Burns - fourth-degree

Etiology / Pathophysiology

• Severe thermal, electrical, chemical, or prolonged injury extends into subcutaneous tissue, muscle, tendon, or bone.
• Deep tissue necrosis can cause massive fluid loss, rhabdomyolysis, compartment syndrome, and limb loss.

Medications

No specific medication class was seeded for this card.

Signs / symptoms

• Electrical burn with small entrance wound can hide deep injury.
• Tea-colored urine suggests myoglobin.
• Absent distal pulse is emergency.

Nursing actions

• Prioritize ABCs, cervical spine/trauma assessment if indicated, and rapid burn/trauma team activation.
• Monitor pulses, sensation, movement, urine output, potassium, CK, and renal function.
• Prepare for aggressive fluids, surgical management, debridement, grafting, or amputation pathway as ordered.

Complications

• Shock
• Rhabdomyolysis
• Hyperkalemia
• AKI
• Amputation
• Sepsis

NCLEX cues

• Electrical burn with small entrance wound can hide deep injury.
• Tea-colored urine suggests myoglobin.
• Absent distal pulse is emergency.

Memory hooks

• Fourth-degree goes beyond skin.

Labs / Diagnostics

• CK
• Potassium
• Creatinine
• Urine color/output
• Continuous cardiac monitoring for electrical burns

Review notes

• Supplemental wife-requested study card. Use for NCLEX review only and verify against school materials, ATI/NCLEX review sources, current orders, and facility policy.