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Reporters:
Linan, Maiden Gay
Dimpas, Aprilgean
 DEFINITION

i A burn occurs when there is injury to the tissue of the body

caused by heat, chemicals, electric current, or radiation.

i Burns can be complicated by shock, infection, multiple organ

dysfunction syndrome, electrolyte imbalance and respiratory distress.
TYPES OF BURN INJURY

i Chemical Burn

Result from tissue injury and destruction from acids ,

alkalis, and organic compound.
Smoke and inhalation injury
Result from the inhalation of hot air or noxious
chemicals and can cause damage to tissues of the respiratory
tract.
THREE TYPES OF SMOKE AND INHALATION
I N J U RY

i Carbon monoxide poisoning- CO poisoning and asphxiation

account for the majority of deaths at a fire scene

i Inhalation injury above the glottis- Injury above the glottis ma

be caused by the inhalation of hot air, steam, or smoke.

i Inhalation injury below the glottis-Tissue injury to the lower

respiratory tract is related to the duration of exposure to smoke
or toxic fumes.
i Electrical burns
 Are the result of intense heat generated from an electric current.
 Direct damage to the nerves and vessels.
i Scalding

Scalding is caused by hot liquids (water or oil) or gases

(steam), most commonly occurring from exposure to high
temperature tap water in baths or showers or spilled hot drinks. A so
called p
p is created when an extremity is held under the
surface of hot water, and is a common form of burn seen in child
abuse
i Radiation burns

are caused by protracted exposure to UV light (as from the

sun), tanning booths, radiation therapy (as patients who are
undergoing cancer therapy), sunlamps, radioactive fallout, and X-rays.
 CLASSIFICATION OF BURN
INJURY

 
M
     


 

Erythema,
  Epidermis
first degree significant pain,
 involvement
lack of blisters
  
      
     
    



A Whiter
appearance or
    Deep (reticular)
second degree fixed red staining
 dermis
(no blanching),
reduced sensation

Epidermis,
Dermis, and
complete Charred or
destruction to leathery,
  third degree subcutaneous fat, thrombosed
eschar formation blood vessels,
and minimal pain, insensate
requires skin
grafts
 EXTENT OF BURN
i Lund-Browder Chart
head 7 R leg 7
Neck 2 L leg 7
Ant. Trunk 13 R foot 3 1/2
Post. Trunk 13 L foot 3 1/2
R. Buttock 2 ½ -----------
L. buttock 2½ total 100%
Genitalia 1
R.U. arm 4
L.U. arm 4
R.L arm 3
L.L arm 3
R. hand 2½
L. hand 2½
R. thigh 9½
L thigh 9½
R leg 7
 RU L E O F N I N E C H A RT

Head and neck 9%

Arms (each) 9%
Ant trunk 18%
Post. Trunk 18%
Legs (each) 18%
Perineum 1%
------
Total 100%
PATHOPHYSIOLOGY
Burn

Vascular permeability

Intravascular volume
edema
hematocrit
Blood volume
Viscosity

Peripheral resistance

Burn shock
EMERGENCY MANAGEMENT
i Minor Burns ( First degree)

1. Immediately apply ice to cool the skin and prevent further

burning.

2. Application of an analgesic- antibiotic ointment and a gauze

bandage to prevent infection.

3. The child should have a follow-up visits in 2 days to have the

area inspected for a secondary infection and to have a dressing
changed.

4. Caution for parents to keep the dressing dry.

i Moderate Burns ( Second degree)

1. Do not rapture the blisters, because doing so invites infection.

2. Cover the burn with a tropical antibiotic such as silver

sulfadiazine and a bulky dressing to prevent damage to the
denuded skin.

3. Child is ask to return in 24 hrs. to assess that pain is adequate

and there are no s/sx of infection.

4. Broken blisters may be cut away to remove possible necrotic

tissue as the burn heals.
i Electrical Burns of the mouth

1. Unplug the electric cord and control bleeding.

2. Pressure applied to the site with gauze is usually effective.

3. Admit the child immediately to the hospital for at least 24

hours I an observation unit, because edema in the mouth can
lead to airway obstruction.
4. Supply adequate pain relief as long as necessary.

5. Clean the wound about 4 times a day with an antiseptic solution to

reduce the possibility of infection

6. For eating, Bland fluids is best

7. Use of a mouth appliance to help maintain lip contour.

NURSING AND THERAPEUTIC
MANAGEMENT

1. EMERGENT PHASE

i Fluid therapy

a) Assess fluid needs

b) Begin IV fluid replacement

c) Insert urinary catheter

d) Monitor urine output

c) Assess extent and depth of burns

d) Initiate appropriate wound care

e) Administer tetanus toxoid or tetanus antitoxin

i Pain and Anxiety

a) Assess and manage pain and anxiety.

i Psychosocial care

a) Provide support to patient and family during initial crisis phase

i Physical/ Occupational therapy

a) Place patient in position that prevents contracture formation

and assess need for splints

i Nutritional Therapy

a) Assess nutritional needs and begin feeding patient by most

appropriate route as soon as possible

2. ACUTE PHASE

i Fluid Therapy

a) Continue to replace fluids, depending on patient·s clinical

response
i Wound care

a) Continue hydrotherapy/ cleansing.

b) Assess wound daily and adjust dressing protocols as necessary.

c) Observe for complications.

d) Continue debridement ( if necessary)

e) Continue assessing for and treating pain and anxiety.

i Early Excision and Grafting

a) Provide temporary homographs.

b) Provide permanent autographs.

c) Care for donor sites.

i Nutritional Therapy

a) Continue to assess diet to support would healing.

i Physical/ Occupational Therapy

a) Begin daily therapy program for maintenance of range of

motion.
b) Assess need for splints and anti- contracture positioning.

c) Counsel and teach patient and family about physical and

psychosocial aspects of care.

d) Encourage and assist patient with self-care as possible.

3. REHABILITATION PHASE

a) Counsel and teach patient and family.

b) Encourage and assist patient in resuming self- care.

c) Prevent and minimize contractures and assess likelihood for
scarring (surgery, physical/ occupational therapy, splinting, or
pressure garments).

d) Discuss possible reconstructive surgery.

e) Prepare for discharge home or transfer to rehabilitation

hospital.
 MEDICATION

i Nutritional support

-Vit. A,C,E and multivitamins- Promotes wound healing.

-Minerals: Zinc, iron- Promotes cell integrity and

hemoglobin formation.

-Oxandrolone (oxandrin)- Promote weight gain and

preservation of lean body mass
i Analgesia

Morphine

Sustained-release morphine (MS Contin)

Hydromorphone (Dilaudid)

Fentanyl (Sublimaze)

Oxycodone (contained in Percocet)

methadone

Nonsteroidal antiinflamatory (e.g Ketoprofen [Orudis])

Adjuvent Analgesics (e.g Gabapentine)

i Sedation

Haloperidol ( Haldol)-Produces antipsychotic and sedative

effects , promotes sleep.

Lorazepam (Ativan)- Diminishes anxiety

Midazolam (Versed)- Has short-acting amnestic properties

i Gastrointestinal Support

Ranitidine (Zantac)- Deceases incidence of curling·s ulcer

nystatin (Mycostatin)-Prrevents of overgrowth of candida

albicans in oral mucosa.

Mylanta, Maalox- Neutralizes stomach acid.

 NURSING DIAGNOSIS FOR
BURNS
i Pain related to trauma to body cells.

i Risk for ineffective tissue perfusion related to cardiovascular adjustments after

burn injury.

i Risk for ineffective breathing patterns related to respiratory edema from burn
injury.

i Risk for impaired urinary elimination related to burn injury. Risk for imbalanced
nutrition, less than body requirements, related to burn injury.

i Risk for injury related to effects of burn, denuded skin surfaces & lowered
resistance to infection with burn injury.
 REFERENCES

i Wong, Hockenberr, Wilson, Perry, and Lowdermilk,

2009,Maternal Child nursing care 3rd edition, p1782-1798

i Lewis, Heitkemper, Dirkson, O·Brien, Bucher, 2008, Medical

Surgical Nursing 7th edition vol. 1,p 483-506