Whether you’re an ED, ICU, Burn Unit Nurse, or a nursing student studying for NCLEX, burns along with their care and treatment are important to know. Let’s take a look at different types of burns, phases of burn care, and nursing interventions. And be sure to stick around for Part 2, when we address burn staging, procedures, and complications.
Types of Burns
As we know, there are various types of burns, such as when you get a sunburn or when you burn your hand on the oven. The full list of burns as defined by Stanford Medicine include: thermal burns, radiation burns, chemical burns, and electrical burns. Let’s take a closer look at each type.
Thermal Burns
According to Stanford Medicine, thermal burns occur from, “external heat sources which raise the temperature of the skin and tissues and cause tissue cell death or charring.” An example of this would be anything physically hot that when touched causes a heat related burn; like a hot pan, scalding hot water or other liquid, steam, and any open flame.
Radiation Burns
Radiation burns occur from prolonged radiation exposure. This can be from the UV rays of the sun or imaging exposure, like a x-ray.
Chemical Burns
Chemical burns occur when strong chemicals come in contact with the skin and cause a reaction, aka a burn. These chemicals can be found in a lab setting, but they can also be found in the home in common cleaning products, such a bleach or detergents. Which is why wearing gloves with these products is so important.
Electrical Burns
Electrical burns occur from electrical current that comes in contact with the body and causes an immediate physical burn. These can be from AC – alternating current, or DC – direct current. This is why electrical wires are so important to stay away from unless properly trained.
Phases of Burn Care
There are three phases of burn care according to ATI Nursing Education; emergent, acute, and rehabilitation.
Emergent Phase
Immediately following a burn, the emergent phase begins. In this phase it is important to seek help by calling 911, receiving paramedic treatment, and then emergency department treatment.
From the nursing perspective, it is important to stop the burn and protect the airway. Once those two things are done, the next vital step is fluid replacement to help combat the third spacing that occurs when extracellular fluid accumulates outside of the cell due to burns. Then comes managing pain, preventing infection since there is no skin barrier, and maintaining a normal body temperature.
Acute Phase
Once out of the emergent phase which typically lasts 24 to 48 hours, then comes the acute phase. In this phase, the third spacing resolves and tissue begins to cover the wound. Wound care, pain management, and emotional considerations are important during this stage.
Rehabilitation Phase
After the wounds have healed most of the way and new skin is present, the rehab phase begins. The healing of burns and formation of scar tissue can lead to limited mobility which is why physical rehab is important early on. Even though it may be painful, it can help with mobility long term. In addition to physical rehab, a burn patient will also likely need emotional and psychosocial support as it can be difficult to return to a normal life after having such significant scarring.
Nursing Interventions
As mentioned in the emergent phase of burns, it is important to stop the burn. You can do this by removing jewelry or any clothing that has metal on it that may still be conducting heat. You’ll want to apply cool, not cold, but cool water to the burn to help stop the burn and further tissue injury. If it is a chemical burn, the wound will need to be flushed multiple times to make sure the chemical that caused the burn is completely off the skin.
In the emergent phase we also need to secure the airway, which may be difficult depending on where the burn is located.
Once you’re sure the burn is no longer actively burning and the airway is protected, IV fluid replacement is crucial. This will help keep the patient adequately hydrated since the body will naturally be third spacing.
It is important to remember that burns are extremely painful to the patient, so once life saving measures have been taken and the airway is secured, we need to address the pain.
In addition to pain, the patient is now at an increased risk of developing an infection since their first line of defense, their skin, is now compromised. Because of this, infection prevention should be a top priority. The doctor will likely have an order for an antimicrobial or antibiotic ointment to apply when providing wound care. There should be additional orders for what exact dressing to use, likely a hydrocolloid dressing to keep from sticking into the wound and causing further tissue damage.
Psychosocial Support
Once the patients acute phase of care is coming to an end, it is our job as healthcare professionals to help them adjust to their new life. Support groups, physical therapy, ways to diminish scarring and prevent contractures all help in returning a patient to their pre-burn life. Before discharge, the patient should be provided with these resources.
Do you treat burn patients? Comment below!
And be sure to stick around for Nursing Fundamentals: A Guide to Burns, Part 2, where we address burn staging, procedures, and complications!
Check out the rest of the Nursing Fundamentals Series here!