Burns Pathophysiology and Treatment

Hey there friends. In this video we are diving into everything that you need to know about burns in nursing school. We are going to go over the pathophysiology and what happens in the body when a burn occurs. We'll talk about the signs and symptoms, what you will need to assess for, and the nursing interventions as well. I will also walk you through the why behind all of it so you can finally start critically thinking about it better. This will be a super important video for you to watch because I will give you some key points that nursing schools love to test you on. And of course, you will also need to know it for when you take care of your patients at Clinical. So let's dive in. Hello. Hello my friend. My name is Christina Rafano and I am the creator of the nursing school show. Welcome where we are going to walk you through how to pass nursing school step by step. Hit that subscribe button and click the notification bell and let's dive in. So I'm going to walk you through the pathophysiology of burns step by step. We will focus on what happens physiologically in the body when a burn occurs through all of the different types of burns, the symptoms of burns, and then what you, what you, as the nurse will do about it. So let's start with the basics. The first step of a burn is heat. Now, this can be caused by a source of heat, chemicals, radiation or electricity which is transferred to the skin. And then the burn occurs. Now, right away or quickly following the initial signs, the burn will start to appear. And these initial signs are things like redness, blistering or charring of the skin. Now let's take it one step deeper. Why do these signs start to appear? What is happening inside the body? This is really what you need to know for nursing school. When the burn occurs, the skin and underlying tissues become damaged, which then triggers the release of certain chemicals. Now, these chemicals go and they tell the blood vessels to constrict. This causes the cells to separate, which is called increased capillary permeability. So the blood vessels, they become leaky and they leak fluid into the surrounding tissues, causing edema. Now, with all of the fluid leaking out of those blood vessels and then into those surrounding tiss, it decreases the amount of fluid inside the blood vessels so there's less of it going to where it needs to go, like the organs. Now, when there's less fluid going to the organs, it also means less oxygen for those organs. So the organs aren't getting perfused appropriately. And this is where you'll start to see a lot of those physiological changes, pathophysiological changes. Now, this decreased organ perfusion will lead to a decrease in urine output since the kidneys aren't getting enough blood flow. And then the patient may have mental status changes as well, if the brain isn't getting enough blood flow, right? And then the GI tract may stall out if it is not getting enough blood. And now since there's less blood going to the organs, the heart is going to try to compensate for that and then get more blood to the body. So what is going to happen? The heart is going to beat faster, but since it's not a heart problem, it's a problem. With the amount of blood available, there's less fluid inside the blood vessels, so the blood pressure and the cardiac output will be decreased. Now, the heart just can't pump enough blood to the organs because there's just not enough blood to start with. Now, here's where your critical thinking skills will really start to kick in. The electrolyte shifts that happen when a burn occurs. So be sure to pay special attention here. Nursing schools love to test you on this stuff. There are two main electrolyte shifts that you need to know about. I can only almost guarantee your test is going to cover these two. A decrease in sodium or hyponatremia and an increase in potassium or hyperkalemia. We do have a video on this as well, if you want to check that out, too. Now, the first question I want you to ask yourself as you think about this is where are each of these electrolytes primarily located? Are they inside of the cell or are they outside of the cell? Now think about the fluid shifts that are because of this burn. So normally, potassium loves to hang out inside the cells. It's a home body. It likes to stay all warm and toasty inside the cell. But sodium, on the other hand, loves to hang out outside the cell. So think about when a burn occurs and fluid starts leaking out of the blood vessels. Where is the sodium going to go? Well, the sodium is going to go right along with that fluid. Since sodium hangs out outside of the cell, it's going to surrounding tissues right along with all that fluid. So this will decrease the sodium level in the blood, which is called hyponatremia. Now, let's talk about potassium. Since potassium is found primarily inside the cells, when those cells become damaged, they break. It causes all of that potassium then to leak out. So the potassium level is going to go up, leading to hyperkalemia. So those are the two key Electrolyte shifts that you need to, the sodium level will decrease because it will leak out into those blood vessels, the surrounding tissues, and then potassium level will increase as more cells are damaged. Now, another lab value that you will need to be aware of is the hematocrit level. As more fluid is lost because of all that edema, the hematocrit level will start to rise. Now, the hematocrit measures the percentage of red blood cells in the blood relative to the fluid and Pl. So let's critically think about this too. So as the fluid decreases, the hematocrit will start to rise, not because the actual number of red blood cells is increasing, but because the amount of fluid is decreasing. All right, Again, the key points that you need to remember, the big points that your nursing exams are going to test you on with burns, is it will cause a lot of fluid to shift out of the blood vessels and into the surrounding tissues, then leading to a whole lot of those physiological changes. These changes will also lead to decreased sodium, increased potassium, and then an increase in hematocrit level. Now, we talked about what is happening inside of the body with burns, but let's talk about the signs and symptoms of burns and then critically think through those and why you might be seeing those signs. The specific signs and symptoms of burns will vary depending on the external event that caused the burn, like if it was a burn from a fire or a chemical burn or electricity. And then the severity of the burn will also depend. So, like if it only affected the epidermis of the skin or the deeper layers, the deeper the burn and the larger the burn, generally the worse that it is. You might hear burns classified by degree, like first degree and second degree burns, or you might hear them classified by thickness, like superficial thickness or full thickness burns. Now, both of these systems are generally the same, but you might see a little bit of variation depending on what nursing school textbook or what nursing resource you're using. So we'll categorize them both ways so that you know which one is which. First degree burns are considered superficial thickness burns, and they only affect the top layer of the skin, the epidermis. Now, a mild sunburn is a great example of a first degree or a superficial thickness burn. These can be painful since the nerve endings are still present and functioning. Now, the next type of burn is a second degree burn, which is also called a partial thickness burn. Now, these burns involve both the epidermis and the dermis layer of the skin, and they're very painful as the nerve endings are still Present and active, a third degree burn, which is also called a full thickness burn. With these types of burns, all of the layers of the skin, the nerve endings, the sweat glands and the hair follicles, those are all involved. Now these usually aren't as painful because those nerve endings are destroyed and the patient won't have much or any sensation because of that nerve damage. Now the last type of burn is a fourth degree burn, which is also called a deep full thickness burn. Now this is when all of the layers of the skin are involved, as well as the muscle, the ligaments and the bone. Now, there is zero pain and no sensation or feeling. Since all of those nerves are destroyed. The skin is usually black with eschar and it will need to be removed and replaced with a skin graft. Now these type of burns take many months to heal. So remember, the deeper the burn, the more damage that occurs and the longer that it takes for it to heal. Now you, as the nurse, you will assess the total burned area, calculating with the rule of nines to help determine the next course of course of action for treatment. So monitoring for areas with discolored skin, like red, yellow, white or black areas of skin, and areas that are different in texture, like stiff or leathery skin. Now, the rule of nines will give you a percentage of the total body surface area or the TBSA that was injured in the burn. Now remember what happens with burns. All the fluid is shifting, so the biggest thing to watch for is hypovolemic shock. Now, there is a tremendous amount of fluid loss that occurs when fluid moves from those blood vessels into the surrounding tissues, leading to swelling and then that intracellular dehydration. So assessing their vital signs, especially their heart rate, their respiratory rate and their blood pressure will help you catch shock early if it's occurring. So watch for an increase in heart rate, an increase in respiratory rate and a decrease in blood pressure. Now, all of these fluid shifts and decreased blood volume can lead to renal failure, kidney failure, since the kidneys won't be getting enough blood. So you'll need to carefully track their intake and their output, especially, especially as they get fluid resuscitation treatment, because you will want to make sure that their kidneys are being perfused properly. And if the kidneys are making urine, that means that they are being perfused better and then the body is circulating blood better. So urine output is a really key indicator for cardiac output. The patient should have a urine output between 30 and 50 milliliters per hour. Another big thing to monitor is for infection throughout the healing process. Process. The skin is the protective barrier for infection. So when it's compromised, the patient is at a higher risk for infection. Right. So monitoring their body temperature will help you determine if they have or are developing a fever or an infection. And then the patient's lab values, they will show you hyponatremia, hyperkalemia, and an increase in hematocrit level. If those things are happening, then remember when a burn occurs and fluid starts leaking out of the blood vessels, that that sodium is going to go right along with it. Since sodium hangs out outside the cell, it's going to travel into those surrounding tissues right along with all that fluid. So this will decrease that sodium level in the blood, which is called hyponatremia. And because potassium loves to hang out inside the cell and be all cozy and warm in its little home, when those cells are damaged or broken because of that burn, all that potassium is going to be forced to leave the broken cell, causing that increase potassium level. Hyperkalemia. So the biggest things to remember here with burns is to keep the patient's airway clear, make sure that their organs are getting enough blood, make sure that you are helping to prevent shock and prevent infection. Now, with all that fluid shifting into the surrounding tissues, it can quickly lead to hypovolemic shock as well as cause respiratory distress if that fluid shifts into the lungs or if they have swelling in their airway. So you'll need to assess your patient often, often to make sure that there's no complications around that. And then managing your patient's pain with IV medications is really important. The burns can be extremely painful, depending on the location and the tissue involved and the swelling that occurs afterwards. It was the burns heal. They will need strict, frequent dressing changes to help prevent infection and then promote better healing. So make sure to use aseptic technique or sterile technique or isolation precautions as appropriate. And then wash, wash your hands constantly, because the patients with burns, they're at a much higher risk of infection. So we need to be very, very careful. So the key points you absolutely need to remember are your top priorities when caring for a patient with a burn. First, you will make sure that their airway is clear always. Then you will give oxygen as prescribed. Take a set of vital signs to establish their baseline vitals, and then you will start IV fluid resuscitation. You will need to monitor for fluid shifts and electrolyte changes that can occur. And you will also monitor for infection very, very closely. Be sure to check out the Parkland formula video so that you can fully understand how to properly resuscitate a patient with fluids if they have a burn. Now there are three ways that I can help you more through Nursing school. Number one, be sure to download the Nursing School Study checklist that I have for you that walks you through step by step step how to Study in Nursing School. Now number two, be sure to check out the Nursing School boxes that we have available for you as well. They are packed with resources to help you succeed in nursing school. And of course if you want me to come alongside your Nursing School journey and hold your hand throughout nursing school, do not miss out on joining the Nursing SOS Membership community. It is packed with step by step nursing lectures to help you understand everything faster and so much easier for Nursing school. You will be so much more prepared for your exam. Be able to critically think a lot better through these things. The links for all those things are down in the description below and if you like this video, make sure to hit that like button. Leave a comment below of course, to let me know that you loved it. Share it with one of your friends. And of course click that subscribe button and hit the notification bell so you never miss a video. And click on one of these videos right here so you can keep rocking nursing school. And as always my friend, go become the nurse that God created only you to be. And I'll catch you next time on the Nursing School Show. Take care. Bye bye.