BURNS
(Reporters : ALBUÑAN, Sheila Marie,
FLORENDO, Joy Cathlyn, GONZALES,
Regilyn, JOVEN, Zellanie, PAGO, Sheena
Marie, PANTE, Ianlyn)
Definition
• A burn is a type of injury to the skin
caused by heat, electricity,
chemicals, light, radiation or
friction.
• Most burns only affect the skin
(epidermal tissue and dermis).
• Rarely, deeper tissues, such as
muscle, bone, and blood vessels
can also be injured.
• Managing burns is important
because they are common, painful
and can result in disfiguring and
disabling scarring.
• Burns can be complicated by
shock, infection, multiple organ
dysfunction syndrome, electrolyte
imbalance and respiratory distress.
• Large burns can be fatal, but
modern treatments, developed in
the last 60 years, have significantly
improved the prognosis of such
burns, especially in children and
young adults.
Classification
• A first degree burn is superficial
and causes local inflammation of
the skin. Sunburns often are
categorized as first degree burns.
The inflammation is characterized
by pain, redness, and a mild
amount of swelling. The skin may
be very tender to touch.
• Second degree burns are deeper
and in addition to the pain, redness
and inflammation, there is also
blistering of the skin.
• Third Degree Burns affect the
epidermis, dermis and hypodermis,
causing charring of skin or a
translucent white color, with
coagulated vessels visible just
below the skin surface
• Fourth Degree Burns burn
extension into muscle and to the
bone, no pain, grafting required,
amputation may be required for
healing
Symptoms
• Redness
• Swelling
• Pain (depends on type)
• Peeling skin
• Shock (pale, clammy skin,
weakness, bluish lips and finger
nails)
• White or charred skin
The Parkland formula (named for the
trauma hospital in Dallas) estimates the
amount of fluid required in the first few
hours of care following a burn: Daily volume
(ml) = 4cc x weight (kg) x burns area (% TBS)
*4cc/ kg of weight/%percent of %burn =
initial fluid requirement in the first 24
hours, with half given in the first 8 hours.
As the percentage of burn surface
area increases, the risk of death increases
as well. Patients with burns involving less
than 20% of their body should do well, but
those with burns involving greater than
50% have a significant mortality risk,
depending upon a variety of factors,
including underlying medical conditions
and age.
TYPES OF BURNS
Thermal
• Most Common
• An injury when the body part has
direct contact with something
• Caused by dry or moist heat
• Heating pads
• Hot water – Steam
• Radiators
• Stove / Oven – Autoclave
• Tar / Wax
Chemical
 • Acids, Organic materials
• Alkaline – not as common
- Cleaning supplies and Paint
products must be used in a well
ventilated area
- Fertilized factors, Farmers at risk
Electrical
• Faulty electric wiring – high voltage
power lines (loggers)
• Look for the entrance and exit
point
• Lightning
• Electrical outlets
Radiation
• X-rays
• Radium implants
• UV Lights – Sunburns
• Sun tanning and tanning bed
PHASES OF BURN CARE
Emergent or Resuscitative
At the scene and first at hospital
• Airway, breathing, circulation (abc)
• First 48-72 hours after the burn
• Continuing to loose fluid and
protein from their burn site into the
interstitial compartment
• Elevated Hematocrit
• Hyperkalemia and Hyponatremia
• Given fluids that are isotonic and
will NOT be given fluids that
contain potassium
• Monitor potassium+ level (If low,
Patient may have Cardiac Arrest)
Acute Phase
• Begins 48-72 hours AFTER the
injury
• Fluid Shifts back into intravascular
compartment
• Fluid remobilization
• Capillary wall is beginning to heal
• Fluid volume excess R/T
resumption of capillary integrity
and fluid shift from interstitial back
to intravascular compartment
• Increased hematocrit and
Decreased in Urine output
Rehabilitation Phase
• Can take months up to years
depending upon the degree of the
burn
• Own home or other agency long
term care
• Concern with body image related
to scars
• Compress scar from back out and
blend into tissue
• Activity Intolerance
• Muscle Wasting
• Decreased movement
• Knowledge Deficit Client/Family
• Care, Food, Activity
MEDICAL TREATMENT
Emergency Treatment
• At the scene
• Stop Burning Process
- Apply cool (not cold)water to burn
or hold burned area under cool
running water.
- Place victim in horizontal position
- Roll victim in blanket or similar
object (Avoid covering head)
• DO NOT disturb any blisters that
form
• DO NOT Apply anything to the
wound such as ointment
• Cover with clean cloth if there is
risk of damage or contamination
• Remove burned clothing and
jewelry
• If it is a chemical burn, you have to
irrigate the burn for 20 minutes
• Assess for an adequate airway and
breathing (If not breathing, begin
mouth-to-mouth)
• Remove burned clothing and
jewelry
• Cover wound with clean cloth
• Transport to medical aid
• Begin IV and Oxygen therapy as
ordered
• Volume Fluid Deficit: IV started
with large gauge cathether with
volume expander
 • Monitor urine output from Foley • Aminograft- Placenta tissue
(Urimeter –small measurements). (temporary)
Replacement is based on urine
output, Vital signs, electrolyte and NURSING DIAGNOSIS
Daily Weight monitoring Fluid volume deficit
• May or may not be connected to • Take priority over all
suction • LR
• Pain Management • Strict I&/O
- Morphine Sulfate IV Impaired Skin integrity
- If allergic to Morphine then give • Change dressing – Sterile
Demerol or maybe Dilaudid Technique
• Perform Wound Care • Isolation
• CHECK URINE OUTPUT every hour Risk for Infection
(3 -5L lost first 24 hrs) • Isolation
• LISTEN TO BREATH SOUNDS • Antibiotics
• Goals of Fluid Volume Replacement • Hand washing
- Systolic BP >100mmHg • Gowns, Mask, Gloves
- Pulse Rate <110 bpm • Bacteria: Screening for visitors,
- Urine output 30-50ml/hr (Most hand washing, Disinfect tank
reliable factor) before and after use.
- Lung sounds; Listen for • Topical Antibiotic use
Pulmonary Edema (frothy sputum) • Sterile Dressing Change and
Hydrotherapy monitor WBC
• Helps to loosen skin QD or BID Altered nutrition: Less than body
• Water temp 100oF – 37.8oC requirements
• Room temp 80-85oF – 26.6-29.4oC • Increase calorie intake 5000-
• Limited 20-30 min period to 6000/day
prevent chilling and added • Vitamins and minerals
metabolic stress • Protein / Calorie rich diet and high
• May add betadine to help disinfect in Vitamin C
skin • Snacks: Milkshakes, Meats, Peanut
Surgical Butter, Cheese, Ensure or Resource
• Cutting away with scissors to good • If they don’t like hospital foods, the
tissue until you have bleeding family may bring foods to eat.
Grafting • Daily weights and Possible TPN
• Done once all old necrotic tissue is
removed from the body NURSING INTERVENTION
• Auto Graft • Protein / Calorie rich diet
- Permanent graft with the persons • Restore fluids and electrolyte
own skin (Best) balance
- Donor Site - The area from the • Maintain body temp
tissue was removed (Be sure to • Control Pain and Anxiety
assess donor site) • Monitor Complications
• Homograft - Same Species; skin • Monitor respiratory status
banks • Daily Weigh the patient
• Heterograft - Graft from a pig • VS Q2-4 hrs
(temporary graft) INFECTION CONTROL
• Prevent atelectasis and pneumonia
 • Deep breathing, turning, with
proper repositioning
• Control edema
• Prevent pressure ulcers and
contractures
• Lower Extremities
- use Elastic Pressure bandage
before placed upright position to
Promote venous return and
minimize swelling

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