Care of the burn patient

A burn injury creates a significant alteration in the functioning and structural integrity of the skin. Major burns also affect all systems of the body. Understanding the systemic response is essential for treatment and a multidisciplinary team approach is necessary. This article reviews causes of burn injury and evaluation of burn injury, including zones of tissue damage, amount and severity of injury and the Rule of Nines method of determining Total Body Surface Area. Systemic responses to burn injury include vascular, pulmonary, renal and gastrointestinal. The article continues by reviewing pulmonary and respiratory problems, mechanical ventilation, fluid resuscitation, and nutrition. Non-operative and operative wound care is covered, including the nursing diagnoses of infection and pain. Issues involved in patient rehabilitation include scarring and contractures, body image and family support, and the seven adaptive stages for burn victims (adaptive, problem of pain, search for meaning, investment in recuperation, acceptance of losses, investment in rehabilitation, and reintegration of identity). In the treatment of a burn patient, each member of the healthcare team brings a different but equally important therapeutic intervention to the care of the patient's many needs.