Nursing Care of Burns

There are three overlapping staging stages of nursing care of burns; resuscitation (emergent),  acute (wound healing), and rehabilitation (restorative).

Resuscitation/Emergent

 Priorities for treatment can be highlighted using the ABCD acronym. These steps are taken from the journal of Nursing Critical Care (2013).

 

https://www.youtube.com/watch?v=vVFQNlAchNU

Airway
Maintaining the patient's airway is the primary concern. Due to smoke inhalation and the complex inflammatory cascade that accompanies burns there is often a great danger that the patient's airway could close. For this reason, many patients with large TBSA and burns of the face and neck will be intubated in order to maintain their airway.

Breathing
This ties in very closely to maintaining an airway but breathing refers more to in-depth respiratory adequacy and assessment. This is where nurses will monitor oxygen saturation and respiratory sounds, to name just a few assessments.

Circulation
Nurses will assess aspects of the cardiovascular system, especially the rate and rhythm of pulses. Additionally, capillary refill, skin color, temperature, and bleeding will be assessed.

Disability
Disability indicates even further assessments to determine any disabilities that the patient may be suffering from. For example, neurological status, level of consciousness, and cerebral perfusion pressures will be assessed. 

Fluid Resuscitation
Fluid resuscitation also should be addressed as soon as possible. Obviously, issues of airway, breathing, and circulation take priority because they have more potential for mortality in the first few hours of a burn injury. However, fluid imbalance also has great potential to send large TBSA burn patients into hypovolemic shock within hours of injury. Please take a look at my post titled "Fluid Imbalance as a Symptom of Burns" for more information on fluid resuscitation practiced for large TBSA burns. 

Acute/Wound Healing

Nursing care of burns in the acute/wound healing stage will address debridement, skin grafting, and escharotomy. I think it goes without saying but a major part of caring for burns, in addition to caring for the associated complications (fluid imbalance and potential organ failure), is providing the wound bed with a clean and sterile environment. Wound dressing need to be changed regularly and depending on the type of wound different dressings will be used.

http://media.jrn.com/images/660*439/28941952-mjs_burnunit-_nws-_sears-_1.jpg

Rehabilitation 

It is misleading that rehabilitation is listed last in the stages of nursing care of burns. Rehabilitation of individuals following large and small burns begins day one and can continue for years. On the burn unit that I work on nurses work very closely with physical and occupational therapy to ensure that patients retain as much range of motion and functionality of their body as possible. With prolonged hospital stays, immobility, and large scale tissue damage and scaring it is not uncommon that burn victims will suffer from contractures. Contractures result from tissues losing their elasticity. This loss of elasticity can result in limited range of motion of joints. Early therapy targets these tissues and helps these tissues to retain elasticity as they heal.

Burn scar tissue taken from https://www.turkeltaub.com/wp-content/uploads/2011/08/Burn-scars-300x224.jpg

It should also be noted that rehabilitation is physical but it is also psychological and social. Hopefully, in later posts we will have more opportunity to discuss these important domains further. 

http://www.sunshine.org.tw/english/images/phy03.jpg

Procter, F. (2010). Rehabilitation of the burn patient. Indian Journal of Plastic Surgery : Official Publication of the Association of Plastic Surgeons of India, 43(Suppl), S101–S113. doi:10.4103/0970-0358.70730

Culleiton, A., Simko, L., (2013). Caring for patients with burn injuries. Nursing Critical Care, 8(1), 14-22.