models, or printed materials if available. Patient and family education is a priority in
the acute and rehabilitation phases.
Nurses must remain sensitive to the possibility of changing family dynamics. It is not
unusual for the provider in the family to be the one who is injured. Roles begin to
change, which adds more stress to the family. In addition, families are often relocated
due to loss of property from the fire. Social services play an integral part in providing
support at this time.
Monitoring and Managing Potential Complications
Heart Failure and Pulmonary Edema
The patient is assessed for fluid overload, which may occur as fluid is mobilized from
the interstitial compartment back into the intravascular compartment. If the cardiac and
renal systems cannot compensate for the excess vascular volume, heart failure and
pulmonary edema may result. The patient is assessed for signs of heart failure,
including decreased cardiac output, oliguria, jugular vein distention, edema, and the
onset of an S 3 or S 4 heart sound. If invasive hemodynamic monitoring is used,
increasing central venous, pulmonary artery, and wedge pressures indicate increased
fluid volume.
Crackles in the lungs and increased difficulty with respiration may indicate a fluid
buildup in the lungs, which is reported promptly to the physician. In the meantime, the
patient is positioned comfortably, with the head of the bed raised (if not contraindicated
because of other treatments or injuries) to promote lung expansion and gas exchange.
Management of this complication includes providing supplemental oxygen,
administering IV diuretic agents, carefully assessing the patient's response, and
providing vasoactive medications, if indicated.
Sepsis
The signs of early systemic sepsis are subtle and require a high index of suspicion and
very close monitoring of changes in the patient's status. Early signs of sepsis may
include increased temperature, increased pulse rate, widened pulse pressure, and
flushed dry skin in unburned areas. As with many observations of the patient with a
burn injury, one needs to look for patterns or trends in the data. (See Chapter 15 for a
more detailed discussion of septic shock.)
Wound and blood cultures are performed as prescribed, and results are reported to the
physician immediately. The nurse also observes for and reports early signs of sepsis
and promptly intervenes, administering prescribed IV fluids and antibiotics to prevent
septic shock, a complication with a high mortality rate. Antibiotics must be
administered as scheduled to maintain proper blood concentrations. Serum antibiotic
levels are monitored for evidence of maximal effectiveness, and the patient is
monitored for toxic side effects.
Acute Respiratory Failure and Acute Respiratory Distress Syndrome
The patient's respiratory status is monitored closely for increased difficulty in
breathing, change in respiratory pattern, or onset of adventitious (abnormal) sounds.
Typically at this stage, signs and symptoms of injury to the respiratory tract become
apparent. Respiratory failure may follow. As described previously, signs of hypoxia
(decreased oxygen to the tissues), decreased breath sounds, wheezing, tachypnea,
stridor, and sputum tinged with soot (or in some cases containing sloughed tracheal
tissue) are among the many possible findings. Patients receiving mechanical ventilation
must be assessed for a decrease in tidal volume and lung compliance. The key sign of
the onset of ARDS is hypoxemia while receiving 100% oxygen, with decreased lung