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Biological Sciences
Stephen Reid

Chapter 25:Burns  Burns are body tissue injuries due to heat, cold, chemicals, electrical current, or radiation.  Smoke and inhalation injuries result from inhalation of hot air or noxious chemicals.  The resulting effect of burns is influenced by the temperature of the burning agent, the duration of contact time, and the tissue type injured.  Burn prevention programs focus on child-resistant lighters; nonflammable children’s clothing; stricter building codes; smoke detectors/alarms; and fire sprinklers.  Nurses need to advocate for scald- and fire risk–reduction strategies in the home. Occupational health nurses need to educate workers to reduce scald, chemical, electrical, and thermal injuries in the work setting.  Burn treatment is related to injury severity determined by depth. The extent is calculated by the percent of the total body surface area (TBSA), location, and patient risk factors.  Burns are defined by degrees: first degree (same as sunburn), second degree, and third degree. A more precise definition of second- and third-degree burns includes the depth of skin destruction: partial-thickness and full-thickness.  Second- and third-degree burn extent can be determined using total body surface area based on two guides: Lund-Browder chart and Rule of Nines. Burn extent is often revised after edema subsides and demarcation of injury zones occurs.  Face, neck, and circumferential burns to the chest/back area may inhibit respiratory function with mechanical obstruction secondary to edema or leathery, devitalized tissue (eschar) formation. These injuries may cause inhalation injury and respiratory mucosal damage.  Hands, feet, and eye burns may make self-care difficult and jeopardize future function. Buttocks or genitalia burns are susceptible to infection. Circumferential burns to extremities can cause circulatory compromise distal to the burn.  Burn management is organized chronologically into three phases: emergent (resuscitative), acute (wound healing), and rehabilitation (restorative). Overlaps in care exist from one phase to another. EMERGENT PHASE  Period of time required to resolve immediate, life-threatening problems. Phase may last from time of burn to 3 or more days, but it usually lasts 24 to 48 hours.  A primary concern is the onset of hypovolemic shock and edema formation. Toward the end of the phase, if fluid replacement is adequate, the capillary membrane permeability is restored. Fluid loss and edema formation cease. The interstitial fluid gradually returns to the vascular space. Diuresis occurs with low urine specific gravities.  Manifestations include shock from the pain and hypovolemia. Areas of full-thickness and deep partial-thickness burns are initially anesthetic because the nerve endings are destroyed. Superficial to moderate partial-thickness burns are painful.  Shivering occurs as a result of chilling, and most patients are alert. Unconsciousness or altered mental status is usually a result of hypoxia associated with smoke inhalation, head trauma, or excessive sedation or pain medication.  Complications: o Cardiovascular system: dysrhythmias and hypovolemic shock o Respiratory system: vulnerable to upper airway injury causing edema formation and obstruction of airway, and inhalation injury o Renal system: if patient is hypovolemic, kidney blood flow may decrease, causing renal ischemia. If it continues, acute renal failure may develop. With full- thickness and electrical burns, myoglobin and hemoglobin are released into the bloodstream and occlude the renal tubules.
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