Burn Phases Timeline: Emergent → Acute → Rehabilitative — Fluid Shifts, Priority Problems, Key Interventions
Burn priorities flip completely across phases — the massive fluid resuscitation that saves your patient in the first 48 hours can drown them once capillary integrity returns. Choosing the wrong intervention for the wrong phase (diuretics during emergent, aggressive fluids during acute) is a lethal mistake the NCLEX will test you on.
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Comparison
Emergent (0–48 hr)
What happens- Fluid leaks OUT of vessels then interstitial edema
Key findings- Hypovolemic shock
- ↓ BP, ↑ HR, ↓ urine, ↑ Hct
Nursing focus- ★Parkland: 4 mL × kg × %TBSA
- ½ in first 8 hr
- Large-bore IV + Foley
- target urine 0.5–1 mL/kg/hr
Acute (48 hr–closure)
What happens- Capillary integrity restored then fluid shifts BACK in
Key findings- Hypervolemia risk
- hemodilution (↓ Hct)
- ★Infection/sepsis = #1 cause of death now
Nursing focus- Aseptic wound care
- silver sulfadiazine
- High-cal/high-protein (~5000 kcal)
- titrate fluids down
Rehabilitative (closure–recovery)
What happens- Wounds closed
- focus shifts to function
Key findings- Stable
- contractures & psychosocial issues
Nursing focus- ROM, splinting, pressure garments
- OT/psych support
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Emergent = fluid OUT, push fluid IN; Acute = fluid BACK, watch for overload and infection; Rehab = prevent contractures.
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