5. May or may not blanch (may see delayed cap refill ) 6. Edema moderate 7. May be less painful 8. Can convert to full-thickness (if damage increases w/infection, hypoxia, or ischemia) 9. Scar formation results 10. Grafts may be necessary ix. Full thickness = 3 rd degree 1. Involves epidermis + dermis + subQ tissue 2. Wound will NOT heal by re-epithelialization grafting probably required
3. Dry, hard, charred, leathery eschar (crust/dead tissue must be removed for healing to occur) 4. Waxy white , deep red , yellow, brown, gray, or black 5. Appears dry (dermis gone no fluid) 6. Edema under eschar 7. Rarely blanches 8. Sensation reduced or absent (nerve endings destroyed) 9. Healing depends on establishing adequate blood supply 10. Requires split- or full-thickness grafts 11. Scarring + wound contractures likely x. 4 th degree = destruction of muscle & bone 1. Typically seen w/electrical injuries 2. Extremity probably NOT salvageable 3. Limbs may warp! xi. Full-thickness & deep partial-thickness burns: initially anesthetic (nerve endings destroyed) xii. Superficial to moderate partial-thickness burns: PAINFUL xiii. Partial-thickness burns: may form blisters w/fluid & protein xiv. Partial-thickness burns may convert to full-thickness wounds when organisms invade viable, adjacent unburned tissue! xv. Burn wound infection may progress to transient bacteremia + sepsis (d/t manipulation: e.g., after showering/debridement) xvi. During rehab phase, complications include skin/joint contractures + hypertrophic scarring 1. Patient often assumes position of flexion (d/t pain), which contributes to formation of contractures encourage movement + extension 2. What type of electrolyte imbalances will you see with a burn patient? a. Na (along with water) moves out of cells into interstitial spaces (2 nd spacing) & into surrounding tissues (3 rd spacing) i. Hyponatremia: excessive GI suctioning, diarrhea, water intake 1. Burn patient may develop dilutional hyponatremia = water intoxication pt should drink fluids other than water (juice, soft drinks, or nutritional supplements) 2. weakness / dizziness / muscle cramps / fatigue / HA / tachycardia / confusion ii. Hypernatremia: may follow successful fluid resuscitation if copious amounts hypertonic solutions were required 1. Could also be d/t tube feeding therapy or inappropriate fluid administration 2. thirst / furry tongue / lethargy / confusion / (possibly) seizures b. K shift develops initially: injured cells & hemolyzed RBCs release K+ into circulation i. Hyperkalemia: noted w/renal failure, adrenocortical insufficiency, or massive deep muscle injury (lots of K+ released from damaged cells)
1. cardiac dysrhythmias / ventricular failure / muscle weakness / ECG changes ii. Hypokalemia: V/D, prolonged GI suction, prolonged IV therapy w/out K+ supplementation 1. Constant K+ loss occurs through burn wound!
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- Fall '16