The skin is the largest organ in the human body and consists of three layers, the epidermis, dermis and subcutaneous tissue. The epidermis is the outermost layer, followed by the thickest layer, the dermis, then the subcutaneous or fat layer. A burn is an injury to the skin caused by one of six mechanisms of injury: contact burns, fires, radiation, electrical, chemical and scalding (?Thermal Burns?, 2017). There are an estimated 450,000 people treated in the emergency department in the United States each year from burn related injuries (Trakalo, 2015, pg 1465). A thermal burn refers to the type of burn that encompasses burn injuries caused by fire or scalding by hot liquid or steam. These burns are the most common type of burns in children and the geriatric population (Trakalo, 2015, pg 1464).
A burn is classified by how many layers of tissue it affects and what percentage of the body has been burned. The three classifications based on depth are superficial, partial thickness and full thickness. A superficial burn only involves the epidermis while a partial thickness burn affects the epidermis and dermis. A full thickness burn is the deepest and affects all three layers of tissue (Trakalo, 2015, pgs 1467-1468).
To determine the extent of the burn, a percentage of the surface of the body that is burned is determined. Superficial burns are not included in burn percentages, only partial and full thickness burns. The area of the burned skin along with a person?s age, can determine how well they will recover from a burn injury (Strauss & Gillespie, 2018). The American Burn Association also classifies burns as minor, moderate, and major depending on their depth and extent (Trakalo, 2015, pg 1469).
There are many effects on the body systems as a result of burns. Skin is lost which can lead to infection and electrolyte imbalances. Infections can occur because skin a barrier against bacteria, and moisture loss (Lewis, Laidlaw & Morrow, 2018). There can be damage to the respiratory system. This is usually caused by breathing smoke or hot gases. This inhalation can cause mild inflammation or something more severe such as ARDS, acute respiratory distress syndrome. With this exposure, cells are destroyed and cilia are no longer functioning. This can lead to infection or congestion (Trakalo, 2015, pg 1470).
Another system burns affect is the cardiovascular system. After a burn injury, a large amount of fluid can shift into the interstitial areas from the intravascular and intracellular areas. This is called burn shock. This fluid is caused by the cell wall failure at the location of the burn. Because of the fluid coming out of the intravascular space which contains plasma and protein, cardiac output decreases and blood pressure lowers. This is a type of hypovolemic shock that usually happens with 24-36 hours of the burn (Trakalo, 2015, pg 171). It can cause a change in circulation because of vasoconstriction. This fluid also causes changes in the lymphatic system causing edema and tissue necrosis. There can be peripheral vascular compromise because circulation to the extremities are affected and compartment syndrome can occur. Because cardiac output is affected, there can also be cardiac dysrhythmias or cardiac arrest. When the fluid leakage is corrected, the cardiac output increases and blood pressure increases (Trakalo, 2015, pg 1471).
Other systems affected are the gastrointestinal, urinary and immune system. The gastrointestinal system is affected because burns can cause a decrease in peristalsis depending on the extent of the burn, which then can cause distention and aspiration. The urinary system is affected because of the decreased fluid volume that occurs after a burn injury. The decreased fluid volume affects renal blood flow and glomerular filtration. This causes the urine output to be decreased, raising serum creatinine and bun levels. The immune system is affected because the fluid leak damages the cell mediated and humoral immune systems. This causes acquired immunodeficiency, increasing the risk of infection for 1-4 weeks after the burn (Trakalo, 2015, pgs 1472-1473).
Because most burn injuries occur in children at all age levels, education about preventing burns in the home is a must. Children are at risk of burns because they do not understand the dangers of items in their homes. They do not know how to get themselves out of dangerous situations they may find themselves. Nurses should promote safety by educating parents on the measures they can take to prevent burns in the home. Some of the measures that can be taken to prevent burns by fire include having working smoke alarms in all levels of the home, having a regularly practiced emergency escape plan, and not leaving open flames unattended when children are around (Trakalo, 2015, pg 1466). Because children are at a risk from scalding, pot handles should be turned away on the stove, so children can?t reach them, bathwater temperature checked, and children should not be left alone near faucets. Another idea for preventing water faucet scalds is installing a scald guard on the faucets or lowering the temperature on a hot water heater to 120 ® F MacDougall, 2018).
Children aren?t the only ones at risk for burns. The geriatric population are also at risk because of sensory impairment, impaired mobility and slower reaction times. They are at a risk of deeper burns because their skin has become thinner as they have aged. Other comorbidities that nurses need to be aware of are preexisting conditions such as diabetes, cardiac issues, renal dysfunctions and alcoholism (Trakalo, 2015, pg 1466). The nurse needs to be aware of these conditions as they can contribute to a patient?s mortality.
The components of nursing relating to patient care are safety, clinical judgment, leadership, professionalism, patient centeredness and health promotion. Safety is a priority in preventing burns in children and the geriatric population. These populations are the most vulnerable to burn injury and should have precautions taken to prevent injury as addressed above. Nurses as leaders have to make sure to educate not only parents, but caregivers as well to risks that can be found in common items in the home. Nurses make sure the parents and caregivers are aware of items in the home that they may not necessarily think of as a danger. They can use clinical judgment to help parents/caregivers strategize ways to burn proof the home. Nurses should demonstrate professionalism when educating parents or caregivers, so they don?t feel as if the nurse looks down on them or thinks they are incompetent as parents or caregivers. Health promotion should be patient centered, and prevention strategies should fit the age or cognitive level of the client. The nurse should include the parents or caregiver?s ideas and thoughts in all strategies and plans, in order to build a mutually healthy relationship.
Burns can be a serious injury with lasting effects. It is important for a nurse to first educate families and caregivers to prevent burn injury. Nurses should ensure parents and caregivers have strategies in place to prevent burn injuries. Education is key in preventing these injuries, especially because most are easily preventable. Burn injuries are still going to occur and it is the nurse responsibility to provide care that follows the nursing considerations of safety, clinical judgment, leadership, professionalism, patient centeredness and health promotion.
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