BURN site of thrombosed veins), without blisters (3rd

degree burn).
 Damage to the skin or other body parts caused  Silver-colored, raised or charred area, usually at
by extreme heat, flame, contact with heated the site of electrical contact.
objects, or chemicals.
 Burn depth is generally categorized as first,
second, or third degree.
 The treatment of burns depends on depth, area,
and location of the burn, as well as additional
factors, such as material that may be burned
onto or into the skin.
 Treatment options range from simply applying
a cold pack to emergency treatment to skin.
 It is also an alteration in skin integrity resulting
in tissue loss or injury caused by heat, chemicals,
electricity or radiation.

 Etiology

Types of burn injury

1. Thermal- results from dry heat (flames) or moist heat

(steam or hot liquids); it is the most common type; it
causes cellular destruction that results in vascular, bony,
muscle, or nerve complications; thermal burns can also Burn depth:
lead to inhalation injury if the head and neck area are
affected.  Superficial thickness burn (1st degree)- mild to
severe erythema of skin, blanches with pressure;
2. Chemical burns- are caused by direct contact with heals in 3 to 7 days
either acidic or alkaline agents; they alter tissue  Partial thickness types of burn
perfusion leading to necrosis. Burn (2nd degree)- large blisters; painful,
heals 2-3 weeks
3. Electrical burns- severity depends on type and Full thickness burns (3rd degree)- white,
duration of current and amount of voltage; it follows yellow, deep red to black (eschar)
the path of least resistance (muscle, bone, blood vessels, disruption of blood flow, no pain ;
and nerves); sources of electrical injury include current, scarring; and wound contractures will
alternating current and lightning. develop. Grafting is required; healing
takes weeks to months
4. Radiation burns- are usually associated with sunburn Deep full thickness burn (4th degree) –
or radiation treatment for cancer; are usually involves injury to muscle and bone=
superficial; extensive exposure to radiation may lead to appears black (eschar)- hand and
tissue damage. inelastic healing takes weeks to months;
grafts are required.
Pathophysiology
Diagnostics
-it depends on the cause and classification of the burn;
the injuring denatures cellular proteins; some cells die  Rule of Nines chart determines the percentage
because of traumatic or ischemic necrosis; loss of of body surface area (BSA) covered by the
collagen cross-linking also occurs with denaturation, burn.
creating abnormal osmotic and hydrostatic pressure
gradients that causes intravascular fluid to move into
interstitial spaces; cellular injury triggers the release of
mediators of inflammation, contributing to local and in
the case of major burns, systemic increases in capillary
permeability.

Clinical manifestations
 localized pain and erythema, usually without
blisters in the first 24 hours (first degree burn)
 chills, headache, localized edema, nausea and
vomiting (most severe first-degree burn)
 thin-walled, fluid filled blisters appearing within
minutes of the injury, with mild to moderate
edema and pain (second degree superficial
partial thickness burn)
 white, waxy appearance to damaged area
(second degree partial-thickness burn)
 white, brown or black, leathery tissue and
visible thrombosed vessels due to destruction of
skin elasticity (dorsum of hand, most common
  Irrigate the wound with amounts of water
or normal saline solution or decreased
responsiveness
 Irrigate the wound with amounts of water
or normal saline solution for chemical burns
 Place the patient in semi-Fowler’s position
to maximize chest expansion; keep patient
as quiet and comfortable to minimize
oxygen demand
 Administer rapid fluid replacement therapy
as ordered

 For burn patient in shock:

 Monitor v/s and hemodynamic
parameters
 Assess patient’s intake and output every
hour, insert an indwelling catheter
 ABG level may be normal in the early stages  Assess the patient’s level of pain,
but may reveal hypoxemia and metabolic including nonverbal indicators and
acidosis. administer analgesics such as Morphine
 Carboxyhemoglobin level may reveal the Sulfate IV as ordered
extent of smoke inhalation due to the presence  Keep the patient calm, provide periods
of carbon monoxide of uninterrupted rest between
 Complete blood count may reveal a decrease procedures and use nonpharmacologic
haemoglobin due to hemolysis, increased pain relief measures as appropriate
haematocrit and leukocystosis.  Obtain daily weights and monitor
 Electrolyte levels show hyponatremia and intake, including daily calorie counts;
hyperkalemia, other laboratory tests reveals provide high calorie, high protein diet
elevated BUN, decreased total protein and  Administer histamine 2 receptor
albumin antagonists are ordered to reduce risk of
ulcer formation
 Creatinine kinase (CK) and myoglobin levels
 Assess the patient’s sign and symptoms
may be elevated
of infections; may obtain would culture
 Presence of myoglobin in urine may lead to and administer antimicrobials an
acute tubular necrosis. antipyretics as ordered
 Administer tetanus prophylaxis if
Nursing Diagnosis indicated
 Risk for deficient fluid volume  Perform burn wound care as ordered;
 Risk for infection prepare patient for grafting as
 Impaired physical mobility indicated.
 Imbalanced nutrition: less than body  Assess the neurovascular status of the
requirement injured area, including pulses, reflexes,
 Ineffective breathing pattern paraesthesia, colour and temperature of
 Impaired tissue perfusion the injured area at least 2 to 4 hours or
 Risk for ineffective thermoregulation more frequently as indicated
 Pain  Assist with splinting, positioning,
compression therapy and exercise to the
 Impaired skin integrity
burned area as indicated; maintain the
burned area in a neutral position to
Nursing Management
prevent contractures and minimize
 Assess patient’s ABCs; monitor arterial deformity.
oxygen saturation and serial ABG values  Explain all procedure to the patient
and anticipate the need for ET intubation before performing them
and mechanical ventilation
 Auscultate breath sounds Pharmacotherapy
 Administered supplemental humidified  Antibiotic prophylaxis will eradicate
oxygen as ordered bacterial component
 Perform oropharyngeal or tracheal  Pain therapy
suctioning as indicated by the patient’s  Tetanus prophylaxis
inability to clear his airway  Topical antimicrobial
 Monitor the patient’s cardiac and  Enzymatic debriding agents such as
respiratory status collagenase, fibrinolysis
 Assess LOC for changes such as confusion, indesoxyribonuclease papin or sutilins
restlessness or decreased responsiveness are used with a moisture barrier to
protect surrounding tissue
  Recommended dressings include
polyurethane films (Op-site,
Tegaderm), absorbent hydrocolloid
dressings (Douderm).

Burn Medications
 NItrofurazone (Furacin)- broad spectrum
antibiotic ointment or cream – used when
bacterial resistance to other drugs is a
problem: apply 1/16 inch thick film directly
to burn.
 Mafenide (Sulfamylon)- water soluble
cream bacteriostatic gr+- bacteria: apply
1/16 inch directly to burn- notify physician if
hyperventilation occurs as this drug
precipitate metabolic acidosis
 Silver sulfadiazine (Silvadene) – cream
borad spectrum gr+- ; does not cause
metabolic acidosis- keep burn covered at
all times with Sulfadiazine (1/16 inch thick);
monitor CBC- causes leukopenia
 Silver Nitrate- antiseptic solution against
gr-, dressings are applied to the burn and
then kept moist with Silver Nitrate: used on
extensive burns that may precipitate fluid
and electrolyte imbalance

 Parkland (Baxter) Formula for fluid

replacement
 4 ml Lactated Ringer’s sol x kg body
mass x total percentage of body
surface burned
 1st 8 hours= ½ of total 24-hours fluid
replacement
 Next 8 hrs= ¼ of total
 Last 8 hrs= ¼ of total

Client education
 Environment safety: use low temperature
setting for hot water heater, ensure access to
and adequate number of electrical
cords/outlets, isolate household chemicals,
avoid smoking in bed
 Use of household smoke detectors with
emphasis on maintenance
 Proper storage and use of flammable
substances
 Evacuation plan for family
 Care of burn at home
 Signs symptoms of infection
 How to identify risk of skin changes
 Use of sunscreen to protect healing tissue
and other protective skin care