Burn treatments - Collaborative Care and Nursing Management of Burn

Introduction Management of burn care requires specific knowledge of the burn phases, possible complications, and appropriate diagnostic tests for each phase. The nurse must collaborate with other health care providers during all phases of burn management to provide the best possible care for the patient. Phases of Burn Management Upon receiving a patient with a burn injury, the ABCs (airway, breathing, and circulation) need to be addressed before any diagnostic studies or focused assessments. This includes providing oxygen, ensuring adequate fluid intake, verifying stable blood pressure, and other interventions that help prevent hypovolemic shock and organ damage. These initial interventions would all be performed during the emergent phase of burn management. Burn management can be chronologically classified into three phases: emergent phase, acute phase, and rehabilitative phase. Emergent Phase      Immediate life-threatening problems resulting from the burn injury are resolved during this phase. The emergent phase lasts up to 72 hours from the time the burn occurred. Primary nursing concerns are hypovolemic shock and edema formation. The emergent phase ends when fluid mobilization and diuresis begin. Major therapeutic interventions are airway management, fluid therapy, and wound care. Acute Phase     The acute phase of burn care begins with the mobilization of extracellular fluid and subsequent diuresis. The acute phase may last weeks or months. The acute phase ends when partial thickness wounds are healed or full-thickness burns are covered by skin grafts. Major therapeutic interventions are wound care, excision and grafting, pain management, physical and occupational therapy, and nutritional therapy. Rehabilitative Phase    The rehabilitative phase begins when the patient’s wounds are healed and the patient starts engaging in some form of self-care. The rehabilitative phase may begin as early as 2 weeks to 8 months after the injury. The rehabilitative phase involves long-term planning regarding home care (including referrals) and pain management. Diagnostic Studies Diagnostic studies are used during the emergent and acute phase of burn management:      Serum electrolytes, especially sodium and potassium to monitor fluid and electrolyte shifts For inhalation injuries: chest x-ray, arterial blood gases, and sputum culture Urine output and specific gravity to evaluate fluid replacement and detect acute tubular necrosis and/or renal ischemia Complete blood count (CBC) to detect anemia and immunologic response to injury White blood cell count and wound cultures if infection is suspected Complications A patient with burns is at risk for complications during each phase of the burn management process.