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A third-degree burn also referred to as a full thickness burn destroys the dermis (layer beneath) and the epidermis (outer layer of skin). Regarding skin involvement, the RN caring for Mr. Cinder should expect to find leathery and dry skin and white, black, yellow or brown skin (Pan, Vu & Yakuboff, 2015). The wound may appear black and charred with blisters that do not develop. The most common clinical manifestations of third-degree burns include waxy or leathery skin, and the burned area may be charred white or black because the burn penetrates all the three layers of the layers of the skin. Most third-degree burns affect nerves resulting in numbness. Additionally, a person experiences carbon monoxide poisoning, smoke inhalation or difficulty breathing. The pathophysiological changes associated with severe burns as per Nielson et al. (2017) involve local and systemic damage that severely alter homeostasis.
The local pathophysiological changes consist of the formation of three zones. The zone of coagulation has irreversible tissue loss and takes place at the point of maximum damage. Zone of stasis has decreased tissue perfusion while there is increased tissue perfusion in the zone of hyperemia. Systemic pathophysiological changes, on the other hand, involve the release of inflammatory mediators and cytokines at the site of the injury producing a systemic effect on burned surfaces greater than 10% (Nielson et al.,
2017). When Mr. Cinder enters the rehabilitative phase of recovery, the three possible complications are scarring of the skin, musculoskeletal complications, and contracture formations. For contracture formations, the nursing diagnosis that I will identify as a priority is physical therapy. Contracture formations result from joints that are allowed to remain in one position without movement (Nielson et al., 2017). Therefore, encouraging physical therapy will help to enhance extremity in good alignment and proper extension thus preserving function.
Nielson, C. B., Duethman, N. C., Howard, J. M., Moncure, M., & Wood, J. G. (2017). Burns: Pathophysiology of Systemic Complications and Current Management. Journal of Burn Care & Research, 38(1), e469.
Pan, B. S., Vu, A. T., & Yakuboff, K. P. (2015). Management of the acutely burned hand. The Journal of hand surgery, 40(7), 1477-1484.
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