Phases of burn management

Phases of burn management 150 150 Tony Guo

Phases of burn management

  • Emergent (resuscitative)
    • Phase is the time required to resolve the immediate, life-threatening problems resulting from the burn injury
  • Acute (wound healing)
    • Begins with mobilization of extracellular fluid and subsequent diuresis
    • Concludes when
      • Partial thickness wounds are healed and/or
      • Full thickness burns are covered by skin grafts
    • Pathophysiology
      • Diuresis from fluid mobilization occurs, and patient is less edematous
      • Bowel sounds return
      • Healing begins as WBCs surround burn wound and phagocytosis occurs
      • Necrotic tissue begins to slough
      • Granulation tissue forms
      • Partial-thickness burn wounds heal from edges and from dermal bed
      • Full-thickness burns must have eschar removed and skin grafts applied
    • Clinical manifestation
      • Partial-thickness wounds form eschar
        • Once eschar is removed, reepithelialization begins
      • Full-thickness wounds require debridement
    • Nursing/Interprofessional management
      • Wound care
        • Daily observation
        • Assessment
        • Cleansing
        • Debridement
        • Dressing reapplication
        • Appropriate coverage of graft
          • Gauze next to graft followed by middle and outer dressings
          • Unmeshed sheet grafts used for facial grafts
            • Grafts are left open
            • Complication: Blebs
      • Monitor for electrolyte imbalance
      • Excision and grafting
      • Pain management
        • Patients experience two kinds of pain
          • Continuous background pain
            • IV infusion of an opioid
            • Or slow-release, twice-a-day oral opioid
          • Treatment-induced pain
            • Analgesic and an anxiolytic
        • Non-pharmacologic strategies
          • Relaxation breathing
          • Visualization, guided imagery
          • Hypnosis
          • Biofeedback
          • Music therapy
      • Physical and occupational therapy
        • Good time for exercise is during wound cleaning
        • Passive and active ROM
        • Splints should be custom-fitted
      • Nutritional therapy
        • Meeting daily caloric requirements is crucial
        • Caloric needs should be calculated by dietitian
        • High-protein, high-carbohydrate foods
        • Monitor laboratory values
    • Complication
      • Infection
      • Decreased ROM
      • Contractures
      • Paralytic ileus
      • Diarrhea
      • Constipation
      • Curling’s ulcer
      • Increased blood glucose levels
      • Increased insulin production
      • Hyperglycemia
  • Rehabilitative (restorative)
    • The rehabilitation phase begins when
      • Wounds have healed
      • Patient is engaging in some level of self-care

Gerontologic considerations

  • Normal aging puts the patient at risk for injury because of the possibility of
  • Unsteady gait

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