The nurse assesses a client with a burn on the arm and finds that the area is red, moist, and covered in shiny, fluid-filled vesicles. Which burn stage does the nurse document?

Question

The nurse assesses a client with a burn on the arm and finds that the area is red, moist, and covered in shiny, fluid-filled vesicles.  Which burn stage does the nurse document?

Quizplus · Accepted Answer

11ecbb05_c9fc_2bb8_b433_7f99aeafa34d_MD0009_00 Second-degree (partial-thickness) burns appear as moist or weeping wounds with blisters and shiny, fluid-filled vesicles, and clients have moderate to severe pain. Both the epidermis and dermis are damaged. Second-degree Immediate care of minor burn injuries involves removal of clothing and debris from the affected area, cooling and cleansing of the wound, and pain management. Minor burn injuries can be treated on an outpatient basis with wound care and dressing changes. Major burn injuries require hospitalization and emergency interventions (eg, airway management, fluid resuscitation). (Option A) First-degree (superficial) burns are dry with blanchable redness. They usually damage the epidermis only. (Options C and D) Third-degree (full-thickness) burns are dry and inelastic with waxy white, leathery, or charred black color. They destroy the dermis and may involve subcutaneous tissue. Fourth-degree (full-thickness) burns have the same appearance as third-degree burns, with additional involvement of fascia, muscle, and/or bone tissue. Due to nerve damage, pain is not the major feature, unlike with second-degree burns. Educational objective: Second-degree (partial-thickness) burns damage both the epidermis and the dermis, and appear as moist or weeping wounds with redness, blisters, shiny fluid-filled vesicles, and moderate to severe pain.

The Nurse Assesses a Client with a Burn on the Arm