Evidence-Based Practice Guidelines
According to Rowley-Conwy, the top four needs that must be managed in clients with burn injuries are:
1. Airway and Respiratory Management
2. Fluid Resuscitation 3. Wound Care 4. Pain Management |
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Airway and Respiratory Management
Clients with inhalation injuries to their airways are at risk for an inflammatory response capable of compromising or occluding the airway. Clients with inhalation burns must receive a definitive airway device in order to maintain adequate ventilation. Inhalation burn injuries cause fluid to shift from interstitial spaces into the extracellular space. This fluid leakage could lead to excessive edema and secretions in the airway so careful assessment, monitoring, and removal of secretions is vital to maintaining these patients (Rowley-Conwy, 2013). In severe cases, inhalation injuries will include the lungs if chemicals or heat traveled through the airway and into the lungs. Fahlstrom’s research suggests that over 60% of patients with inhalation injuries will develop ARDS (Fahlstrom, 2013).
Fluid Resuscitation
As stated earlier, burn injuries cause intravascular fluid and plasma to shift into the interstitial spaces, causing a decrease in intravascular fluid volume, which could lead to burn shock, increased tissue loss, and organ damage or failure. The goal of fluid resuscitation is to replace fluid that is lost from the intravascular space within the first 24 hours after a burn injury occurs. According to Kyra Fahlstrom, the Parkland formula is the definitive guide to calculating the amount of fluid administered to burn victims in the first 24 hours after sustaining a burn injury. Using the Parkland formula, the care provider multiplies 4mL times the client’s weight in Kg, times the total body surface area that was burned (4mL X Kg X % TBSA). Half of the fluid is administered within the first 8 hours after the burn injury occurs, and the second half is administered over the following 16 hours. Lactated Ringers is generally considered the fluid of choice when using the Parkland formula (Fahlstrom, 2013).
Wound Care
Proper assessment of burns will dictate what dressings
should be used. Care providers have an array of choices in dressings for burn
injuries and many more are being developed on a regular basis. Rather than
relying on specific brands or materials, nurses should follow certain criteria
for what a burn dressing should be able to do. According to Rowley-Conwy, burn dressings
should:
1. Protect the wound from physical damage and microorganisms.
2. Be comfortable, compliant and durable. 3. Be non-toxic, non-adherent and non-irritant. 4. Allow gaseous exchange. 5. Promote high humidity in the wound bed. 6. Be compatible with topical antimicrobials. 7. Allow maximum activity for the wound to heal (Rowley- Conwy, 2013) |
Pain Management
Proper pain management in burn injuries is vital to patient satisfaction and outcomes. Improper management of pain may lead to abnormal vital signs, unwillingness to participate in interventions such as wound debridement or dressing changes, increase the metabolic needs of the client, and may reflect negatively on the client-nurse relationship. Additionally, due to the fluid shift that occurs within the first 24 hours after a burn injury, medications should not be administered intramuscularly, since the medication would not be able to reach the circulatory system.
Opioids via a PCA combined with nonopioid oral medication such as ASA and NSAIDs generally form the basis of pain treatment. Gabapentin is frequently used in neuropathic pain associated with uncontrolled diabetes and cord injuries, but a small research study by Paul Gray suggests that it is also useful at treating burning dysesthesia due to burn injuries (Gray, 2008). Due to the small size of Gray’s patient population, more research may be needed regarding Gabapentin’s true effectiveness in burn injuries
Opioids via a PCA combined with nonopioid oral medication such as ASA and NSAIDs generally form the basis of pain treatment. Gabapentin is frequently used in neuropathic pain associated with uncontrolled diabetes and cord injuries, but a small research study by Paul Gray suggests that it is also useful at treating burning dysesthesia due to burn injuries (Gray, 2008). Due to the small size of Gray’s patient population, more research may be needed regarding Gabapentin’s true effectiveness in burn injuries