Burns Fluid - PowerPoint PPT Presentation

Loading...

PPT – Burns Fluid PowerPoint presentation | free to download - id: 732ccc-MDg2N



Loading


The Adobe Flash plugin is needed to view this content

Get the plugin now

View by Category
About This Presentation
Title:

Burns Fluid

Description:

Title: Burns Fluid & Electrolytes Author: SOHEILA KHAZAEI Last modified by: lornejad Created Date: 10/10/2002 3:53:18 AM Document presentation format – PowerPoint PPT presentation

Number of Views:66
Avg rating:3.0/5.0
Slides: 35
Provided by: SOHE8
Learn more at: http://www.ssu.ac.ir
Category:

less

Write a Comment
User Comments (0)
Transcript and Presenter's Notes

Title: Burns Fluid


1
(No Transcript)
2
Burns Fluid Electrolytes
3
Nursing Care BURN INJURIES
  • 1. Identify the mechanism of burn (TYPE)
    injuries.
  • 2. Describe methods for determining
    assessment/physiology/ classification of burns.
  • 3. Differentiate degrees of burn (1st- 4th)
    versus epidermal/superficial, partial and full
    thickness, deep burns.
  • 4. Determine nursing care based upon the systemic
    pathological changes associated with burn injury
    in the first 24 48 hours.
  • 5. Identify assessment, nursing diagnoses and
    management of the burn victims airway, breathing
    and circulation and wounds.
  • 6. Identify the Pain/Nutritional/Rehab
    requirements for a burns patient.

4
Mechanism/Burn Type
  • Thermal - burning of tissue via direct contact
    with a heat source hot water, flame
  • Zones of Injury
  • 1. Zone of coagulation thrombosis,
    vasoconstriction, necrosis and cell death
  • 2. Zone of stasis - low blood flow
  • 3. Zone of hyperemia - inflammatory response

5
Mechanism/Burn Type
  • Chemical - tissue destruction via direct contact
    chemical
  •          oxidizing agent sodium hypo chloride
  •          reducing agent hydrochloric acid
  •          corrosives phosphorus
  •          protoplasmic poisons formic acid
  •          desiccants sulfuric acid
  •          vesicants mustard gas
  •          gasoline

6
Mechanism/Type Chemical Burn
7
Mechanism/TypeElectrical Burn
  • - direct contact with electrical current
  •                   entry exit wounds

8
Burns Assessment/Physiology/ Classification
  • Based on
  • Depth/Degree of injury,
  • Percent of body surface areas involved,
  • Location of the burn,
  • Association with other injuries.

9
Burns Physiology/Classifica
tion Depth of Burn Assessment
  • Epidermal destruction epidermis only
  •      reddened,
  •      blanches to pressure,
  •      no blisters
  •      painful
  •      healing 3-5 days
  •      no scarring

10
Burns Physiology Classification Depth/Degree
of Injury
  • First Degree superficial, epidermal damage
  • erythematous painful due to intact nerve
    endings
  • heal in 5-10 days
  • pain resolves within 3 days
  • no residual scarring

11
Burns Physiology Classification Depth/Degree
of Injury
  • Second Degree partial thickness, epidermis/
    dermis
  • superficial burns moist, blister
  • deeper burns - white and dry, blanch with
    pressure, and have reduced pain
  • heal in 10-14 days
  • can develop into third degree burns with
    infection, edema, inflammation and ischemia
  • treatment varies with degree of involvement -
    grafting is indicated for deep burns

12
Superficial Burn
13
Burns Physiology /
Classification Depth of Burn Assessment
  • Partial Thickness
  • Superficial destruction epidermis to upper dermis
  •  bright red to pale ivory, blistered or
    weeping, blanches to pressure
  •   sensitive to pain, pressure temperature
      healing 14-21 days , no scarring

14
Burns Physiology/Classifica
tion Depth of Burn Assessment
  • Partial Thickness
  • deep destruction epidermis to deep dermis
  •    mottled
  •    white waxy
  •    blistering
  •    diminished sensation to light pressure
  •    healing months-weeks/usually scarring
  •  

15
Burns Physiology Classification Depth/Degree
of Injury
  • Third Degree full-thickness, most severe of
    burns
  • results in necrosis and avascular areas
  • tough, waxy, brownish leathery surface with
    eschar, numb to touch
  • grafting required
  • usually have permanent impairment

16
Deep Burn
17
Burns Physiology Classification Depth/Degree
of Injury
  • Fourth Degree
  • full-thickness as well as adjacent structures
    such as fat, fascia, muscle or bone
  • reconstructive surgery is indicated
  • severe disfigurement is common

18
Burns Physiology Classification Depth/Degree
of Injury
  • Full - destruction to epidermis, dermis,
    subcutaneous
  •     dry,
  •     pearly/yellow-charred,
  •     does not blanch,
  •     leathery, inelastic
  •     minimal to no sensation of pain, healing
    via secondary granulation/graft

19
Burn Assessment
  • Body Surface Area
  • Rule of Nines
  • adult 9 head 9 arms 18 legs 18 chest
    18 back 1 perineum
  • child 18 head 9 arms 14 legs 18 chest
    18 back

20
Burn Assessment Lund Browder Chart
21
Burn Assessment
  • Location
  • Important for assessing potential disability
  • greatest risk with face, eyes, ears, feet,
    perineum and hands
  • Upper extremities involved in 71 of burns, head
    and neck 52
  • Associated Injuries
  • Smoke inhalation
  • hoarseness, cough, singed nasal hairs, oral
    burns, wheezing
  • Carbon monoxide poisoning
  • Fractures
  • Trauma

22
Hospitalization in Major Burns
  •     gt10 surface area in children, elderly
  •     gt15 surface area in adults
  •     specific regions - respiratory tract,
    face, neck, circumferential burns, hands,
    feet, major joints, genitalia, electrical
    burns, lightening burns
  •     3rd degree burns gt3 children, gt5 adults
  •  

23
Mortality in Burns
  •          gt65 body surface area (BSA)
  •          associated smoke inhalation
  •          infection
  • gt20 BSA with shock and other complications/relate
    d sequelae

24
Collaborative Nursing Medical Management
  • Pathology of the First 24 hours
  •      Temperature loss hypothermia
  •      Plasma Protein Loss
  •      Hypovolemia/hemoglobin concentration
         Tissue/blood destruction hypoxia
  •      Release hemoglobin pigment/myoglobin
  • GFR UO
  •      Tissue hypoxia and reduced renal function
    metabolic acidosis
  •      Platelet destruction of activation
    clotting cascade via intrinsic/extrinsic pathway
    DIC
  •  

25
Collaborative Nursing Medical Management
  • Pathology of the Second 48 hours
  • temperature
  • 2. fluid mobilization to intravascular space
  • 3. renal loss K
  • 4 Fluid resuscitation Serum Na
  •   dilutional coagulopathy
  •  

26
Collaborative Nursing Medical Management
  • Wound Care     
  •    tetanus toxoid gt 50 BSA burn
  •    and/or tetanus immunization
  •    chemical burns
  • irrigate all burns, cover until initial
    resuscitation complete  
  •    electrical burns
  • AC current Tetany risk Vent Fib
  • High energy check volts blunt injuries

27
Collaborative Burn Management
  • Primary Assessment Resuscitation
  • Airway check risks event in an enclosed area,
    singed eyebrows/nasal hair, hoarse voice,
    stridor, wheeze, air entry/edema
  • Breathing check risks event in an enclosed
    area evaluate for
  • CO2 poisoning
  • high PaO2
  • low SataO2

28
Collaborative Burn Management
  • Circulation Assessment Resuscitation
  • Parkland Formula one of the most commonly
    usedFirst 24 hours an isotonic solution (Ringers
    Lactate)4mL/kg x TBSA
  • divide into 8 hour periods
  • - first 50 in 8 hours
  • - next 25 in 8 hours
  • - final 25 in 8 hours
  • urinary output should be 50-70mL/hr (1mL/kg) in
    the first 24 hours
  •  

29
Collaborative Burn Management
  • Circulation Cont Assessment Resuscitation
  • Second 24 hours
  • Colloid/plasma is delivered 0.5mL/kg x TBSA for
    the next 8 hours.
  •  At 32 hours
  • 5 Dextrose nutritional replacement
  • require serial measurement serum electrolytes,
    urea, hematocit, blood albumin, urinary N.

30
Nursing Diagnoses
  • Altered Tissue Perfusion
  • Fluid Electrolyte Imbalance
  • Risk for Infection
  • Altered Comfort Pain
  • Altered Nutritional Less than Body Requirements
    (more Calories needed)
  • Body Image Change Loss? Role?

31
Nursing Care
  • IV access (Multiple)
  • Manage perfusion needs by parameters of CVP,
    Urinary Output
  • Pain management
  • once vital signs have stabilized, pain medication
    should be used (ie morphine, or meperidine,
    fentanyl, benzodiazepines as indicated )
  • Morphine or Fentanyl Drip

32
Nursing Care of Ulcer/Pain/Tetanus
  • Curlings ulcer prophylaxis (Peptic Ulcer)
  • An H2 blocker (cimetidine, ranitidine,famotidine)
    start first 6 hours
  • antacids are no longer recommended - the patient
    should be kept NPO
  • with burns gt 15 of BSA, an NG (OG) tube and
    bladder catheter should be placed
  • Tetanus
  • immunization if out of date

33
Nursing Care of Burn Wounds
  • Wound Care (Sterile Technique)
  • Debridement
  • Anti-microbial Application
  • silver sulfadiazine (Silvadine)
  • mafenide acetate (Sulfamylon)
  • Closed dressing except face perineum
  • Wound cover
  • synthetic,biosynthetic, biological
  • Graft
  • Wound Allograft
  • Split thickness skin graft
  • full thickness graft

34
Evaluation of Nursing Care
  • ABCs Airway stridor
  • Breathing use of accessory muscles, lung sounds
  • Circulation CVPs, BP, Pulse-Ox
  • Fluids Electrolytes/Renal
  • Urinary output, labs, specific gravity,
    osmalarity, myoglobin
  • Pain
  • Infection (Gram Negative Sepsis)
  • Nutrition
  • Weight, ulcer Management
About PowerShow.com