Burns

BURNS
Description
Burns denotes heat or chemical injury to tissues which may be permanently disfiguring and
incapacitating depending on the degree and severity of the burns injury
 Partial thickness or Full thickness
 First Degree, Second Degree and Third Degree
 Superficial or Deep
1. First-degree burns (superficial, partial thickness) are localized injuries to epidermis and
not life-threatening.
2. Second-degree burns (deep, partial thickness) produce destruction of epidermis and some
dermis with thin-walled and fluid-filled blisters. When the nerve endings are exposed to
air, the blisters break causing pain and loss of barrier function of the skin.
3. Third- and fourth-degree burns (full thickness) affect every body system and organ,
extending into the subcutaneous tissue layer. They cause damage to muscle, bone, and
interstitial tissues; interstitial fluids result in edema. Immediate immunologic response
and threat of wound sepsis occurs, but is painless.
Causes
■ Chewing electric cords
■ Child abuse
■ Contact with faulty electrical wiring and high voltage power lines
■ Contact, ingestion, inhalation, or injection of acids, alkalis, or vesicants
■ Friction or abrasion
■ Improper handling of firecrackers
■ Improper use or handling of matches
■ Improperly stored gasoline
■ Motor vehicle accidents
■ Residential fires
■ Scalding accidents
■ Space heater or electrical malfunctions
■ Sun exposure
Assessment Findings
■ Depth and size of the burn
■ Severity of the burn estimated sing eg. Rule of Nines
■ Major burns —more than 20% of body surface area (BSA)
■ Moderate—10% to 20% of BSA
■ Minor—less than 10% of BSA
■ Respiratory distress and cyanosis
■ Edema
■ Alteration in pulse rate, strength, and regularity
■ Stridor, wheezing, crackles, and rhonchi
■ Hypotension & shock
Common characteristics of Burns

First-degree burns
_ Localized pain
_ Erythema
_ Blanching
_ Chills
_ Headache
_ Nausea and vomiting
Second-degree burns
_ Thin-walled, fluid-filled blisters
_ Mild to moderate pain
_ White, waxy appearance of damaged area
Third- and fourth-degree burns
_ Pale, white, brown, or black leathery tissue
_ Visible thrombosed vessels
_ No blister formation
_ Painless
Electrical burns
_ Silver colored, raised area at contact site
_ Smoke inhalation and pulmonary damage
_ Singed nasal hair
Mucosal burns
_ Sores in mouth or nose
_ Voice changes
_ Coughing, wheezing
_ Darkened sputum
Test results
■ Arterial blood gas analysis shows evidence of smoke inhalation and may also show decreased
alveolar function or hypoxia.
■ Complete blood count shows decreased hemoglobin level and hematocrit (if blood loss
occurs).
■ Electrolytes are abnormal due to fluid losses and shifts.
■ Blood urea nitrogen is increased (with fluid losses).
■ In children, glucose is decreased because of limited glycogen storage.
■ Urinalysis shows myoglobinuria and hemoglobinuria.
■ Carboxyhemoglobin is increased.
■ Electrocardiogram may show myocardial ischemia, injury, or arrhythmias, especially in
electrical burns.
■ Fiber-optic bronchoscopy may reveal edema of the airways.
Extent of Body Surface Area Injured
Various methods are used to estimate the TBSA affected by burns; among them are the rule of
nines, the Lund and Browder method, and the palm method.
Rule of Nines
An estimation of the TBSA involved in a burn is simplified by using the rule of nines. The rule
of nines is a quick way to calculate the extent of burns. The system assigns percentages in
multiples of nine to major body surfaces.
Lund and Browder Method
A more precise method of estimating the extent of a burn is the Lund and Browder method,
which recognizes that the percentage of TBSA of various anatomic parts, especially the head and
legs, and changes with growth. By dividing the body into very small areas and providing an
estimate of the proportion of TBSA accounted for by such body parts, one can obtain a reliable
estimate of the TBSA burned. The initial evaluation is made on the patient’s arrival at the
hospital and is revised on the second and third post-burn days because the demarcation usually is
not clear until then.
Palm Method
In patients with scattered burns, a method to estimate the percentage of burn is the palm method.
The size of the patient’s palm is approximately 1% of TBSA.
Treatment
Collaboration
Surgeons may be needed to perform escharotomy and fasciotomy to remove burn tissue. Wound
care specialists may be needed to prevent wound infections and complications (such as
contractures) and promote wound healing. Respiratory therapy is needed to maximize respiratory
function in cases of inhalation injury. As the patient improves, physical therapy is necessary to
maintain or improve range of motion and prevent contractures. Nutritional therapists can
prescribe an optimal diet to promote wound healing.
■ Eliminating the burn source
■ Securing airway
■ Preventing hypoxia
■ Giving I.V. fluids through a large-bore I.V. line
■ Child under 66 lb (29.9 kg): maintain urine output of 1 ml/kg/hour
■ Nasogastric tube and urinary catheter insertion
■ Wound care
■ Nothing by mouth until severity of burn is established, then high-protein, high-calorie diet
■ Increased hydration with high-calorie, high-protein drinks, not free water
■ Total parenteral nutrition, if unable to take food by mouth
■ Activity limitation based on extent and location of burn
■ Physical therapy
■ Booster of tetanus toxoid
■ Analgesics
■ Antibiotics
■ Antianxiety agents
■ Loose tissue and blister debridement
■ Escharotomy
■ Skin grafting
Key Patient Outcomes
The patient will:
■ Report increased comfort and decreased pain
■ Attain the highest degree of mobility
■ Maintain fluid balance within the acceptable range
■ Maintain a patent airway
■ Demonstrate effective coping techniques.
Nursing Interventions
■ Apply immediate, aggressive burn treatment.
■ Use strict sterile technique.
■ Remove clothing that’s still smoldering. (Don’t remove clothing that’s stuck to a burn.)
■ Remove constricting items.
■ Perform appropriate wound care.
■ Provide adequate hydration.
■ Weigh the patient daily.
■ Encourage verbalization and provide support.
■ Refer the patient to rehabilitation if appropriate.
■ Refer the patient to psychological counseling if needed.
■ Refer the patient to resource and support services.
■ Monitor the patient’s vital signs, respiratory status, signs of infection, intake and output, and
hydration and nutritional status.
Patient Teaching
Be sure to cover:
■ The injury, diagnosis, and treatment
■ Appropriate wound care
■ All medications, including administration, dosage, and possible adverse effects
■ Developing a dietary plan
■ Signs and symptoms of complications.
Criteria for classifying extent of Burn Injury
Minor Burn Injury
 Second-degree burn of less than 15% total body surface area (TBSA) in adults or less
than 10% TBSA in children
 Third-degree burn of less than 2% TBSA not involving special care areas (eyes, ears,
face, hands, feet, perineum, joints)
 Excludes electrical injury, inhalation injury, concurrent trauma, all poor-risk patients (eg,
extremes of age, concurrent disease)
Moderate, Uncomplicated Burn Injury
 Second-degree burns of 15%–25% TBSA in adults or 10%–20% in children
 Third-degree burns of less than 10% TBSA not involving special care areas
 Excludes electrical injury, inhalation injury, concurrent trauma, all poor-risk patients (eg,
extremes of age, concurrent disease)
Major Burn Injury
 Second-degree burns exceeding 25% TBSA in adults or 20% in children
 All third-degree burns exceeding 10% TBSA
 All burns involving eyes, ears, face, hands, feet, perineum, joints
 All inhalation injury, electrical injury, concurrent trauma, all poor-risk patients
Fluid Requirements
The projected fluid requirements for the first 24 hours are calculated by the clinician based on
the extent of the burn injury. Some combination of fluid categories may be used: colloids (whole
blood, plasma, and plasma expanders) and crystalloids/electrolytes (physiologic sodium chloride
or lactated Ringer’s solution). Adequate fluid resuscitation results in slightly decreased blood
volume levels during the first 24 post-burn hours and restores plasma levels to normal by the end
of 48 hours. Oral resuscitation can be successful in adults with less than 20% TBSA and children
with less than 10% to 15% TBSA. Formulas have been developed for estimating fluid loss based
on the estimated percentage of burned TBSA and the weight of the patient.
1. Parkland/Baxter Formula
Lactated Ringer’s solution: 4 mL × kg body weight × % TBSA burned Day 1: Half to be given in
first 8 hours; half to be given over next 16 hours or 525ml/hr in first 8hrs, 262.5ml/hr in the
subsequent 16hrs.
2. Galveston formula for children
Alternative formula that t is preferred by many for calculating fluid needs in children is the
Galveston formula which is based on body surface area than weight, this formula is more
accurate than parkland’s.
5000 ml/m2x % TBSA burns+2000mlxm2.
One half of the total fluid is given in the first 8hrs, with the balance given over the next 16hrs. in
children keep the urine output at 1ml/kg/hr.

Burns

Uploaded by

Copyright:

Available Formats

Burns

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Burns

Uploaded by

Copyright:

Available Formats

BURNS

Common characteristics of Burns

5000 ml/m2x % TBSA burns+2000mlxm2.

You might also like