Nursing Care for burn Victims

Nurses play a big role in caring for burn victims.  They are required to help in resuscitating and stabilizing the burn victim and continue caring for them through the acute, chronic, and rehabilitative phases of patient care.

Nurses carry a great leadership role in the acute care of the burn victim.  They are responsible for measuring the fluid intake and output of the patient with second degree or third degree burns by keeping track of the IV fluids the patient receives, balancing these numbers out with the urine output.  Blood pressure and observation of the amount of swelling the patient develops can also be parameters that help in fluid management.

Management of Lung Conditions

Nurses also help manage the dangerous inhalation injury that can occur in the burn patient.  Along with respiratory therapists, nurses manage the ventilator settings so that the burn victim can be properly oxygenated.  They need to be especially careful in cases of smoke inhalation or if there is a circumferential burn around the patient’s chest, which can impact the ability to take a breath.  Upper airway swelling can interfere with air intake, leading to respiratory distress.  Other lung conditions, including tracheobronchitis, bronchorrhea (too much mucus in the bronchial passageways), pneumonia and adult respiratory distress syndrome must be prevented if possible and managed when they occur.

Patients with burns received in closed places are likely to have an inhalation injury.  Nurses watch for signs of hoarseness and respiratory distress as signs that upper airway swelling has occurred.  In such cases, the nurse may call for a respiratory team to place a ventilator tube down the patient’s trachea so as to get air through the swollen passageways.

Confusion, altered level of consciousness and coma may stem from inhalation of dangerous toxins such as cyanide or carbon monoxide.  The treatment for these  conditions is to provide 100 percent oxygen as soon as possible.  Frequent suctioning by the nurse is necessary if the burn victim develops excess secretions in the bronchial tree as a result of inhaling smoke.

Nurses help whenever a ventilator is needed. They watch for the amount of air that gets into the lungs and make sure that the tidal volume (the amount of air inspired in a single breath) is adequate.  If not, there may be restrictions to breathing from circumferential burns or from stiff lungs suffering from the shock of inhalation of smoke.    They are also responsible for keeping the endotracheal tube in place, suctioning the tube regularly, and keeping good oral hygiene, which is known to help prevent pneumonia.

Wound Care

The burn nurse is responsible for watching for signs of wound infection and applying/reapplying burn dressings as is appropriate.  Wound care can be extremely challenging, especially for large burns.  There are many types of possible wounds types to care for—from eschar burns, autograft, skin bud wounds, and exposed muscles and tendons.  The skilled nurse must do the appropriate thing for these types of burns, usually as directed by the burn surgeon.

The nurse aids in maintaining function of the burned areas of the body.  He or she must continually move joints and position the patient so that joint contractures do not occur.  These are much more difficult to treat than preventing the contractures from occurring in the first place.

Wounds must be cleansed on a regular basis to prevent wound infections or even systemic infections following the burn.  Nurses are responsible for watching out for a bad odor emanating from the wound and redness around the burned area.  Topical antibiotics and sterile dressings must be given and maintained so that infection rates are minimized.

The nurse is primarily responsible for preventing skin graft loss.  When the burn victim returns from the operating room with a skin graft, the graft is susceptible to shearing for the first 3-4 days following the surgery.  Grafted areas must be kept as immobile as possible during the early stages of post-operative care until the graft has had a chance to adhere to underlying tissues.

Patients with serious burns must be bed-bound for the most part and are therefore susceptible to getting pressure sores.  Pressure sores are difficult to treat but can be prevented by turning the patient frequently and protecting areas that take on too much pressure, such as the buttocks and heels.

Burn victims often go to surgery for excision of the burn and grafting.  Nurses are responsible for getting the patient ready for surgery and for the post-operative management after the surgery is over.  There are even nurses aiding anesthetists and surgeons during the surgery itself.

Pain Management

It is the nursing staff who is primarily responsible for observing the patient for evidence of pain and providing pain medications.  On a burn unit, most pain management is given by intravenous means.  Pain is often associated with anxiety and this must be managed with medications or simple reassurance.  The patient may even need to be placed in a medication-induced coma so as to control both pain and anxiety until the burn begins to settle down and heal.

Nutritional Support

Burn victims are naturally in a hypermetabolic state, burning up skeletal muscle and fat for food.  The nurse is responsible for providing the nutrition by means of total parenteral nutrition or enteral nutrition through the use of a feeding tube.  As with other fluids, the amount of nutrition is carefully calculated and provided by nurses on a steady or intermittent basis in order for the patient to have enough protein and calories to begin to heal the burn.

Education

The nurse spends the most time with patients and their families and is thus charged with providing direction and education for these people.  Both the patient and family are in a new and anxiety-producing situation.  A good nurse will provide education about what is going on with regard to the patient’s recovery.  The nurse must recognize knowledge deficits and begin planning the patient’s discharge from the hospital from the moment the patient is admitted to the hospital.  The nurse begins by developing an education plan that start at admission and ends with discharge instructions.

Rehabilitation

Eventually, the burn will heal and the patient will need to get back to as close a pre-injury state as possible.  Nurses carry out plans made by physical and occupational therapists to help the patient learn new skills necessary after a severe burn and to begin to ambulate and have function of the arms and legs that as closely as possible relate to the pre-burn state.

A serious burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.
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