Nursing the patient with major burns: inhalation injury, circulation to the limbs, wounds, infection, temperature, pain and nutrition
- Safe practice
In a major burn the nurse watches the airway, the pulses of burned limbs, temperature and infection, controls pain and supports early feeding and movement.
What it is
After the first hours, the patient with a major burn needs close nursing care for days to weeks. The airway can swell after smoke or heat inhalation; circumferential burns of a limb or the chest can cut off circulation or breathing; the loss of skin makes the patient lose heat and opens the door to infection; pain is intense, above all during dressings; and the body enters a long hypermetabolic state that needs early nutrition. Rehabilitation and psychological support start from admission. This page covers that care; the fluid calculation is on the burn resuscitation page.
What it requires
- Inhalation injury has three types: poisoning by combustion products (carbon monoxide, cyanide), thermal injury to the upper airway and chemical injury to the lower airway.
- Patients with carbon monoxide poisoning can have normal carboxyhaemoglobin on arrival; high-flow oxygen continues until levels are confirmed low.
- Escharotomy is indicated when circumferential eschar threatens the blood supply of a limb or restricts breathing in the chest, abdomen or neck.
- Burns of 20 % TBSA or more carry a high risk of hypothermia.
- Burn patients are prone to infection, including ventilator-associated pneumonia; sepsis and multiple organ failure are the main causes of death.
How it is applied (and why)
- Assess the airway and breathing often and keep the head raised 30–45° — lung injury from smoke can take time to show.
- Have intubation equipment ready if there are signs of inhalation injury, and report hoarseness or stridor at once — early airway control prevents obstruction.
- Check pulses, refill, colour, sensation and pain in burned limbs hourly; elevate them — eschar and oedema can cut off the circulation.
- Measure core temperature every 1–2 hours, keep the room warm and uncover only the area in use — open wounds lose heat fast.
- Follow strict hand hygiene, clean technique and the unit's precautions, and teach visitors the rules — the lost skin barrier invites infection.
- Do the dressings ordered after giving analgesia in advance, and add non-drug measures (distraction, music, relaxation) — dressing pain is the most intense.
- Start feeding early by mouth or tube as ordered and record intake — the hypermetabolic state wastes muscle.
- Do range-of-motion exercises and keep positions and splints as planned — they prevent contractures and stiffness.
- Watch the eyes in facial burns and screen for anxiety, low mood and acute stress — the eyes and the mind are also at risk.
In nursing practice
- Normal oxygen saturation and a normal chest X-ray on arrival do not rule out inhalation injury.
- Report fever or a low temperature, a change in the wound, intolerance of feeds or confusion: they may be early signs of infection or sepsis.
- Facial burns can injure the eyelids and expose the eye to infection and foreign bodies.
- Psychological effects of a burn can last for years; social work and psychology belong in the team.
Common mistakes
- Waiting for stridor before calling about a hoarse patient after smoke inhalation.
- Checking the pulses of a burned limb only once per shift.
- Leaving the patient uncovered during long procedures.
- Starting a dressing without analgesia given in advance.
Test yourself
Think of the answer, then tap the question to see it.
Which findings suggest inhalation injury in a burned patient?
A fire in a closed space, soot in the mouth, singed nasal hair, facial burns, hoarseness, stridor, carbonaceous sputum, wheeze or breathlessness.
When is an escharotomy needed?
When circumferential eschar threatens the blood supply of a limb or restricts breathing in the chest, abdomen or neck.
Why does the burned patient lose heat so easily?
Because the lost skin barrier allows evaporative heat loss; the risk is high from about 20 % TBSA.
When should analgesia be given for a burn dressing?
Before the dressing starts, as ordered, combined with non-drug measures, because dressing pain is the most intense.
Elsewhere in DurgiPedia
Connections
Educational content for students; it does not replace your institution's protocols, supervised clinical training or a prescriber's order. Dose-calculation examples use made-up numbers: they are educational, not a clinical order.
Sources: Bridging the evidence–practice gap in early burn injury care: a comprehensive evidence synthesis of global guidelines, consensus, and systematic reviews for resource-limited settings (European Burn Journal, 2026); Burn injury (Primer) (Nature Reviews Disease Primers (Jeschke et al.), 2020); The pivotal role of nursing personnel in burn care (Indian Journal of Plastic Surgery, 2010).
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Representative model, for educational purposes only.