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According to the American Burn Association Burn Injury Severity Grading System (Edlich et al., 1978), severe burns are defined as the following:

• 25% total body surface area (TBSA) or greater, 10 to 40 years of age (excludes superficial burns, such as sunburn)
• 20% TBSA or greater in children under 10 years; adults over 40 years of age (excludes superficial burns), 10% TBSA or greater full-thickness burns
• All burns involving eyes, ears, face, hands, feet, or perineum that are likely to result in cosmetic or functional impairment

Burns can be extremely painful and require treatment with multiple medications (opioids, NSAID, anxiolysis) as well as nonpharmacology treatments (distraction, guided imagery, hypnosis, relaxation techniques); this pain may last for years (Patterson et al., 2004). Burn patients are at increased risk for developing sepsis and may need nutritional evaluation and support as they heal (Kreymann et al., 2006).

Table 17-8 Burns