Chapter 26: Burns: Assessment & Management

Burn injuries result from various mechanisms including thermal exposure from flames or scalding liquids, chemical contact with acids or alkalis, electrical current passage through tissues, and radiation exposure, with injury severity determined by temperature, exposure duration, anatomical location, and patient comorbidities. The classification system categorizes burns by depth into partial-thickness injuries affecting epidermis and dermis that present with pain and blistering, and full-thickness burns that destroy all skin layers appearing leathery and painless due to nerve destruction. Assessment techniques utilize the rule of nines and Lund-Browder charts to calculate total body surface area involvement, while American Burn Association criteria guide referral decisions to specialized burn centers. Management follows three distinct phases beginning with the emergent resuscitative phase focusing on airway management, fluid resuscitation using the Parkland formula, prevention of burn shock, and potential escharotomy procedures to maintain circulation. The acute phase emphasizes wound care through debridement and excision, surgical interventions including autografting and synthetic dermal substitutes, aggressive nutritional support with high-protein and antioxidant-rich diets, and infection prevention using topical antimicrobials like silver sulfadiazine. The rehabilitative phase addresses long-term functional restoration through contracture prevention, scar management with pressure garments, psychosocial support for body image concerns and trauma recovery, and comprehensive pain management strategies. Special considerations include increased vulnerability in older adults due to comorbidities and delayed healing, while nursing interventions span prevention education, acute care delivery, wound healing facilitation, and support throughout the recovery continuum.