RNSG 2432-Mod_16 Notes Integumentary Disorders

RNSG 2432-Mod_16 Notes Integumentary Disorders - NOTES

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NOTES Module 16: Integumentary Disorders- Burns Marnie Quick, RN, MSN, CNRN Etiology/Pathophysiology 1. Normal skin physiology as it relates to burns. a. Layers of skin- (p. 414 Fig 15-1) 1) Epidermis; dermis; subcutaneous tissue; muscle; bone 2. Risk factors a. 73% of all fire related death in home. b. Age, smoking, alcohol/drugs, physical/mental impairment, occupation 3. Types of burn (p.412 Table 15-2; Box 15-1) a. Thermal 1) Exposure to moist (steam/liquid) or dry (flames) heat. 2) Most common cause of burns. 3) Stop, drop and roll; stop the burning process; cool water, not ice as it  vasoconstricts; cover to prevent hypothermia. b. Chemical 1) Direct skin contact acid or alkaline  2) Destroys tissue protein resulting necrosis 3) Oxidizing, corrosive, protoplasmic poisons 4) Severity dependent on type, concentration, mechanism, duration of  contact, and amount of body surface exposed. 5) Neutralize or dilute; remove clothing; call poison control. c. Electrical 1) Direct or alternation current; lightning 2) Severity depends on type and duration current and amount of  voltage. 3) Electricity follow path of least resistance- first being muscles, bones,  blood vessels and then nerves. 4) Lightning results in entry-exit wounds; exit is usually blow out type;  flash-over effect when current travels over moist skin. Most electrical  burns of extremities develop gangrene with resultant amputation. d. Radiation 1) Sunburn; x-rays; radioactive agents such as cancer treatments. 2) Shield the skin appropriately; limit exposure time; move away from  radiation source. 4. Classification of burn (p. 413 Table 15-2) a. Depth of burn 1) Combination of temperature and length of contact. 2) Superficial (1 st  degree) a) Only epidermal layer b) Sunburn; ultraviolet light RNSG 2432 111
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c) Red, local edema, pain, no scaring d) 3-6 days to heal 3) Superficial partial-thickness (2 nd  degree) (P414 Fig 15-2) a) Bright red, moist with blisters, blanch on pressure, has touch  and pain sensation b) Heal 21 days with minimal scarring 4) Deep partial-thickness (2 nd  degree) a) Entire dermis, still have- hair follicles and sebaceous glands b) Pale, waxy with large blisters or blisters appear tissue paper  like. c) Less painful than superficial, but have pressure sensation.  Edges of burn may be very painful. d) May convert to full-thickness burn. e) Healing- more than 21 days, may need grafting.  5) Full-thickness (3 rd  degree) (p414 Fig 15-3) a) All layer of skin; may extend into fat, connective tissue,  muscle, and bone b) Prolonged contact flame, moist/dry heat, electrical current. c)
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RNSG 2432-Mod_16 Notes Integumentary Disorders - NOTES

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