Nurses play a big role in caring for burn victims. They are required to help resuscitate and stabilize the burn victim and continue caring for them through the acute, chronic, and rehabilitative phases of patient care. They are responsible for measuring the fluid intake and output of the patient with second-degree or third-degree burns by keeping track of the IV fluids the patient receives and balancing these numbers with the urine output. Blood pressure and observation of the amount of swelling the patient develops can also help fluid management.

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Nurses also help manage the serious inhalation injury in the burn patient. Along with respiratory therapists, nurses manage ventilator settings to be properly oxygenated the burn victim. They need to be especially careful in cases of smoke inhalation or if there is a circumferential burn around the patient’s chest, which can impact the ability to take a breath. Upper airway swelling can interfere with air intake, leading to respiratory distress. Other lung conditions, including tracheobronchitis, bronchorrhea (too much mucus in the bronchial passageways), pneumonia, and adult respiratory distress syndrome, must be prevented if possible and managed. Patients with burns received in closed places are likely to have an inhalation injury. Nurses watch for signs of hoarseness and respiratory distress as signs that upper airway swelling has occurred. In such cases, the nurse may call for a respiratory team to place a ventilator tube down the patient’s trachea to get air through the swollen passageways. Confusion, altered level of consciousness, and coma may stem from inhalation of dangerous toxins such as cyanide or carbon monoxide.

The treatment for these conditions is to provide 100 percent oxygen as soon as possible. Frequent suctioning by the nurse is necessary if the burn victim develops excess secretions in the bronchial tree due to inhaling smoke. Nurses help whenever a ventilator is needed. They watch for the amount of air that gets into the lungs and makes sure that the tidal volume (the amount of air inspired in a single breath) is adequate. If not, there may be restrictions to breathing from circumferential burns or from stiff lungs suffering from the shock of inhalation of smoke. They are also responsible for keeping the endotracheal tube in place, suctioning the tube regularly, and maintaining good oral hygiene, which is known to help prevent pneumonia.

The burn nurse is responsible for watching for signs of wound infection and applying/reapplying burn dressings as is appropriate. Wound care can be highly challenging, especially for extensive burns. There are many different wound types to care for—from autograft, eschar burns, skin bud wounds, and exposed tendons and muscles. The skilled nurse must do the right thing for these burns, usually as directed by the burn surgeon. The nurse aids in maintaining the function of the burned areas of the body. They must continually move joints and position the patient so that joint contractures do not occur. These are much more difficult to treat than preventing the contractures from occurring in the first place. Wounds must be cleaned regularly to avoid injuries or even systemic infections following the burn. Nurses are responsible for watching out for a bad odor emanating from the wound and redness around the burned area. Topical antibiotics and sterile dressings must be given and maintained to minimize infection rates.

The nurse is primarily responsible for preventing skin graft loss. When the burn victim returns from the operating room with a skin graft, the graft is susceptible to shearing for the first 3-4 days following the surgery. Grafted areas must be kept as immobile as possible during the early stages of postoperative care until the graft can adhere to underlying tissues. Patients with severe burns must be bed-bound for the most part and are therefore susceptible to getting pressure sores. Pressure sores are difficult to treat but can be prevented by turning the patient frequently and protecting areas that take on too much pressure, such as the buttocks and heels. Burn victims often go to surgery for excision of the burn and grafting. Nurses are responsible for getting the patient ready for surgery and postoperative management after the surgery is over. There are even nurses aiding anesthetists and surgeons during the surgery itself.

The nursing staff is primarily responsible for observing the patient for evidence of pain and providing pain medications. In a burn unit, most pain management is given by intravenous means. Pain is often associated with anxiety, and this must be managed with drugs or simple reassurance. The patient may even need to be placed in a medication-induced coma to control pain and anxiety until the burn begins to settle down and heal.

Burn victims are naturally hypermetabolic, burning up skeletal muscle and fat for food. The nurse is responsible for providing nutrition utilizing total parenteral nutrition or enteral nutrition through a feeding tube. As with other fluids, the amount of nutrition is carefully calculated and provided by nurses on a steady or intermittent basis for the patient to have enough protein and calories to heal the burn.

The nurse spends the most time with patients and their families and is thus charged with providing direction and education for these people. Both the patient and the family are in a new and anxiety-producing situation. A good nurse will educate what is going on in the patient’s recovery. The nurse must recognize knowledge deficits and begin planning the patient’s discharge from the hospital when the patient is admitted to the hospital. The nurse begins by developing an education plan that starts at admission and ends with discharge instructions.

Eventually, the burn will heal, and the patient will need to get back to a pre-injury state as possible. Nurses carry out plans made by physical and occupational therapists to help the patient learn new skills necessary after a severe burn and to begin to ambulate and have a function of the arms and legs that as closely as possible relate to the pre-burn state. A severe burn is a catastrophe. Anyone who has a serious burn thru the negligence of another should contact an experienced catastrophic injury lawyer.

The video below provides physical and occupational therapy to help you maintain mobility while healing from a burn injury.

Editor’s Note: This page has been updated for accuracy and relevancy [cha 5.25.22]

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