Скачать или смотреть Burns: Assessment & Management | Chapter 26 – Lewis’s Medical-Surgical Nursing (12th)

Chapter 26 of Lewis’s Medical-Surgical Nursing (12th Edition) covers the causes, classification, pathophysiology, and nursing management of burn injuries, one of the most complex and devastating medical-surgical emergencies. Burns can result from thermal, chemical, electrical, or radiation sources, with severity influenced by temperature, duration of exposure, tissue type, and patient comorbidities. The chapter emphasizes burn prevention through smoke alarms, safe cooking, water heater regulation, chemical safety, and fire escape planning.

Types of burns:
🔥 Thermal burns – most common, caused by flames, scalds, steam, grease, or hot objects.
⚗️ Chemical burns – acids, alkalis, organic compounds causing tissue necrosis or systemic toxicity.
⚡ Electrical burns – current passage through tissues damages vessels, nerves, and organs, often leading to hidden deep injuries, arrhythmias, or myoglobinuria-induced kidney injury.
☢️ Radiation burns – less common, caused by sun or medical/radiologic exposure.
❄️ Cold thermal injury (frostbite) – addressed in Chapter 21 but linked to integumentary trauma.

Burn severity classification considers depth, extent (TBSA), location, comorbidities, and associated trauma.
✨ Partial-thickness burns – involve epidermis ± dermis; painful, blistered, moist wounds.
✨ Full-thickness burns – destroy all skin layers, appearing leathery, white, brown, or charred; often painless due to nerve destruction; require grafting.
Assessment tools include the Rule of Nines, Lund-Browder chart, and ABA burn center referral criteria.

Phases of burn management:
⏱️ Emergent (resuscitative phase, 24–72 hrs) – priorities are airway, breathing, circulation, fluid resuscitation (Parkland formula), preventing shock, pain control, and wound stabilization. Complications include burn shock, respiratory injury (CO poisoning, inhalation injuries), AKI, and dysrhythmias. Escharotomy may be required for circulation.
💧 Acute phase (wound healing, weeks–months) – focuses on wound care, debridement, excision, grafting, pain control, infection prevention, nutrition (high protein, high calorie, vitamins A/C/E, zinc), and physical/occupational therapy to prevent contractures. Complications include sepsis, pneumonia, GI ulcers (Curling ulcer), electrolyte imbalances, delirium, and musculoskeletal dysfunction.
🧑‍🦽 Rehabilitative phase (restorative) – begins when wounds nearly heal. Goals are functional independence, contracture prevention, scar management (pressure garments, massage), psychosocial support, reconstructive surgery, and reintegration. Emotional support is essential for coping with disfigurement, depression, anxiety, PTSD, and altered sexuality.

Therapies:
🧴 Wound care – showers, debridement, topical antimicrobials (silver sulfadiazine, mafenide acetate), biologic/synthetic dressings.
✂️ Surgery – excision, autografts (split-thickness), cultured epithelial autografts (CEA), dermal substitutes (Integra, Biobrane).
💊 Drugs – opioids, sedatives, antidepressants, anticoagulants, PPIs/H2 blockers, vitamins/minerals.
🧠 Pain management – multimodal analgesia (opioids, NSAIDs, gabapentin) with non-drug methods (relaxation, guided imagery, music).
🍲 Nutrition – aggressive early enteral feeding, protein-rich, antioxidant-enhanced diet.

Gerontologic considerations highlight higher risks due to thinner skin, comorbidities, slower healing, delirium, and complications, while psychosocial care addresses body image, caregiver strain, survivor guilt, and posttraumatic growth. Nurses must advocate for prevention, deliver lifesaving acute care, manage wound healing, and support long-term rehabilitation.



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