Wound Healing

Occurs in _ ___________ stages: 

3 overlapping

Inflammation

Coagulation

Reconstruction 

Inflammation 

occures

Coagulation

Sealing of wound - ↓ bacterial invasion & vasodilitation. (Leukocytes ingest debris & bacteria)

5 days to 4 wks

Natural debridement: enzymes dissolve clots & clean wound 

mos to yrs

Collagen production - forms scar tissue

Burns

Injury to skin & subcutaneous tissue -  thermal, chemical, electrical, radioactive

Burn injury - can range from mild redness to major tissue destruction

2nd leading cause-injury/death – 5 -14 yrs.

Etiology of Burns

Accidental or non-accidental

10% of burn injuries, 2nd to child abuse

Thermal burn: flames or hot object

Chemical burn: caustic agents

Electrical burn: direct contact - electrical source (cords, appliances)

Radioactive: sun, nuclear accidents, radiation tx

Burn Classification

Classification/tx - depth of damage

Burn Classification

1st ° 

epidermis only

Heals within a few days (sunburn)

Burn Classification

epidermis & top layers of dermis (partial thickness)

Heals within 10-14 days, minimal scar formation

Burn Classification

all skin layers & nerve endings (full thickness)

Burns

Rule of Nines

Burn Assessment in Children

lCalculate TBSA involved (Total burn surface area)

lAssess depth of injury

lBurns covering 10% or > of TBSA - fluid replacement

lAssess involvement body parts-functional impairment

lAssess pain – 3rd degree burns are painless

lYounger children - higher mortality rate

lAssess renal function & urine output

lPerform complete respiratory assessment

Burns

Systemic Effects of a Burn Injury

lAsphyxia from smoke inhalation

lEdema of respiratory passages

lHypovolemic shock:

¡Massive fluid shifts

¡Renal failure

lProtein loss from open wounds

lK+ excess from tissue destruction & renal failure

Burns

Nursing Interventions

lABC’s

¡Airway, breathing, circulation

lAdminister fluid replacement as ordered

¡Large bore IV, LR

lFoley insertion - accurate I&O’s

lMonitor vital signs

lPrevent infection

lKeep environment warm

lAdminister ↑ nutrient diet

¡Major injury - Enteral nutrition, maintain/promote healing.

lPromote active/passive ROM exercises

lMeticulous skin care

lCoordination of health care team

lEmotional support for child & family,

Burns

Medication Therapy

lAnalgesics

lAntibiotics

¡Local, topical antibiotics

¡Systemic antibiotics if infection occurs

¡Mafenide (Sulfamylon) appy thin layer over wound

¡Silvadene applied, reapplied q 8-12 hours

lH2 receptor antagonists (Tagamet, Zantac)

Burns

Evaluation

lBurns - profound insult to body & body image

lBurn tx requires ICU - multidisciplinary team

lFamilies need much support

¡Family dynamics, emotional distress, child abuse?

¡Parental guilt

lEducation

lLong Term rehabilitation