Burns and the Integumentary System

By May 15, 2017 Nursing


Burns and the Integumentary System
Peter Schuckert
Kaplan University

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Burns and the Integumentary System
The patient is a 67 year old male named Fred Smith. The patient arrived at St. John??™s Memorial Hospital via ambulance and was immediately admitted to the Emergency Room. Once the patient was stabilized Dr. Salazar had the patient was transferred over to the Critical Care Unit. The patient has suffered second and third degree burns that affect approximately 44 % of his body. The majority of the damage to the body is to the integumentary system with secondary damage to the surrounding muscles, and nervous tissue.
The skin, hair, nails, and the skin glands together form an organ system called the integumentary system. The skin is the primary organ of the integumentary system. The primary function of the integumentary system is to act as a barrier to protect the body from the outside world. The integumentary system also functions to retain body fluids, protect against disease, eliminate waste products, and regulate body temperature (Patton, 2008). The skin suffers most of the damaged caused by most burns.
When the skin is burned the burns are classified into three categories depending on the severity of the burn and the amount of tissue damage that is caused by the burn. First degree burns cause very minor pain, and some redness of the skin. Surface layers of the epidermis may peel in 1 to 3 days. There is also no blistering in first degree burns, and tissue destruction is minimal. First degree burns are typically sunburns. Second degree burns involves the deep epidermal layers, and always results in damage to the upper layers of the dermis. Deep second degree burns can damage sweat glands, sebaceous glands, and hair follicles. In second degree burns complete destruction of the dermis does not occur. Some symptoms of second degree burns include severe pain, swelling to the affected area, and fluid loss due to blistering. Scarring is also common when second degree burns occur. Both first and second degree burns are classified as partial thickness burns. Third degree burns on the other hand are classified as full thickness burns. In third degree burns the tissue death extends down to the subcutaneous tissue. There is total destruction to the dermis, and epidermis. Third degree burns often involve the underlying bone and muscle tissue. One big difference between second and third degree burns is that third degree burns are insensitive to pain immediately. This is because in third degree burns the nerve endings are destroyed (Patton, 2008). Burns regardless of degree of severity should be treated promptly and properly.
Proper treatment of burns is very important to minimize the risk of infection and to promote healing. Burns must be cleaned and bandaged to protect the affected area and also to protect from infection. In severe burns the wound must undergo debridement to promote the healing process. Debridement is the medical removal of a patients dead, damaged, necrotic, or infected tissue to improve the healing potential of the remaining healthy tissue. There are many new treatment options available for burns that are more effective than traditional skin grafts. When treating a burn patient body fluid loss must be closely monitored. This is due to the fact that the blistering that is seen on severe burn victims is actually fluid loss from the underlying damaged blood vessels. A burn victim can go into shock because of a high volume of body fluid loss from blistering. Fluid replacement from an intravenous drip is a common treatment for severe burns as well as many complications from burns.
There are many conditions that can affect the healing process of burns. The presence of diabetes is just one condition of many that can hinder the healing process. Peripheral Vascular Disease (PAD) is another condition that can hinder the healing process. A good rule of thumb is to remember is that any condition that can have an effect on the delivery of oxygenated blood can also complicate the healing of burns (McCulloch, 2004). Damaged tissue needs a good supply of oxygen and nutrients to heal efficiently.
There are many new treatment options for burns that did not exist just a few years ago. One of these new treatment options that are available for burn patients is called autologous fibroblast therapy (Isolagen). Isolagen therapy has been used to achieve functional and cosmetic improvements in patients with acute and chronic burn injuries involving the face, neck, hands and chest. Patients that had received Isolagen therapy typically benefit from reduced restriction of movement, improved scar pliability, skin softening and reduction in cracking of chronic scars (Guttman, 2008). Isolagen therapy is great treatment option that is being used more and more each day.
Another new treatment option is the use of antimicrobial dressings on the wound. With the use of antimicrobial dressings the risk of sepsis is greatly reduced. Antimicrobial dressings also have the added benefit helping to reduce pain in burn patients (Jeter, 1998). Any steps that can be taken to reduce infection in a burn victim are appropriate steps to take. This is because infections are one of the more serious complications that a burn patient may experience. ???Infection is the primary cause of morbidity and mortality in burn patients ???(Crosby, 2006). This is because infections can be hard to diagnose in burn victims. And in many instances infections are not caught until it is too late for the patient.
There have even been improvements in the area of skin grafts. Numerous times when a skin graft is necessary instead of obtaining the skin for a graft from the patient??™s body bioengineered composite skin is used. There are many advantages to using bioengineered skin over traditional skin grafts. The use of bioengineered composite skin for skin grafts promotes quicker healing than using a traditional skin graft. Bioengineered composite skin also can help in reducing fluid loss. Reducing fluid loss is very important in burn patients to promote healing, and to help the body maintain homeostasis (Mitchell, 1998). There are other complications that can arise from extreme fluid loss as well.
Rhabdomyolysis also known as striated muscle dissolution is a very common muscle wasting response that burn victims experience. When suffering from Rhabdomyolysis movement is difficult to near impossible. The standard treatment for Rhabdomyolysis is the replacement of fluid. Fluid replacement therapy is typically accomplished via an intravenous drip. Rhabdomyolysis left untreated can lead to renal failure and in some cases even death. In come cases severe burn victims can suffer from a metabolic muscle wasting response. Beta-blockers have been found to diminish this muscle wasting metabolic response in many cases. The use of beta-blockers to diminish muscle wasting works by inhibiting the function of hormones such as epinephrine and other so-called catecholamines, which are known to play a role in post-traumatic hyper metabolism (Harder, 2001). The use of beta-blockers to combat metabolic muscle wasting responses in burn victims provides another avenue of treatment for severe burn victims.
With the advent of new treatment options for burn victims there are many treatment plans that can be custom tailored to best suit the specific needs of the patient. This custom tailoring is done depending on the severity of the burns, and the amount of the body that is burnt. Burn patients have a better outcome in this day and age because of custom tailored treatment plans that are possible. There are many different options for skin graft material nowadays. Many of the treatment options that are available can decrease scarring. As well as prevent the onset of infection. Muscle wasting conditions can be combated with modern medicines. With the modern treatment options the favorable outcome for burn victims is significantly better that twenty or thirty years ago.

Crosby, C. (2006). Burn would protection. Healthcare purchasing News, 30(6), 60-62. Retrieved from Business Source Premier database.
Guttman, C. (2008). After the Burn. Dermatology Times, 29(7), 38. Retrieved from Health Source ??“ Consumer Edition database
Harder, B. (2001). Beta-blockade guards victims??™ muscle. Science News, 160(17), 263. Retrieved from Health Source ??“ Consumer Edition database
Jeter, D. (1998). New Antimicrobial Dressing Decreases Infection, Pain in Burn Patients. Dermatology Times, 19(5), 76. Retrieved from Health Source ??“ Consumer Edition database.
McCulloch, J. (2004). The Integumentary System—Repair and Management: An Overview. PT: Magazine of Physical Therapy, 12(2), 52-72. Retrieved from Health Source: Nursing/Academic Edition database.
Mitchell, D. (1998) Engineered skin substitutes provide quicker healing for patients. Dermatology Times, 19(10), 19. Retrieved from Health Source ??“ Consumer Edition database.
Patton, K. & Thibodeau, G (2008). Structure & Function of the Body (13th ed.). Saint Louis, MO: Mosby Elsevier


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