Victims of third-degree burns demonstrate the loss of vital functions performed by the skin. What are the two most important problems encountered clinically with such patients? Explain each in terms of the absence of skin.
The two most important problems encountered clinically with burn victims are dehydration and infection. In a third degree burn the entire thickness of skin is involved and nerve endings have been destroyed. The body's barrier against water loss is no longer there. When the protective covering does not exist, fluid seeps from the burned area causing dehydration and electrolyte imbalance. Unless fluids are replaced immediately, renal shut down and shock will occur. Skin is both a physical barrier, preventing water loss, and also a chemical barrier, preventing the growth of bacteria. The skin releases low pH secretions, which either kill bacteria or slow their rate of multiplication. Burned skin is sterile for about 24 hours, and then it is an open passageway for all bacteria, fungi and other pathogens to enter. When bacteria enter they multiply rapidly in the nutrient rich environment of dead tissues and protein containg fluid. Also the burned victims' immune system weakens 1-2 days after the severe injury which adds to the critical problem. The patient will need high doses of antibiotics and intravenous fluids to help maintain stability until a skin graft can be done.
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