Nursing Care of Clients with

Burn Injuries
Learning Activity
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© 2019 Assessment Technologies Institute®, LLC
Types of Burns

Types Definitions
Contact Burns Occurs with hot metal, tar or grease contact to skin
Chemical Burns Occurs with exposure of caustic agents
Electrical Burns Occurs with electrical current that causes tissue destruction and
internal organ damage

Thermal Burns Occurs when clothes ignite from heat or flames

Flash Burns Occurs when electrical currents travel though air from one
conductor to another

Radiation Burns Occurs as a result of therapeutic treatment for medical

conditions or sunburn

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Impact of Burn Injury

• In addition to destruction of body tissue, a burn injury may result in the

loss of:
• Temperature regulation
• Sweat and sebaceous gland function
• Sensory function

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Severity of Burn Injury
• Based on:
• Percentage of total body surface area (TBSA) affected.
• Depth of the burn – Burns are classified according to the layers of
skin and tissue involved.
• Body location of the burn – In areas where the skin is thinner, there
is more damage to underlying tissue.
• Age of client – Young clients and older adult clients have less
reserve capacity to deal with a burn injury.
• Causative agent – Thermal, chemical, electrical, or radioactive.
• Presence of other injuries – The presence of fractures or other
injuries increases the risk of complications.
• Involvement of the respiratory system – Inhalation of deadly fumes,
smoke, steam, and heated air can cause respiratory failure and/or
carbon monoxide poisoning.
• Overall health of the client – Chronic illnesses can impact prognosis
and lead to greater risks and complications.

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Depth of Injury
• Superficial • Deep partial-thickness
• Damage to epidermis • Damage to entire epidermis and
• Pink to red, tender, no blisters, deep into the dermis
mild edema, no eschar • Red to white, with moderate
• Superficial partial-thickness edema, free of blisters, soft and
• Damage to the entire epidermis dry eschar
and some parts of the dermis • Full-thickness
• Pink to red, blisters, mild to • Damage to the entire epidermis
moderate edema, no eschar and dermis and may extend into
the subcutaneous tissue; nerve
damage also occurs
• Red to tan, black, brown, or
white; free from blisters; severe
edema; hard and inelastic
eschar
• Deep full thickness
• Damage to all layers of skin,
muscle, tendons and bone
• Black, no edema

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Stages of Burn Injury/Burn Shock

• Hypovolemic stage – begins at the onset of burn and lasts for the first 48
to 72 hr.
• Rapid fluid shifts from the vascular compartments into the interstitial
spaces
• Capillary permeability increases due to the vasodilation created by
the burn
• Fluid loss deep in wounds results in:
• Hypoproteinemia, hemoconcentration, oliguria, hyponatremia
(due to third spacing), hyperkalemia (damaged cells release K+),
metabolic acidosis

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Stages of Burn Injury/Burn Shock

• Diuretic Stage – begins 48 - 72 hours after burn injury.

• Capillary membrane integrity returns, causing fluid shifts back into
vessels; blood volume increases.
• Increase in renal blood flow result in diuresis (unless renal damage),
which causes:
• Hemodilution, hypokalemia (as K+ moves back into the cell or is
excreted in urine with the diuresis), fluid overload can occur due
to increased intravascular volume, metabolic acidosis because of
HCO3 loss in urine, increase in fat metabolism

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Three Phases of Burn Care

• Emergent (Resuscitative phase)

• First 24 to 48 hr after the burn occurs.
• Acute phase
• Begins when fluid resuscitation is finished.
• Ends when the wound is covered by tissue.
• Rehabilitative phase
• Begins when most of the burn area is healed.
• Ends when reconstructive and corrective procedures are complete
(may last for years).

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Nursing Care of Minor Burns

• Stop the burning process.

• Remove clothing or jewelry that might conduct heat.
• Apply cool water soaks or run cool water over injury (do not use ice).
Flush chemical burns with large amounts of water.
• Cover the burn with clean cloth to prevent contamination and
hypothermia.

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Nursing Care of Moderate and Major Burns

• Seek emergency care.

• Maintain airway and ventilation.
• Monitor vital signs.
• Intravenous fluid replacement is important during the first 24 hr.
• Rapid fluid replacement is needed during the emergent phase to
maintain tissue perfusion and prevent hypovolemic (burn) shock.

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Interventions in the Acute Period

• Psychosocial support
• Wound care
• Nutrition
• May need double the normal calorie requirements
• Large protein requirement
• Carbohydrates and fats for energy
• TPN often used (ileus is common following a burn)
• Pain control
• Monitor for infection

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Fluid Resuscitation for Burn Injuries:

• "Parkland Formula" 4 mL of Lactated Ringer’s × weight (Kg) x % BSA

burned = mL of Lactated Ringer’s to be given during the first 24-hr period
following the burn. BSA is determined by the Rule of Nines.
• The first 8 hr following the burn are the most crucial. Administer the first
half the total fluids in the first 8 hr, giving one-quarter of the total fluids
the second 8 hr and the remaining one-quarter the last 8 hr. With severe
burns, it is not uncommon to give greater than 20,000 mL in a 24-hr
period.

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Signs of Adequate Fluid Resuscitation

• Pulse < 120 beats/min

• Urine output (for adults) 30 to 50 mL/hr
• Systolic blood pressure > 100 mm Hg
• Blood pH within expected reference range, 7.35 to 7.45

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Prevent Infection

• Follow standard precautions when performing wound care.

• Restrict plants and flowers due to the risk of contact with Pseudomonas.
• Restrict consumption of fresh fruits and vegetables.
• Limit visitors.
• Monitor for manifestations of infection and report to provider.
• Use client-designated equipment, such as BP cuffs, thermometers.
• Administer tetanus toxoid if indicated.

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Wound Care
• Goals
• Close wound as soon as possible.
• Prevent infection.
• Reduce scarring and contractures.
• Provide for comfort.
• Care
• Wound cleaning: hydrotherapy tanks, spray tables
• Debridement
• Mechanical
• Surgical
• Enzymatic
• Topical antibacterial therapy (silver nitrate 0.5%, sulfonamide,
sulfadiazine, and bacitracin)
• Homografts – same species (cadaver skin)
• Heterografts – another species (pig skin)
• Autografts – client’s own skin

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Nutritional Support

• The client who has a large area of burn injury will be in a hypermetabolic
and hypercatabolic state.
• Increase caloric intake to meet increased metabolic demands and
prevent hypoglycemia.
• Increase protein intake to prevent tissue breakdown and to promote
healing.
• Enteral therapy or total parenteral nutrition (TPN) may be necessary due
to decreased gastrointestinal motility and increased caloric needs.

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Restoration of Mobility

• Maintain correct body alignment, splint extremities, and facilitate position

changes to prevent contractures.
• Maintain active and passive range of motion.
• Assist with ambulation as soon as the client is stable.
• Apply pressure dressings/garments to prevent contractures and scarring.
• Closely monitor areas at high risk for pressure sores (heels, sacrum,
back of head).
• Provide emotional support and assist with coping.

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Prevention of Burns

• Ensure that the number and placement of fire extinguishers and smoke
alarms are adequate, and that the fire extinguishers are operable.
• Keep emergency numbers near the phone.
• Have a family exit and meeting plan for fires.
• Review that in the event that clothing or skin is on fire, client should
“Stop, drop, and roll” to extinguish the fire.
• Store matches and lighters out of reach and out of sight.
• Reduce setting on water heater to no higher than 120° F.
• Teach to avoid sun exposure between 10 a.m. and 4 p.m. and to use sun
block and protective clothing.
• Advise to avoid using tanning beds.
• Avoid smoking in bed and smoking when under the influence of alcohol
or sedating medications.

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Learning Activity Review Questions

1. A client is undergoing fluid replacement after being burned on 20% of her

body 12 hr ago. The nursing assessment reveals a blood pressure of 90/50
mm Hg, a pulse rate of 110 beats/min, and a urine output of 20 mL over the
past hours. The nurse reports the finding to the provider and should
anticipate which of the following prescriptions?
A. Transfusing 1 unit of packed red blood cells
B. Administering a diuretic to increase urine output
C. Changing the IV lactated Ringer’s solution to one that contains
dextrose in water
D. Increasing the amount of IV lactated Ringer’s solution administered per
hour

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Learning Activity Review Questions

2. A nurse is administering fluids intravenously as prescribed to a client who

sustained superficial partial-thickness burn injuries to the back and legs. In
evaluating the adequacy of fluid resuscitation, the nurse understands that the
most reliable indicator of adequate fluid volume would be
A. vital signs.
B. urine output.
C. mental status.
D. peripheral pulses.

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