Types of Burns
This type of burn involves only the outer layer of skin, causing redness and pain, but no blisters.
What is a superficial (first-degree) burn?
Rationale:First-degree burns are superficial, affecting only the epidermis and are the most common type. Understanding the degree of burns is essential in assessing severity and treatment.
In the early management of a burn patient, which assessment measure is considered the most reliable indicator of adequate fluid resuscitation and tissue perfusion?
What is urine output?
Rationale: Urine output is a direct measure of renal perfusion and an essential marker for assessing the effectiveness of fluid resuscitation. In adults, a target of at least 0.5 mL/kg/hr (and 1 mL/kg/hr for children) is maintained to ensure that tissue perfusion is adequate and that the patient is not developing burn shock. Monitoring urine output allows the nurse to adjust fluid therapy promptly, preventing complications related to under- or over-resuscitation.
This ointment is used for burns on the face and hands
What is bacitracin?
rationale: bacitracin is an antibiotic used on superficial/first degree burns, face and hands to prevent infection. Silver Sulfadiazine is indicated for deeper burns or larger surface area burns to prevent infection but can only be placed IN the wound bed as it can break down healthy skin surrounding the burn.
What is the initial priority in the emergent phase of burn care?
What is airway?
Rationale: Airway is always the first concern, especially with facial or inhalation injury d/t risk of obstruction from selling, soot, or inhaled chemicals.
A nurse is preparing to apply a topical medication to a patient with second-degree burns and open blisters. Which topical agent is most appropriate for application to non-intact skin?
What is Silvadene?
Rationale: Silver sulfadiazine (Silvadene) is commonly used on partial-thickness and full-thickness burns. It helps prevent infection by inhibiting bacterial growth and is specifically used on non-intact skin, not superficial burns or intact areas.
These burns affect both the epidermis and the dermis, causing blisters and intense pain, and may lead to scarring.
What is a part-thickness (second-degree) burn?
Rationale: Second-degree burns damage the skin deeper than first-degree burns, affecting both the epidermis and dermis. The formation of blisters is a key feature.
These two vital sign changes are expected during the early assessment phase of a major burn due to fluid shifting.
What are increased heart rate and decreased blood pressure?
Rationale:
Burns cause fluid to leak from vessels (third-spacing), leading to low blood volume. HR increases to compensate and BP drops due to less circulating fluid.These are early signs of burn shock and indicate the need for fluid resuscitation.
This intervention is required when a burn has destroyed the entire dermis layer of skin (ex: full thickness 3rd degree burns)
What is grafting?
rationale: the dermis is needed to regenerate skin, A full thickness third degree burn has burned through the dermis and into the fat layer and it will require grafting to the area.
What type of shock occurs d/t burn complications?
What is hypovolemic shock & distributive shock?
Rationale: Burn injuries cause fluid to shift out of the vasculature space causing hypovolemia
A nurse is educating a patient about a method that removes necrotic tissue from burn wounds by applying topical agents that break down dead tissue. What is this procedure called?
What is enzymatic debridement?
Rationale: Enzymatic debridement uses topical enzymes to digest necrotic tissue, promoting a clean wound bed and stimulating granulation tissue and regrowth. It's a less invasive option compared to surgical debridement.
This burn injury extends through the skin and damages underlying tissues such as muscle, tendon, or bone, often necessitating extensive debridement and complex reconstructive surgery.”
What are fourth-degree burns?
Rationale: Fourth-degree burns are the most severe type of burn injury, involving not only the full thickness of the skin but also the destruction of deeper structures like muscle, tendons, or even bone. Due to the extensive tissue damage and loss of viable tissue, these injuries require aggressive surgical management including debridement and reconstructive procedures, as natural healing is impossible
A 35-year-old male is brought to the ED with burns to the entire anterior trunk, entire left arm, and the anterior portion of the left leg. Using the Rule of Nines, what is the estimated total body surface area (TBSA) burned?
What is 36% TBSA?
Rationale: The calculation would be:Anterior trunk- 18%, Entire left arm- 9%, Anterior left leg- 9%
Total TBSA burned = 18%+9%+9% = 36%
Interventions a nurse can provide to a patient with burns on their arms and legs to promote mobility.
What is ROM exercises, NO pillows, Q2 turns/proper repositioning?
rationale: all of these choices reduce the risk of contractures forming. pillows are not indicated as they can restrict movement and promote formation of inflexible scar tissue. moving/repositioning the affected areas help encourage proper healing.
The nurse observes the patients skin is cherry red and the patient is confused. What complication should the nurse expect?
What is carbon monoxide poisoning?
Rationale: Carbon monoxide poisoning can cause cherry red skin, AMS, N/V, & coma. It binds to hemoglobin more readily than oxygen reducing oxygen delivery.
A nurse calculates fluid needs for a burn patient using a formula based on the patient’s weight and the percentage of total body surface area burned. What is the name of this formula?
What is the Parkland formula?
Rationale: The Parkland formula estimates fluid resuscitation in the first 24 hours post-burn. It uses the formula: 4 mL x kg body weight x %TBSA burned. Half the volume is given in the first 8 hours.
List 3 characteristics of a full thickness (third-degree) burn.
What is pain is diminished or absent, hard, inelastic, DRY eschar, edema is SEVERE?
Rationale: Third-degree burns are severe, destroying all layers of skin. These burns can be painless due to nerve damage and require specialized treatment, including potential grafting; Requires grafting – bc it’s all the way through the dermis and skin will not grow back
List at least 3 clinical findings that would prompt a nurse to suspect an inhalation injury in a burn patient.
What are singed nasal hairs, hoarseness, facial burns, soot around the mouth, and carbonaceous sputum?
Rationale: Inhalation injuries are not always obvious from pulse oximetry alone. Findings such as singed nasal hairs and hoarseness indicate thermal exposure of the airway, while carbonaceous sputum suggests smoke inhalation. Recognizing these signs prompts early airway management.
A nurse is caring for a patient in the emergent phase with deep partial thickness burns. What are some ways the nurse can assist with thermoregulation?
Warm IV fluids, burn blankets, bear hugger, warm environment (85-100 degrees)
rationale: patients tend to be hypothermic in the emergent phase as they lose the protective layer of skin that helps with thermoregulation. Rectal thermometers are most accurate in assessing core temperature.
These 6 sign & symptoms indicate the development of compartment syndrome, a life-threatening burn complication
What is pain, pallor, paraesthesia, pulselessness, paralysis, & pilkothermia?
Rationale: These are the 6 P's of compartment syndrome, caused by increased pressure within confined tissue spaces, leading to ischemia.
A patient exposed to smoke in a house fire presents with confusion, cherry red skin, and drowsiness. The nurse suspects which life-threatening complication?
What is carbon monoxide poisoning?
Rationale: Carbon monoxide binds to hemoglobin more readily than oxygen, causing hypoxia even if oxygen saturation appears normal. Classic signs include altered mental status, headache, cherry red skin, and drowsiness. High-flow 100% oxygen is the treatment.
List at least 3 key differences between superficial partial-thickness and deep partial-thickness burns.
What is
1. Pain: Superficial burns are very painful; deep partial-thickness burns may have reduced pain.
2. Appearance: Superficial burns are red, moist, and blistered, and blanchable; deep burns may look pale or mottled, drier, and non-blanchable, scarring is common.
Rationale: Nerve endings more damaged in deeper burns. Deeper burns have less perfusion and more tissue damage.
List the three distinct phases in the continuum of burn injury management and provide one key nursing assessment or intervention associated with each phase.
What are:
1. Resuscitative (Shock) Phase – Key intervention: Aggressive fluid resuscitation and airway assessment
2. Acute Phase – Key intervention: Wound care and infection prevention
3. Rehabilitation Phase – Key intervention: Physical therapy and psychosocial support
Rationale: Emergent (resuscitative) Phase: Occurring in the first 24–48 hours after injury, this phase is marked by massive fluid shifts and capillary leak. The nurse’s priority is to secure the airway and initiate fluid resuscitation (often guided by formulas like the Parkland formula) to prevent burn shock. Acute Phase: Following stabilization, wound management is essential. This phase focuses on preventing infection, managing pain, and preparing the wound for healing. Rehabilitation Phase: This phase emphasizes restoring function and includes physical therapy, psychosocial support, and education on self-care post-discharge.
A patient comes into the ED suffering full thickness burns to the neck, entire torso, and right anterior leg after being rescued from a house fire. They begin to develop altered mental status and stridor. What is the priority intervention?
What is emergency intubation?
rationale: the priority intervention for all patients is airway, breathing and circulation. the patient is showing symptoms of a compromised airway from full thickness burns to the neck that will continue to swell. This requires emergency intubation to maintain a patent airway and keep the patient alive.
A patient with electrical burns presents with dark brown urine, hyperkalemia, and rising creatinine kinase levels. This complication must be caught quickly to prevent an AKI
What is Rhabdomylosis?
Rationale: Electrical burns can cause deep tissue damage, leading to muscle break down (rhabdomylosis). The release of myoglobin into the bloodstream can obstruct renal tubules, causing an acute kidney injury. Dark urine, hyperkalemia, and elevated CK are key signs. IV fluid hydration is critical to flush myoglobin and prevent renal failure.
A patient with full-thickness circumferential burns to the lower extremity is exhibiting decreased pulses and swelling. Which emergency procedure may be required to restore circulation and prevent tissue damage?
What is an escharotomy to prevent compartment syndrome?
Rationale: Escharotomy is a surgical procedure where the burned tissue is incised to relieve pressure and restore blood flow. Circumferential burns can compress blood vessels and nerves, leading to compartment syndrome, which is a surgical emergency.