injury to tissue -- duration & temperature --
1st degree: superficial damage to epidermis -- pain and tactile sensation intact
2nd degree: damage to epidermis and dermis --epithelial regeneration skin elements remain
3rd & 4th degree: whole skin element destroyed --destroyed nerve endings -- surgical intervention is required
FLUID SHIFTS: increased permeability --massive fluid shift (water,sodium,plasma proteins) -- decreased colloidal osmotic pressure -- fluid shift into second & third spacing -- insensible fluid loss (30-50 mL/h) -- intravascular volume depletioin -- hypovolemic shock -- hemolysis of RBC -- elevated hematocrit --- major sodium and potassium shift -- restored fluid replacement --- edema ends --interstitial fluid back to vascular space -- diuresis -- coagulation necrosis -- accumulation of neutrophils and monocytes -- wound repair by fibroblasts and collagen fibers -- suseptible to infection

Skin and joint contracures, and hypertropic scarring. Contractures will develop due to the shortening of the scar tissue in the flexor tissues of the joint (most at risk: anterior and lateral neck areas, axillae, anticubital fossae, fingers, groin, popliteal fossae, knees and ankles).

Cardiovascular: include dysrhythmias and hypovolemic shock. Circulation to the extremities can be severely impaired. Escharotomy frequently performed.

Other cardiopulmonary problems: patient with preexisting cardiac disease = at high risk for complications. If preexisting respiratory disease = likely to developed respiratory tract infection. Increased risk for VTE.

Respiratory: Upper airway burns and lower airway injury. Watch for signs of impending distress: agitation, anxiety, restlessness or change in patient's breathing.

-Encourage patient and caregiver to participate in care.

Teach patient and caregiver skills for dressing change and wound care.

Water-based creams should be used routinely on healed areas to keep the skin moist (decreases itching and flaking). Low dose antihistamines can be used if itching persists.

Urinary: Most common complication is Acute tubular necrosis

Skin appears flat and pink. in 4 -6 weeks, the area becomes raised and hyperemic. Mature healing is reached in about 12 months when suppleness has returned and the pink or red color has faded to a slightly lighter color.

2 characteristics of scarring: discoloration and contour. Discoloration fades with time.

wound care: soap and water or NS to clean the wound silver impregnated dressing. Gauze until after wound has been fully debrided. Blebs, aspiration with tb syringe. Pain management: IV infusions, and prn pain management, anxyolitics. PT and nutritional therapy include antioxidant protocol, multivitamin, high protein, high carb.

Wound care: Debridement. Provide emotional support. Prevent infection. For wound change change dressing every 12 to 24 hours to once every 14 days. Wear protective PPE when changing a wound dressing.

Drug therapy: Analgesics and sedatives to control pain and anxiety. Tetanus immunization (Tetanus toxoid). Antimicrobial agents and covered with light dressing. VTE prophylaxis.

Other care measures: Eye care for corneal burns or edema with antibiotic ointments. Ears should be kept free from pressure and do not use pillows. For burn hands and arm elevate them on pillows. Keep patient perineum as clean and dry as possible. Monitor fluid and electrolytes. Active and passive exercises to prevent contractures.

Nutritional therapy: early and aggressive nutritional support within several hours of injury. Enteral feedings or parenteral feeding. Feedings slowly at a rate of 20 to 40ml/hr and increase to the goal rate within 24 to 48 hours.