Burns Are Significant in the of Human Health - Case Study Example

Burns are significance in the study of human health. They refer to kinds of injuries resulting from exposure to chemicals, electrical current, radiation, or heat. Burns are characterized by physiological processes that may cause irreversible damage to the body tissues (Lemone & Burke, 2004, pg. 412). In addition, they vary in terms of their severity, ranging from medically minor damage of a small outer-skin layer segment to serious injuries affecting the entire body system (Wiebelhaus & Hansen, 2001). This study examines the types and causes of burns, the skin layers associated with these burns, and the characteristic of pain typical with these burns. Furthermore, it analysis the assessment and management approach to the pain associated with these burns. Types and causes of burns, pain characteristics, and skin layers Typically, there are three types of burns namely first-degree, second-degree and third-degree burns. The distinction of these types of burns is primarily by the level of skin depth or rather the skin layers that are involved. First-degree burns, also referred to as superficial burns, involve only the outermost skin layer (or epidermis). It may be characterised by skin colour change to either bright red or pink (Lemone & Burke, 2004, pg. 413). Normally, first-degree burns heal in three to six days. The outer skin layer becomes dry and peels but there is no formation of scar. Manifestation of these burns is chills, nausea, vomiting, and headache. Second-degree burns, which are also known as partial-thickness burns, involve the papillary (superficial) dermis including the papillae, although they may involve the reticular (deep) dermis layer (Wiebelhaus, 2001). Therefore, they are further classified into superficial partial-thickness burns and deep partial-thickness burns. Superficial partial-thickness burns are usually bright red with moist, form blister, and appear to glister. Pain is severe especially in response to air and temperature. These types of burns heal in 21 days and may either form minimal scars or leave none at all. Deep partial-thickness burns extends deeper into the dermis layer than the superficial partial-thickness burns. Often, the burned surface is waxy and pale. There may be presence of blisters that rupture easily, or that appear like a “flat, dry tissue paper” (Lemone & Burke, 2004, pg. 414). The severity of pain in these burns is lesser than in superficial partial-thickness burn. These types of burns normally take more than 21 days to heal. Note that necrosis, hypertrophic scars and contractures as well as conversion to third - degree burns and functional impairment may characterize deep partial-thickness burns (Wiebelhaus, 2001). Third-degree burns, which are also called full-thickness burns, involve all the skin layers, including the epidermal appendages. The muscle, bone, the connectivity tissue, and the subcutaneous fat may also be involved (Lemone & Burke, 2004, pg. 415). The burned area may look non-blanching red, waxy, brown, pale, yellow, charred or mottled. Normally, there is no pain sensation due to destroyed pain receptors (Lemone & Burke, 2004, pg. 415). Burns can result from exposure to either heat, cold, chemicals (Huisman et al, 2001), radiation, or electrical shock. Therefore, burns are classified as thermal burns, chemical burns, radiation burns and electric burns depending on their corresponding cause. Sunburn, ultraviolet rays, or mild radiation often causes superficial burns (Wiebelhaus, 2001). Second-degree burns may result from flash flame, dilute chemicals, or hot surface (Lemone & Burke, 2004, pg. 415). Third-degree burns result from prolonged exposure to chemicals, steam, flames, or high electric current (Wiebelhaus, 2001; Lemone & Burke, 2004, pg. 415). Assessment and management of pain Burn pain cause extremely unpleasant suffering and can prove difficult to deal with (Patterson, et al, 2004); therefore, effective assessment is vital to determine the most appropriate approach to patient care. Pain assessment is continuous and systematic, and therefore, various pain assessment tools have been developed. Pain assessment tool The consensus on effectiveness of assessment tools is that they should be able to address the minimum aspects of pain namely location of pain, onset of pain, duration of pain, quality of pain, pain intensity, relieving or exacerbating factors, effects of pain, and expression of pain (De Jong & Gamel 2006). Determining pain location may help in understanding the type of pain. Various types of pains have their unique characteristics (Loeser, & Melzack, 1999). For instance, visceral pain is associated with hollow organs while somatic pain involves the bones and tissues, and neuropathic involves nerve fibres. Asking the right questions to patient is also very important. To determine the onset and duration of pain, for instance, the assessment results should read when the pain started, how long it lasts, whether it keeps the patient awake, and if it is continuous or sporadic (Loeser, & Melzack, 1999). Quality of pain may be explained through the feeling by patient . Furthermore, identify cramping or squeezing, and restriction, tightness, or band for visceral pain. Somatic may feel like somebody is pressing the burned area very hard. Neuropathic pain is normally described as shooting, sharp or flashing while visceral pains takes the terms squeezing and deep. Somatic pain is described as aching or gnawing. For exacerbation factors, patient is assessed on the effect of cold and heat, painful deep breath, sleep interruption due to pain, and what makes the pain better or worse. Measurability of data is vital in assessing pain intensity. In this regard, assessment scales such as Verbal Descriptive Rating Scale (VDRS) and Visual Analogue Scales (VAS) are used (De Jong & Gamel, 2006). It is essential, therefore, that they are easy to use and language specific to allow patients to cognitively relate their pain to the scale. Speech and cognitive impairment as well as cultural differences, however, are an impediment in use of these tools. In recording expression of pain, it is vital to understand that individual patients react differently to pain due to various factors. These include previous experiences in pain care, mental status and personality, prognosis and diagnosis (Wikehult, 2008), culture, anxiety, religion, age, and gender. The assessor, moreover, should note if the patient is willing to discuss the pain. Burn nurses can assess other aspects including the effect of pain, pain interference, and temporal pattern. As research advances, more discoveries into significance of pain assessment aspects are made. These aspects must be relevant to allow effective management of pain (Wikehult, 2008); nonetheless, there several challenges in the pain assessment process and tools (Wickramasekera, 2008). Challenges in pain management There are various challenges that pain nurses experience and should understand while assessing burn pains (Patterson et al, 2004). These are cultural factors, addiction, neuropathic factors, patients who cannot communicate effectively such as children and the elderly as well as other individuals with impaired communication like unconscious patient. In addition, patients who do not accept pain relief are a challenge in this process. For patients with impaired communication, using tools that depend on behaviour observation may be extremely useful in the assessment process (De Jong & Gamel, 2006). Nonetheless, developing such tools is quite challenging, with research indicating that all the tools that are available require additional validation (De Jong & Gamel, 2006). That notwithstanding, burn nurses need to aim for the most effective pain management techniques using available information. Management of pain Burn pain management is a team-oriented practice involving doctors, nurses, allied health officers and the patient (De Jong & Gamel, 2006). It entails the use of both pharmacological and non-pharmacological methods. If both of these methods are used, there is a more positive result on pain relief (Wikehult et al, 2007) as opposed to only a single method (Ostadalipour, 2007). The pharmacological methods involve the use of analgesics including opiods such as codeine, morphine, or thebaine-based drugs; non-opiods; and adjuvant. Opioids work by modifying the transmission of pain by stimulating the opioid receptors. They are either endogenous meaning that they are produced within the body or are exogenous meaning they are administered. Secretion of the endogenous opioids can be increased by pain, trauma, stress, and physical exercise. Although some study recommend the use of opioid analgesics as the basis for treatment of acute pain (Patterson et al, 2004), there is a consensus that the effectiveness of pharmacologie analgesia is wanting. Pharmacological approach to burn pain management present a number of shortcomings. Some researchers have established that phamacologies “do not control all pain in all patients” (Patterson et al, 2004). In addition, pharmacological drugs such as opioids cause side effects that can result in more complications such as constipation, nausea, sedation, urinary retention, irritation, cognitive impairment, respiratory depression, and hallucinations (Patterson et al, 2004). Use of dose opioids, which is typical with burn patients, can overly extend the duration of stay at the health centre and, therefore, increase the hospital bill burden among other social issues. Since study indicate that non-pharmacological means of pain management have benefits such as decreased duration of care and costs, it is vital that research focus on psychological techniques for analgesic to supplement pharmacologie analgesia, potentially minimize or even eradicate the need to use opioid analgesics. The non-pharmacological methods are either physically based or psychologically based. The physical interventions include immobilisation, physiotherapy, therapeutic touch, exercise, etcetera; while psychological approach entail mainly the use of cognitive-behavioural strategies such as hypnosis, listening to music, meditation, etcetera. Nevertheless, when choosing a non-pharmacological approach for treatment of burn patients it is significant that the method is easy to learn, can be used immediately, and has minimal effort and time expenditure when being used. Further contribution by nurses on burns patients biopsychosial health and wellbeing There are other significant factors and treatment that research has found to be useful in burn pain management. Continuous supplementation of Cu and Zn, for instance, is helpful for types two and type three burns, since they play a vital role in healing of wound and minimizing burn injuries (Anonymous, 2008). In addition, Honey, which was commonly used in ancient times for wound management, is useful in therapeutic treatment. It usefulness is based on its antibacterial capability since it can produce hydrogen peroxide, which is a sterilizing agent. Moreover, honey can help in “deodorising malodorous wounds”, it promotes the debridement in necrotic and sloughy wounds, it stimulates growth of fresh tissue, and it has anti-inflammatory capability (Saunders, 2009). It is also important that nurses recognize and address the predicament of the burn patients as well as those of patients’ family members. Psychological support in form of psychiatric consultation is necessary especially when a burn patient is faced with problems like severe stress disorder, depression, delirium, or anxiety. (Klein, 2009, pg. 1; Wikehult et al, 2007, pg. 2). In fact, Goyatá and Rossi (2009) and Klein (2009, pg. 2) have explained that “psychological status affects their physical recovery. The psychiatrist, furthermore, should be ready to extend similar service to the patient’s family members if needs arise. It is important to note that presence of family members in during patient’s burn care is vital for the nurse. Nurses should involve the patients family members in diagnosing and caring for the burn patients to provide necessary information and support. Normally, nurses are ‘emotionally distanced’ and this has been associated with poor results in assessment on burn patients by nurses (Anonymous, 2004, pg. 35). Goyatá and Rossi (2009) have asserted that patients family members can be useful in providing “social support” to the patients as well as giving their perception of the patients difficulties. The relatives concerns include such issues as the patient re-integration into the societal life including the support that would be needed after discharge from hospital. Research has indicated that several patients experience severe pain even after discharge from hospital (Anonymous, 2002, pg. 5). Determining the perceptions of the family members, therefore, helps in promoting techniques that would effectively improve care of burn patient after discharge from the hospital. Research has also shown that techniques such as Topical Negative Pressure (TNP), to be useful in burn management. Use of TNP helps in draining blood or vital fluid, reducing rates of infection, and therefore in proper and faster healing of the burn wound. Specifically, TNP is beneficial where bones are exposed and “free tissue transfer is contraindicated”, as well in wound excision and sophisticated care on children with large burns resulting from debridement (Moola, 2009). References Anonymous, (2002): Phantom burn pain often goes unrecognized, HealthFacts, vol. 27, no. 3, Academic Research Library. Anonymous, (2004): Burns pain misjudged by nurses, Australian Nursing Journal, vol 11, no. 11, Academic Research Library. Anonymous, 2008, Burn Care; Research on burn care detailed by scientists at Mazandaran University, Medical Letter on the CDC & FDA, Atlanta, pg 18. De Jong, A. E. E. & Gamel, C. 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(2001): Managing burn emergencies, Nursing Management, vol. 32, no. 7, Chicago. Wikehult, B., Hedlund, M., Marsenic, M., Nyman, S. & Willebrand, M. (2008): Patient and family perspectives: Evaluation of negative emotional care experiences in burn care, Journal of Clinical Nursing, vol. 17, Blackwell Publishing Limited, Australia. Read More