LECTURE NCM 109| MATERNAL AND CHILD HEALTH NURSING AT RISK (PEDIA)

BURNS
SARASPI, MA. JOSEFINA SUNSHINE P.| 2nd Semester |FINALS
BSN-2A |S.Y. 2023 – 2024

• hide matches
• An estimated 265 000 deaths every year are caused • be careful with candles
by burns - the vast majority occur in low- and middle- • take care with cigarettes
income countries. • use space heater wisely
• common areas to have fire are urban areas because of
light materials that are used COMMON CAUSE OF BURNS
• houses are too close together
• Non-fatal burn injuries are a leading cause of morbidity. 1. Thermal Burns
- can’t cause death but can cause infection, prolonged 2. Radiation Burns
hospitalization, and disabilities 3. Chemical Burns
- Burns occur mainly in the home and workplace. 4. Cold Burns/ Frostbites
- Burns are preventable.
ASSESSMENT
DEFINITION
First questions must ask:
BURNS
• Where is the burn?
• are injuries to tissue caused by excessive heat greater • What are its extent and depth?
than 40°C
• is defined as destruction found in the epidermal tissue, Along with the size and depth, be certain to assess and
dermal tissue, or deeper tissues, due to contact with document the location of the burn.
thermal, chemical, or electrical agents.
• are the second most common unintentional injuries Examples:
seen in children 1-4 years old and the third most
common cause in children 5-14 years of age. 1. Face and throat- are particularly hazardous because they may
• According to CDC (2016), every day, there are more be accompanying but unseen burns in the respiratory tract that
than 300 children treated in emergency rooms for burn could lead to respiratory tract obstruction.
related injuries.
• Younger children are most at risk for scald burn that are 2. Hand burns are also hazardous because if the fingers and
caused by hot liquid or stream. thumb are not position properly during healing, adhesions will
• Older children are more apt to be burned from flames inhibit full range of motion in the future.
after they move too close to a campfire, heater or
fireplace, touch a hot curling iron or play with matches 3. Burns of the teeth carry a high-risk secondary infection.
or lighted candles.
• Burn injuries tend to be more serious in children than 4. Genital burns are also hazardous because edema of the
in adults because the same size burn covers a larger urinary meatus may prevent child from voiding
surface of a child's body
RULE OF 9
TO PREVENT
✓ used in adults
➢ Be "alarmed".
✓ is a quick method of testing the extent of burn
➢ know the happenings on your surrounding
✓ 9%: head back, chest and
➢ Have an escape plan.
abdomen, front and back legs,
➢ important to be discuss in child to exit facility
front and back thighs
safely
✓ 18% Posterior trunk
➢ cook with care
✓ 4.5%: arms and hands,
➢ check water heater temperature
✓ 1%: genitals
✓ 18% Posterior trunk
BURN SAFETY OUTDOORS

• Watch grills, fire pits and camp fires

- stop fire when your done using it
• check car seats
- since the seats can absorbs heat
• avoid backyard fireworks

FIRE PREVENTION

MJSPS 1
 LECTURE NCM 109| MATERNAL AND CHILD HEALTH NURSING AT RISK (PEDIA)
BURNS
SARASPI, MA. JOSEFINA SUNSHINE P.| 2nd Semester |FINALS
BSN-2A |S.Y. 2023 – 2024

STRUCTURE OF THE SKIN - Skin grafting is necessary; muscle and bone may be
permanently damaged; scarring will cover the healed
LAYER OF THE SKIN: site.

- Hair follicle MANAGEMENT

- epidermis
- dermis - All burns, including minor burns, need immediate
- subcutaneous fat care because of the potential pain involved
- Although minor burns (typically first- degree partial
FUNCTION OF THE SKIN thickness burns) are the simplest type of burn, they
involve pain and death of skin cells and therefore
- barrier to infection must be treated seriously.
- Be certain that parents have a follow-up appointment
- protection from external injury in about 2 days to have the dressing changed and the
- temperature control area inspected for a secondary infection.
- Caution parents to keep the dressing dry (no
- control of the body fluids
swimming or getting the area wet while bathing until
- sensory organ the burn is healed about 1 week). Moderate or
second-degree burns typically are blistered.
- determine identity
• Do not rupture these blisters because doing so denudes
the site and invites infection.
CLASSIFICATION OF BURNS • The burn should be covered with a topical antibiotic
such as silver sulfadiazine and a bulky dressing to
First degree prevent damage to the burned site and promote healing.
• The child usually is asked to return in 24 hours to assess
- redness, swelling, affected part is epidermis that pain control is adequate and there are no signs and
- Involves the epidermis or outer layer of skin. symptoms of infection.
- Appears reddened, dry, and feels mildly painful. • Broken blisters may be debrided (cut away) to remove
- Heals by simple regeneration so takes 1-10 days to possible necrotic tissue as the burn heals.
heal. • the goal is to prevent disability caused by scarring,
- back in color for months infection, or contracture

Second degree BURNS IN MOUTH

- type A: redness, blister, superficial dermis - If a child puts the prongs of a plugged-in extension-
- type B: pallor, blister, pain, partial dermis cord into the mouth or chews on an electric cord, the
- Involves the epidermis and part of the dermis layer of mouth can be burned severely.
skin.
- Appears red, blistered, and may be swollen. - When electrical current from a plug is conducted for
- Very painful. Heals by regeneration of tissue over 2- a distance through the skin and underlying tissue it
6 weeks.
can cause an ulcer.
Third Degree - Most children with electric burns are admitted to an
observation unit for at least 24 hours because edema
- Greyish white or black necrosis analgesia, complete
in the mouth could lead to airway obstruction.
dermis
- Involves the epidermis and full extent of the dermis. - Eating will be a challenge for the next week because
- Appears white or charred and lacks sensation the child's mouth is so sore.
destroyed. nerve endings are the ne as
- Skin grafting is usually necessary, and healing takes - Soft foods and fluids may be easiest to swallow.
months. - Electrical burns of the mouth turn black as local
- Scar tissue will cover the final healed site.
tissue necrosis begins.
Fourth degree - They heal with white, fibrous scar tissue, possibly
leaving a deformity of the lips or cheeks and difficulty
- carbonization
speaking clearly afterward.
- Full-thickness burn extending into muscle or bone.

MJSPS 2
 LECTURE NCM 109| MATERNAL AND CHILD HEALTH NURSING AT RISK (PEDIA)
BURNS
SARASPI, MA. JOSEFINA SUNSHINE P.| 2nd Semester |FINALS
BSN-2A |S.Y. 2023 – 2024

- This can be minimized by using a mouth appliance, seconds), an escharotomy (cut into the eschar) may be
performed (Kupas & Miller, 2010)
which helps maintain lip contour.
• Some bleeding will occur after escharotomy. Packing
the wound and applying pressure usually relieves this.
THERAPY FOR BURNS
DEBRIDEMENT
• Second- and third-degree burns may receive
• the removal of necrotic tissue on which microorganisms
a) open treatment could thrive from a burned area to reduce the possibility
of infection
- leaving the burned area exposed to the air, or • This may be done using collagenase (Santyl), an
enzyme that dissolves devitalized tissue, or manually.
b) closed treatment • For manual debridement, children may have 20 minutes
of hydrotherapy beforehand to soften and loosen
the burned area is covered with an antibacterial cream and eschar, which then can be gently removed with forceps
many layers of gauze. and scissors.
• Debridement is painful, and some bleeding occurs with
• As a rule, burn dressings are applied loosely for the first 24 it.
hours to prevent interference with circulation as edema • Premedicate the child with a prescribed analgesic and
forms. help the child use a distraction technique during the
procedure to reduce the level of pain.
• Be certain not to allow two burned body surfaces, such as
• Transcutaneous electrical nerve stimulation (TENS)
the sides of fingers or the back of the ears and the scalp, to
therapy ог patient-controlled analgesia also can be
touch, because, as healing takes place, webbing will form
helpful pain management measures.
between these surfaces.
• If burned areas are debrided in this manner day after
• Do not use adhesive tape to anchor dressings to the skin; it
day, granulation tissue forms underneath.
is painful to remove and can leave excoriated areas, which
• When a full bed of granulation tissue is present (about 2
provide additional entry sites for infection.
weeks after the injury), the area is ready for skin
• Netting is useful to hold dressings in place because it
grafting.
expands easily and needs no additional tape.
• In some burn centers, this waiting period is avoided by
immediate surgical excision of eschar and placement of
TOPICAL THERAPY skin grafts.

• If a topical cream is not effective against invading GRAFTING

organisms in the deeper tissue under the eschar, daily
injections of specific antibiotics into the deeper layers of
the burned area may be necessary.
• If a burned area, such as the female genitalia, cannot
Skin grafting
be readily dressed, the area can be left exposed. The
danger of this method is the potential invasion of
pathogens. - is a surgical procedure that involves removing skin
from one area of the body and moving it, or
ESCHAROTOMY transplanting it, to a different area of the body.
- can be from animals or other people skin
• is defined as the surgical incision through the eschar
into the subcutaneous tissues to allow the extremity to Allografting
continue to swell without compressing the underlying
blood vessels - the placement of skin (sterilized and frozen) from
• As natural protection for a burned arca, a rigid scab (an cadavers or a donor on the cleaned burn.
eschar) forms over moderately or severely burned - These grafts do not grow but provide a temporary
areas. protective covering for the area.
• Fluid accumulates rapidly under an eschar, putting - In small children, xenografts, or skin from other
pressure on underlying blood vessels and nerves. sources, such as porcine (pig) skin, may be used.
• If an extremity or the trunk has been burned so that both -
anterior and posterior surfaces both have eschar
formation, a tight band may form around the extremity Autografting
or trunk, cutting off circulation to distal body portions.
• If distal parts feel cool to the touch and appear pale, any - is a process in which a layer of skin of both epidermis
tingling or numbness is present, pulses are difficult to and a part of the dermis (called a split- thickness graft)
palpate, and capillary refill is slow (longer than 5

MJSPS 3
 LECTURE NCM 109| MATERNAL AND CHILD HEALTH NURSING AT RISK (PEDIA)
BURNS
SARASPI, MA. JOSEFINA SUNSHINE P.| 2nd Semester |FINALS
BSN-2A |S.Y. 2023 – 2024

is removed from a distal, unburned portion of the child's

body and placed over the prepared burn site, where it
will grow and replace the burned skin
- The advantage of both types of grafting is that they
reduce fluid and electrolyte loss, pain, and the chance
of infection.
- Skin for a split-thickness graft is removed from the
buttocks or inner thigh under general anesthesia.
- Fish skin can be grafted onto burns. It recruits the
body's own cells and is converted into living tissue over
time

MJSPS 4