pull that fluid back into the intravascular system and again monitoring that urinary output because you're gonna be tight writing these fluid amounts based on how much you're in there putting out so if they're not really saying they're only putting out about ten CCS an hour well let the physician know probably gonna tell you to increase the fluid rate so they can get some more fluids but whenever they are getting fluids you've really got to watch out for fluid volume overload are you giving them too much how can you know that listening to their lungs do they sound wet crackles the swelling edema that is it getting worse and things like that now let's talk about that edema you get a demo because just the nature of the injury but the albumin is leaving and the fluids are shifting to the interstitial tissue which can cause us a lot of problems we're hitting back on circumference old barns again and we got to watch out for this with those patients who have those full thickness burns because what can develop that really burnt tissue called eschar which will act like a band in permanent respiratory effort or circulation so we're gonna look for compartment syndrome and whenever you have circumferential burns on the extremities nursing wise what you want to do is you want to elevate those above the heart level to help with the edema decrease that edema because the swelling the eschar all that together is not a good thing because it can decrease circulation to those extremities now sometimes it is just really bad they may have to perform an emergency escharotomy this is where the we'll go and cut those bands of dead tissue that eschar and whenever they do that that relieves pressure to if it was on the torso the chest extremity and they will feel better and how you can look to see if that was successful or not you can look and and feel the pulses and that extremity that was being affected what's the skin color what's the capillary refill and respiratory vis on the chest is the patient breathing better so that would tell you if it was successful or not another system being affected by a severe burn can be the GI system and why is that why would a burn affect the stomach well what happens remember just like with the kidneys they've lost perfusion so they're going to be affected this stomach has received decreased perfusion and remember in the stomach when we went over a GI series we learned that there's a lot of cells in there that secrete like v carb and other things that help keep our stomach lining nice and protected from the gastric acid in there so those two can survive together and what happens is you have decreased perfusion to those handy little cells and then you have increase in acid production due to the stress response on the body so that makes perfect conditions or an ulcer to develop specifically in the duodenum is where they can happen and they're called curling's ulcers and a patient can report like pain that's just like gnawing in their stomach they can have nausea vomiting and blood so as a nurse you'll be assessing them for that and looking at their stools for blood because it can leak into there and what patients are typically given they're not as prevalent as they used to be and burn patients because they get treatment with antacids and things like that another thing that can happen is that they can experience what's called an ileus this is literally where the gut is just not working anymore and what's happening is you're getting decreased function from the decreased perfusion among other things which is leading to decreased motility so it literally just freezes and stops so as a nurse you wanna be listening to bowel sounds do you here bowel sounds and another red flag a lot of my patients who've had Ilyas Ilyas is they have had vomiting where they're throwing up this grime green vomit and it's where whenever they've ate the food is just literally saying stagnant in their stomach and it has to come out so you see that think of that as well you're going to keep the patient nothing by mouth because of everything that can go on they're going to have a nasogastric tube in there to remove air and secretions and then once the bowel sounds returned they're hitting that acute phase they can start getting food because how do you think their cowl or their calorie needs are going to be they're going to be very high because they have a lot of percentage of their body burn they need calories for the body to work and to help rebuild and repair so a lot of times they may have like a central line to get nutrition that way dog coughs feeding tubes can be inserted and they'll get feedings and they need high calorie high protein and high carb vitamins and foods and things like that to help with their healing now one thing you go to watch with these patients is that they may have hyperglycemia where they have an increase in their blood sugar so you're gonna be checking that looking at that now why is that well the stress response with the catecholamines everything being released is going to cause the liver to release it's to release glycogen which is going to increase that blood sugar so you may see that as well another system that is affected of course is the respiratory system especially if they have burns on the face on the neck so you want to be thinking about that as a nurse where are their burns located a lot of times these patients are going to be intubated fairly fast if they do have burns there because of the swelling that comes afterwards also you want to be making sure and asking yourself is this an upper airway problem because that mechanically obstruct the airflow or do they suffer a lower airway problem where some toxic substance got down in there in the lungs and it's damaged alveoli sacs which is going to impair gas exchange so you'll be watching the rest of our effort looking at that monitoring their ventilator settings if you're on if they're on that they'll probably have an arterial line you're gonna be looking at their ABG's drawing a carboxy hemoglobin level just to confirm no carbon monoxide poisoning remember levels greater than 15% are not good and a lot of times a little bit later if they need to confirm an inhalation injury they can do that with a bronchoscopy another system affected is our immune system so what does that put the patient at risk for infection why is that because they've lost the protection from the skin it's gone it's burned so we're at risk for the outside germs in the environment and the cells that help us fight infection or gone and damage so we're at risk for that so as the nurse we got to do some things to help prevent infection because this is a huge risk during that acute phase okay protective isolation is what they will be in we're protecting the patient from us from visitors from outside things that can cause them harm so whenever we provide care to a patient with severe Bernt you want to wear a hair covering gloves gown a mask and shoe coverings don't want to take anything in that room to hurt that patient also linens are going to be sterile covers and whenever we do wound care will be using sterile gloves and it's important that you assess the patient's last injection of a tetanus shot because they're at risk for developing this and if it's been at least five to ten years they may need another injection another thing is temperature regulation they've really lost their ability to regulate their temperature especially if that hypodermis that subcutaneous tissue being affected really can't regulate their temperature because that's what helped us do it so the room temperature needs to be anywhere from 85 to 100 degrees Fahrenheit you know look at your patient are they shivering that's not good so they need to get warm next pain we want to make sure that we're addressing their pain because burns are very very painful especially whenever they start having wound care and things like that so on a test well option are you gonna select what route is the best for the patient who's how to burn the IV route why is that the best well we don't want to do oral because we just learned the GI system is really shot it's not doing good so we can't really determine how effective that medicine is gonna be whenever they absorb it so we don't want to do that sub-q yeah their skin integrity is messed up we can't measure how it's being absorbed and I am nolle is that painful but again the muscles can be affected with burns so IV is the best another thing is wound care various types of wound care really depends on the physician the hospital protocols what they do but you can have various methods you can have the open method where there's a topical antibiotic ointment that goes on the burn and it's left open to air nothing's covering it or if it's closed topical antibiotic ointment goes on they use some type of covering over like sterile gauze or something like that and again premedicate before wound care if you get a test question about that we're gonna do wound care what are you gonna do first as a nurse premedicate and the wound needs to be clean they can do this with hydrotherapy or shower very painful again debridement they have to remove the necrotic tissue from the burn or wound healing won't help so they'll have to do that and again that's very painful as well now with healing issues this is going into the Q to the rehab phase so we want to make sure that we never have to burn areas touching each other because webbing can occur so always make sure you don't do that and four pillows avoid using whenever you have burns to the ears and the neck why is that well the ears the circulation as we already learn is compromised so we have a pillow on the ear that's already compromised that can decrease circulation even more affect healing cause it go necrotic or with the neck it can cause what's called contractures and this is where you have tightening of that burning skin and they're gonna lose their mobility without it's not correct it so we don't want to do that and speaking of contractures physical therapy we'll be working with them a lot with range of motion and splinting to prevent that okay so that wraps up this lecture over burns thank you so much for watching don't forget to take the free quiz and to subscribe to our channel for more videos

Channel: RegisteredNurseRN

Views: 988,550

Keywords: burns nursing, burns nursing care, types of burns, burns nclex, degrees of burns, burns nursing lecture, burns nursing management, burns nursing school, burns nursing interventions, burns nursing care plan, burns nursing questions, burns pathophysiology, burns treatment, burns, 1st degree burn, 2nd degree burn, 3rd degree burn, 4th degree burn, burn phases, eschar burn, skin burn layers

Id: nN6Bf-CPVo0

Length: 46min 45sec (2805 seconds)

Published: Thu Apr 26 2018