Collaborative CareEmergent phaseAirway managementFluid therapy!!Wound carePain and anxiety – remember burns are mixed!!!Pain meds are always IV due to edema and impaired circulationPsychosocialPT/OTNutritionDIAGNOSTIC PROCEDURES Diagnostic studies can include renal scans, computed tomography, ultrasonography, bronchoscopy, and magnetic resonance imaging to determine the extent of the burn injury. Indirect calorimetry can help determine calorie needs (on admission to a burn center and weekly).Evaluation of burn depth using indocyanine green video angiographyand laser Doppler imaging. Thermography is not as reliable. INTERPROFESSIONAL CARE ●Initiate referrals to a dietitian, social worker (for community support services), psychological counselor, and physical therapist. ●Respiratory therapy can help improve pulmonary function. ●Consult a case managerto coordinate the client’s postdischarge care, and assist the client with reintegration into the community, work, or school. ●Initiate a referral for home healthnursing care.●Initiate a referral to occupational therapy for evaluation of the home environment and assistance to relearn how to perform ADLs.●Specialists can evaluate vision and hearing if eyes and ears are affected.●Speech therapy can be indicated. ●Prosthetics might be required. CLIENT EDUCATION ●Infection controlprecautions are extremely important to prevent harm. ●In the acute phase, it is common to experience many feelings (confusion, anxiety, fear). Talk about these feelings with the provider
●Hgb and Hct: decreased (hemodilution) due to the fluid shift from the interstitial space back into vascular fluid ●Sodium: remains decreased due to renal and wound loss ●Potassium: decreased due to renal loss and movement back into cells (hypokalemia)●WBC count: initial increase then decrease with left shift ●Blood glucose: elevated due to the stress response●ABGs: slight hypoxemia and metabolic acidosis●Total protein and albumin: low due to fluid loss and people you care about. ●Peer or support groups can be helpful in coping.●Anticipate changes in appearance from wounds or surgical procedures, and understand that scarring and discoloration will occur.●Wear compression dressings and garments as prescribed (usually 23 hr daily) to minimize scarring and prevent difficulty with mobility.●Massage scars with moisturizers daily.●Avoid tight clothing over burned areas. Loose fitting clothing from dye-free fabric is best.●Participate in sexual activity as desired.●Use splints and assistive devices as instructed.●Follow-up appointments are often required for 2 years following burn injury. FLUID RESUSCITATION IN BURNSParkland FormulaLactated Ringers2-4 ml X kg X % burned area (calculate by rule of 9 or other established scale)Give ½ of total over first 8 hours, remainder over next 16 hoursRule of Nine ChartFluid treatment is essential for major burns….the Parkland’s Burn Formula may be used to calculate the amount of fluids needed over the next 24 hours.